Inside one of El Camino Hospital's intensive care units, nurse Lynn Hudson began the long and methodical process of checking up on a patient. Suiting up with new gloves, a protective coverall and a specialized helmet, Hudson balances a tray of food into the room and shuts the door behind her.

For months, the hospital's ICU beds have been filled close to capacity, with one unit entirely devoted to patients who fall very ill with COVID-19. The arduous donning and doffing of protective gear along the bustling hallway of rooms is just part of the new reality, as hospital staff meticulously treat the highly infectious patients.

Starting in December, El Camino and other hospitals across the region found themselves essentially out of room: Available ICU capacity sank to less than 1% across the Bay Area, prompting a return to stay-at-home orders that state officials only recently lifted. The surge in new COVID-19 cases forced hospitals to push beds into hallways and forced some hospitals to compromise staff-patient ratios.

Though December and January were filled with frantic ICU overloads and record-breaking infection, the inside of the narrow hallway of the COVID ICU at El Camino remained a quiet and methodical operation -- if a little crowded.

The numbers change by the hour, but it's a safe bet that at any given point the hospital is treating dozens of COVID-19 patients, a portion of whom are very ill and transported to the ICU, said Cheryl Reinking, El Camino Health's chief nursing officer. During a visit on Jan. 14, Reinking said the hospital had 23 of its 24 ICU beds filled, 10 of which had patients sick with COVID-19.

Though the hospital stayed narrowly below maximum ICU capacity, it spilled over during the surge. Last month, the hospital had to turn away ambulances with several patients because there simply wasn't any room, she said.

"There were periods of time, like 90 minutes each, over the Christmas holiday where we got five ambulances all at once, and we said we can't take any more right now," she said. "It's very uncommon for us to go on diversion, but when we are impacted we do have that relief valve."

Across the entire hospital, a total of 62 patients were deemed positive for COVID-19. Six had been admitted for so long they were no longer considered contagious. El Camino has had "very little" in the way of community transmission within the hospital, Reinking said, unlike the recent outbreak that infected dozens of staff members at Kaiser San Jose.

The precarious work with infectious patients, along with the recent surge, has been stressful for hospital staff. No one was preparing for a global pandemic during nursing school, Reinking said, and nurses are being asked to do things they've never had to do before. Simple tasks now involve bunny suits and putting on a space helmet-like device called a positive air pressure respirator -- or PAPR -- which have to be used multiple times per shift.

Reinking said El Camino Health started buying up the helmets during the Ebola scare in 2014, purchasing dozens in the event of a surge in tuberculosis cases. They've since been an incidental but invaluable part of the hospital's response to the pandemic.

Patients in the ICU are housed in negative pressure rooms, reducing the risk of infection to hospital staff working just feet away. Other clever workarounds have helped ease the workflow, with IV drips and monitors stretched out of each room and into the hallway for easy access.

Among those nurses working in the ICU is Hudson, who moved to the Bay Area from Hawaii in August with no prior experience with COVID-19 patients. Though the protective gear is a burden, she said the real difference is the no-visitor policy. No one is allowed to visit members who are seriously ill and pass away in the ICU, she said, leaving it to people like herself to be that emotional support. It can be emotionally draining

Treatment has improved and mortality rates have decreased among COVID-19 patients, but it remains high: The mortality rate among those admitted to the ICU with COVID-19 exceeds 30%. Nurses are accustomed to seeing patients die, Hudson said, but it's frustrating to know that the disease is still new and unfamiliar, and that more could have been done to save them.

"COVID-19 is such a new disease and sometimes I feel helpless, whereas with other illnesses we know what to do," she said. "There's usually a peace knowing in that."

The fast-advancing world of COVID-19 treatment has found that steroid treatment, antiviral medication and even blood thinners can help keep people alive in the ICU, improving the odds for patients. Another critical advancement was the decision by doctors, in the summer of last year, to pull back on the common practice of putting patients on mechanical ventilators.

Respiratory therapist Christina Bumbacca said she and others at El Camino are constantly monitoring patients to see what minimal oxygen treatment is needed while keeping blood oxygen levels healthy, including bilevel positive airway pressure (BiPAP) machines that do not require intubation.

"Not everyone needs a ventilator," she said. "We try modalities that are less invasive first so we can try to protect their lungs and their airways."

As for possible exposure to the virus, Hudson said she isn't too worried. There's no shortage of protective equipment, nearly all of the hospital staff have received doses of the COVID-19 vaccine, and everyone seems to be doing the best they can with what they have.

"That's not to say if cases continue to go up we won't struggle, but I feel pretty safe," she said. "And I'm happy to take that risk."