Blum served as president and chairman of Blum Capital Partners, an equity investment company he founded in 1975, and was a longtime member for the University of California Board of Regents, the body that oversees the system.

“My heart is broken. My husband was my partner and best friend for more than 40 years,” Feinstein, 88, said in a statement. “He was by my side for the good times and for the challenges. I’m going to miss him terribly”

Blum was born in San Francisco and received a bachelor’s degree in business administration and a master of business administration from UC Berkeley. Blum married Feinstein in 1980, when she was mayor of San Francisco. Feinstein has represented California in the U.S Senate since 1992. Blum’s death comes as Feinstein, the Senate’s oldest member, struggles with low approval ratings and calls for her resignation from some progressive members of the Democratic Party.

In a statement, Gov. Gavin Newsom praised Blum as a model Californian.

“Richard Blum lived an extraordinary life, and he left this world better than he found it – lifting up our communities and helping connect people from across the globe,” Newsom said.

At the age of 23, Blum joined Sutro and Co., an investment brokerage firm, and became partner before turning 30. Blum helped acquire Barnum and Bailey Circus and Ringling Bros. for $8 million before selling the circus to Mattel for $40 million.

He had great interest in Tibet, founding the American Himalayan Foundation, a San Francisco-based non-profit to help Nepalis, Tibetans and Sherpas in the area by funding hospitals, building schools and taking care of the elderly and children. A friend of the Dalai Lama, Blum served as an honorary consul of Nepal. He also befriended Sir Edmund Hillary, one of the first climbers to have reached Mount Everest, and attempted his own trek in 1981.

Blum created the Blum Center for Developing Economies at the University of California, Berkeley in order to address global poverty by focusing on education, initiatives and research. Blum served as a UC regent for nearly two decades and was chairman emeritus of the board.

His tenure as a regent was not without controversy, however. In 2020, a state audit found that dozens of students were admitted to selective UC campuses over more qualified applicants because of exaggerated athletic abilities, wealth and connections. Blum sent a letter of support to the chancellor after a student was placed on a waitlist for UC Berkeley, which ultimately accepted the student.

In an interview with this news organization, Blum dismissed the episode as “much ado about nothing.”

He and Feinstein have similarly waved away concerns about their complicated finances. Several years ago, the senator initially failed to disclose that Blum owned more than $100,000 in Facebook shares until after Facebook CEO Mark Zuckerberg testified to the Senate. Her office said the pair did not discuss her husband’s financial transactions and the mistake was reported when discovered.

Feinstein praised her husband’s “enormous generosity” in her statement Monday.

“We have a hole in our hearts that will never be filled. Dick, we love you, we’ll miss you and we’ll continue to celebrate everything you accomplished during an amazing life,” she said.

House Speaker Nancy Pelosi spoke about Blum’s contributions to San Francisco, the city the Democrat represents.

“A lifelong San Franciscan, Richard was a powerful force for good in our city,” Pelosi said in a statement. “Building a successful career in business, he constantly gave back to our city: whether as a patron of our arts, a donor to our food banks or a benefactor to our efforts to end homelessness.”

Sen. Alex Padilla said that Blum was a “compassionate humanitarian who dedicated his life to improving the world for others.”

“Above all, Dick was devoted to his family,” Padilla continued. “Over his four decades of marriage to Senator Feinstein, he took tremendous joy in supporting her pioneering leadership as a public servant. Angela and I send our deepest condolences and prayers to Dianne and her family in this difficult time.”

The Bay Area, where COVID-19 vaccination and mask compliance both run high, awoke Wednesday to new state health rules letting those who’ve had the shots shed their face coverings in stores and many other indoor places.

And Yvonne Lindquist was grateful.

“I’m here all day, sometimes it’s just so hard to breathe,” a mask-less Lindquist said during her shift at Anthem Bed and Bath in Menlo Park, adding that it’s also easier to make sales when she doesn’t have to speak through a mask. But she kept one in her pocket in case a customer asks her to wear one. “I would honor whatever they want.”

An old sign on the door still says masks required, but she said the store owner may decide to remove it soon. Like everyone, they’re still figuring out how to navigate the change.

For Californians, the new rules mean vaccinated people generally don’t have to wear masks when inside businesses, retail stores, restaurants, theaters, family entertainment centers, meeting facilities and state and local government offices serving the public. The indoor mask rule still applies for public transportation, health care facilities, shelters, jails, prisons, long-term care facilities and K-12 schools.

But across the Bay Area on Wednesday, plenty of people still didn’t feel safe without masks as infection rates are still running high.

Both hairstylist Yvette Smith and her customer were vaccinated but wearing masks at Divine Beauty Salon in downtown Antioch.

“That’s the only thing that’s really working,” the 50-year-old stylist said of masks. Her brother was seriously ill from the virus, which she said is “no joke,” and she thinks the state is relaxing the mask rule too soon.

“It should never be lifted,” Smith said. “That’s my opinion until COVID is completely eradicated.”

The state rule shift comes as COVID-19 cases fall across California and the U.S. from a winter peak last month driven by the super-contagious omicron variant. The surge in infections had prompted California health officials in mid-December to reinstate the universal indoor masking requirement.

The Centers for Disease Control and Prevention continues to recommend indoor masking for everyone regardless of vaccination in areas of substantial or high transmission of the virus, which CDC Director Dr. Rochelle Walensky said Wednesday “is currently over 97% of our counties in the country.”

But over the past week, California and several other states with similar statewide mask rules announced plans to lift them, and Walensky said Wednesday the CDC is “looking at an overview of much of our guidance, and masking in all settings will be a part of that.”

“We want to give people a break from things like mask wearing when these metrics are better,” Walensky said, “and then have the ability to reach for them again should things worsen.”

Though the state mask mandates have been controversial, a CBS/YouGov poll this week found 56% of those surveyed support them, with higher numbers among the vaccinated and Democrats.

In California, the state allows local health authorities and businesses to continue requiring masks. Santa Clara and Los Angeles counties are maintaining the indoor mask rule. That didn’t sit well with Robert Fazo and his friend Robert Kosovilka, both in their 80s, who sat drinking coffee in the cab of a pickup truck in San Jose rather than subject themselves to masks in a cafe.

“What, the germs obey county boundaries?” scoffed Kosovilka, 80, a retired police officer. “It’s a pain in the ass and it’s stupid.”

But at San Jose’s Recycle Bookstore, owner Eric Johnson is happy to continue the mask-wearing policy, even though he was dubbed a “mask Nazi” last summer for requiring face coverings in his shop the last time the state eased restrictions. He still has four “masks required” signs taped on his front double doors and believes the coverings have kept him from getting COVID-19, such as when a coworker developed symptoms on their shift.

Even in other counties where businesses are free to let customers show their smiles, many such as Kepler’s Books in Menlo Park were keeping up signs telling shoppers masks are still required Wednesday.

“Masks are staying on at Kepler’s for now,” said a manager, Brittany Caine.

That’s also still the rule at De Lauer’s gift shop in Alameda, where Miles Brown, 21, was wearing his mask behind the counter when customers entered.

“I’m gonna keep wearing it,” said Brown, who’s been infected, vaccinated and boosted, explaining that his dad has a weak immune system. “I can’t bring it home to him. If other people don’t need it, that’s their decision.”

At Mike’s Camera in Menlo Park, about half the workers weren’t wearing face coverings. Robert Silver, who works behind the counter for Panasonic, was one of them, and the “proudly vaxxed and boosted” Democrat felt there’s not much more people can do to be safe anymore.

“I did everything,” Silver said. “I’m good.”

But customer Matt Feuer put on his mask before entering after seeing so many people without, explaining that “I think people are still quite antsy.”

The change in rules, enforced by the honor system, created some friction at a Brentwood Trader Joe’s on Wednesday between shoppers who think the masks are a joke and those who see them as a survival tool. An unvaccinated woman who entered the store maskless noted the mask rule was widely ignored at the Super Bowl in Los Angeles County last weekend, though fans needed to be vaccinated or tested before entering.

But masked fellow shopper Deb Voss found the unvaccinated shopper infuriating.

“People are still contagious,” Voss said, “and still getting it.”

At Al’s Barber Shop in Alameda, owner Nick Vlahos had another reason for keeping his mask on.

“I’m a fan of the mask,” he says as he trimmed a customer’s hair, “I think it improves my looks.”

The proposal, from a group of Democratic lawmakers, is part of a broader package of legislation aimed at limiting the spread of the deadly virus.

“People are craving stability,” said Assemblymember Buffy Wicks, an Oakland Democrat who is one of the bill’s lead authors. “We can make that stability happen together.”

The move comes after the U.S. Supreme Court blocked a nationwide vaccine mandate for large employers the Biden administration had hoped to implement, leaving vaccine rules up to states to implement. That decision, Wicks said, put the onus on Sacramento to act.

“We feel very strong about our legal footing here,” Wicks said.

Assembly Bill 1993 would allow for limited medical or religious exemptions, but require testing for anyone who remains unvaccinated. The bill would require new hires to have at least one dose of a COVID-19 vaccine by the time they start, and a second dose within 45 days. Businesses that do not comply would face a penalty, although the specifics are still being worked out.

“We haven’t determined that yet,” Wicks said, adding that she wants to have a conversation with members of the business community to create a strong bill.

“Workers deserve to be safe,” she said. “There are many jobs that can’t be done remotely.”

The bill is already generating pushback from Republicans and conservatives who have chafed at policies they say limit personal freedoms and sow partisan divides.

“I have a whole bunch of problems with this,” said Matt Shupe, chair of the Contra Costa County GOP. “I think a bill like this only doubles down on the division and the fighting and it’s really unfortunate.”

The proposal, Shupe said, forces every business to be “an enforcer on their employees,” and puts people who don’t want to be vaccinated in an impossible position.

“Are we forcing them to become homeless? How is that good policy?” he said, adding that he thinks the state risks losing jobs or tax revenue if the mandate passes.

Less sweeping earlier mandates have also prompted some resistance. In San Jose, for instance, the police union and other public safety workers lobbied the city to scale back a vaccine mandate. And the proposal comes as some places, including most Bay Area counties, are rolling back mask mandates, and as people increasingly grow frustrated with pandemic restrictions. Republican state lawmakers have called for an end to California’s state of emergency. North in Canada, truckers have blocked a busy U.S. border crossing, snarling the movement of goods and shuttering nearby auto plants, in protest of COVID-19 restrictions.

“While other blue states are restoring freedoms, California Democrats are trying to further restrict them, making our workforce and economic problems even worse,” CAGOP Chairwoman Jessica Millan Patterson said in a statement. “The voters will hold them accountable.”

But health care workers, labor organizations and some business groups praised the idea of a universal worker vaccine mandate Friday.

The current patchwork of mandates varies from city to city, leaving many businesses struggling to keep up and forcing them into making uncomfortable, politically charged decisions about whether to require vaccines.

“We need a statewide standard,” said John Arensmeyer, CEO of the Small Business Majority, which represents nearly 20,000 small businesses in California. “Small businesses don’t want to be traffic cops in debates about public safety.”

Businesses, he said, “just want to put their heads down and run their businesses knowing they have certainty and stability.”

From a public health perspective, said infectious disease expert John Swartzberg, mandates work where education campaigns about the safety and efficacy of vaccines, as well as outright bribery, have not, and help reduce the strain on hospitals and exhausted health care workers.

Swartzberg acknowledged that “nobody likes being told what they have to do.” But, he said, he remembers years ago when seat belt requirements were controversial. “Look at the number of lives they save.”

Last year, Wicks developed a proposal that would have required not only workers but patrons to be vaccinated. That bill never went to print. The current version, which is limited to workers, will “focus the conversation a little bit more,” she said.

This year’s bill is part of a broader slate of legislation put forward by members of the state “vaccine caucus.” State Sen. Scott Weiner, a San Francisco Democrat, has proposed legislation allowing children 12 and up to get vaccinated without parental consent, and lawmakers have also introduced bills aimed at making sure students are vaccinated.

Richard Pan, a doctor and lawmaker who chairs the state Senate’s health committee, co-authored the worker mandate proposal and introduced a school vaccine bill, said the worker vaccine legislation would help protect the most vulnerable members of society, noting that while vaccines don’t entirely prevent transmission of COVID-19, they do keep people safe from severe illness and death, and reduce the likelihood of infection.

“This is so critically important,” Pan said. “We don’t want people to be worried when they go to work that they might be exposed to this disease.”

The agreement, which comes after a similar law passed in 2021 expired several months ago, would give workers access to supplemental paid sick leave through Sept. 30.

The framework would provide up two weeks of leave to full-time workers at businesses with at least 26 employees. It would cover workers who are sick with the coronavirus and those caring for loved ones with COVID-19.

Workers who themselves test positive would need to present a test to receive the full amount of paid leave, which would be retroactive to Jan. 1.

The deal also proposes restoring suspended tax credits in a bid to help businesses shoulder the costs of the extra paid leave, which could be especially valuable for restaurants and other small businesses that have been battered by the pandemic.

The legislation is expected to reach Newsom’s desk in “days, maybe a week, but not a month,” said state Sen. Dave Cortese, a San Jose Democrat who chairs the Senate Labor, Public Employment and Retirement Committee.

Cortese said lawmakers had been working on the idea for weeks, adding that lawmakers’ offices in Sacramento have also been affected by the virus.

“By extending sick leave to frontline workers with COVID and providing support for California businesses, we can help protect the health of our workforce, while also ensuring that businesses and our economy are able to thrive,” Newsom said in a joint statement with Senate President pro Tempore Toni Atkins and Assembly Speaker Anthony Rendon.

Labor leaders who had called for the return of supplemental paid sick leave praised the announcement.

“We spoke up about the impossible choices we faced without enough sick time to recover from COVID-19 without our kids going hungry,” SEIU California President Bob Schoonover said in a statement. “We know we can’t wait for employers to keep us safe — we have to advocate for ourselves, and Governor Newsom and legislators listened.”

The state is so flush with cash, with a surplus projected at more than $45 billion, the governor will be faced with a little-known provision that may force California to do something else with its bounty in the coming year: Give state taxpayers some of their money back.

At a marathon news conference Monday, laden with slides, Newsom kicked off the state’s annual six months of budget negotiations with a positive note about California’s finances after another strong year for stocks and a record housing market that stuffed the state’s coffers.

“I’m optimistic about the future,” said Newsom, who warned that the state’s financial picture could change and priorities could shift as the pandemic rages into its third year.

Newsom demurred when asked whether the state would send some of its surplus back to taxpayers in the form of more stimulus checks.

“That’s an open-ended question,” he said, adding that the state’s projected surplus — which the state’s Legislative Analyst’s Office tabbed at $31 billion last fall — could shift significantly in the coming months. But, he said, “there likely will be substantial contributions back to taxpayers.”

Under California law, Newsom may have little choice. The voter-approved Gann limit is a spending cap that sets a limit on the amount of money the state can spend, although there are ways to restructure a budget to avoid triggering the limit. Right now, Newsom’s team thinks the state could exceed the limit by more than $2 billion.

With schools struggling to rebound after a devastating year of online learning, the 2022-23 budget proposal calls for $70.5 billion on K-12 education and another $21.8 billion on higher education.

Perhaps Newsom’s most urgent priority is a $2.7 billion COVID-19 response package aimed, in part, at expanding testing capacity and bringing in more medical workers as the state heads into its third year of the ongoing pandemic. Unlike his other budget proposals, Newsom wants lawmakers to green light spending some of that money soon, as the state faces an ongoing surge of the highly infectious omicron variant.

The budget also aims to address more long-standing problems, including climate-related issues such as wildfires and drought. It calls for an additional $1.2 billion to boost forest management and $750 million to round out last year’s $5.2 billion water package to help residents, farmers and wildlife respond to the historic drought. Long-term, the budget proposes spending $6.1 billion in 2022 and 2023 for incentives to expand electric vehicles, trucks and buses, along with building charging stations and creating programs to encourage in-state manufacturing.

In 2020, Newsom announced that California would become the first state in the nation to ban the sale of new passenger vehicles that run on gasoline, starting in 2035, as a key effort to reduce climate change. Newsom also proposed Monday spending $4.2 billion on the controversial high-speed rail project and $3.7 billion on regional and local transit and rail programs, like light rail, ferries and bike lanes.

“The governor has shown that California takes the climate crisis seriously,” said Victoria Rome, government affairs director for the Natural Resources Defense Council.

Although Republican leaders had hoped Newsom would devote some of the state’s surplus to building new reservoirs amid the current drought, he did not.

“On the surface, there are certainly things to like in this proposal; funding for clean water, wildfire prevention and homelessness are all worthy goals,” said Assembly Republican Leader Marie Waldron, R-Escondido. “But look at the details and you’ll see that much of this spending isn’t going to transformative projects to improve the lives of Californians … Returning humans to the moon will be quicker and cheaper than California’s attempt to build a railroad from San Francisco to L.A.”

Newsom acknowledged that the state needs to do far more to adequately address homelessness and clean up encampments.

While this year’s proposed budget doesn’t invest in the fight against homelessness at the same eye-popping level as last year, Newsom on Monday signaled his intent to increase funding in several key areas.

The governor wants to spend $1.5 billion over the next two years to expand housing for people with behavioral health conditions. Another $500 million would be used to clear homeless encampments and house their occupants.

The proposal builds on the $12 billion he allocated to combating homelessness in 2021. The state is in the process of spending that money on projects such as Homekey, which helps convert hotels and other buildings into homeless housing.

Michael Lane, state policy director at SPUR, a Bay Area public policy think tank, said Newsom’s proposals are in line with what he expected, given that the state has a smaller surplus this year than in 2021, when the figure topped $75 billion.

“There’s some caution there,” he said, “but even in that context, these are bold and unprecedented investments, certainly.”

Newsom also proposed spending $1 billion over two years to accelerate housing production in downtown areas, including money to help cities pay for roads, utilities and other infrastructure needed to support developments. Another $1 billion would go toward affordable housing, through low-income housing tax credits and other investments.

“It’s the exact kind of financing we need right now to move projects that are in the pipeline and get them built to be able to house folks at rates that they can afford,” Lane said.

On health care, another focus of the budget proposal, Newsom said California could become the first state to achieve universal health coverage for low-income residents, regardless of immigration status or age. But he largely sidestepped questions about a proposal to implement single-payer health care in the state.

The budget blueprint also includes $255 million in grants to local law enforcement, calling for the creation of a new smash-and-grab enforcement unit to combat organized retail crime and grants for impacted small businesses. Newsom also called for a new statewide team to investigate and prosecute criminals and a new statewide gun buyback program.

Whitman, who lived in the Bay Area and previously served as CEO of Hewlett Packard and eBay, supported the Democratic president’s bid for the White House last year and spoke out against former President Donald Trump.

“Kenya is a strategic partner of the United States, and if confirmed, I look forward to working with the Kenyan government on a wide variety of issues to advance peace, prosperity and health in the country and throughout the region,” Whitman said in a statement obtained by Reuters.

The business executive sits on the boards of Proctor & Gamble and General Motors, and she is chair of the board of Teach for America. She recently served as head of the video streaming service Quibi, which dissolved at the end of last year just months after launching.

In 2010, Whitman ran for governor against Democrat Jerry Brown and lost, spending more than $100 million out of pocket in the race.

Whitman, a billionaire, holds a bachelor’s degree from Princeton University and an MBA from Harvard University.

Her nomination must be approved by the Senate.

Prepare to open your wallet a little wider this year if you want a Christmas tree.

From supply chain problems to the effects of climate change and hiring challenges, it’s gotten harder and more costly for Christmas tree sellers to find product — and that means more sticker shock for buyers, too.

Oh, and here’s another warning: Don’t wait too long to bring yours home.

“The economic instability caused by COVID-19 and the impacts of extreme weather have affected all parts of the global and U.S. supply chain, and Christmas trees are no exception,” the American Christmas Tree Association warned recently. “These challenges mean that there will be fewer live and artificial Christmas trees available this year, and those that are available will cost more than before.”

A June triple-digit heatwave in Oregon, where many West Coast sellers buy from, damaged some trees — especially popular Noble firs, which bud late and had fragile new foliage that turned brown and dry under the intense sun. According to researchers at Oregon State University, the ongoing drought also made things worse — with low soil moisture contributing to a “perfect storm.”

In Canada, the world’s leading tree exporter, a recent atmospheric river in British Columbia left some tree farms flooded and roads shuttered. And in California, wildfires wreaked havoc on some fan favorites.

According to a U.S. Department of Agriculture survey of Oregon tree growers, the cost of live trees has nearly doubled since 2015 and the number of acres devoted to trees was down 24%. That, the tree association said, has forced retail prices up as much as 20-30% from last year. On average, live trees are selling for a little under $80 and artificial trees for slightly more than $100, although prices can be significantly higher in the Bay Area.

Still, that wasn’t stopping many families from carrying out a longstanding tradition of heading out the day after Thanksgiving to find the perfect tree.

“We were going to get one anyway,” said Margie Sanchez of San Jose, who was picking out a 7-to-8 foot Douglas fir at ABC Tree Farms on Blossom Hill Road in South San Jose on Friday with her husband, their daughter and her boyfriend.

“The tree is central,” she said of their holiday traditions. “It’s all about family — especially with COVID.”

They opted to have their tree flocked with white powder to look like snow again — bringing the total bill to $196, a bit higher than last year.

“It’s a little more,” Sanchez said. “But if the four of us go out to a nice restaurant, we’d probably spend that and it’s over and done with after an hour or two.”

Business was bustling at Moore Christmas Trees in Livermore, too.

“We’re busy,” said owner Johnny Moore. “Really busy.”

But the season has come with its challenges, and he’s had to raise prices “just a little bit to cover some costs.”

“Trucking has been a nightmare,” Moore said, which has made getting trees from Oregon and Washington more difficult. And “fire burned up a lot of Silvertips,” which grow high in the Sierra Nevada.

Tim Williams of Livermore and his family have previously bought trees as tall as 13 feet from Moore’s place to fill their soaring vaulted ceilings. But they opted for an 11-foot Noble fir this year, which still came in around $400.

“It’s totally understandable,” Williams said of the hike. “We just scaled back a little” on the size.

Anthony Stoloski, who owns and operates Ski Lane Tree Farm in Half Moon Bay with his wife, Amanda, is facing the same issues.

Trucking costs, he said, have almost doubled, and he’s heard from other sellers that they’re having trouble finding enough seasonal workers.

The Moss Beach resident has been lucky on the labor front — and able to rely on his tight-knit community for help. On Friday, Stoloski’s young sons, Jameson and Blake, 4 and 7, were helping their dad haul small trees around the lot, with plenty of extended family and friends on hand for heavier lifting.

Still, they’ve had to raise prices slightly, with trees ranging from about $40-$200 depending on their type and height.

“We always used to have a $20 tree,” Stoloski said, “but we don’t anymore.”

Marianne Mendez and Pam Grandpre weren’t deterred Friday morning as they scoped out their options.

“People have to make a decent living,” Mendez said.

And, Stoloski pointed out, seemingly everything has increased.

“It cost you more to drive here” this year, he said.

Some families are opting for artificial trees — which can offer not only convenience but significant cost savings since they can be used for a decade or more.

Mac Harman is the founder and CEO of Balsam Hill, a Redwood City-based company that sells artificial trees and decor all over the country. And while it’s too early to tell whether more people are flocking to artificial trees this year, which in the Bay Area can range from less than $100 to well over $1,000, because of sticker shock at the real thing, he thinks it’s a definite possibility.

“I’m sure that in a market where you can’t find the real tree you’re looking for, we’re likely to be a lucky recipient of that consumer’s business,” he said.

But he’s also had to raise prices about 20%. It’s costing Balsam Hill 300% more to bring items in from overseas, including millions of dollars in fines for picking up containers late because they can’t find enough truckers or truck chassis to get them on time.

Still, Harman said, costs aren’t likely to decline anytime soon. He’s already put in orders for Christmas ’22.

“It’s looking,” he said, “like this year is going to be less expensive for consumers than next year.”

Staff photographers Ray Chavez and Dai Sugano contributed reporting. 

“In my department,” Robledo said Friday, “the turnover rate is so high right now that I can come to work any day and look around and say, ‘I don’t know anybody here.’”

This week, thousands of Kaiser health care workers across the Bay Area walked off the job in support of striking engineers whose job it is to keep Kaiser’s medical centers up and running.

The labor action forced the health care giant to shutter some labs, transfer some patients and postpone some surgeries. But the strike is just one symbol of broader pain in a health care industry battered by a pandemic with no end in sight, as mounting stress has exacerbated staffing challenges.

Kaiser said in a statement that it has hired “hundreds of nurses and other care team members in recent months” in Northern California, including roughly 1,800 “experienced nurses” by the year’s end, along with 300 nurses set to graduate from the HMO’s own residency program.

But Kaiser also acknowledged that “staffing continues to be a challenge across health care,” with California in particular facing an “acute shortage of nurses.”

The Oakland-based health care system is not alone.

In a September report, the UCSF Health Workforce Research Center on Long-Term Care said the state will be hit by a shortfall of registered nurses over the next half-decade, with the pandemic making matters worse. According to the report, the state currently needs about 40,500 nurses it does not have, and that shortage — a 13.6% gap — is expected to last until 2026. About 30% of the nurses working in the state are over the age of 55, according to the report, and many are planning to retire or quit amid the intense demands of the pandemic.

About one-fourth of registered nurses ages 55-64 said they plan to leave in the next two years, up from 12% in 2018, a shift the report says is likely due to burnout and wanting to protect vulnerable family members from COVID-19. Combine that with what the report says is a reluctance among health care providers to hire inexperienced nurses during the pandemic and fewer students graduating, in part because programs struggled to put students in clinical environments as COVID-19 was raging, and the workers on the frontline are struggling to keep up — and demanding better pay and working conditions.

Jessica Nunez is one of those worn-out nurses. “It’s gotten worse over the pandemic because a lot of nurses have transferred to other positions, have quit (or) retired,” said Nunez, who along with Robledo joined the sympathy strike Friday outside Kaiser San Jose.

Beyond having to suit up in N95 masks, face shields and gowns every day, there’s the exhaustion and stress of battling an invisible deadly infectious disease that not everyone is willing to take seriously.

“There’s definitely burnout,” Robledo said. “This hospital has gone through a lot because we were one of the epicenters of the pandemic and we were dealing with our own outbreak. We’re dealing with the stress at work and we don’t escape it when we go home. Right now, since with COVID, everything is stressful everywhere, there’s no way to get away from it. You have to educate your patients about COVID and they have their own theories, whether they don’t believe in vaccines or COVID. Then you go home and have to do the same with your family members, spouses or children. The burnout is a real thing. We’ve had a lot of people who left nursing altogether.”

Just how big of an impact the staffing crisis is having locally isn’t clear. Health systems across the Bay Area either did not respond or declined to go into detail about how much outside help they’re bringing in — or how much they pay — and insisted they are prepared for a possible winter surge in COVID cases.

“We’ve been preparing for surges since we received our first two patients in February 2020 and have continuously balanced the numbers of patients with COVID-19 against the numbers of other patients in our hospitals,” a spokesperson for UCSF said, adding that the number of health care workers at the health provider has increased nearly 10% from 2020 when the pandemic began.

“We will adjust staff as appropriate should we have a seasonal increase in patients with COVID-19 or other illnesses,” said a spokesperson for Santa Clara Valley Medical Center, adding that the county is “not seeing any extraordinary retirements or staff leaving our hospitals.”

But workers say health providers are relying on traveling nurses and short-term help, and paying handsomely to get it — even as they push back on union demands for higher wages and other benefits.

“They were offering quite large amounts of money,” said Robledo, the Kaiser nurse. “It’s been easy to get travelers in California because they can pay better than other parts of the country.”

Trusted Health, a startup that matches nurses to jobs in the Bay Area and elsewhere, said it is seeing high demand in Northern California and rates of $120-$165.

Yet hospital administrators say the pandemic has hit medical centers hard, too. For a time, they had to halt lucrative elective procedures and scramble to stock up on masks and other protective gear for workers.

According to the California Hospital Association, the state’s hospitals lost more than $8 billion in 2020 due to the pandemic, even after the federal money they got through the CARES Act. And they’re projected to lose up to $2 billion in 2021, with operating margins expected to drop between 19% and 65% because of COVID-19. Kaiser posted a net income of $6.4 billion in 2020, down about 14% from 2019.

“At the heart of the issues in bargaining is this: Health care is increasingly unaffordable, and escalating wages are half of our costs,” Kaiser said in a statement Friday. “The challenge we are trying to address is that if we continue to increase costs so high above the marketplace, our members will not be able to afford to get the care they need.”

But the unions representing Kaiser’s workers and others say that if the industry doesn’t become a more desirable place to work, there won’t be enough workers to care for those patients.

Across the Bay Area and beyond, Kaiser patients were running into locked doors and long waits for lab work, eye care and more — and the delays could get worse Friday if the company can’t work out a deal with its striking engineers.

On Thursday, tens of thousands of Kaiser union workers in the Bay Area, Sacramento area and Central Valley — from X-ray technicians to phlebotomists to housekeepers — joined the walkout in a sympathy strike that sent the company scrambling to find reinforcements. On Friday, at least 20,000 nurses and thousands of mental health professionals who work for the company are expected to strike in solidarity.

The engineers — who keep everything from boilers and refrigeration to air conditioning and generators up and running — have been on strike since their contract expired in September in a quest for higher wages. Kaiser has said the engineers earn more than $180,000 in combined wages and benefits and that union leadership is requesting “unreasonable increases” beyond what other unions have demanded.

Marsh, on the other hand, found it all a pain — besides the one in his foot.

“I’m going over to the emergency department to see if they’ll let me have an X-ray. If not, I’m screwed,” the San Jose resident said. “I’ve had Kaiser since 1987. I’ve never run into anything like this.”

The turbulence comes nearly two years into a pandemic, as exhausted health care workers pushed to the brink lean on their employers, many of which have taken a financial hit thanks to COVID-19, for better compensation, higher staffing levels and more.

Earlier this week, Kaiser reached a deal with thousands of its pharmacists, averting another possible strike that had sent patients rushing to refill prescriptions before planned pharmacy shutdowns. But so far, no deal with the engineers has emerged.

In the meantime, Kaiser has lined up reinforcements to get through this latest labor action.

“During the strike, care will be provided by physicians and experienced clinical managers and staff, with the support of trained and qualified contingency staff,” Kaiser said in a statement. “We will not postpone any urgent or emergency care, or critical medical appointments.”

But, the company acknowledged, it was postponing some non-urgent appointments and procedures, and its Northern California medical centers were diverting stroke and severe heart attack patients to other hospitals through Friday. Wait times at emergency departments were also expected to be extra long.

Michelle Gaskill-Hames, senior vice president of hospital and health plan operations at Kaiser Permanente Northern California, would not say which other hospitals were taking Kaiser patients but said “it’s a broad list of partners.”

Up the Peninsula from Marsh, Villegas was trying to get blood drawn at the health care giant’s Redwood City medical center on Thursday morning. But, she said, Kaiser told her to return Monday instead.

“They’re closed,” Villegas said.

Nearby, patients were continuing to stream in and out of the facility’s COVID booster shot clinic, and Thomas Schapp, who was heading in to see his doctor, said he’d been notified of the strike ahead of time but didn’t think it would affect his appointment. Still, some Kaiser members said they were waiting to get booster shots and flu shots until after the strikes.

Down the street, striking SEIU-UHW union workers clad in purple carried signs and chanted in support of the striking engineers, cheering when passing cars honked in approval.

Ben Maka, an engineer at Kaiser Santa Clara, said he’s been out at the strike line at least five days a week since it began more than 60 days ago.

“We’re not asking to be the highest-paid in the valley. We just want to be paid like our peers,” Maka said.

Gaskill-Hames said Kaiser will continue to “bargain in good faith” but would not get into the specifics of the negotiations. “Our patients shouldn’t be brought into it,” she said.

A spokesperson for the engineers’ union, IUOE Stationary Engineers, Local 39, did not respond to a voicemail seeking comment.

Joseph Renois is a cancer patient who goes to Kaiser Santa Clara five days a week for radiation treatment.

“Yesterday, they put me in the machine to get my radiation treatment and they said I had to switch to another machine and do it again because it was malfunctioning,” he said. “It’s the second time it happened in two months.”

The striking engineers aren’t surprised.

“There’s a lot of equipment that’s breaking down, that’s not being fixed correctly,” said Mark Ceanez, a biomedical engineer at Kaiser Santa Clara who was picketing Thursday.

Kaiser, he said, is flying in engineers from Southern California to help fix the equipment.

“The equipment that we work on requires preventative maintenance every six months every year, so all of the equipment in there is becoming due,” Ceanez said.

Gaskill-Hames said Kaiser is “disappointed that labor leaders have put us in this position.”

But Kaiser employees who walked off the job Thursday said they support the engineers continuing to strike.

“They’re effectively getting a pay cut and housing prices are getting higher in the Bay Area,” said Ethan Ruskin, a health educator at Kaiser San Jose and a member of the SEIU-UHW. “For a company that made $6 billion in profit during the pandemic to be offering that — they’re not asking for the moon, they’re asking for a fair contract.”

Unions representing Kaiser nurses, mental health professionals and others say their members are prepared to strike in sympathy with Kaiser engineers, who have been picketing for better compensation for roughly two months. Kaiser acknowledges that some member services would be affected by the strike but says hospitals will remain open and urgent care available.

Around 40,000 members of three unions representing X-ray technicians, optometrists, phlebotomists, housekeepers and other employees are set to strike for a day if Kaiser and Local 39, which represents hundreds of engineers charged with keeping the health care provider’s buildings running smoothly, don’t reach an agreement by early Thursday morning.

“We are sympathy striking because Kaiser has lost its way and is putting its drive for profits over people, hurting our patients and union co-workers,” said Ethan Ruskin, a health educator at Kaiser San Jose and a member of the SEIU-UHW, which is striking. “The Local 39 engineers play a critical role in maintaining our facilities and the equipment we use to take care of patients.”

According to the SEIU-UHW, it would be the largest sympathy strike in the country in recent memory.

The showdown comes as health care providers across the Bay Area and their employees are battling over work demands, wages and staffing shortages as the pandemic enters its second winter and medical centers prepare for yet another surge in COVID-19 patients.

Beginning Friday morning, more than 20,000 Kaiser registered nurses in the California Nurses Association are expected to strike for 24 hours, along with about 2,000 mental health professionals represented by the National Union of Healthcare Workers.

Kaiser’s medical centers across the Bay Area, out to Sacramento and down into the Central Valley, are expected to be affected by the strike.

Kaiser said some non-urgent medical appointments or procedures might be affected by the strike. Lab, optometry and radiology services could also be closed or reduced. And some outpatient pharmacies are set to close temporarily both days.

“During the strike, care will be provided by physicians and experienced clinical managers and staff, with the support of trained and qualified contingency staff,” Kaiser said. “All our hospitals and emergency departments will continue to be open during a strike and remain safe places to receive care.”

In a note to members Wednesday evening, Kaiser said it anticipated significant wait times, writing, “Emergency Departments at other, non-Kaiser Permanente facilities may have shorter waiting times during this period.”

The engineers say they are striking because the wages proposed by Kaiser are lower than what other major health care providers are willing to pay. But Kaiser has said the engineers earn about $180,000, factoring in wages, benefits and retirement benefits — making them among the highest paid in the profession.

In a statement Wednesday afternoon, Kaiser said the engineers were “asking for unreasonable increases far beyond any other unions at Kaiser Permanente.”

Kaiser said it had resumed bargaining talks with the union on Tuesday and “is committed to bargaining as long as it takes to reach an agreement that continues to reward our employees and supports health care affordability, just as we have with several unions this week.”

Kaiser also urged the unions staging a sympathy strike to come to work instead.

“We question why leaders of other unions are asking their members to walk out on patients on Nov. 18 and 19 in sympathy for Local 39,” the Oakland-based health care provider said. “This will not bring us closer to an agreement and most important, it is unfair to our members and patients to disrupt their care when they most need our employees to be there for them.”

Kaiser engineers are not the only workers still trying to hammer out a contract. Mental health employees — including psychologists, social workers, marriage and family therapists and addiction medicine workers — represented by the National Union of Healthcare Workers are also working under an expired contract. The union is pushing Kaiser to hire more mental health staff, saying they are not able to provide necessary treatment in an appropriate amount of time at current staffing levels.

Kaiser has cast itself as “indisputably one of the most labor-friendly organizations” in the U.S. but blasted union leaders for asking workers to show solidarity to the engineers by striking.

But union members planning to strike don’t see it that way.

“We’re embarrassed that Kaiser has dragged the engineers strike on for 8 weeks,” said Kundra Vaughn, a Kaiser Oakland pharmacy technician and member of OPEIU Local 29, which is striking. “Kaiser is supposed to be the labor-friendly health plan. They have lost their way.”