At Los Angeles County-USC Medical Center, the tipping point came on Sunday night.
There was no bed available for at least 30 patients who needed intensive or intermediate care, and the hospital had to close its doors to all ambulance traffic for 12 hours. Some patients, including the very sick who needed intensive oxygen, had to wait up to 18 hours to enter the intensive care unit.
The main entrance to Huntington Park Community Hospital was closed to the public on Monday; the back of the building saw a steady stream of ambulances over the weekend, with a security guard saying vehicles arrived every half hour.
And Gardena Memorial Hospital on Monday was operating at 140% capacity, forcing authorities to call for a four-hour suspension of new ambulance calls so it could move patients. The hospital is struggling to maintain sufficient oxygen and supplies amid the crisis of patients with COVID-19 who need them.
“It is a crisis – there is no doubt about it,” said Memorial Hospital chief executive Kevan Metcalfe. “And they keep coming.”
The crisis in Los Angeles County hospitals has reached new levels as patients continue to arrive during the holiday weekend, and the medical system is preparing for a new wave of coronavirus spread due to Christmas travels and meetings. . The cumulative number of COVID-19 deaths in LA County is expected to exceed 10,000 this week.
Hospitals are so flooded that they resorted to placing patients in conference rooms and gift shops. Even so, many facilities are running out of space. Virtually every hospital in LA County is being forced to divert ambulances with certain types of patients to other places most of the time. On Sunday, 94% of LA County hospitals that receive patients from 911 calls were diverting some ambulances.
“But soon, there will be nowhere for these ambulances to go,” said Dr. Christina Ghaly, director of health services for LA County. “If all hospitals are on diversion, no hospital is on diversion.”
The number of people with COVID-19 in LA County ICUs has broken records for 16 consecutive days, rising to 1,449 on Sunday, the most recent data available. Every day for the past week, there was a net daily increase of 35 patients with COVID-19 in the ICU – slightly below 44 in mid-December, but at a rate that is packing even more critically ill patients in crowded facilities.
As of Monday morning, there were 54 ICU beds available across LA County, and half were for pediatric patients. Two-thirds of the ICU staffed beds in LA County are occupied by COVID-19 patients.
“All hospitals are experiencing this tension, but it is especially more pronounced and more severe for some of the smaller hospitals,” said Ghaly. “Many hospitals have reached a critical point and are having to make many difficult decisions about patient care.”
There was evidence this Monday in Huntington Park. With the Community Hospital closed to visitors, East 58th Street has become a waiting room. Cars waited outside the hospital’s crowded parking lot, headlights on in the rain, while passengers waited for their loved ones inside. Occasionally, a passenger would step out of a vehicle, umbrella out, to approach the new main entrance to the hospital, the “ambulance entrance”.
A Los Angeles Fire Department ambulance arrived, sirens sounding, and the driver unloaded a patient on a stretcher. A single blanket was hanging on the side of the stretcher, not fully covering the patient from the rain.
The hospital staff took the patient’s temperature and gave him a wrist tag. After checking in, firefighters took the patient back to the parking lot and to one of the two makeshift white tents. Behind the thin cover that served as the tent door, the patient could be seen dragging himself to a chair while a hospital worker, holding a clipboard, spoke to him.
At Gardena Memorial, officers used the four-hour suspension of ambulance deliveries to move some patients home – or at least out of the hospital’s 10-bed ICU and to an expansion area previously reserved for postoperative patients – to make room for 18 others in need of intensive care.
“You have to be very creative and resourceful and use your resources perhaps in a way you have never done before,” said Metcalfe, the hospital’s CEO.
It is an increasingly difficult task, as these resources are decreasing. COVID-19 patients require “triple the amount of oxygen,” said Metcalfe, so supplies that normally last a week now last three days.
Even the oxygen storage tanks on the hospital grounds are draining quickly due to increased demand, he said. If a hospital were to run completely without oxygen, it would be in “deep, deep trouble,” said Metcalfe.
“Patients using these respirators with a high oxygen flow can die,” he said. “Would you try to use a [manual oxygen] bag, but if you have 40 or 50 people, you don’t have enough staff to do that. “
The hospital is screening newcomers and sending people who are not very sick or who can receive outpatient care home to keep the number low.
“I’ve been in the market for 40 years,” said Metcalfe, “and I’ve never seen anything like it.”
Larger hospitals are doing what they can to continue accepting patients.
Kaiser Permanente is postponing non-urgent and elective surgeries and procedures at its facilities throughout California. The break will remain in effect until January 10 in the Kaiser region of southern California and until January 4 in northern California, according to statements by the health consortium. In Southern California, Kaiser did not schedule any further elective surgery until January.
In extreme circumstances, hospitals can be forced to ration care – with doctors making no more efforts to save lives and, instead, devising strategies on where to use resources and equipment most effectively.
“We are at an inflection point. If it continues to get worse, many hospitals will begin to ration care, ”said Dr. Elaine Batchlor, CEO of Martin Luther King Jr. Community Hospital in Willowbrook, a 131-bed facility that had 215 patients on Monday.
Huntington Hospital in Pasadena has also warned of this possibility on an information sheet for patients and their families.
If the situation “comes to a point where our hospital faces a shortage that will affect our ability to care for all patients”, the authorities wrote, then a clinical committee consisting of doctors, a community member, a bioethicist, a health care provider spiritual care and other experts “will review the cases of all seriously ill patients” and “make the necessary decisions about allocating limited medical resources based on the best medical information possible”.
“This frees the bedside team from making any decision about screening for care when resources are scarce,” said the hospital.
At LA County-USC, the county’s main public hospital on Eastside, officials are trying to improvise, but as they saw on Sunday night, the constant flood of patients makes it difficult.
“We were completely overwhelmed,” said medical director Dr. Brad Spellberg, adding that the hospital is trying to “build daily, hourly solutions to help us overcome this crisis.”
Conditions at the municipal hospital – one of the largest trauma centers in the western United States – have steadily worsened since Thanksgiving, with an average of 10 COVID-19 patients arriving each day. As of Monday, there were about 240 patients with COVID-19 in all areas of the hospital, according to Spellberg, almost double the amount seen during the July surge.
In an effort to free up some beds in the ICU, the hospital opened on Monday a space previously reserved for postoperative recovery to accommodate intermediate-level COVID-19 patients, since the operating rooms are now closed to everyone except emergency cases. Like many other hospitals in the region, LA-USC County built field hospitals, or medical tents, to assist in hospitalization outside the emergency room.
But it is not just the influx of patients that contributes to the lack of beds, Spellberg said. Many COVID-19 patients remain in the hospital for much longer than the average ICU patient, with some on mechanical ventilators occupying beds for six, eight or even 12 weeks.
And the anticipated “Christmas wave” hasn’t even started yet.
“If there is a sudden increase in Christmas, we probably haven’t experienced it yet,” said Spellberg, noting that the cases resulting from that holiday may take another week or two to appear.
He added, “If that happens, Los Angeles County will become what New York was in April.”
Times staff writers Jaclyn Cosgrove and Harriet Ryan contributed to this report.
This story originally appeared in the Los Angeles Times.