One of the countless challenges facing the Southern California medical system, burdened by patients with COVID-19, involves one of the most basic staples of any hospital.
Oxygen.
Authorities are having trouble getting the amount of oxygen needed for critically ill patients with COVID-19 struggling to breathe because their inflamed lungs are being damaged or destroyed.
Sunday’s problems caused at least five hospitals in LA County to declare an internal disaster, which shut down facilities for all ambulance traffic – not just for certain types of ambulance patients, as is more common.
It is not simply a lack of oxygen in itself, say county and hospital officials. There is a shortage of containers, which patients need to return home, and old hospital plumbing is breaking down due to the huge amount of oxygen needed to be delivered by the hospital.
There are two problems with oxygen delivery in old hospitals.
First, there are so many patients who need a high rate of oxygen that the system cannot maintain the necessary pressure in the pipes.
The second is that there is a flow so high through the tubes that they freeze, “and obviously, if it freezes, then you can’t have a good flow of oxygen,” said Dr. Christina Ghaly, director of health services for County OVER THERE.
Some hospitals are forced to move patients to lower floors, because it is easier to supply oxygen without the need for pressure to push them to higher floors, said Ghaly.
Gardena Memorial Hospital is one of the centers facing oxygen problems. Chief Executive Kevan Metcalfe said the hospital was low on oxygen.
If it ends, the hospital will have “deep, deep problems,” he said.
Doctors and nurses learned from the early days of the pandemic to avoid placing patients on ventilators as much as possible, which involves putting a breathing tube down their throat.
Instead, many patients are treated with high-flow oxygen, in which oxygen is sent through plastic tubes placed in the nose.
While a non-COVID patient can receive six liters of oxygen per minute, COVID-19 patients need 60 to 80 liters per minute. So now hospitals need a lot more oxygen than before.
One of the biggest concerns for hospitals is that more patients are on the way.
COVID-19 patients at the hospital now reflect coronavirus cases diagnosed two weeks earlier – a time when LA County had an average of 11,000 new cases per day. That number has since increased – to almost 14,800 new cases per day during the seven-day period that ended on December 22 – before dropping slightly to 14,000 cases per day on Monday night.
This means that hospitals still expect to see growing demand in the new year because of infections that occurred before Christmas. About 10% of people tested positive for coronavirus in LA County end up needing hospital treatment.
Barbara Ferrer, director of public health for LA County, said that “all the indicators tell us that our situation can only get worse in the beginning of 2021. The transmission rate in the community remains extraordinarily high…. As cases continue at these alarming levels, hundreds of people may die. “
She added: “We all need to give our hospitals a chance to fight to cope with the flood of COVID-19 patients who arrive every day.”
The pace of the autumn and winter wave has been impressive. As of November 1, LA County had an average of 1,300 cases of coronavirus per day per week; LA County now averages 14,000 cases a day. The daily rate at which coronavirus test results are turning positive is now 17% in LA County, more than quadrupling the comparable number on November 1, when the rate of positivity was less than 4%.
LA County now averages 90 COVID-19 deaths per day last week, one of the highest numbers during the pandemic. The death toll in the county on Monday night was 9,564, according to an independent Times count of local health jurisdictions; Ferrer said on Monday that his agency is still analyzing a portfolio of reports and expects to add 432 deaths, bringing the death toll to close to 10,000.
County supervisor Hilda Solis asked people not to think that anything could be done about the pandemic and asked people to stay at home. A coronavirus test that shows negative can easily lose its meaning, as a person may be infected and contagious when the results come back.
“I understand the futility that so many people are feeling now – the idea that some people just want to throw their hands up. But we can’t think like that, ”said Solis. “It is entirely within our control to limit how many people are infected and how many people can die.
“To be more frank, each of us has the power to cause or prevent death and illness among our family members, co-workers and even strangers.”
It is not just older people who can suffer from COVID-19, said Solis; a child died this month of multisystemic inflammatory syndrome associated with coronavirus in children, known as MIS-C, in LA County. There were at least 51 cases of MIS-C in the municipality – all requiring hospitalization, with half treated in intensive care units. Latin children were responsible for almost three quarters of these cases.
Ferrer said LA County ran 29 samples of coronavirus for genetic analysis, and none were positive for the potentially more contagious coronavirus variant identified in Britain. While the variant is very likely to be here, she said, it does not appear to be dominant.
“Whether the variant is here or not, the steps we need to take are exactly the same,” said Ferrer.
Times editors Sean Greene and Colleen Shalby contributed to this report.