How bad are the next few weeks going to get?
The death toll from COVID-19 in California and Los Angeles County – an epicenter of the pandemic – is breaking records, or near records, almost daily. There is clear evidence that the increase in cases after the Christmas holiday is getting worse, as the numbers continue to rise, particularly in LA County.
But the big question is whether this new wave of cases will result in a similar increase in hospitalizations that occurred during the post-Thanksgiving rise, which brought hospitals to the breaking point, resulting in dire shortages of staff and certain supplies and affecting the quality of medical care provided to critically ill patients.
Around Thanksgiving Day, about 300 new COVID-19 patients a day were admitted to hospitals in LA County; that number has skyrocketed for about a month, finally stabilizing at around 750 to 800 new hospitalizations a day on Christmas Eve. Another doubling or tripling of new hospitalizations per day would be catastrophic.
As terrible as the crisis has become, most hospitals have not yet entered into a prolonged and widespread period of rationed care. But that would probably happen if the Christmas wave was dramatically worse.
Teams of screening officers – usually led by emergency and critical care doctors – would have to be fully activated. Facing shortages of staff and supplies, they would be forced to make the most painful decisions: determining who receives the most aggressive rescue care and limited time from the best trained professionals and equipment, and who has the least chance of survival and treatment provided for them. comfort them while they die. The way hospitalizations were stopped this week will give authorities an idea of what to expect.
“We are all looking forward to seeing how hospital admission data unfolds in the coming days,” said Dr. Roger Lewis, director of COVID-19 for hospital demand modeling for the LA County Department of Health Services. .
“The hospital-based system is literally at the breaking point, where a substantial increase in demand can result in situations where we cannot provide people with the care that everyone would expect to be able to provide or receive when we are seriously ill,” he added.
COVID-19 patients who are now entering hospitals were infected mainly in the post-Thanksgiving period, before Christmas. The flattening of new admissions probably resulted from the imposition of residence orders issued by the city and state.
But the effect of holiday meetings over Christmas will soon begin to show in hospitals. Soon, a certain percentage of people who were infected at Christmas and tested positive will start to get so sick that they will need hospital care. If the number of new daily hospital admissions for patients with COVID-19 worsens, it is a big sign of trouble.
Now, it is possible that the increase in hospitalizations could be moderated if, for example, you are younger, otherwise healthier people who were infected during the holiday season, and quarantined or isolated to avoid infecting more family and friends old people who are most at risk of dying.
But it is also plausible that vulnerable and elderly people would attend Christmas and New Year’s gatherings or be infected by young people who did not stay away from them – something that happened during the Thanksgiving holiday.
“The fear, or intuition, of most people who do predictive modeling is that it will get worse. The uncertainty is at the worst. And to quantify how much worse, it requires data that will only be available to us next week, ”said Lewis.
The postnatal increase in new cases of coronavirus is growing every day. The average number of new coronavirus cases in LA County on Thursday, Friday and Saturday was about 18,000 – significantly above the average of about 14,000 new cases per day last week.
“This is clearly the most recent increase in winter and New Year holidays – without a doubt,” said Dr. Paul Simon, head of science for the LA County Department of Public Health. “It started gradually at the beginning of the week, but [definitely] here on the last day or two. “
About 1 in 5 coronavirus tests performed daily in Los Angeles County are positive, a large increase since the beginning of November, when about 1 in 25 tests confirmed an infection. And when community transmission is so prolific, authorities warn that activities that seemed mundane months ago are at greater risk of infection than ever.
Simon said the rise in daily coronavirus cases is expected to continue for the next two weeks, which will translate into even worse hospitalizations and more deaths. The number of daily deaths from COVID-19 is already breaking records; in early December, about 30 people a day in LA County died of COVID-19 on average over a seven-day period; now, about 200 people die each day.
The number of people dying from COVID-19 daily is now exceeding the average number of deaths in LA County from all other causes, including heart disease, cancer, stroke, diabetes, car accidents, suicides and homicides, which is about 170 deaths per day.
Some veteran epidemiologists suspect that higher levels of hospitalizations and deaths will, in fact, materialize and that hospitals will be forced to adopt “crisis care standards,” in which screening doctors may have to choose who will receive the treatment they need. saves lives.
“I predict that with the increase in the number of cases we are seeing – which will translate into an inevitable increase in the number of hospitalizations and ICU patients – hospitals will be forced to operate under crisis protocols that may include rationing care” , he stated. said UCLA medical epidemiologist and infectious disease specialist Dr. Robert Kim-Farley.
Kim-Farley said he suspects that there will soon be a further increase in hospitalizations, which will continue to increase until the end of January. A fraction of these people will not survive the disease, and a peak in daily deaths from COVID-19 is likely to occur in mid-February, said Kim-Farley, due to the gap between initial hospitalization and death.
It was wise for state officials to be ready to distribute dozens of large refrigerated trailers that can act as temporary morgues for bodies being dispatched to counties, said Kim-Farley. Funeral homes across the state are already overwhelmed by the increase in bodies and some have been forced to send families away.
“Unfortunately, the reinforcement capacity that is being made for morgues will actually be necessary,” said Kim-Farley.
LA County has now reached new milestones in the pandemic: more than 12,000 deaths from COVID-19 and more than 900,000 cases of coronavirus.
On Saturday, 218 COVID-19 deaths were reported in LA County. This happened a day after the county set a record 318 days.
LA County officials on Saturday confirmed three additional cases of coronavirus-related inflammatory disease in children known as MIS-C. A total of 54 children in LA County contracted the serious illness and one died. The disease can cause fever and inflame the heart, lungs, kidneys, brain, skin, eyes and gastrointestinal organs. The disease is disproportionately affecting Latin children, responsible for about 3 of the 4 reported cases.
In the past few days, in LA County, the available ICU beds have dropped to zero or one in each of the following regions: downtown LA, Westside, southeast LA County, San Gabriel Valley and Antelope Valley. The South Bay-and-Long Beach region had only three ICU beds available in the past few days, and the San Fernando Valley, only six.
In the municipality of Santa Clara, which has about 2 million residents, there were approximately 20 to 25 ICU beds available on Friday; in Fresno County, with about 1 million residents, only 10 beds were available.
Dr. Rais Vohra, interim health officer for Fresno County, said hospitals are preparing for “a very difficult January and possibly February rest”, including fighting to find supplies related to the provision of oxygen treatments and ways to perform antibody infusions to prevent patients needing hospitalization.
Some help has begun to arrive: US Department of Defense staff, as well as ICU nurses recruited by the state, have been deployed to hospitals in the region, said Dan Lynch, director of Fresno County’s Emergency Medical Services agency. And a hospital in San Mateo County has offered to receive seriously ill patients from Fresno County.
But it will not be easy to make these transfers in practice. “It’s a risky move when you move them over a long distance,” said Lynch.
Although the increase in the California pandemic is dire, the state has one of the lowest cumulative numbers of deaths from COVID-19 on a per capita basis, ranking 38th out of 50 states, probably as a result of the initial imposition of the order of staying home at the close of spring and summer for certain high-risk companies. The cumulative death rate for COVID-19 in New Jersey is three times that of California; Arizona’s is twice that.
Times staff writer Ryan Murphy contributed to this report.