Los Angeles County’s healthcare system was sinking on Wednesday with an unprecedented increase in patients with COVID-19, with bodies huddled in morgues and medical professionals resorting to increasingly desperate measures as they prepared for conditions to worsen. in the next weeks.
With hospitals crowded with patients and no escape valve available, doctors, nurses and paramedics are being forced to make painful choices about who receives care and at what level.
“No one would believe this is in the United States,” said Scott Byington, an intensive care nurse at St. Francis Medical Center in Lynwood. “Everyone is doing what they can. It is not that someone is relaxing. It’s just too overwhelming for everyone. ”
Hospital morgues are so crowded that the National Guard is being called on to assist county officials as the corpses are transferred to the LA County Medical Examiner’s warehouse. Overcrowded crypts in hospitals are the result of private morgues running out of space and staff to deal with the unprecedented number of COVID-19 deaths.
Deteriorating conditions occurred when Governor Gavin Newsom announced that a potentially more contagious variant of coronavirus identified in the UK had been found in southern California, although officials said the findings were not unexpected and should not cause undue alarm.
Los Angeles County recorded its 10,000th COVID-19 death on Wednesday. On the same day, it recorded 262 deaths, breaking the record for one day of COVID-19 deaths for the second consecutive day. LA County averaged about 129 COVID-19 deaths per day in the past week, a number that has never been higher.
‘Unfortunate Results’
Although the authorities did not provide details about the patients who suffered because the resources were not available, it is clear that the crisis is taking a terrible toll.
Dr. Christina Ghaly, director of health services for LA County, said on Wednesday: “There have been some unfortunate results from patients in hospitals and ambulances across the county that could not be unloaded in an emergency department in a timely manner. “.
County officials have been concerned about patients suffering from strokes, heart attacks and seizures waiting in ambulances outside hospitals, said Cathy Chidester, director of the county’s Emergency Medical Services Agency. “Early intervention, in some of these cases, if you fail, can lead to worse results,” she said.
The crowd of patients prompted the county to allow certain types of ambulance patients to be unloaded in the waiting room instead of the emergency room, according to memos issued by the EMS agency.
In addition, 911 patients who have a no resuscitation policy will not be taken to intensive care facilities, such as a hospital, or certain trauma patients whose hearts have stopped.
The agency is also allowing emergency medical service providers to refuse to take low-risk patients to hospitals with mild respiratory diseases.
Shortness of breath patients
In St. Francis, a backup intensive care unit transformed the emergency room into a landing site for people who, under normal circumstances, would be admitted to the ICU, including COVID-19 patients on ventilators. The corridors of the emergency room are full of sick patients. The part of the hospital where victims of gunshots and car accidents are usually examined is also usually crowded with people infected with the coronavirus.
In a recent shift, Byington, the intensive care nurse at St. Francis Medical Center, cared for 12 patients in crisis. On the suspended speakers, he heard almost constant calls for rapid response and Code Blues as patients fell.
“I’m upstairs in a COVID room, he’s programming, and then I go down to a COVID room, he’s coding, and then there’s a problem and I’m going and going and going,” he said. “It’s all night – it’s crazy.”
Watching the suffering of patients with COVID-19 is horrible. Their eyes widen in panic as they struggle to breathe in enough oxygen and breathe. It is a process much like choking.
“You expect some of these patients who are not going to survive, they will actually be unconscious before that, because it is very scary,” said Byington. “It is no different than probably drowning.”
In a recent shift, there were more than 40 patients in the telemetry units – some with heart attacks and others with COVID-19 – but the team was unable to find technicians to monitor their cardiac monitors because employees also fell ill with COVID.
Some nurses and doctors have been hospitalized with severe cases of the disease, he said.
Dying in the emergency hall
Hospital staff are also dealing with patients in a non-COVID crisis who have postponed urgent medical care for fear of contracting the coronavirus at the hospital. A patient may have had shortness of breath and chest pain for a few days, but he does not go to the hospital for a heart attack until it is almost too late, said Byington.
“We had a lady who came in and had a stroke in the lobby,” he said.
In a recent shift, seven patients died in the hospital in six hours, said Byington. The hospital morgue is usually packed. There were patients who died between the ages of 20 and 30, he said. Recently, a sick patient was seen in the emergency room corridor because there was no more space in the hospital.
The patient could not be saved and died there, said Byington.
“When it was time for them to pass, they passed in the hall.”
Running out of oxygen and critical machines
Byington, who has worked at the hospital for almost 30 years, said the medical team is working hard. The situation is similarly bleak at other nearby hospitals, he said.
“They give in 110% and come back the next day to start over,” added Byington. “It is like a MASH unit, in the entire hospital. This is a situation that people get into and it’s like rolling the dice. “
At different times, the hospital ran out of high-flow oxygen, as did the BiPap machines, a mask that helps push oxygen into the lungs, usually a last resort before placing sick patients on a ventilator.
Choices are often difficult. A patient may need a BiPap machine, and there may be only one, only delivered by a patient who has died, said Byington. Once the machine is delivered to the needy patient, it may take just a few minutes before another may need one – but there are no more.
“You have to choose and choose,” he said. “It’s where we really are – we’re really at that point.”
This feeling was shared by medical professionals across the region, who fear that, however bad the conditions are now, they will get worse.
‘It’s so scary’
“I have never been in a position in my career where I could not provide vital care to anyone who needed it,” said Dr. Marc Futernick, a Los Angeles emergency room physician who also serves as regional medical director for VEP Healthcare. “This is literally what we are talking about. If there is no space, no fan and no oxygen. … we’re going to have to sit on our hands. Just saying it out loud is so scary. None of us want to face this. “
At Greater El Monte Community Hospital, employees were trying to squeeze as much space out of the small facility as possible, but conditions were becoming increasingly difficult.
“The conversation you hear … is very dark,” said Dr. Victor Lange, a clinical epidemiologist at the hospital and director of quality and risk management. “It is very common to see someone crying in the hall.”
Although California and LA County have seen some reduction in the net daily increase in ICU patients with COVID-19 – probably related to the order of stay at home that began to be implemented across the state on December 6 – the county of LA is seeing less relief than other parts of the state.
At its peak in mid-December, LA County had an average daily net increase of 44 ICU patients to COVID-19; on Tuesday, LA County averaged 35 additional ICU patients every day in the previous week.
LA County reporting positive test rate of 20%
The rate of positive coronavirus test results continues to increase. The daily positivity rate is now 20% – five times worse than the comparable value on November 1, when the rate was less than 4%.
“And we’re not even counting the Christmas increase,” said LA County supervisor Hilda Solis. “From what we’ve seen with so many people who came to meetings and trips, we are still very concerned about another outbreak besides the current one.”
Solis pleaded with the public to cancel the New Year’s parties to reduce the intensity of the increase forecast for January.
Guard troops are stationed at 13 medical facilities in the state, including Adventist Health White Memorial in Los Angeles, Southern California Methodist Hospital in Arcadia and Pacifica Hospital of the Valley in Sun Valley.
“It is such a bleak reality,” said Solis.
But she added: “Please don’t give up. Broad access to the vaccine, as we know, will come in a matter of months. And don’t be a victim of this pandemic. “
Times team writers Harriet Ryan, Laura Newberry, Andrew J. Campa, Jaclyn Cosgrove, Lila Seidman and Melissa Gomez contributed to this report.