A violent attack by COVID-19 patients is hammering medical facilities across Los Angeles County as Christmas approaches – forcing hospitals to bypass ambulances and leave patients helpless for hours. It is also warning authorities to warn healthcare professionals not to send patients to the emergency room, unless absolutely necessary.
County health officials sent a memo to doctors and nurses across the county on Wednesday night, reiterating that hospitals were reaching their limit.
“Hospitals have implemented their emergency plans and are adjusting staff and space to try to meet the needs of their community,” wrote Dr. Sharon Balter, the county’s chief communicable disease control and prevention, in the memo. “It is critical that, as a healthcare community, we look at all the opportunities available to help slow the rise in hospitals and our 911 system, whenever possible.”
Balter asked providers to talk to patients suffering from ongoing medical problems about when it would be appropriate to visit the ER or call 911, and only do so when it was a real emergency. She also encouraged the rapid discharge of hospitalized patients to try to create as much space as possible in the wards, citing a “marked increase” in cases of COVID-19 and hospitalizations.
In a stern recommendation, Balter also asked providers to reach out to patients who had severe illnesses or were clinically fragile to review their advanced care guidelines and ensure that forms detailing their end of life care were filed.
The memo shows what the authorities have been warning for weeks: the increase in patients with COVID-19 is also affecting other sick people who need medical care.
“There are very limited hospital and ICU beds and the emergency departments are exhausted,” wrote Balter.
Dr. Brian Gantwerker, a neurosurgeon from Santa Monica, said he feared what the next few weeks would hold for Los Angeles. The community hospital where he works is already “flooded with COVID cases”, with doctors fearing that they will soon have to ration care due to the lack of beds and staff.
Every day that the number of patients with COVID-19 grows, it also increases the likelihood that more patients with neurosurgery will have to wait for care or find it elsewhere, he said.
This puts doctors in the uncomfortable position of determining who receives the limited resources that remain in the hospital. A large brain tumor would probably be operated on immediately, he said, but surgery for a smaller and less dangerous one might have to be postponed.
“So the question is, ‘Where is the breaking point? When do we have to start sending patients to other places? ‘And the nightmare scenario is:’ What happens if there are no beds available in the municipality? ‘ “, He said. “Everything we care about, talk to and alert people to since February is becoming a reality – we are at that point now.”
Terrible and deteriorating conditions in California’s most populous county occur at a time when a giant wave of new coronavirus infections continues to affect the region, leaving behind an unprecedented number of hospitalized or dead Angelenos.
“We are in the midst of a terrible wave and we all need to take the difficult and wise steps to reduce transmission and exposure now, during the holidays and in early 2021,” said LA County Director of Public Health, Barbara Ferrer. “The sooner we all take these vitally important measures, the sooner we can prevent the increase in cases that are overloading our hospital care system.”
Now, she added on Wednesday, “it’s time to double or triple all of our efforts to stay safe.”
The authorities, however, say they expect the situation to get worse before it gets better.
Due to the delayed nature of the coronavirus, it usually takes two to three weeks from the time a person is infected to when they can become sick enough to require hospitalization. In other words, patients in need of care today were widely exposed to the virus weeks ago – when case rates across the county and state, while high, were significantly lower than they are now.
In the past week, LA County has reported an average of 13,970 new cases of coronavirus per day, an increase of about 60% over two weeks ago, according to data compiled by The Times.
That average includes 16,974 new infections that were reported on Wednesday – the county’s second highest daily total of all time.
The authorities are also concerned that the increase in cases and hospitalizations could cause a huge increase in deaths. Los Angeles County reported one of the deadliest days of the COVID-19 pandemic on Wednesday, when 134 people died.
An average of 85 Angelenos per day died of COVID-19 last week. That number was 10 on November 3.
Dr. Christina Ghaly, the county’s director of health services, predicted this week that nearly 7,000 people will die of COVID-19 by the end of January if trends continue.
The disease has killed 9,165 people across the county.
“These people did not have to die,” she said on Wednesday. “We have never seen daily mortality rates so high during the course of the pandemic, and the model predicts that the worst is yet to come.”
At certain times of Tuesday, 96% of all hospitals in LA County were so crowded that they diverted some ambulances to more distant hospitals, a figure that is typically only 33% at this time of year, according to Ghaly .
Ambulances had to wait hours to unload patients in crowded emergency rooms, and scheduled surgeries are being postponed to make room for those suffering from COVID-19.
About half of all intensive care beds in LA County are occupied with COVID-19 patients at this time. Two out of three are suffocating due to the inflammation of the lungs triggered by the coronavirus, said Ghaly.
“They are suffocating to the point where they can no longer breathe on their own and need someone to put a tube in their throat to oxygenate their organs,” said Ghaly. “Many of these people will not live to see 2021.”
There were about 6,700 coronavirus-positive patients hospitalized across the county on Wednesday, according to the latest state data, with 1,329 of them in the ICU.
It is in the midst of this distressing scenario that the authorities have made increasingly strong calls for residents to avoid traveling and meeting to celebrate their winter holidays.
Similar calls made before Thanksgiving have often fallen on deaf ears, officials say, and the widespread rejection of this guidance has spawned the worst and deadliest wave of the pandemic so far.
“Life, as we know, does not allow us to go back in time and redo or relive our mistakes,” said Ghaly. “All we can do is change our behavior from now on.”
If a large number of people make the same choices over Christmas and New Year, officials and experts warn that this is likely to trigger an “outbreak at the top of an outbreak” – meaning that more people will be infected, become ill and eventually die.
“Whatever happens during the winter holidays,” said Ferrer. “It’s all the same as what happened, or even half of what happened, during the Thanksgiving holiday, we are in serious trouble.”