It was the first day of a new year, and yet, in much of California, the numbing realities that we yearn to leave behind – crowded hospitals, a growing death toll and massive unmasked meetings – followed us until 2021.
On Friday, the number of Californians who died of complications from COVID-19 exceeded 26,000 – almost the same number of Californians who, in a recent year, died of complications from the flu, diabetes, hypertension and combined liver disease.
In LA County, where hospitals were so crowded that patients had to wait outside in ambulances for up to eight hours, hope for some relief finally arrived on Friday: The Army Corps of Engineers was planning to send teams specialists for the region to update oxygen delivery systems in a handful of old hospitals.
Days earlier, several hospitals declared internal disasters and temporarily refused all ambulance traffic because their internal oxygen systems began to fold under the high demand for airflow needed by patients whose lungs were devastated by the coronavirus.
As emergency rooms and intensive care units across the county continue to be overwhelmed with patients with respiratory illnesses, hospitals continue to suffer the dangerous cascading effects that have affected almost every aspect of healthcare.
With 700 nurses from primary care clinics diverted to hospitals and other critical needs, county officials have been forced to temporarily close five primary care clinics across the county and shorten the hours of most others, which provide immunizations for children and where people with chronic illnesses have their medications administered.
“We kept a minimal team to continue working in our outpatient clinics,” said Dr. Christina Ghaly, director of health services for LA County. “But in general, our capacity for outpatient services is much less than in routine times.”
This means that patients with chronic diseases will be at greater risk of needing go to the emergency room if they become more seriously ill due to lack of outpatient care.
It also means that hundreds of procedures and surgeries have been put on hold.
For Matt Howard – a 44-year-old high school teacher who was scheduled to have a kidney transplant surgery at Cedars-Sinai on January 15 – that meant receiving a disappointing phone call on a recent afternoon.
“We’re sorry,” said the voice on the other end of the line. “There are no ICU beds available, so we have to postpone the surgery.”
When he told his wife, she started to sob. His two daughters, 20 and 22, were also devastated. But Howard, who lives in Lakewood, said he takes comfort in knowing that his donor – his older sister – is not going anywhere. It would have been a far worse situation, he said, if he had received a new kidney from a recently deceased donor.
Hospitals are doing the best they can in impossible circumstances, he said, and don’t blame them for the cancellation. Still, he said, he is looking forward to the transplant. The last time he had his kidneys examined, doctors said they were running at 3%, said Howard, who undergoes nine-hour dialysis treatments at home every night.
“It’s a waiting game,” he said, noting that he still doesn’t have a new surgery date set.
The situation at many medical facilities in Southland remains dire.
Paramedics now regularly decide not to transport low-risk patients to overcrowded hospitals, hoping to free up space for those most in need, which has forced people who would otherwise go to the emergency room to seek care elsewhere.
Hospitals are struggling to find enough staff, and sometimes emergency medical technicians are called on to work in hospitals. Meanwhile, older hospitals are being reconfigured to house many more patients than they expected, leading to oxygen problems.
Dr. Christina Ghaly, director of health services for LA County, said the demand for a high flow of oxygen is so great and the pipes in the buildings are so old that they can’t maintain enough pressure and sometimes start freezing. In confusion, Ghaly said, some hospitals have been forced to move patients to lower floors, because it is easier to supply oxygen there without the need for pressure to push them to higher floors.
Another oxygen-related problem – the chronic shortage of portable tanks – has also damaged hospitals’ abilities in recent days, county officials said. To discharge patients in recovery as quickly as possible and free up space for other sick patients, hospitals often send patients home with oxygen tanks.
The Army Corps design and construction expert team will evaluate six hospitals – Adventist Health White Memorial in Boyle Heights, Beverly Community Hospital in Montebello, Emanate Health Queen of the Valley Hospital in West Covina, Lakewood Regional Medical Center, Mission Community Hospital in Panorama City and PIH Health Hospital in Downey – and then oversee updates where deemed necessary.
Mark Ghilarducci, director of the California Governor’s Office of Emergency Services, said in a statement that the updates “will improve the ability to provide vital health care to those in need.”
The assessments are scheduled to begin on Saturday, state officials said.
The basic problem is that patients, suffocating with inflamed lungs, are demanding an oxygen flow so high that some hospitals are unable to meet demand with existing infrastructure.
“Running out of oxygen and oxygen tanks is a problem,” said Cathy Chidester, director of the LA County Emergency Medical Services Agency.
And LA County Public Health Director Barbara Ferrer said she expects these trends to continue for several weeks.
“We are experiencing extreme conditions in LA County,” she said. “Our hospitals are still overloaded. As more and more people are rushed to hospitals, the tragic fact is that hundreds of people will die every week from COVID-19. These trends, unfortunately, will continue into January. “
And yet, there was a small piece of hope released on New Year’s Day. For the first time in 50 days, the net number of people hospitalized in LA County for COVID-19 has declined – though only by one. Still, it broke the consecutive daily sequence of 32 days of record hospitalizations for COVID-19 in LA County.
On New Year’s Eve, there were 7,627 COVID-19 patients hospitalized in LA County, down from 7,628 the previous day, according to data released on Friday.
The slower increase in daily patients is a sign that the order to stay in effect in southern California for nearly four weeks is having an impact.
“I have no doubt that if we were not ordered to stay at home, the situation would be much more dire than it is now,” said Dr. Robert Kim-Farley, an epidemiologist and infectious disease specialist at UCLA Fielding School of Public Health, which described the current situation as a “viral tsunami”.
“However, I think the magnitude of the numbers shows that, given the order to stay at home, many people are choosing to ignore it,” he said, adding that any slight relief in new hospitalizations is likely to be reversed soon because of how many people traveled during Christmas and New Year.
For Howard, the professor who expects a transplant, it is deeply frustrating to see people refusing to wear masks or going to New Year’s Eve parties.
“It is disappointing,” he said.
When Howard was diagnosed with IgA nephropathy four years ago, his kidney function was at 30%. When it dropped to less than 10% last year, he started dialysis using a catheter in the stomach lining. Even with treatments, he said, he feels constantly exhausted.
A high school football coach, he said he was looking forward to returning to the level of energy and motivation he felt before. He dreams of returning to work by bicycle and, when the pandemic is left behind, one day traveling with his wife.
For her sister, Gail Houseweart, a labor nurse in Colorado, the news of the delayed surgery was heartbreaking.
After several blood tests – involving 33 vials in all, she remembers – and undergoing a whole day of tests, including a mammogram and a chest X-ray, she finally got the green light about a month ago: she was compatible, and they were all ready. She was elated. When people said she was a hero, she replied that no, in fact, she felt selfish. She needed her younger brother.
“I want him around for me, his children and his wife,” she said.
She bought a plane ticket to Los Angeles and booked an Airbnb for after the procedure, but got the call about the cancellation. She was shaken for a few weeks, she said, but is trying to focus on the future.
“2021 is our year,” she says, pausing. “I think so, I hope.”