“This is a tragedy,” said Dr. Nida Qadir, co-director of the medical intensive care unit at the Ronald Reagan UCLA Medical Center, about the MLK statistics. Her hospital had mortality rates “much lower than that,” she said, although the hospital has not released the number publicly. A new study of patients in 168 hospitals found that about half of Covid ventilator patients died, and survival varied widely between hospitals.
Dr. Theodore J. Iwashyna, an intensive care physician at the University of Michigan, said the differences in the hospital’s results reflect a “system choice”. He and others studied patients with complex lung diseases and found that those treated in smaller hospitals with fewer resources and less experience in managing them tend to have lower survival rates. “The big hospitals should be taking these patients and removing them” from MLK, he said.
During the sudden increase in Los Angeles, hospital mortality also increased because fewer patients with minor illnesses were hospitalized, said Dr. Roger J. Lewis, professor of emergency medicine at Harbor-UCLA Medical Center who helps analyze Covid’s data to the county. This was likely to happen even more in small hospitals like MLK, in areas with high rates of chronic diseases, he said.
The medical team invited Flores’ wife to the hospital, usually closed to visitors during the pandemic. She found her husband scared and trembling. He was not getting enough oxygen, a doctor explained, and without a respirator he could die in two days. Mr. Flores told her that he wanted to go home, but changed his mind. He was exhausted and had chest pains, he said. He would try the respirator because he wanted to live longer for his family.
Even so, their oxygen levels remained low. Doctors gave him steroids and drugs that fight blood clots. They turned him face down and even paralyzed him for periods to help the fan work more effectively. But nothing seemed to make a difference. Flores had “definitive Covid’s lung failure,” said Prasso.
Some Covid patients have one last option: treatment with a machine that gives the lungs a chance to rest and, hopefully, repair. The procedure, extracorporeal membrane oxygenation or ECMO, is usually offered only in larger hospitals for patients who meet strict criteria.
Flores may have been a candidate for her at some point, according to Dr. Christopher Ortiz, an intensive care specialist at UCLA, a first-rate hospital, who helped MLK But Dr. Prasso said he stopped considering treatment. At the start of the pandemic, he pushed to transfer some MLK patients to hospitals that provided ECMO, but he finally gave up.
“We were never successful,” he said. “Nobody wants their insurance.”