Los Angeles County health officials, hit hard, issued their most dire warning about the COVID-19 crisis, saying on Monday that struggling hospitals are at risk of running out of space, especially with the imminent threat of a new outbreak fueled by Christmas that the county could reach the total number of 10,000 coronavirus-related deaths in a matter of days.
Hospitals are so flooded that they resorted to placing patients in conference rooms or gift shops. Some are struggling with aging and insufficient infrastructure that threatens to disrupt the flow of life-saving oxygen.
The count of new daily cases, while not rising exponentially as they were at the start of the wave, remains alarmingly high.
Most tragic of all, the virus is killing Angelenos at an excruciating rate. The county is rapidly advancing to 10,000 coronavirus-related deaths and is expected to surpass that previously unthinkable milestone in a matter of days.
On Christmas Eve, 140 people died of COVID-19 across the county – an average of one fatality every 10 minutes, according to data compiled by The Times.
“These are numbers that cannot be normalized,” said county supervisor Hilda Solis, during a meeting on Monday. “Just like the sound of ambulance sirens, we can’t turn it off.”
And the authorities say that darker days are almost certainly on the horizon.
“As bad as it is, the worst is certainly yet to come,” said Dr. Christina Ghaly, director of county health services.
According to the latest state data, there are 7,181 coronavirus-positive patients hospitalized in LA County, with 1,449 of them in intensive care. Both figures are the highest ever seen at any point in the pandemic.
Ghaly said on Monday that approximately 50% of the beds currently served in the county, and just over two-thirds of the beds in the intensive care units served, are occupied by COVID-19 patients.
In light of the deteriorating situation, Governor Gavin Newsom announced on Monday that the state will incorporate a new team in LA County to encourage load leveling and “greater coordination between hospitals”.
An overworked and overworked healthcare system, he pointed out, endangers anyone who needs professional care – not just those infected with the coronavirus.
“Routine emergency room care is slowing down,” he said. “So, if you think that it doesn’t affect you, if you think that you are somehow immune to the impact of COVID: there is the direct impact, and this is the transmission of this virus. There is the indirect impact, God forbid, you have a stroke or a heart attack, you have a car accident or you have other intensive care needs. The impact of this virus, this pandemic, is being felt throughout the hospital system ”.
At Los Angeles County-USC Medical Center, the situation hit “massive crisis” mode on Sunday night, according to medical director Dr. Brad Spellberg.
There was no bed available for at least 30 patients who needed levels of intensive or intermediate care, Spellberg said, and the hospital had to close its doors to all ambulance traffic for 12 hours.
Some patients, including some who were very ill and needed intensive oxygen, had waiting times of up to 18 hours.
“We were completely overwhelmed,” said Spellberg, adding that the hospital is trying to “assemble daily, hourly solutions to help us overcome this crisis.”
Conditions at the hospital – one of the largest trauma centers in the western United States – have steadily worsened since Thanksgiving Day, with an average of 10 new COVID-19 patients arriving each day.
As of Monday, the hospital had about 240 patients with COVID-19 in all areas of the hospital, according to Spellberg, almost double the previous increase in July.
And the long-awaited “Christmas wave” hasn’t even started yet.
“When you enter the ICU and see each bed occupied by a ventilated COVID patient, with tubes entering every hole in the body, you begin to understand that we are not dealing with what we were dealing with 10 months ago,” Spellberg said.
Hospitals across the county and state have already been forced to take significant steps to deal with the flood of COVID-19 patients – such as postponing some procedures, keeping patients in ambulances for hours until space is available, and moving some patients who would normally be in the hospital. ICU to other areas of the hospital.
However, these measures only go so far, and health officials warn that capacity is limited not only by physical space, but by a shortage of trained personnel.
If the medical system is overloaded, authorities warn that there may not be enough staff or resources to provide intensive care to everyone in need, which would significantly increase the chances of patients dying.
“The sad reality is that all the indicators tell us that our situation can only get worse in early 2021,” said LA County public health director Barbara Ferrer. “The rate of transmission in the community remains extraordinarily high and this has burdened our hospital system, as more patients with COVID-19 continue to arrive, in addition to the thousands of patients who are already fighting for their lives.”
In extreme circumstances, hospitals may be forced to ration care – with doctors no longer making every effort to save a life and, instead, devising strategies on where to use resources and equipment most effectively.
Huntington Hospital in Pasadena now warns of this bleak possibility in an information leaflet for patients and their families.
If the situation “comes to a point where our hospital faces a shortage that will affect our ability to care for all patients”, the authorities wrote, then a clinical committee consisting of doctors, a community member, a bioethicist, a health care provider spiritual care and other experts “Will review the cases of all critically ill patients” and “make the necessary decisions about allocating limited medical resources based on the best medical information possible and use the same decision criteria that are being used nationally and across California in all patient cases. ”
“This frees the bedside team from making any decision about screening for care when resources are scarce and instead delegates those decisions to a committee that will follow an ethical framework for decision making,” added hospital officials in communicated on Monday. “It is important to note that no person will make a decision about care and the committee will not receive information about the patient’s race, ethnicity, religion, citizenship, insurance or any other information not related to the patient’s health.
“We are committed, as always, to providing compassionate care to everyone and sincerely thanking our first-rate healthcare professionals, doctors and staff who help manage our hospital,” continues the statement.
Kaiser Permanente is also postponing elective and non-urgent surgery and procedures at its facilities throughout California.
The break will remain in effect until January 10 in the Kaiser region of southern California and January 4 in northern California, according to statements by the health consortium.
In Southern California, Kaiser also did not schedule any further elective surgery until the end of January.
Cancer-related surgery will continue, as will procedures in “any situation where postponing surgery has a negative impact on the patient’s medical condition, including pain,” officials added in a statement.
It is necessary to postpone less urgent procedures, officials said on Monday, “to respond to current and anticipated increases in COVID-19 cases” and to release staff “to focus on supporting COVID-19 care.”
“We are facing an unprecedented increase in patients with COVID-19 and the number of available ICU beds continues to decline,” said Kaiser officials in a statement on Monday. “Last week, 52% of our hospitalized patients in Southern California were being treated for COVID-19. Today, that number has soared to 82%. “
Given the large number of patients, Kaiser is “converting and using all possible spaces available, including old conference rooms, waiting rooms, recovery areas and other non-traditional areas of the hospital”.
“We are very proud of the experience and compassion that our employees and doctors have shown each moment in the past nine months and continue to provide in the midst of the current increase in COVID-19 in our communities,” continues the statement. “But the current increase means that our nurses, doctors and our entire team – who are already tired and tired – must go even further, to take care of more and more patients. We are very concerned about what will happen in the next few days and weeks if we do not take all measures to slow the spread of this virus. “
On Sunday, the most recent day for which complete data is available, there were 19,766 coronavirus-positive patients hospitalized across the state – a historical record of 45% more than two weeks ago.
Of these patients, 4,228 were in intensive care, also a record.
Health officials fear that these numbers will continue to rise if the state faces an outbreak of infections from travel and Christmas events.
COVID-19 patients in the hospital now reflect cases of coronaviruses diagnosed two weeks earlier. This means that hospitals are yet to see increasing demand in the new year because of infections that occurred in early December.
Any fallout from Christmas will take weeks to fully assess, but officials have warned that the healthcare system cannot handle another increase like the one that happened after Thanksgiving.
Unfortunately, state officials said on Monday that they believe another peak fueled by the holiday is on the horizon.
“We certainly anticipate that mid-January will be a very difficult time in our hospitals, where this week’s and next’s cases will really start to pile up – impacting emergency rooms, our wards and our ICU spaces,” said Dr. Mark Ghaly, California’s secretary of health and human services.
There is a real fear that this “outbreak at the top of an outbreak” may be too much for the overworked hospital staff.
“It is a very, very different and infinitely more dangerous situation to have hospitals going through a peak when the staff is exhausted, they are overwhelmed and are already caring for more patients than they can handle safely,” said Christina Ghaly.
The state imposed strict restrictions on business and activities earlier this month, hoping to contain the violence.
Although the wave of new coronavirus cases has continued to rise since then, the authorities noted that the rate of this increase, along with the number of new coronavirus-related hospitalizations, appears to be stabilizing in many areas.
“We are now seeing the majority of the state experiencing a plateau of new hospital admissions … in fact, seeing this growth rate start to decline, with one big exception – which is Southern California,” said Newsom on Monday, in Los Angeles Riverside and San Bernardino counties continue to report high numbers of infections.