Kaiser Permanente is postponing elective and non-urgent surgery and procedures across California, as its hospitals – like healthcare systems across the state – continue to recover from a devastating attack by critically ill patients with COVID-19. .
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.
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.”
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.
“We understand and recognize the potential for patient concerns, but we believe that these necessary steps will help us ensure that we can continue to have the capacity and staff available to provide high quality care to our members, while meeting current needs and we prepare for continued increases in the number of COVID-19 patients during this increase, ”said the statement from Kaiser Permanente Southern California.
Delaying procedures is one of the tools that health professionals have at their disposal to de-stress their systems.
The latest virulent wave of COVID-19 is applying more pressure than ever.
“Sixteen of our 36 hospitals are already over 100% occupied in our ICUs,” said Greg Adams, president and chief executive of Kaiser Permanente, during a news conference last week. “We are struggling to add capacity to COVID patients right now.”
In addition to postponing some procedures, hospitals across the state have already been forced to take other measures to deal with the crushing of patients with COVID-19 – how to keep patients in ambulances for hours until space is available and move some patients who would normally be in the 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.
“As the hospital bed count continues to decline, we simply won’t be able to keep up if the COVID peak continues to increase,” said Adams.
If the medical system becomes too overburdened and overburdened, 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.
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.
The worst wave of the coronavirus pandemic is hitting every corner of California.
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.
In view of the already unprecedented number of patients with COVID-19, health officials fear an outbreak of infections resulting from travel and meetings at Christmas time.
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.
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 going through a plateau of new hospital admissions … in fact, seeing this growth rate start to decline, with one big exception – which is Southern California,” said Governor Gavin Newsom in Monday, as Los Angeles, Riverside and San Bernardino counties continue to report a large number of infections.
LA County, the most populous in the country, is of particular concern. Hospitals there have already reported critically crowded conditions, patients having to wait hours in ambulances and overworked doctors and nurses.
In light of the crisis, Newsom said the state is sending a new team that will be incorporated into LA County “to encourage load leveling and to encourage greater coordination between hospitals”.
“Routine emergency room care is declining,” said Newsom. “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.
Four of California’s five defined regions – Southern California, Bay Area, San Joaquin Valley and Greater Sacramento – are under a state-issued home stay request and are subject to restrictions, such as reduced capacity in retail stores; the closing of some businesses, including hairdressers, manicures, card games, museums, zoos and aquariums; and the ban on most meetings, hotel stays for tourism and dinner in open-air restaurants.
These orders, which are made when a region’s ICU availability drops below 15%, have a mandatory three-week life. After that, they can be removed, depending on the expected conditions of the hospital in a region in the near future.
Southern California and the San Joaquin Valley reached a three-week low on Monday. However, as the two regions have been unavailable in their intensive care units for more than a week, officials said they expect these requests to be extended.