Many Californians spent New Year’s Eve in a safe place with their immediate family. Dr. Nick Kwan, the assistant medical director of emergency services at Alhambra Hospital in Los Angeles County, passed a COVID-19 patient who went into blue code – cardiac or respiratory arrest – five different times.
The blue code requires the medical team to call for a quick and intense response to resuscitate the patient.
“It’s mentally, physically and emotionally draining,” said Kwan, who struggled to articulate the price that a month-long wave of COVID-19 patients is causing in his hospitals and other hospitals in Los Angeles County.
“This is a complete category 10. It is literally World War III,” he said.
“It is not the volume of patients,” he said. “It’s the intensity and the disease of the patients. I never thought that some of those numbers were compatible with life, with patients getting more sick than you can imagine.”
Across LA County and much of Southern California, hospitals are struggling with an influx of critically ill patients with COVID-19 and a lack of resources, including staff and vital infrastructure, such as oxygen tubing.
On Friday, the state called on the United States Army Corps to help six hospitals deal with serious oxygen delivery challenges to patients in need.
The Alhambra Hospital was not among them, but it was nonetheless stretched by COVID-19 and the emotional burden it caused everyone involved.
“I don’t think that many outsiders are seeing what we’re seeing,” said Kwan. “It is difficult until you are there, until your family and loved ones are there.”
Since Thanksgiving Day, the 144-bed hospital that serves as a melting pot in the San Gabriel Valley, many of whom are first and second generation Latino and Asian residents, has seen a steady wave of patients struggling to breathe.
Kwan said that in addition to the Alhambra, he knows that several other hospitals along the 210 freeway corridor are crowded and overwhelmed with the weight of the current increase.
The waiting room at the Alhambra Hospital became a COVID ward. Regular beds were quickly converted to ICU beds. And ambulances wait outside with incoming patients because “we cannot physically accommodate the patient” at that time, said Kwan. “It’s widespread. The virus doesn’t care who you are. You can be sick, healthy, young, old.”
Younger patients died and a patient in her 90s left the hospital with an oxygen tank.
“It is so unpredictable in each case,” he added.
“On November 29 and 30, we started to see the increase, and it hasn’t stopped since,” said Kwan. “It’s easy to say that it’s the holidays – or maybe the coldest weather … Christmas and New Year scare me, and I think the worst is yet to come.”
A state-sponsored nurse recently arrived to help fight the patient burden and was a necessary boost to morale, said Kwan. Still, the team fears that the December flood is a harbinger of a long and deadly winter.
“Next month, I don’t see the end. It will continue to accumulate and we have to be ready.”
It was a similar situation in the municipality of Santa Clara, where hospitals remained stretched to the limit, with 50 to 60 patients trapped in emergency rooms every day waiting for a hospital bed.
Often, the only way for a patient to be transferred to an ICU bed is because a COVID-19 patient died, according to Dr. Marco Randazzo, an emergency physician at O’Connor Hospital in San Jose and Regional Hospital St. Louise in Gilroy.
“This has been the state of the pandemic for the past few weeks and is showing no signs of abating,” said Dr. Ahmad Kamal, Santa Clara County health preparedness director. The daily rate of coronavirus cases there is more than 10 times higher than it was on October 30. “What we are seeing now is not normal.”
At Alhambra Hospital, the virus hit the team directly: a doctor in the hospital’s emergency room died of COVID-19, and a nurse who contracted the virus was out for months, Kwan said.
“Everyone is exhausted. Our CEO is exhausted. Our entire medical team is exhausted,” said Kwan.
Kwan and other team members had to get used to being the last person a patient sees before they die, with families kept away from their loved ones.
“You cry with the patients’ family. It’s just sad,” he said. “I feel that this virus attacks all of our humanity.”
Behind fatigue and pressure on resources is the simple fact that patients with COVID-19 stay in the hospital longer than the average patient and require more resources.
There are constant concerns about whether there will be enough fans and the oxygen tanks are occasionally low. But a big concern is simply the space: “It doesn’t matter if it’s Cedars, USC or Alhambra – the hospital isn’t big.”
The morgue space, he said, is also finite – and a constant concern.
“When was the last time I thought we would run out of space in the morgue? I never thought it would be my concern.”
Many patients who arrive because of routine illnesses – such as family members who brought the baby to the emergency room on New Year’s Eve – are treated in the parking lot, sometimes even in their vehicles.
Kwan said he knows the price the pandemic is taking: businesses closing, family and friends limiting social gatherings. He hasn’t seen his mother since February and his father since March. Their children waited until five days after Christmas to open their presents and celebrate with their father.
“I would tell people that this is serious. Help us to fight in this war,” he said. “It is a group effort – we cannot fix it alone. It is really public awareness and a collective effort to win it over.”
Kamal, the doctor in the municipality of Santa Clara, pleaded with the public not to give up wearing masks, to remain socially aloof and to cancel meetings. There is evidence in the bay area and elsewhere, these measures have helped to stem the spread.
“We know,” he said, “that our decisions and actions drive the curve of this pandemic.”
This story originally appeared in the Los Angeles Times.