Christmas arrived in Los Angeles County with hospitals in the midst of a coronavirus crisis.
There are now so many patients that some hospitals have dangerously low levels of oxygen and other essential supplies for treating people with COVID-19.
Patients wait up to eight hours in ambulances before entering the emergency room. With intensive care units at 0% of available capacity, health officials are asking people to avoid the emergency room or call 911 for assistance unless absolutely necessary.
And in a bleak reminder that the worst is yet to come, an LA county health officer asked providers to reach out to patients who are seriously ill or are clinically fragile to review their advanced care guidelines and ensure that forms are in place. filed detailing your end of life care.
However dire the conditions now, there is a growing concern that large numbers of people may choose to ignore health guidelines once again and meet with other families to celebrate the holidays – a potentially disastrous outcome that experts say that would surely trigger another outbreak of coronavirus that could other hammer hospitals already recovering from the wave fueled by Thanksgiving.
The stakes are already high and the losses are already devastating. On Thursday, LA County saw the highest number of COVID-19 deaths in a single day: 140.
As the coronavirus continues to spread widely and send an unprecedented number of angelenos to the hospital, Los Angeles County hospitals are running dangerously low on oxygen, a person familiar with the matter told The Times.
Oxygen is critical for the treatment of critically ill patients with COVID-19 who have started to suffocate because of their virus-inflamed lungs. Doctors and nurses have learned from the early days of the pandemic to avoid putting patients on ventilators as much as possible, which involves sticking a breathing tube down their throat.
Many patients, instead, are treated with high-flow oxygen, in which oxygen is sent through plastic tubes placed in the nose.
And the need for such assistance is high. While a non-COVID patient can receive six liters of oxygen per minute, COVID-19 patients need 60 to 80 liters per minute.
So now hospitals need 10 times more oxygen than before. There were periods when hospitals were dangerously out of oxygen supplies before obtaining additional supplies, said the source, who spoke on condition of anonymity.
Hospitals are also short of other essential supplies, such as special plastic tubes used to deliver oxygen to the lungs.
The county sent a letter this week to health care providers urging them to take additional steps to deal with the flood of patients in need of hospital treatment.
“Hospitals have implemented their emergency plans and are adjusting staff and space to try to meet the needs of their community,” wrote Dr. Sharon Balter, the county’s chief communicable disease control and prevention, in the memo. “It is critical that, as a healthcare community, we look at all the opportunities available to help slow the rise in hospitals and our 911 system, whenever possible.”
Balter asked providers to talk to patients with ongoing medical problems about when it would be appropriate to visit the ER or call 911, and to do so only when it was a real emergency. She also encouraged the rapid discharge of hospitalized patients to try to create as much space as possible in the wards, citing a “marked increase” in cases of COVID-19 and hospitalizations.
“There are very limited hospital and ICU beds and the emergency departments are exhausted,” wrote Balter.
There were about 6,700 coronavirus-positive patients hospitalized across the county on Wednesday, according to the latest state data, with 1,329 of them in the ICU. These numbers have increased by 85% and 62%, respectively, in the past two weeks.
Dr. Brian Gantwerker, a neurosurgeon from Santa Monica, said he feared what would happen in the coming weeks. The community hospital where he works is “flooded with COVID cases”, with doctors fearing that soon have to ration care due to the lack of beds and staff.
Every day that the number of patients with COVID-19 grows, it also increases the likelihood that more patients with neurosurgery will have to wait for care or find it elsewhere, he said.
This puts doctors in the uncomfortable position of determining who receives the limited resources that remain in the hospital. A large brain tumor would likely be operated on immediately, he said, but surgery for a smaller and less dangerous one could be postponed.
“So the question is, ‘Where is the breaking point? When do we have to start sending patients to other places? ‘And the nightmare scenario is:’ What happens if there are no beds available in the municipality? ‘ “, He said. “Everything we care about, talk to and alert people to since February is becoming a reality – we are at that point now.”
As hospitals struggle, officials expect people to take their request seriously to avoid meetings and parties on Christmas Day. If a large number of people disregard this guidance and meet with those they do not live with for the next winter break, authorities and experts warn that this is likely to lead to a “sudden increase” – which means that more people will be infected, become ill and they eventually die.
Dr. Christina Ghaly, director of health services for LA County, predicted this week that nearly 7,000 more people could die from COVID-19 by the end of January if current trends continue. Already, the disease killed 9,305 people across the county.
“We know that this emergency is our darkest day, perhaps the darkest day in the history of our city,” said Los Angeles Mayor Eric Garcetti. “But we must find the strength, we must gather the strength to ensure that we save lives.”
LA County public health director Barbara Ferrer said crowded shopping malls are a major concern. According to regional requests from the state to stay at home, shopping malls must have up to 20% capacity, but it is clear that these limits are not being met.
“This weekend we are going to take a look at the malls because the photos we saw are … another small disaster,” said Ferrer. “Occupation is expected to drop to 20%. But when you look around, they look more crowded than 20%. And that just means a thorough analysis of what we are demanding. ”
Inspectors will be leaving during the postnatal weekend, said Ferrer, “and we will have to take a good look at what we see.”
She added: “The only way to open these malls is because there would be no agglomeration. So, if there is a lot of crowding, this is a situation that we have to fix immediately. This can be fixed when shopping malls take more responsibility, or it can be fixed … by going ahead and checking if we need to change [health] requests. But I think the right place to start is to go and take a good look at what’s going on. “
The county’s Department of Public Health also issued an appeal on Thursday for people of faith to forgo indoors to worship any winter holiday, and instead participate remotely in broadcast or outdoor services.
Although county health officials lifted the ban on closed religious services Last Saturday – after a series of court rulings involving houses of worship that argued that pandemic-related restrictions violated religious freedoms – they said in their testimony that attending services at home is “too risky” now.
Times staff writers Jaclyn Cosgrove and Hayley Smith contributed to this report.