Dr. Nicole Van Groningen is exhausted. Hospitalist and assistant professor at Cedars-Sinai Medical Center in Los Angeles, Van Groningen has been on the front lines fighting Covid-19 for 11 months, and as LA emerges from its worst case peak since the pandemic began, it has passed the last two weeks of January in the hospital’s overcrowded intensive care unit. Even when cases started to stagnate, morale is down.
“Everyone is on the edge, it is a feeling that we are constantly preparing ourselves for things to get worse. And the ICU patients have been so sick for so long, ”she says with a slight sigh. It is late January and the area is receiving an average of more than 40,000 cases per week. The hospital’s ICU exceeded 33% of its maximum capacity. “They get worse and don’t recover as we normally see. We are used to having the skills we can use to make most people better. We know that we are doing everything we can, but it costs a psychological price when we cannot heal these people. “
Dr. Van Groningen’s description of fighting Covid is frightening. Patients arrive frightened, anxiously waiting to see if the symptoms end or rise enough to go to the ICU, where the chances of survival are much less. “Our patients arrive terrified. They are very scared when they arrive at the hospital with difficulty breathing, we make them better after receiving some oxygen ”, she says. “So sometimes, even then, they start to progress and they get short of breath again. When you talk about taking them to the ICU, it is palpable how scared they are ”.
A few kilometers away, the lethal number of the virus is barely visible. A few days before my conversation with Dr. Van Gronigen, I parked near the entrance to Runyon Canyon Park, a popular hiking spot overlooking the city of Hollywood Hills. It is quiet, even peaceful. Two teenagers get out of a jeep, unmasked and standing side by side as they prepare to start the trail. If there was anything like a feeling of normalcy during Covid-19’s devastating health crisis, it would be this one.
Across the country, the pandemic has exposed deep-seated divisions in our communities, with black and Latino populations contracting the disease and dying twice as many as whites, according to the Centers for Disease Control and Prevention. Nowhere is this more clear than in Los Angeles, where depending on someone’s zip code, the most recent coronavirus outbreak wave was a slightly removed discussion point during Zoom calls – something to wait until dinners and holidays happen again – or the brutal plague that destroyed families and communities. Ten of the wealthiest neighborhoods in Los Angeles County combined, representing about 323,000 people, have about 700 fewer confirmed cases of coronavirus than just the city of Compton (95,000 people) alone.
This is far from coincidence. The wealthier, white cities are more sparsely populated, have less overpopulation and more residents who can work from home and travel by car, crucial components in infection rates. Meanwhile, those who live in poorer communities they depend more on public transport and are forced to leave their homes to work, taking the virus back to their families. After two brutal months of infections and deaths in the holiday season, Los Angeles is recovering, with confirmed cases, hospitalizations and deaths continuing to fall from its heights in late December and early January. But as the city slowly returns, the disproportionate number of victims becomes clear.
Seeing Covid’s daily statistics and hearing horror anecdotes on the front lines of the ICU is disorienting. Although a Los Angeles resident died every 10 minutes from the virus during the peak of the sudden increase, residents could still scream in the malls for the holiday. The most secure home order reinstated in Los Angeles County did not begin until three days after Black Friday. As cases skyrocketed, the county took preventative measures, ending outdoor meals and closing deals like beauty salons in late November, and residents were told to avoid leaving the house when it was not essential. Even so, Los Angeles never really went into a blockade again.
Christopher Prado, EMT, left, and Jesse Lynwood, ED RN, right, work with a suspected Covid-19 patient in the Martin Luther King Jr. Emergency Department, Community Hospital on April 23, 2020 in the Willowbrook neighborhood located in South Los Angeles, California.
Francine Orr / Los Angeles Times / Getty Images
A stark contrast to the beginning of the quarantine, where traffic was nonexistent and the city seemed empty, during LA’s deadliest period, shopping malls, jewelry stores, bookstores and many other types of retail establishments were open with limited capacity. The city and state also needed to support a significantly damaged economy, with California having the country’s third highest unemployment rate in December, according to the Bureau of Labor Statistics, and facing continued pressure from companies that had been suffering for months. Restaurants across the state have sued California Governor Gavin Newsom over dinner restrictions, and Newsom faces a small but notable effort to remember of California Republicans due to the state’s response to the virus.
The limited capacity openings just added a new sense of normality, and what resulted was a mixed message to Angelinos about what was expected and what was allowed.
Martin Luther King Jr. Community Hospital in southern Los Angeles is surrounded by black and Latin majority neighborhoods like Watts, best known for the 1965 Watts riots, and has become a symbol of how the coronavirus has hit these communities disproportionately. The relatively small 131-bed hospital has been well above capacity since December, and, as MLKCH CEO Dr. Elaine Batchlor says, her hospital has seen more Covid-positive patients than four times larger hospitals. Despite the considerable drop in the increase in February, the hospital’s ICU remains 100% full.
The community that MLKCH serves was particularly vulnerable to a pandemic. Access to health care is more limited and the underlying health conditions are more common. Diabetics, for example, are one of the highest risk groups for severe cases of Covid, and South LA has diabetes rates three times higher than anywhere else in the state, says Batchlor, and diabetic amputations and wounds are number one surgery from hospital. “Many of our patients are on the front lines, and if they continue to spread and they are exposed to it quickly, they live in crowded quarters, go home and donate to the rest of the family. We are seeing whole families getting sick, losing important family members. ”
The hospital equipped its gift shop to treat more patients, doubled rooms, converted an entire floor into an intensive care unit and set up five screening tents outside the hospital, where patients are treated and admitted until there is a place inside the hospital.
As Batchlor says, the neighborhoods her hospital serves have long been the most likely to face the impact of any health emergency, and she hopes the pandemic will underline the need for better resources for impoverished communities across the country. “Even before the emergence of Covid, we had a public health crisis in our community, and it is an epidemic of poorly treated chronic diseases. [Covid] then it attacked a vulnerable population and hit it with much more force than any other, ”says Batchlor. “In the long run, we need to create better access and quality health care for underserved communities. We are all connected. I hope the pandemic has shown us that we are all suffering ”.
Batchlor and Van Groningen see both sides of Covid’s Los Angeles story every day. After treating the sickest patients in the county, they return to their homes in Westchester and Santa Monica, where income is higher and cases are lower. Several times, Batchlor came home to see her neighbors promoting social events and disregarding the city’s mandatory protocols, something she says was “demoralizing”.
“It is really frustrating and sad that people do not take it seriously enough and are not willing to make the smallest sacrifices necessary to maintain the safety of others in the community,” she says. “And I get angry when I think about how hard we are working to treat people who are affected by greed. At the beginning of the pandemic, when I saw people walking around without a mask, I said something. I stopped because it was happening many times. “
Van Groningen comes and goes from work passing by the beach in Santa Monica, where especially on weekends, she says, it is difficult to discern any difference from a pre-coveted world. Without mask it is not rampant, but it’s still noticeable, she says, and she still sees enough people from different families getting too close for comfort. Finding a way between keeping cases low, supporting the economy and reducing residents’ mental health for almost a year in a pandemic is a difficult task, she says, but abandoning the first option is dangerous. Like many epidemiologists and health experts told the Los Angeles Times, fatigue and decreased social distancing practices were factors commonly cited in the increase in cases during the holiday season. Still, Van Groningen is optimistic.
“I like to think we don’t give up,” she says. “Through my experiences with friends and people I’m close to, I mean that most people are still trying to do the right thing. But there is a disconnect. I think that sometimes people are confused about what is the right thing. “