Hospitals across Los Angeles County were fighting a losing fight on Tuesday to stay ahead of the coronavirus surge, as the number of hospitalized COVID-19 patients exceeded 8,000 and the number of coronavirus deaths across the county increased. at almost 1,300 in the last week.
LA County reached another distressing milestone, surpassing 11,000 deaths on Tuesday since the pandemic began. The authorities warned that conditions will only worsen in the coming weeks, as people infected during the holidays become ill and need medical care.
“It is becoming increasingly difficult for healthcare professionals to care for those who come to the hospital with gunshot wounds, heart attacks, spills and injuries from car accidents,” said Los Angeles County supervisor Hilda Solis. “Hospitals are declaring internal disasters and having to open church academies to serve as hospital units.”
Last week, LA County averaged 183 COVID-19 deaths per day – the equivalent of one every eight minutes – and 13,500 new coronavirus infections, a count that is expected to grow with the reopening of test sites after Vacations. The cumulative count of coronavirus cases in the county now stands at 841,000.
Hospital staff remain stressed across the county and authorities have warned that the quality of care is being compromised. More than three quarters of patients in ICUs have COVID-19.
All hospitals are facing large numbers of staff unable to work because they are under isolation or quarantine, Dr. Christina Ghaly, director of health services for LA County, told the County Council of Supervisors on Tuesday.
Another major problem is being able to discharge patients quickly. In the four hospitals administered by the county, about 10% of hospital patients no longer need hospital care, but “we are having a series of problems and delays in transferring them” to lower levels of care settings, such as nursing homes , Ghaly said.
Some nursing homes are refusing patients from hospitals; sometimes, patients do not want to be transferred to a lower level of care and state law prohibits the movement of a patient unless the person agrees with the placement. Qualified nursing facilities and other areas that can provide lower levels of care are facing understaffing, limiting the number of patients they can receive.
Dialysis centers are also starting to struggle with staff shortages, and now there are not enough outpatient dialysis resources available. This is causing problems because hospitals cannot discharge patients when there are not enough outpatient dialysis chairs available to accommodate them. Dialysis facilities are also sending patients to the emergency room to receive the coronavirus test, instead of testing at the dialysis center, Ghaly said.
It has also been difficult to find portable oxygen cylinders needed to send hospital patients home who still need oxygen treatment. There is a lack of containers needed to transport oxygen through hospitals and store them in tents that are being used to care for patients.
Like facilities throughout California, the county-run system of hospitals is struggling to find temporary medical staff to make up for staff shortages. The county’s hospital system has increased its payment offer to find contracted medical personnel and has sent requests for help to the state.
So far, the county-administered system has received 36 contracted nurses from the state and is anticipating two medical teams of 20 people from the U.S. Department of Defense to be deployed at Harbor-UCLA Medical Center near Torrance and LA County-USC Medical Center in Eastside this week.
Five private hospitals in Los Angeles County are also expected to receive federal health teams to support the medical team, said Ghaly.
The largest source of additional hospital personnel comes from the county’s outpatient clinics.
The county closed five of its public outpatient clinics and reduced hours and services in the rest of them to divert more than 800 nurses and other staff to work in emergency departments and quarantine and isolation facilities for people who have COVID-19 or have been exposed to virus.
The county-run hospital system has already ordered more ventilators, BiPAP machines and more high-flow oxygen devices – all devices designed to help patients breathe – and the authorities do not believe there will be a supply problem with these devices in the coming weeks. , Ghaly said.
Two of the county-run hospitals had problems with their patients’ oxygen supply at the hospital, Ghaly said. Olive View-UCLA Medical Center in Sylmar solved its problem of freezing oxygen in its tubes; Harbor-UCLA Medical Center is still having problems with the flow of oxygen through the tubes. It is not creating urgent patient care issues at Harbor-UCLA, “but it does provide some limitations on what physical spaces within the Harbor we can use to maintain patients,” said Ghaly.
Amid the already overwhelming increase, California faces another potential threat: the presence of a new coronavirus variant, which has grown rapidly in England, which some scientists believe is more likely than the conventional version to infect people exposed to it.
Although the prevalence of the variant across the state is unclear, San Diego County health officials reported on Tuesday 24 additional confirmed cases and four probable cases. This brings the total of known or suspected infections in the county to the variant virus to 32.
The two dozen infected patients “have no travel history and come from 19 different families, but the investigation and contact tracking is ongoing,” according to a statement from San Diego County officials. Those infected are widely dispersed geographically and vary in age from 10 to 70 years.
The variant was also identified in two people from the same house in Big Bear, San Bernardino County.
Experts say there is no evidence that, once it infects a person, the variant – known as B.1.1.7 – is more likely to cause death, more serious illnesses or make vaccines less effective. But any high risk of infection is undesirable news, particularly in areas that already suffer from extremely high levels of coronavirus transmission.
Although LA county officials have not yet documented the presence of the variant, “having a virus that can infect more people more quickly than we see today” is a “scary thought,” said county director of public health, Barbara Ferrer .
Although many of those infected may have only mild symptoms or none at all, California health officials have warned that a sizeable portion, about 12%, will be sick enough to require hospitalization a few weeks after exposure. Twelve percent of people who are hospitalized end up in the intensive care unit.
A significant and continuous wave of new infections, then, will invariably shake hospitals with additional patients.
State officials asked hospitals to come up with a plan in which they should offer “patterns of care crisis”, in which the most severe form of catastrophe has reached the hospital and, at worst, requires certain supplies, therapies and personnel to be rationed .
In such a situation, it would be necessary to prioritize the time of highly trained personnel – such as physiotherapists, ICU nurses and intensive care doctors – in order to keep as many people as possible alive. This means that those least likely to survive may not receive the same level of care that they would otherwise receive.
According to a status memo issued in June, in a situation where there is a severe shortage of medical resources and a patient has a poor prognosis for immediate survival, healthcare professionals may need to decide to provide palliative care designed to provide patients with pain relief when they die, rather than to improve your prognosis.
When it comes to deciding who is eligible for admission to the ICU or should have access to a ventilator, patients most likely to survive on this care will be given priority.
A hospital-appointed triage officer is expected to make decisions to benefit patient populations, “although these decisions may not necessarily be the best for some individual patients,” according to the memo.
The LA County Department of Public Health said late Tuesday night that no hospital has formally declared to the county that it is operating under “crisis care standards”.
Times staff writer Andrea Roberson contributed to this report.