Although new hospitalizations for COVID-19 have recently declined in Los Angeles County, many medical facilities remain overburdened. The intensive care unit of a hospital in South Bay, Memorial Hospital of Gardena, is at 320% occupancy, officials said on Wednesday.
The 172-bed medical center has been at various levels of “internal disaster status” since March, and the latest wave of coronavirus is manifesting itself in alarming but increasingly familiar ways – including the shortage of domestic oxygen supplies that is delaying unloading many COVID-19 patients and keeping beds occupied.
Demand for oxygen inside the hospital has also skyrocketed, according to hospital spokeswoman Amie Boersma.
“Mass oxygen delivery has gone from once a month to every three days and is decreasing,” said Boersma by email. “We must monitor every day.”
But it is the lack of personnel that presents the biggest challenge. In a region besieged by COVID-19, “it is still very difficult to find enough ICU nurses,” said Boersma, adding that the hospital is looking for itinerant nurses from across the country and also requested nursing resources from the National Guard.
While the hospital awaits extra assistance, it has implemented a team structure that allows teams from closed departments, such as outpatient surgery on the same day, to help lighten the workload and allow ICU nurses to focus on the most critical tasks.
The hospital is also using registered professional nurses and advanced medical assistants to complement the 10-bed ICU and emergency departments and provide “another pair of hands and eyes,” said Boersma, along with hiring senior year nursing students to act as nursing assistants.
Nearly two dozen patients requiring intensive care are also being treated on the telemetry floor and in recovery rooms, she said.
And although ambulances with critically ill patients with advanced life support are being diverted because most would require ICU admissions, Boersma said the request for diversion has a limit.
“When most hospitals are on ALS diversion, no one is on diversion,” she said.
LA County hospitals reported an average of 750 to 800 new hospitalizations for COVID-19 per day – an astonishing number that has remained stable since Christmas Eve. The count meant that the ICUs were effectively over capacity, and the hospital morgues are so full that the National Guard was called in to help move the bodies to the county coroner’s office until funeral homes and mortuaries can solve the problem. delay.
There are still fears that new hospitalizations may increase again as a result of transmission during the winter holidays. If that happens, hospitals across LA County may need to ration care, activating teams of screening staff who will have to decide which patients will receive intensive care nurses, respiratory therapists and access to ventilators, and which patients will receive palliative care when die.
Dr. Christina Ghaly, director of health services for LA County, said the number of hospitalizations has dropped slightly in the past few days – just below 8,000.
Although they did not increase at the rapid rate seen earlier in the increase, “they have stabilized at a rate that is not really sustainable,” she said during a briefing on Wednesday. “This high plateau does not leave enough open beds to care for patients.”
This is especially the case, said Ghaly, because the county has not yet determined all the ramifications of potential post-holiday exposures. Any increase in transmission, she warned, “would be absolutely devastating for our hospitals.”
“For there to be any significant relief for healthcare professionals, we need a rapid and significant decline in hospitalizations for a period of at least one to two months,” she said.
The county is still reporting an extremely high number of new infections – more than 15,000 a day on average – and officials say some positive tests will invariably require hospital care two to three weeks later.
On Tuesday, the most recent day for which complete state data are available, there were 7,906 coronavirus-positive patients hospitalized in LA County, with 1,699 in intensive care.
Although both numbers have remained relatively equal, or even slightly decreased, Ghaly emphasized that they remain “unprecedented in the course of this LA county pandemic, and everyone should continue to worry about what may happen” if they continue to rise.
Any optimism must also be expressed by the reality that post-holiday transmission remains unclear, she added.
“If our case numbers continue to be so high, and even increase slightly, that bodes ill for hospitals,” said Barbara Ferrer, director of public health for LA County.
Unless conditions improve, Ferrer said it is possible that the county will seek further restrictions – particularly due to the imminent threat posed by the new variant of the coronavirus, which was first detected in the UK and is considered even more contagious.
“We are considering all options right now,” she said. “We are very, very concerned about the continuing high number of cases and feel that there really is not a big window here to try to keep the increase under control.”
The stakes, she said, are literally life or death for many – and all Angelenos must redouble their efforts to protect themselves.
“Make it as if your life or the life of a loved one depends on it,” she said. “Because you can.”