California hospital staff is getting thinner amid an explosion of coronavirus cases threatening to overwhelm the state’s emergency system.
As of Sunday, more than 16,840 people were hospitalized with Covid-19 infections, more than double the previous peak reached in July. A state model using current data to predict future trends shows the number could reach 75,000 by mid-January.
Until vaccinations became widespread, hospitals were preparing for the possibility of rationing care. A document recently distributed to doctors in the four Los Angeles County hospitals calls on them to change their strategy: instead of trying everything to save a life, their goal during the crisis is to get as many patients as possible to save. That means those who are less likely to survive will not receive the same kind of care that is provided in normal times.
“A compromise in the standard of care is inevitable; it is not that an entity, system or locale chooses to limit resources, it is that the resources are clearly not available to provide regular care, ”reads the document obtained by the Los Angeles Times.
The director of the county health services, Dr. Christina Ghaly, said the guidelines were not in effect as of Friday night, but were essential to develop as the wave has arrived and “the worst is yet to come.”
Intensive care units in California care for more than 3,610 Covid-19 patients. All of Southern California and the 12-county San Joaquin Valley to the north have exhausted their regular ICU capacity, and some hospitals have begun to use “surge” space. Overall, the state’s ICU capacity was only 2.1% on Sunday.
In LA County, Nerissa Black, a nurse at Henry Mayo Newhall Hospital, estimated that she needed less than 10 minutes of care per patient per hour, on average. That includes not only bedside grooming, but also putting on equipment, drawing up charts, viewing lab results, and consulting with doctors, she said.
“And the patients who come in are now sicker than ever, because a lot of people are waiting to receive care. So when they come in they are really, really sick, ‘Black said on Sunday.
The number of cases in the past six weeks has made the death toll in California steadily higher. Another 161 deaths were reported Sunday, totaling 22,593.
Nurse Wendy Macedo said all 25 beds in her ward were filled with Covid-19 patients across the LA district of the UCLA Health Santa Monica Medical Center. She said a department on another floor devoted to orthopedic patients had been turned into care for people who tested positive for the virus. Nurses worked longer shifts, and more of them, she said. Nearly 5,550 people are admitted across the country with Covid-19.
“The more patients we have, the greater the risk that we will make a mistake, especially if we rush,” Macedo said on Sunday. “We try to avoid that, of course, but we are only human.”
California was experiencing “some of the darkest days of our Covid-19 wave,” said Governor Gavin Newsom, but there was some light on Sunday as a working group of scientists and experts endorsed a vaccine developed by Moderna. The move paves the way for the drug’s distribution in California and other Western states that have separately reviewed it from the U.S. Food and Drug Administration.
Shipments of the vaccine are expected to arrive in California early this week, but it could take months for it to be available to the general public, officials said.
“Until vaccines are more widely available in the state, it is critical that all Californians do their part to stop the wave by staying at home and wearing a mask when they leave home for essential work and needs,” said Newsom.
Corona Regional Medical Center southeast of Los Angeles has converted an old emergency room to treat nearly double the number of ICU patients. It uses space in two disaster tents to triage ER patients, as the emergency room is filled with patients who need to be hospitalized.
In the hard-hit Fresno district of central California, a new 50-bed alternative care facility has opened in recent days near the community’s regional medical center. The beds for Covid-19 negative patients will free up space in local hospitals, where only 13 of the roughly 150 ICU beds were available on Friday, said Dan Lynch, the director of national emergency services.
Lynch said he expected them to use the Fresno Convention Center, which can accommodate up to 250 patients, given current demand.
Fresno and three neighboring counties have also taken the unprecedented step of sending paramedics on emergency calls to evaluate people. They won’t be taken to the emergency room if they can go to an emergency room or wait a few days to talk to their doctors, Lynch said.
Some hospitals have canceled non-essential elective surgeries, such as hip replacements, which may require beds that may soon be needed for Covid-19 patients. Others extend staff hours or move patients to free up space.
LA County health officials announced on Saturday that they had adjusted their health regulations to comply with recent US Supreme Court rulings calling for the allowance of places of worship outside and inside, with appropriate health safety measures.
On Saturday evening, Apple announced it would temporarily close all 53 stores in California due to the coronavirus outbreak. Under the stay-at-home order in effect for almost the entire state, stores are limited to 20% capacity.
Supermarkets have been hit hard by the virus rise, further taxing an essential service that remains open during the last stay-at-home order. Of the six outbreaks at Food 4 Less locations in the Los Angeles area, three were recorded for the first time this month, linked to the current wave, according to an analysis by Times. An outbreak is defined as three or more cases among employees in a 14 day period.