He was sitting behind a glass screen, heavily sedated, alive thanks to a machine that delivered oxygen into his lungs through a tube attached to his mouth that reached the back of his throat. It had been a few days since she was hospitalized, and she got worse quickly.
“His respiratory and cardiovascular systems are not working,” says Dr. Luis Huerta, a specialist in intensive care in the intensive care unit (ICU). The survival rates for the patient, who was not identified for privacy reasons, were low, Huerta said.
The 60-year-old woman was one of 50 patients with COVID-19 who required constant medical attention during the week of December 13 at the ICUs of the Los Angeles County Medical Center + USC (LAC + USC), a public hospital with 600 beds in East Los Angeles. The vast majority of these patients had diabetes, obesity or hypertension.
An additional 100 COVID patients, currently less ill, were in other parts of the hospital. And the number grew. Between Saturday 12 and Wednesday 16 September, eight COVID patients died, twice as many as in the five days before.
The avalanche of COVID patients at LAC + USC in recent weeks has put enormous pressure on the capacity of the unit and staff; Especially since non-COVID patients, such as those arriving with gunshot wounds, drug overdoses, heart attacks, and strokes, also need intensive care.
There were no more beds available in the ICU, said Dr. Brad Spellberg, the hospital’s chief medical officer.
Similar scenes – crowded rooms, overworked medical staff, pressured administrators, and grieving families – are seen in hospitals across the state and across the country.
On Christmas Day, no ICU beds were available in the 11 counties of the Southern California region, nor in the San Joaquin Valley.
On Thursday the 24th, county health officials reported that the number of new COVID deaths for the second day in a row had skyrocketed above the previous high during the pandemic.
LAC + USC has been severely affected by COVID since the start of the pandemic, in part because it serves a low-income, mainly Latino community that has been hit hard. Latinos make up 39% of the California population, but have suffered 56% of the state’s COVID cases and 48% of the deaths, according to data updated Dec. 22.
Many people who live near the hospital do essential jobs and “cannot work from home. They go out and expose themselves because they have to make a living, ”explained Spellberg. “They don’t live in huge houses where they can isolate themselves in one room,” he added.
The worst cases end in a bed, in the midst of a tangle of tubes and bags, in ICU units designed to keep air and viral particles from entering the corridors.
The sickest, such as the woman described above, need breathing equipment. They are fed through nasal tubes, their bladders drain into catheter bags, while intravenous lines deliver fluids and drugs to relieve pain, keep them numb, and raise their blood pressure to the level necessary for life.
To relieve the pressure on the ICU, the hospital has just opened a new “minor unit” for patients who, despite being very ill, can be treated with a little less care. Spellberg said he hopes the unit can accommodate up to 10 patients.
Hospital staff also check patients’ health insurance to see if they can be transferred to other hospitals. “But at the moment it’s almost impossible because everyone is filling up,” said Spellberg.
Five weeks ago, of COVID patients who came to the emergency room, only a small percentage of severe symptoms of the disease showed fewer hospital and IC admissions than at the July peak. That helped keep the disease at bay, Spellberg said.
But not anymore.
“Over the past 10 days, I have a clear impression that the weather has gotten worse, which is why our ICU is filling up so quickly,” Spellberg said on December 14.
The total number of COVID patients admitted to hospital, and the number in their ICUs, is now well above their July peak, and both are nearly six times higher than at the end of October. “It’s the worst we’ve ever seen,” said Spellberg. And he added that things will get worse in the coming weeks as people travel and reunite with their families at Christmas and New Year, as they did with Thanksgiving.
Think New York in April. Or Italy in March, ”said Spellberg. “This is how ugly things can get.”
And they are bad enough. Nurses and other members of the medical staff are exhausted for months from patients in need of careful care. And the work is getting more intense, explains Lea Salinas, director of nursing in one of the divisions of the hospital’s ICU. To avoid understaffing, he asked his nurses to work overtime.
Typically, ICU nurses are assigned two patients per shift. But a critically ill COVID patient can take over almost the entire shift, also with the help of other nurses. Jonathan Magdaleno, one of the ICU nurses, explained that a critically ill patient needs 10 hours of care in a 12-hour shift.
Even in the best cases, he said, you usually have to go into a patient’s room every 30 minutes, because the bags that deliver drugs and liquids are emptied at different rates. Whenever nurses or other caregivers enter a patient’s room, they should put on uncomfortable protective gear and remove it upon departure.
One of the most delicate and difficult tasks is a maneuver known as “pronation”, in which the patient with acute breathing difficulties is turned on his stomach to improve lung function. Salinas said this could take up to half an hour and would require as many as six nurses and a respiratory therapist, as hoses and cables must be disconnected and reconnected, not to mention the risks associated with moving an extremely vulnerable person. And they have to do it twice because at the end of the day every patient has to be turned again.
For some, working in the COVID room at LAC + USC is very personal. This is the case with Magdaleno, a Spanish-speaking nurse who was born in Mexico City. “I grew up in this community,” he said. “And even if you don’t want to, you see your parents, your grandparents, your mother with these patients, because they speak the same language.”
Magdaleno plans to spend Christmas alone with the members of his household and asks us to do the same. “If you lose a family member, what’s the purpose of Christmas? [o Año Nuevo]? “I ask.” Is it worth going to the mall now? Is it even worth buying a present for someone who is likely to die?
That the darkest hour of the pandemic comes just when COVID vaccines start to arrive is particularly heartbreaking, said Dr. Paul Holtom, chief epidemiologist at LAC + USC.
“The tragic irony is that the light is at the end of the tunnel,” he said. “The vaccine is being distributed right now, and people just have to live until they can get the vaccine.”
Article by Kaiser Headline News.