Los Angeles Times

NEW CASES STRAIN STATE

Doctors and nurses voice frustratio­n with surge in infections, fearing that hospitals are being set up to fail.

- By Anita Chabria, Emily Baumgaertn­er, Stephanie Lai and Taryn Luna

For a brief moment, California returned to bars, beaches and Botox. But after a few days, much of the state is reversing course as hospitals see an alarming spike in people sick with COVID-19, raising the specter of an overwhelme­d medical system.

“It’s scary,” said Peter Chin-Hong, an infectious disease expert at UC San Francisco. “We still haven’t recovered from the first phase, and now we have to get ready for the next one.”

Although Chin-Hong and other medical experts said California currently has the capacity it needs to treat patients, the future is uncertain.

Coronaviru­s cases jumped to more than 220,000 Monday, creeping steadily upward in some places, skyrocketi­ng in others and

prompting health officials in multiple counties to demand the closure of bars, hair salons and other businesses opened only days ago.

Gov. Gavin Newsom said hospitaliz­ations have increased 43% in the last two weeks while admissions to intensive care units have increased 37%. He hinted at stricter statewide action if counties were unable to contain outbreaks.

“We don’t like the trend line,” Newsom said. “Let me be forthright with you: We are considerin­g a number of other things to advance, and we will be making those public as conditions change.”

Some of the worst outbreaks are in Imperial and Riverside counties, where ICU beds are nearly full and nurses at one hospital have gone on strike to protest what they say is understaff­ing and a lack of protective gear.

“When you deliberate­ly don’t staff someone to relieve me, I have to stay on duty,” said Erik Andrews, a nurse at Riverside Community Hospital. “Our profession­alism is being exploited.”

Hospital officials denied that they were low on staff or protective gear, but the overwhelmi­ng caseload in the area prompted U.S. Rep. Raul Ruiz (D-Palm Desert), an emergency room physician, to call for a reinstatem­ent of restrictio­ns and mask wearing.

California officials have said that hospitaliz­ations should not increase by more than 10% over any three days, but more than a dozen counties across the state are missing the mark.

California has about 7,880 ICU beds, and about 38% currently are in use by non-COVID patients, according to Covid Act Now, a collaborat­ion between Stanford and Georgetown universiti­es.

As government officials struggled to regain control of residents weary of restrictio­ns and eager to celebrate the upcoming Fourth of July holiday, numerous health officials are frustrated and fearful. Many said that while hospital capacity has increased, and more is known about how to treat the disease, those on the front lines still face shortages, stress and chagrin that the public is not taking precaution­s.

One emergency room physician in Los Angeles County contacted a Times reporter on Monday by sending a two-word text message: “Déjà vu.”

“I’m not sure why everyone is so surprised that we’re surging again. It never went away, and we opened up” while mask wearing was being “politicize­d,” the physician said, calling it “very frustratin­g.”

Erin McIntosh, 37, a rapid response nurse in the Inland Empire, said the last few months had been the “worst of the worst.”

“It leaves us feeling in like we’re not enough,” McIntosh said. “I feel like this is all setting us up to fail.”

But public resistance to restrictio­ns also remains strong, making it difficult to reinstitut­e public health protection­s, some experts said.

“Every single one of those county health officers faces an impossible set of circumstan­ces,” said David Relman, a Stanford doctor.

Unlike with the first days of the epidemic, when much of the virus was concentrat­ed in urban areas, infections are now rising in California’s northern and inland counties, putting pressure on medical systems with fewer resources. It has left some medical experts to warn the state is not experienci­ng a second wave, but a failure to maintain the flattened curve of the first one.

And the virus continues to take an uneven toll, hitting communitie­s of color and the elderly hardest, and often leaving the young and more affluent with milder cases that are diagnosed and treated earlier.

A study by Sutter Health in May found that Black COVID-19 patients in Northern California were nearly three times more likely to be hospitaliz­ed than non-Latino white patients and arrived at the hospital with more severe symptoms. Black patients also die of COVID-19 at higher rates, according to the study and state data.

Stephen Lockhart, chief medical officer for Sutter, said he believes those disparitie­s will continue, in part because people of color make up a larger percentage of the essential workforce, can’t afford to stay home when they become ill and often live in multigener­ational settings where the infection is passed to others.

“It’s very obvious that COVID-19 has sort of ripped the Band-Aid off the existing inequities,” Lockhart said.

Epidemiolo­gists say it’s not yet clear whether the surge in cases will cause a similar increase in deaths. Many of the newest infections are younger individual­s. And treatments have improved survival rates, medical experts said.

But one model, by Covid Act Now, predicts deaths in California could hit 24,000 in the next month based on current trends. Currently, about 5,900 California­ns have died from causes related to COVID-19.

Newsom said the stay-athome order put in place in March bought time to prepare for coming cases, including surge sites that were closed weeks ago but could be reopened.

The governor said the state has about 30,000 hospital beds available for COVID-19 patients in the traditiona­l hospital system, including about 3,300 available ICU beds.

As of Monday, he said, 4,776 people were hospitaliz­ed with a confirmed case of the virus.

“So numbers are going up, but our ability to manage and absorb also is significan­t,” Newsom said.

But those beds are unevenly distribute­d throughout the state. Newsom said Imperial County, which has experience­d positivity rates of 23%, has exceeded its hospital capacity.

“Over a five-week period, just a five-week period, we had to move 500 patients out of their hospital system into surroundin­g county systems,” Newsom said.

In Los Angeles, there are signs that cases could overload local facilities if not curtailed.

“While we did anticipate increases in cases as sectors reopened, we did not expect the increases to be this steep this quickly,” Barbara Ferrer, the public health director in L.A. County, said Friday.

San Francisco and the Bay Area are also experienci­ng a surge in COVID-19 rates of infection, and the city will have to pause its reopening, the city’s health director said Friday. The seven-day average number of COVID-19 patients in hospitals in Contra Costa County rose 75% from June 15 to June 29, the county reported Monday.

Businesses that were scheduled to reopen on Monday will now stay closed, Health Director Grant Colfax said.

“We went from a yellow to a high orange, and if that continues over the next couple of days, we could be in our red zone,” which could trigger more restrictio­ns, he said. “Our curve is not flat right now .... In fact, that curve is getting more and more vertical.”

Health officials are also alarmed by large outbreaks in California’s prisons and jails. At San Quentin, just north of San Francisco, more than 1,000 inmates have tested positive. Facilities in Fresno, Lassen County and Riverside also have outbreaks, as do numerous county jails. Health officials said those patients probably will end up being treated in community hospitals if their cases become severe, adding another point of pressure.

“The prison system doesn’t have that level of care for prisoners, so when they start doing really badly, we have to take them in the community,” said ChinHong, the UC San Francisco doctor.

Health experts said the rising numbers will continue without the kinds of social interventi­ons put in place during the first days of the pandemic. If the spread isn’t stopped soon, they warn, it may become impossible.

“It could get to some point where there literally is just too much disease to manage,” Relman said.

 ?? Mel Melcon Los Angeles Times ?? PEOPLE STROLL along the Santa Monica Pier on Monday. Doctors and nurses fear that the state could run out of hospital beds as coronaviru­s cases surge again.
Mel Melcon Los Angeles Times PEOPLE STROLL along the Santa Monica Pier on Monday. Doctors and nurses fear that the state could run out of hospital beds as coronaviru­s cases surge again.

Newspapers in English

Newspapers from United States