Hospitals can’t keep up with surge
L. A. County passes another COVID- 19 milestone: 11,000 deaths since the pandemic began.
Hospitals across Los Angeles County were fighting a losing battle Tuesday to stay ahead of the coronavirus surge as the number of hospitalized COVID- 19 patients topped 8,000 and the countywide coronavirus death toll rose by nearly 1,300 in the last week.
L. A. County hit another distressing milestone, surpassing 11,000 deaths Tuesday since the beginning of the pandemic. Officials warned that conditions will only worsen in coming weeks as people infected during the holidays become sick and need medical care.
“It is getting harder and harder for healthcare workers to care for those coming to the hospital with gunshot wounds, heart attacks, strokes and injuries from car accidents,” said Los Angeles County Supervisor Hilda Solis. “Hospitals are declaring internal disasters and having to open church gyms to serve as hospital units.”
Over the last week, L. A. County averaged 183 COVID- 19 deaths a day —
the equivalent of one every eight minutes — and 13,500 new coronavirus infections, a count expected to grow with the reopening of testing sites after the holidays. The county’s cumulative coronavirus case count now tops 841,000.
Hospital staffing remains stressed across the county, and officials have warned that the quality of care is being compromised. More than three- quarters of the patients in ICUs have COVID- 19.
All hospitals are experiencing a large number of staff unable to work because they are under isolation or quarantine, Dr. Christina Ghaly, the L. A. County director of health services, told the county Board of Supervisors on Tuesday.
Another major problem is the inability to quickly discharge patients. Across the four county- run hospitals, about 10% of hospital patients no longer need hospital care, yet “we’re having a number of problems and delays in moving them out” to lower levels of care settings, such as nursing homes, Ghaly said.
Some nursing homes are refusing patients from hospitals; sometimes, patients don’t want to be moved to a lower level of care and state law prohibits the movement of a patient unless the person agrees to the placement. Skilled nursing facilities and other places that can provide lower levels of care are facing their own staffing shortages, limiting the number of patients they can take in.
Dialysis centers are starting to struggle with staffing shortages too, and there are now not enough outpatient dialysis resources available. That’s causing problems because hospitals are unable to discharge patients from hospitals when there are too few outpatient dialysis chairs available to accommodate them. Dialysis facilities are also sending patients to the emergency room to receive coronavirus testing rather than performing the testing at the site of the dialysis center, Ghaly said.
It has also been hard to f ind portable oxygen canisters needed to send patients home from hospitals who still need oxygen treatment. There’s a shortage of canisters needed to transport oxygen around the hospitals and to store them in tents that are being used to provide care for patients.
Like facilities across California, the county- run hospital system is struggling to find temporary medical staff to backfill the staffing shortage. The county hospital system has increased its offer of pay to f ind contract medical staff and submitted requests for help to the state.
So far, the county- run system has received 36 contract nurses from the state and is anticipating two 20person medical teams from the U. S. Department of Defense, which will be deployed at Harbor- UCLA Medical Center near Torrance and L. A. County- USC Medical Center on the Eastside this week.
Five privately run hospitals in L. A. County are also due to receive federal health teams to support medical staffing, Ghaly said.
The biggest source of additional hospital staffing is coming from the county’s own outpatient clinics.
The county has closed f ive of its public outpatient clinics and reduced hours and services at the rest of them to divert more than 800 nurses and other staff to work in emergency departments and quarantine- andisolation sites for people who have COVID- 19 or have been exposed to the virus.
The county- run hospital system has already ordered more ventilators, BiPAP machines and more highf low oxygen devices — all of which help patients breathe — and officials do not believe there will be a supply problem for those devices in the coming weeks, Ghaly said.
Two of the county- run hospitals have had problems with the delivery of oxygen in the hospital to their patients, Ghaly said. Olive View- UCLA Medical Center in Sylmar has resolved its issue of oxygen freezing in its pipes; Harbor- UCLA Medical Center is still having a problem with the f low of oxygen through its pipes. It’s not creating urgent patient care issues at HarborUCLA, “but it does provide some limitations into which physical spaces within Harbor we can use to keep patients,” Ghaly said.
Amid the already overwhelming surge, California faces another potential threat: the presence of a new coronavirus variant, which has grown rapidly in Britain, that some scientists believe is more likely than the conventional version to infect people who are exposed to it.
Though it’s unclear how prevalent the variant is statewide, San Diego County health officials Tuesday reported 24 additional confirmed cases and four likely cases. That raises the county’s total of known or suspected infections by the variant virus to 32.
The two dozen newly infected patients “are believed to have no travel history and to have come from 19 different households, but the investigation and contact tracing are ongoing,” according to a statement by San Diego County officials. Those infected are widely dispersed geographically and range in age from 10 to their 70s.
The variant has also been identified in two people of the same household in Big Bear in San Bernardino County.
Experts say there’s no evidence that, once it infects a person, the variant — known as B. 1.1.7 — is more likely to cause death, more severe illness or renders vaccines less effective.
But any heightened risk of infection is unwelcome news, particularly in areas already reeling from skyhigh levels of coronavirus transmission.
Although many of those infected may experience only mild symptoms or none at all, California health officials have warned that a sizable slice, about 12%, will fall ill enough to require hospitalization within a few weeks after they are exposed. Twelve percent of people who are hospitalized end up in the intensive care unit.
A significant and sustained wave of new infections, then, will invariably slam hospitals with additional patients.