Swamped L.A. County hospitals running out of oxygen
With supplies dwindling and hospitals overflowing, oxygen use is reserved for dire emergencies
The United States has entered the new year with record numbers of Americans hospitalized with coronavirus, straining a health care system bracing for a post-holidays surge that has the potential to further stretch hospitals.
At least 128,000 COVID-19 patients were hospitalized nationwide as of Monday, eclipsing the record set in the last week of 2020. Facilities across the West and South are especially burdened.
Los Angeles County has been so overwhelmed it is running out of oxygen, with ambulance crews instructed to use oxygen only for their worst-case patients. Crews were told not bring patients to the hospital if they have little hope of survival and to treat and declare such patients dead on the scene to preserve hospital capacity. Several Los Angeles hospitals have turned away ambulance traffic in recent days because they can’t provide the air flow needed to treat patients.
Arizona, once heralded for turning the corner after a summer surge, now has the nation’s highest rate of coronavirus hospitalizations. In the Atlanta area, nearly every major hospital is nearly full, prompting state officials to reopen a field hospital for the third time.
The optimism that came with new vaccines and a new year is colliding with a grim reality: The United States has reached the worst stage of the pandemic to date with the deadly results of holiday gatherings yet to arrive. Vaccine distribution is also off to a slow start, with at least 4.6 million inoculated, far short of the 20 million the Trump administration vowed to vaccinate by the end of 2020.
“We have so many crises happening simultaneously on multiple fronts,” said Saskia Popescu, an epidemiologist with George Mason University. “And all signs point to things getting a whole lot worse before they get better.”
The back-to-back timing of Christmas and New Year’s Eve could have catastrophic results because many people develop symptoms roughly five to seven days after infection and are most contagious during 48 hours before those symptoms appear. That means someone exposed to the virus on Christmas could be contagious by the time they attended a New Year’s party or began traveling home.
Just how badly the situation in America devolves may depend on how widely the new variant that scientists believe is more contagious, but not deadlier or vaccine resistant, is circulating. The variant has been reported in four states.
With estimates that the new variant could be 10 percent to 70 percent more transmissible, the Centers for Disease Control and Prevention said in a statement last week that it “could lead to more cases and place greater demand on already strained health care resources.”
Deaths and cases have increased 20 percent over the last week to 352,000 fatalities and nearly 21 million infections. But experts say the toll on hospitals paints a clearer picture of the pandemic because of complications in reporting test results during the holidays.
States with the largest share of their populations hospitalized are largely concentrated in the South and west: Arizona, Nevada, Alabama, California, Georgia, Tennessee, Oklahoma, Mississippi, Texas and Delaware.
The situation in California has grown especially dire in recent days. On Monday, California hit a new single-day record for hospitalizations with 22,003 COVID-19 patients. Nearly 4,700 were in intensive care units. And as cases continue to soar, the ability of hospitals and EMTs to save the sick will keep degrading.
Hospital officials in Southern California said they were running low not just on ICU beds but also ventilators and morgue spacew. But perhaps the most dire shortage is now oxygen. Because coronavirus is a respiratory disease that attack the lungs, most hospitalized patients require oxygen. The sheer number of patients has placed such a strain on oxygen systems that some hospitals are struggling to provide adequate air pressure and flow into patients’ lungs. There are also shortages of portable oxygen tanks in ambulances and ones that are sent home with patients, making it difficult to discharge some patients even as hospitals run out of capacity.
In a directive Monday, the Los Angeles County Emergency Medical Services Agency told EMTs to conserve oxygen by only giving it to patients with oxygen saturation levels below 90 percent. To ease the backup at hospitals, county officials also issued a plan to set up tents just out hospitals to crate temporary “ambulance receiving spaces.” Officials hope that makeshift system will free up ambulances now sitting idle outside hospitals because their patients can’t be admitted.
“We’re no longer a wave or surge or surge upon a surge. We’re really are in middle of a viral tsunami,” said Robert Kim-Farley, a medical epidemiologist at UCLA Fielding School of Public Health.
On Monday, Democratic Gov. Gavin Newsom announced a statewide plan and a team of officials focused on bolstering the California’s oxygen supply. The Army Corps of Engineers has also been called in and is sending crews to update oxygen-delivery infrastructure at several aging hospitals — five in downtown Los Angeles and two in San Bernardino. Separately, state emergency teams have been deployed to refill oxygen tanks 42 of medical support units across the state. The state is also leasing mobile oxygen systems to bolster supplies and looking to order several hundred oxygen concentrator units. The overarching goal, Newsom said, is to reduce the stress placed on hospitals’ existing oxygen systems so that they can maintain adequate air pressure for patients.
Expanding the oxygen supply doesn’t end the challenges for hospitals, Kim-Farley said.
“When you get to that level of volume being pumped through, some of pipes start to freeze up. You start running out of oxygen tanks that patients need to be sent home and discharged,” Kim-Farley said. “As the cases keep increasing you’re going to see those kinds of effects start to pile up. ICU beds get full. The ER gets backed up. Ambulances have no where to take patients. You get severe, chronic staffing shortages. Elective surgeries get canceled again. The ability to care simply degrades.”