An explosion of coronavirus cases threatens to overwhelm California’s emergency care system.

People are waiting until they’re sicker to get care, nurse says

LOS ANGELES — Medical staffing is stretched increasingly thin as California hospitals scramble to find beds for patients amid an explosion of coronavirus cases that threatens to overwhelm the state’s emergency care system.

As of Sunday, more than 16,840 people were hospitalized with confirmed COVID-19 infections — more than double the previous peak reached in July — and a state model that uses current data to forecast future trends shows the number could reach 75,000 by mid-january.

More than 3,610 COVID-19 patients were in intensive care units. 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 using “surge” space. Overall, the state’s ICU capacity was just 2.1 percent on Sunday.

In Los Angeles County, Nerissa Black, a nurse at Henry Mayo Newhall Hospital, estimated she’s been averaging less than 10 minutes of care per patient every hour. That includes not just bedside care, but donning gear, writing up charts, reviewing lab results and conferring with doctors, she said.

“And the patients who are coming in are more sick now than they’ve ever been, because a lot of people are waiting before they get care. So when they do come in, they’re really, really sick,” Black said Sunday.

The enormous crush of cases in the last six weeks has California’s death toll spiraling ever higher. An additional 161 fatalities were reported Sunday for a total of 22,593.

Many hospitals are preparing for the possibility of rationing care. A document recently circulated among doctors at the four hospitals run by Los Angeles County calls for them to shift strategy: Instead of trying everything to save a life, their goal during the crisis is to save as many patients as possible. That means those less likely to survive won’t get the same kind of care offered in normal times.

“Some compromise of standard of care is unavoidable; it is not that an entity, system, or locale chooses to limit resources, it is that the resources are clearly not available to provide care in a regular manner,” the document obtained by the Los Angeles Times reads.

The county’s Health Services director, Dr. Christina Ghaly, said the guidelines were not in place as of Friday night but that they were essential to develop given that “the worst is yet to come.”