Los Angeles Times
A different kind of COVID surge
Dr. Brad Spellberg noted that although the number of coronavirus-positive cases has risen, “this isn’t because we’re seeing a ton of people with symptomatic disease getting admitted.”
Spellberg said around 90% of the hospital’s coronavirus-positive patients were admitted for other reasons.
“Virtually none of them go to the ICU — and when they do go to the ICU, it is not for pneumonia. They are not intubated,” he said, citing other issues such as electrolyte abnormalities. “It is just not the same pandemic as it was, despite all the media hype to the contrary . ... A lot of people have bad colds, is what we’re seeing.”
Epidemiologist Dr. Paul Holtom chimed in that, as of Wednesday, “we have no one in the hospital who had pulmonary disease due to COVID.”
Holtom noted the possibility of a mask mandate but said “there’s no reason, from a hospitalization-due-toCOVID perspective, to be worried at this point.”
As video from the town hall spread online, some highlighted the pair’s remarks to repudiate the concept of a masking order — or to argue that dangers associated with the current coronavirus wave are overstated or unfounded.
In a statement to The Times on Monday, the L.A. County Department of Health Services, which has oversight of County-USC, said the pandemic “remains a very serious public health threat that we must continue to fight with every tool available, including vaccines, masking, social distancing, and treatment.
“To use our weekly internal town hall to suggest such measures are unnecessary is fundamentally contrary to our position as a medical center,” the statement continued.
Although it’s true that many coronavirus-positive patients are not requiring admission to the ICU, the Department of Health Services credits that in part to the high level of vaccination coverage in L.A. County.
“While we are not currently experiencing an increase in ICU admissions at [County-USC], we are seeing a significant increase in the number of infections among our patients, staff and the communities we serve,” officials wrote in the statement. “Rising rates of infection are extremely concerning, as the more people who become infected, the greater the probability that ICU admissions for COVID-19 will rise in the future.”
Hospitalizations have swelled, though not as severely as during previous surges. L.A. County hospitals had 1,299 coronaviruspositive patients as of Monday, up 60% from the start of the month.
Further, County-USC’s experience in its ICU may not be representative of L.A.
County as a whole. There were 137 coronavirus-positive patients in county ICUs Monday, far below the highs of previous waves but an increase of almost 51% since July 1. The last time L.A. County enacted an indoor mask mandate, on July 17, 2021, there were 134 coronavirus-positive patients in ICUs.
On Thursday, L.A., the nation’s most populous county, reported 10.5 new coronavirus-positive hospitalizations for every 100,000 residents, up from 8.4 the previous week.
The move above 10 per capita pushed L.A. County into the “high” COVID-19 community level as defined by the U.S. Centers for Disease Control and Prevention. Health officials have long said that should the county reach that threshold, they would prepare to institute a mask mandate in indoor public settings. Unless conditions improve, the order could go into effect July 29 for those age 2 and up.
COVID-19 deaths across L.A. County have increased significantly in the last month, from about 50 a week to between 86 and 100. That’s the first significant increase since the end of the winter Omicron wave. At the peak of that surge, weekly deaths exceeded 500.
There are a number of other indicators to explain why the L.A. County Department of Public Health and institutions across Southern California are concerned about rising levels of infection, which are resulting in large numbers of workers out sick, sometimes for weeks.
The growing number of cases at County-USC, for instance, has put a strain on hospital staffing, Chief Executive Jorge Orozco said during last week’s town hall.
“We have a significant number of employees who are testing positive,” he said, adding that those employees may not be very ill, but they need to isolate. “It causes significant challenges in terms of coverage, in terms of providing appropriate care.”
Last week, L.A. County Public Health Director Barbara Ferrer said that while vaccinations, boosters and anti-COVID drugs are making it less likely that large numbers of people will require intensive care or ventilators, there will still be a need for such resources.
“Somewhere between 5% and 10% of folks that are hospitalized with COVID are still ending up in the ICU, and some of them are needing ventilators. So there still is some serious illness associated with COVID,” she said. “But nothing like what we were seeing during the Omicron surge.”
Still, she said, “we also have a lot of unknown with BA.5 and anything else that comes our way. What’s going on in our hospitals could change.”
Ferrer said emergency rooms, urgent care centers and community clinics are telling her department “that they’re feeling very strapped. They have staffing shortages, because lots of their staff are sick with COVID and out, and they also have lots of their patients that, while they don’t need to go to the hospital, they do need medical care, and that creates some stress.”
Two months ago, 5% of emergency room visits countywide were coronavirus-related; now, it’s 10%.
Clusters of cases at work sites “are disruptive and hazardous,” Ferrer said during a recent briefing. “Worksite outbreaks create worrisome risk for vulnerable employees, and they often contribute to additional spread of the virus across households and communities where our workers live.”
The county is also seeing an impact on nursing homes. Outbreak investigations were underway at 41 nursing homes in the last week, five times more than in early May.
“Back in May, about 5% of all deaths occurred among nursing home residents,” Ferrer said. “Sadly, this number rose to 12% in June.”
In 2022 so far, L.A. County has reported 4,390 deaths from COVID-19. There were nearly 12,000 COVID-associated deaths in 2020 and 14,500 in 2021.
By contrast, in the prepandemic era, about 1,500 residents in the county died each year from the flu, more than 2,000 from accidental drug overdoses and nearly 900 from motor vehicle accidents.
Coronavirus infection also presents the risk of long COVID; the possibility of death due to complications of the heart or gastrointestinal or neurological systems can persist for years.
Some question the wisdom of a renewed masking order — or what sort of compliance L.A. County could hope to expect.
Maria Salinas, president and CEO of the Los Angeles Area Chamber of Commerce, and Jessica Lall, president and CEO of the Central City Assn., a downtown business group, sent a letter to Ferrer last week expressing concerns.
Requiring masks, they wrote, “puts employees in the increasingly challenging position of enforcing a mandate that many customers no longer wish to — or are unwilling to — comply with.”
“L.A.’s restaurants, retail stores, museums, amusement parks, sports centers and so many other establishments are working every day to recover from the pandemic, all while facing workforce shortages, supply chain challenges and more,” they wrote. “Businesses should not be expected to enforce a mask mandate in addition to these ongoing constraints. Businesses cannot shoulder this burden of compliance alone as they have been required to do so in the past.”
If L.A. County does mandate indoor public masking, and other counties don’t follow suit, “residents and visitors may choose to take their spending power to businesses in other parts of Southern California, which would only harm our local economy,” they wrote.
Ferrer noted that “we’ve always benefited in L.A. County from most people actually going ahead and complying with what we say are sensible precautions.”
Health officials, she added, will spend the time leading up to a new masking order “working with our businesses so that they’re clear about their need to both supply those masks for all of their employees, make sure that their employees are masked appropriately indoors and do their best to message to their customers.
“We need an additional layer of protection, and this is the additional layer,” she added. “So our hope is that folks will go ahead and make every effort to come into compliance.”