Hospital staffing in California is increasingly stretched thin 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 Covid-19 infections, more than double the previous peak reached in July. A state model that uses current data to forecast future trends shows the number could reach 75,000 by mid-January.
Until vaccinations become widespread, hospitals were 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 will not 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 surge has arrived and “the worst is yet to come.”
Intensive care units in California are caring for more than 3,610 Covid-19 patients. 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% on Sunday.
In LA county, Nerissa Black, a nurse at Henry Mayo Newhall hospital, estimated she had 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 on Sunday.
The crush of cases in the last six weeks has California’s death toll spiraling ever higher. Another 161 fatalities were reported on Sunday for a total of 22,593.
Across LA county at UCLA Health Santa Monica medical center, nurse Wendy Macedo said all 25 beds on her unit were filled with Covid-19 patients. She said a ward on another floor that had been devoted to orthopedic patients had been converted to care for people who have tested positive for the virus. Nurses were working longer shifts, and more of them, she said. Nearly 5,550 people are hospitalized with Covid-19 countywide.
“The more patients we have, the more there’s a risk of making a mistake, especially if we’re rushing,” Macedo said on Sunday. ”Obviously we’re trying to avoid that, but we’re only human.“
California was experiencing “some of the darkest days of our Covid-19 surge”, Governor Gavin Newsom said, but there was some light on Sunday as a working group of scientists and experts endorsed a vaccine developed by Moderna. The step clears the way for the drug to be distributed throughout California and other western states that reviewed it separately from the US Food and Drug Administration.
Shipments of the vaccine are expected to arrive in California early this week, but it could be months before it is available for the general public, officials said.
“Until vaccines are available more widely across the state, it’s critical that all Californians do their part to stop the surge by staying at home and wearing a mask when leaving home for essential work and needs,” Newsom said.
Corona Regional medical center south-east of Los Angeles has converted an old emergency room to help handle nearly double the usual number of ICU patients. It is using space in two disaster tents to triage ER patients because the emergency room is filled with patients who need to be hospitalized.
In hard-hit Fresno county in central California, a new 50-bed alternate care site opened in recent days near the community regional medical center. The beds for Covid-19-negative patients will free up space in area hospitals, where just 13 of some 150 ICU beds were available on Friday, said Dan Lynch, the county’s emergency medical services director.
Lynch said he expected they would have to use the Fresno Convention Center, which can accommodate up to 250 patients, given current demand.
Fresno and three neighboring counties also have taken the unprecedented step of sending paramedics on emergency calls to evaluate people. They will not be taken to the emergency room if they could go to an urgent care facility or wait a few days to talk to their doctors, Lynch said.
Some hospitals have canceled non-essential elective surgeries, such as hip replacements, that might require beds that may soon be needed for Covid-19 patients. Others are increasing staff hours or moving patients to free up space.
LA county health officials announced on Saturday they had modified their health orders to comply with recent US supreme court rulings calling for places of worship to be allowed to have outdoor and indoor services, with appropriate health safety precautions.
On Saturday night, Apple announced that it was temporarily closing all 53 of its stores in California because of the coronavirus outbreak. Under the stay-at-home order in effect for nearly the entire state, retail stores are limited to 20% capacity.
Supermarkets have been hit hard by the virus surge, further straining an essential service that remains open during the latest stay-at-home order. Of the six outbreaks at Food 4 Less locations in the Los Angeles area, three were first logged this month, linked to the current surge, according to a Times analysis. An outbreak is defined as three or more cases among staff in a 14-day period.