Sunday, March 7
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Children apologize to their dying elders as L.A. County reels – Los Angeles Times

As hospitals across California braced this week for a surge in COVID-19 patients who got infected over Christmas, officials relayed painful stories of dying victims’ last moments with their families.

“One of the more heartbreaking conversations that our healthcare workers share is about these last words when children apologize to their parents and grandparents for bringing COVID into their homes for getting them sick. And these apologies are just some of the last words that loved ones will ever hear as they die alone,” Los Angeles County Supervisor Hilda Solis said. “Please, for your loved ones, stay home. Stay safe. Keep your loved ones alive.”

Officials believe the current spike was driven in part by family gatherings around Thanksgiving and Christmas that allowed younger people, who were more likely to be out and about, to spread COVID-19 to their elders, who otherwise tended to stay home.

“The situation is more dire than ever before, which is why I’m going to share some stories from our local hospitals,” Solis said. “Dying from COVID in the hospital means dying alone. Visitors are not allowed into hospitals for their own safety. Families are sharing their final goodbyes on tablets and mobile phones.”

Dr. Mark Lepore, intensive care unit physician at Ventura County Medical Center, said last week that too many families were bringing their gravely ill loved ones to the hospital too late.

“They’re concerned that when they go, they’re not going to come out alive,” Lepore said.

Lepore said he had been forced to have tough conversations with critically ill patients when they came in, explaining treatment they might receive to keep them alive such as flipping them onto their bellies to make it easier to breathe, and administering pressurized oxygen via a mask if their blood oxygen levels were to fall too low.

If those methods don’t work, Lepore said, he has asked patients whether they want to be placed on a ventilator — which involves inserting a tube into their windpipe that is attached to a machine to help them breathe and being sedated — or if they’d rather simply be made comfortable as they die.

The chance of surviving COVID-19 once a patient is placed on a ventilator is between 20% and 60%. The discussion is a tough one, Lepore said. “And if it gets to the point that after putting you on a breathing machine that your heart were to stop, we would not do CPR on you because it would not work — because the disease will have taken hold,” Lepore says he tells patients.

Lepore said it was imperative that people seek medical care if they have shortness of breath. “Even if hospitals are full, you have to go seek care or call your doctor,” he said. People can purchase a device called a pulse oximeter to monitor their blood oxygen levels, and if the level is less than 90%, that means you should call the emergency department, Lepore said.

“The longer you wait for this disease,” he added, “the less chance we have to give you some of the therapies that can help you get through this.”

A doctor at one Los Angeles County public hospital said families unable to be there for their dying loved ones were devastated.

Working in the ICU, where there is little caregivers can do to save extremely ill patients, the doctor said he had heard “families wail on the phone, in agony that their loved one is dying. … The way most people leave is by dying. We spend our days calling families to let them know their loved one has exhausted all medical treatment and are going to pass away despite our best efforts.”

Solis noted that more than 200 people in L.A. County were dying from COVID-19 daily, and hospitals were on the brink of having to ration care, where doctors would choose which patients receive treatment and which do not.

Because of staffing issues, one privately operated hospital in L.A. County on Monday declared an internal disaster, which means the hospital is so overwhelmed that the emergency room is closed to all incoming ambulances, according to L.A. County Health Services Director Dr. Christina Ghaly.

The coronavirus is so widespread that across Southern California, at least one in five people who are tested for the virus, or about 15,000 a day, are testing positive.

L.A. County Public Health Director Barbara Ferrer on Monday pleaded with the public to stay at home as much as possible. When leaving home to access essential services, she urged people to bring sanitizing wipes so they could wipe down their phones, keys, work stations and door handles — anything they touch that others have touched.

Ferrer also issued a new recommendation that people who must go out — and live in a household with an elderly person or someone with underlying medical conditions — begin to wear masks at home to protect their loved ones.

“Because there is so much spread, we’re also recommending that people keep their face coverings on while they’re inside the home,” Ferrer said. For anyone who works outside or is the person who runs the essential errands in the family, wearing a mask at home “will just add a layer of protection while we get through the surge.”

People should also make sure that frequently touched surfaces are sanitized, utensils are not shared and, if possible, that bedrooms and bathrooms are not shared with the most vulnerable.

“This is the time to be extremely cautious and very careful. We cannot lighten up our efforts yet — not now, and not for the next several weeks. Every minute, 10 people in LA County on average are testing positive for COVID-19,” Ferrer said.

Ferrer reiterated that people who are infected can transmit the virus to others for two days or more before they exhibit any symptoms themselves. At least 10% to 12% of people infected with the virus are hospitalized, and more than 1% of people diagnosed with the virus end up dying, Ferrer said.

“The damaging impact to our families and our local hospitals from this surge is the worst disaster our county has experienced for decades,” Ferrer said.

Ferrer said officials have done much in the past months to try to control the virus — banning gatherings, inspecting workplaces, issuing fines. “But it has been insufficient, because the biggest single factor in all of this comes down to individuals taking appropriate action,” Ferrer said. “We need to make sure that everyone survives to benefit from the vaccine.”

“Now is not the time to meet up with friends at your home to watch the game. It’s not the time to go for a walk without your face covering. All it takes is one mistake, and soon, five, 10 or 20 other people become infected,” Ferrer said. “The most important way to stop it in its tracks is to avoid interactions with others and protect ourselves at all times.”

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