Los Angeles area hospitals are at a breaking point due to the coronavirus pandemic in Southern California, where the mounting death toll has overwhelmed intensive care units and led to contingency plans for possibly rationing care.
Though coronavirus hospitalizations are stabilizing in parts of California, patients are still overwhelming hospitals in a large swath of the state, leading California Gov. Gavin Newsom to warn that the state must brace for the effect of a “surge on top of a surge” from recent holiday travel.
Intensive care units in Southern California and the agricultural San Joaquin Valley have no capacity remaining, according to state figures.
Over the weekend, most Los Angeles County hospitals reached a crisis point where they had to divert ambulances because they didn’t have beds available.
The Los Angeles Times reports that Sunday night was the breaking point for hospitals like USC Medical Center, where at least 30 patients could not get beds for intensive or intermediate care, and the hospitals was forced to turn away all ambulance traffic for 12 hours.
Other Los Angeles County hospitals were hit as hard, forced to divert ambulances and even place patients in conference rooms and gift shops due to the overflow, the Times reports:
And Memorial Hospital of Gardena on Monday was running at 140% capacity, forcing officials to ask for a four-hour suspension of new ambulance calls so it could move patients. The hospital is struggling to keep enough oxygen and supplies on hand amid the crunch of COVID-19 patients who need it.
“It’s a crisis — there’s no doubt about it,” said Memorial Hospital Chief Executive Kevan Metcalfe. “And they just keep coming.”
Hospitals are so inundated that they’ve resorted to placing patients in conference rooms and gift shops. But even so, many facilities are running out of space. Virtually all hospitals in L.A. County are being forced to divert ambulances with certain types of patients elsewhere during most hours. On Sunday, 94% of L.A. County hospitals that take in patients stemming from 911 calls were diverting some ambulances away.
L.A. County’s number of ICU patients with COVID rose to 1,449 on Sunday, breaking records for 16 consecutive days with a net increase of 35 new patients per day. This has not yet reached the county’s 44 per day peak from mid-December, but the strain on resources and personnel has led Newsom to declare that his latest stay-at-home order would be extended Tuesday in places where hospital ICUs have less than 15 percent capacity.
Newsom said Monday that even with hospital admissions plateauing in some places, the state was destined to move into a “new phase” that it’s been preparing for as it sets up hospital beds in arenas, schools, and tents, though it is struggling to staff them.
“As we move into this new phase, where we brace, where we prepare ourselves for what is inevitable now … based on the travel we have just seen in the last week and the expectation of more of the same through the rest of the holiday season of a surge on top of a surge, arguably, on top of, again, another surge,” Newsom said.
State officials also notified hospitals that the situation is so dire they should prepare for the possibility that they will have to resort to “crisis care” guidelines established earlier in the pandemic, which allow for the rationing of care. In a rationed care situation, doctors would have to triage care by determining the most effective use of their limited resources on the patients most likely to get well. This was the situation doctors in Italy were forced into during the darkest days of that county’s coronavirus pandemic, when hospitals were forced to turn away some elderly patients due to lack of resources.
Should the situation “reach a point where our hospital faces a shortage that will affect our ability to care for all patients,” officials wrote, then a clinical committee consisting of doctors, a community member, a bioethicist, a spiritual care provider and other experts “will review the cases of all patients who are critically ill” and “make necessary decisions about allocating limited medical resources based on the best medical information possible.”
“This unburdens bedside staff from making any decisions about triaging care when resources are scarce,” the hospital said.
At L.A. County-USC, the flagship county public hospital on the Eastside, officials are trying to improvise, but as they saw Sunday night, the steady flood of patients makes that difficult.
“We were just completely overwhelmed,” said Chief Medical Officer Dr. Brad Spellberg, adding that the hospital is trying to “daily, hourly, cobble together solutions to get us through this crisis.”
“The sad reality is that all indicators tell us that our situation may only get worse as we begin 2021,” county Public Health Director Barbara Ferrer said.
Last week, after L.A. County’s COVID death toll reached record highs on consecutive days, Ferrer stated, “A person now dies every 10 minutes in L.A. County from COVID-19.”
Los Angeles County, which accounts for a quarter of California’s nearly 40 million residents, has about 40 percent of the state’s 24,000 deaths. The county is approaching a milestone of 10,000 deaths.
“These are figures that can’t be normalized,” county Supervisor Hilda Solis said. “Just like the sound of ambulance sirens, we can’t tune this out.”
The surge of infections is due in large part to Thanksgiving travel and celebrations, which happened despite warnings from health officials not to gather because the nation’s most populated state was already seeing explosive growth in cases.
It’s created the greatest challenge for California’s health system since the pandemic began, with case counts, hospitalizations, and deaths from COVID-19 regularly breaking records.
While daily coronavirus cases were down to 31,000 Monday from a seven-day average of above 37,000, it was likely due to a lag in data from the weekend, Newsom said.
Models used for planning show hospitalizations more than doubling in the next month from about 20,000 to more than 50,000.
The state has several makeshift hospitals that are taking patients, but more health care workers are needed to staff them, the governor said. The state has deployed more than 1,000 people to 116 hospitals and other facilities through a volunteer corps or the National Guard. On the upside, Newsom said California finally expects to receive more of the traveling health care workers it had requested in anticipation of the shortage.
The Department of Public Health is sending an emergency medical team to Los Angeles to help better distribute patients among hospitals. Some hospitals are well above capacity and others are below, Newsom said.
Meanwhile, the state’s funeral industry is also having difficulty keeping up with the demand on their services due to the pandemic death toll. The Daily Beast reports that the death industry is “overloaded and overwhelmed” with “bodies piling up in area crematoriums, casket makers facing a shortage of supplies, and gravediggers struggling to keep up with equipment breakdowns.”
One funeral home in East Los Angeles rented a 52-foot refrigerated trailer to store cadavers because the 20-foot trailer they rented in the summer for the COVID overflow was no longer enough, according to the Daily Beast.
A local casket manufacturer told the Daily Beast that they are running low on caskets due to this surge in death:
“Wood is getting scarce, especially pine, which is the most inexpensive,” said Auriel ‘Guero’ Suarez, owner of the Universal Caskets Manufacturing Corporation in East Los Angeles. “In 52 years in the business, I’ve never seen anything like this.”
“It’s awful what these families have to live through,” Suarez said. “The caskets are practically flying out the door as soon as they’re built.”
“Sometimes,” he added, “the coffins don’t arrive on time for the funeral.”
Meanwhile, California health office are moving quickly to vaccinate health workers and people at nursing homes and then expand to other groups, likely including teachers, the Associated Press reports.
The state expects to have received 1.7 million doses of vaccine by the end of the week, Newsom said. He also announced that CVS and Walgreens pharmacies would begin vaccinating residents in nursing homes and assisted living facilities.
The Associated Press contributed to this article.