Many hospitals are reaching their breaking points as the coronavirus continues to spread, and at a Los Angeles County-USC Medical Center, their breaking point came Sunday night.
Some patients, including the very sick who required intensive oxygen, experienced wait times as long as 18 hours to get into the intensive care unit. There weren’t any available beds for at least 30 patients who needed intensive or intermediate levels of care. The hospital even had to close its doors to all ambulance traffic for 12 hours.
On Monday, the front entrance of the Community Hospital of Huntington Park was closed to the public; the back of the building had a steady stream of ambulances coming in over the weekend, with one security guard who said that the vehicles were arriving as frequently as every half hour.
Memorial Hospital of Gardena was running at 140% capacity, which forced officials to ask for a four-hour suspension of new ambulance calls so that they 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.
Memorial Hospital Chief Executive Kevan Metcalfe said, “It’s a crisis — there’s no doubt about it, and they just keep coming.”
During the holiday weekend, the crisis at Los Angeles County Hospitals hit new levels as patients continued to come in. The medical system is preparing itself for a new wave of coronavirus spread from Christmas travel and gatherings. L.A. County’s cumulative COVID-19 death toll is expected to climb past 10,000 this week.
Hospitals are so flooded that they have resorted to putting patients in gift shops and meeting rooms. Even so, several facilities are running out of capacity. 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. ambulances were diverted by county hospitals bringing in patients resulting from 911 calls.
L.A. County health services director Dr. Christina Ghaly said, “Soon, there won’t be any places for these ambulances to go.” She said, “If every hospital is on diversion, then no hospital is on diversion.”
The number of people with COVID-19 inside L.A. County’s ICUs has broken records for 16 consecutive days, rising to 1,449 on Sunday, the most recent data available. Every day over the last week, there has been a net daily increase of 35 COVID-19 patients in ICUs — down slightly from 44 in mid-December but at a pace that’s packing even more critically ill patients into crowded facilities.
As of Monday morning, there were 54 available ICU beds across L.A. County, and half were for pediatric patients. Two-thirds of staffed ICU beds in L.A. County are filled with COVID-19 patients.
“All hospitals are experiencing this strain, but it’s especially more pronounced and more serious for some of the smaller hospitals,” Ghaly said. “Many hospitals have reached a crisis point and are having to make many tough decisions about patient care.”
There was proof of this in Huntington Park on Monday. East 58th Street became a waiting room with the Community Hospital closed to tourists. Outside the crowded hospital parking lot, cars waited, headlights on in the rain, as passengers waited inside for loved ones. Occasionally, a passenger left a car to enter the hospital’s current main entrance, now known as the “ambulance entrance.”
A Los Angeles Fire Department ambulance arrived, sirens blaring, and the driver unloaded a patient on a gurney. A single blanket, not completely shielding the patient from the rain, hung off the side of the gurney.
The patient’s temperature was measured by hospital staff, and a wrist tag was given to him. The firefighters wheeled the patient back out to the parking lot and into one of two improvised white tents after checking him in. Behind the thin covering that served as the tent’s door, the patient could be seen shuffling to a seat as a hospital staff member, holding a clipboard, spoke to him.
At Gardena Memorial, officials used the four-hour suspension of ambulance deliveries to transfer some patients home and make room for 18 others in need of intensive care, or at least out of the hospital’s 10-bed ICU and into an area previously designated for postoperative patients.
“You have to be very resourceful and creative and utilize your resources may be in ways that you haven’t before,” Metcalfe, the hospital CEO, said. It’s a task that is proving increasingly difficult, as those resources are dwindling. COVID-19 patients require “triple the amount of oxygen,” he said, so supplies that might typically last a week now last three days. Even oxygen storage tanks on the hospital grounds are draining quickly because of increased demand, he said. If a hospital were to run out of oxygen completely, it would be in “deep, deep trouble.”
He explained, “Patients that are on these respirators that have high-flow oxygen, they could die,” he said. “You would try to use a [manual oxygen] bag, but if you’ve got 40 or 50 people, you don’t have enough staff that you can do that.”
The hospital is triaging new arrivals and sending home people who aren’t very sick or those who can receive outpatient care to keep numbers down.
“I’ve been in the business 40 years,” Metcalfe said, “and I’ve never seen anything like this.”
Larger hospitals are doing what they can to keep accepting patients.
At its facilities in California, Kaiser Permanente is delaying non-urgent and elective surgeries and procedures. According to announcements from the healthcare alliance, the pause will remain in place through Jan. 10 in Kaiser’s Southern California area and through Jan. 4 in Northern California. Kaiser is not scheduling any new elective procedures through January in Southern California.
Hospitals may become forced to ration care in severe situations, with doctors no longer pulling out all the stops to save a life and strategizing more on when to use resources and equipment most efficiently.
“We’re at a turning point. If it continues to get worse, many hospitals will begin rationing care,” said Dr. Elaine Batchlor, CEO of Martin Luther King Jr. Community Hospital in Willowbrook, a 131-bed facility that had 215 patients Monday.
Huntington Hospital in Pasadena also warned of that possibility in an information sheet for patients and their families.
Should the situation “reach a point where our hospital faces a shortage that will affect our ability to care for all patients,” officials wrote, 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.”
Conditions have been gradually deteriorating since Thanksgiving at the county hospital, one of the largest trauma centers in the western United States, with an average of 10 COVID-19 patients arriving per day. According to Spellberg, there were roughly 240 COVID-19 patients in all areas of the hospital on Monday, almost twice the number seen during the surge in July.
On Monday, the hospital opened a space previously reserved for postoperative rehabilitation to accommodate intermediate-level COVID-19 patients in an attempt to free up some of the beds in the ICU since operating rooms are now closed to all but emergency cases. Like several other hospitals in the region, L.A. County-USC has constructed field hospitals, or medical tents, to help with intake outside the ER.
But it’s not just the influx of patients contributing to bed shortages, Spellberg said. Many COVID-19 patients stay in the hospital for far longer than average ICU patients, with some mechanical ventilators occupying beds for six, eight, or even 12 weeks.
And the anticipated “Christmas bump” hasn’t even begun.
“If there is a Christmas surge, we probably have not experienced it yet,” Spellberg said, noting that cases arising from that holiday may not show up for another week or two.
He added: “If that happens, Los Angeles County will turn into what New York was in April.”
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