Hospitals discuss rationing care as California faces deluge of Covid cases

Hospitals in California are scrambling to handle an explosion of coronavirus cases that threatens to overwhelm the state’s emergency care system, with some facilities in hard-hit Los Angeles county even drawing up emergency plans for rationing care.

As of Sunday, more than 16,840 people were hospitalized with Covid-19 infections, more than double the previous peak reached in July. That number could reach 75,000 by mid-January, according to one state model.

Vaccinations are being rolled out nationwide, but it could still be months before they become widespread. Until then, four hospitals run by Los Angeles county are weighing what to do if they cannot treat everyone because of a shortage of beds or staffers.

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.

Plans for rationing care are not in place yet, but they need to be established because “the worst is yet to come,” said Los Angeles county’s health services director, Dr Christina Ghaly.

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.“

Across the state, 62 patients were being treated at “alternative care” temporary field hospitals, the governor, Gavin Newsom, said at a virtual press conference on Monday. With ICU at or past capacity, at least in southern California and in the San Joaquin Valley region, shelter-in-place orders, which are set to expire at the end of the month, are likely to be extended, he noted.

To address hospital staffing shortages, Newsom urged recently retired medical workers to consider joining the effort to battle the latest coronavirus surge.

The governor was addressing his constituents from his home, where he is quarantining after being exposed to a staff member who tested positive for the virus.

As the death rate continued to climb rapidly, Newsom conveyed sympathy for lives lost “during the holiday period when families are being torn asunder”. There was some light, however, as hundreds of thousands of the vaccine developed by Moderna arrived in the state.

Many hospitals are already executing emergency plans to stretch the resources they have. At Corona regional medical center, south-east of Los Angeles, an old emergency room has been converted to help handle nearly double the usual number of ICU patients. The hospital has also been using space in two disaster tents to triage ER patients because the emergency room is filled with patients.

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.

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.


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