Los Angeles hospitals take drastic steps to grapple with Covid-19 crisis

California health officials are resorting to drastic measures to reduce the crippling strain on its hospitals, as the surge in coronavirus hospitalisations illustrates the high costs of the state’s failure to flatten the pandemic’s curve.

At Christmas, public health officials had pleaded with Californians not to gather — with family, friends or strangers — in a desperate attempt to fend off an oncoming increase in cases. New restrictions were imposed on much of the state last month in an effort to keep a lid on the upward trajectory.

The crisis, however, has not been averted: hospitalisations in the state have increased 17 per cent in the past two weeks, the health department said, with intensive care unit (ICU) usage up 21 per cent as capacity dwindles.

“The anticipated surge from the winter holiday gatherings has begun,” said Dr Barbara Ferrer, Los Angeles county public health director, during a press conference. “We’re likely to experience the worst conditions in January that we’ve faced the entire pandemic. And that’s hard to imagine.”

California, the most populous US state, has been hammered by the sustained surge in Covid-19 infections and hospitalisations sweeping across the country. The US has registered more than 20m infections and nearly 350,000 deaths, while hospitalisations are hovering at a record high — 131,195, according to data from the Covid Tracking Project.

California’s health department on Tuesday attributed a further 368 deaths to coronavirus, among the biggest one-day increases in the state’s death toll, and 31,440 new infections. 

In Los Angeles county, which has 10m residents, officials have taken drastic steps to grapple with the massive strain.

A January 4 memo from county officials told paramedic agencies to no longer bring to hospital patients who had an extremely slim chance of survival. For example, under the guidelines, a person severely injured in a car accident, and who cannot be resuscitated after at least 10 minutes, should not be taken in.

“Hopefully this serves as a wake-up call,” said Dr Marc Eckstein, medical director and commander of the Los Angeles Fire Department’s ambulance service. “We’re approaching the peak in the next few weeks, I suspect.”

He said ambulance operators had seen hours-long waits to get critically ill patients — of any nature — into hospitals, where emergency beds and holding pens had been set up in almost any conceivable space, including parking lots.

“It doesn’t matter who they are, or their level of insurance, or whether they’re there for a heart attack or a gunshot wound or Covid — there’s no resources,” said Dr Eckstein, stressing that with ambulances kept waiting at hospitals, response time for all emergencies was increasing.

“We were very low on ambulances today,” he said on Tuesday. “We moved firefighters from fire engines and trucks to back-up reserve ambulances.”

Of his 3,500-strong team, 170 were currently suffering from Covid-19, Dr Eckstein said, including three who were “fighting for their lives”.

Patients in the hallway of an emergency room at the Providence St Mary Medical Center © Getty Images
Patients wait outside the emergency room at the Los Angeles County+USC Medical Center © ETIENNE LAURENT/EPA-EFE/Shutterstock

State officials on Tuesday evening ordered hospitals, in areas where there is no ICU availability, to start delaying some surgeries and procedures — transferring those patients to lesser-affected regions in order to free up capacity. “Serious cancer removal and necessary heart surgeries” could still take place, officials said.

“This order helps ensure that patients continue to receive appropriate medical services by better distributing available resources across the state to prevent overwhelming specific hospitals, counties and regions,” said Dr Tomás Aragón, director of California’s department for public health.

Averaged over the past two weeks, the state is recording 38,000 positive cases per day, with almost 300 deaths. According to state-provided demographic analysis, Latinos have been disproportionately represented among the dead, accounting for almost half.

The large number of sick has also created an oxygen shortage. In a separate directive to ambulance operators, paramedics were told to strictly ration any supplemental oxygen given to patients, with exceptions made only for patients in “severe respiratory distress”.

Within hospitals, ageing pipes has made delivering sufficient oxygen to so many patients at once difficult, according to Dr Christina Ghaly of LA County’s health department.

Members of the US Army Corps of Engineers had been deployed at seven hospitals — in LA county and neighbouring San Bernardino — to upgrade oxygen systems and “bring in additional oxygen trucks”.

“We’re trying to assess how we can reduce the strain on their facilities and mechanical spaces,” Colonel Julie Balten of the Corps told reporters.

That effort was part of a broad “oxygen task force” set up by the state that would work on sourcing more portable units, California governor Gavin Newsom said at a press conference,

With hospitals under intense pressure, the state has also faced criticism for being too slow to roll out vaccines.

So far, while 1.6m doses of the Moderna vaccine had been distributed to healthcare facilities across California, just 459,564 had been administered, according to the most recent figures.

“We want to see 100 per cent of what’s received immediately administered in people’s arms, and so that’s a challenge,” Mr Newsom said. “It’s a challenge across this country. It’s a challenge, for that matter, around the rest of the world. But that’s not an excuse.”

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