L.A. County Issues Most Dire Coronavirus Warnings Yet: Hospitals In Crisis as Death Toll Surges Toward 10,000https://www.latimes.com/california/story/2020-12-28/hospitals-postpone-surgeries-warn-of-rationed-care-amid-covid-19?_amp=trueAccording to the latest state data, there are 7,181 COVID-19 patients hospitalized in L.A. County; 1,449 of them are in intensive care units. Both figures are the highest seen at any point in the pandemic.
Ghaly said Monday that approximately 50% of the county’s currently staffed beds, and just over two-thirds of staffed ICU beds, are filled by COVID-19 patients.
Among the four county-operated hospitals, a stunning 86% of ICU patients have COVID-19, Ghaly said. The majority of nonessential surgeries and procedures in those facilities have been postponed, and officials are working to discharge patients to skilled nursing facilities, outpatient dialysis sites and other locations.
Virtually all hospitals in L.A. County are being forced to divert ambulances with certain types of patients elsewhere because they are too crowded. On Sunday, 94% of the county’s hospitals that take in patients from 911 calls were diverting some patients in ambulances.
There are situations in which 10 ambulances are waiting to offload patients at emergency rooms, forcing patients to be treated in the vehicles for as long as eight hours.
Hospitals are also having problems getting oxygen to critically ill COVID-19 patients who are struggling to breathe. Such problems on Sunday caused at least five hospitals in L.A. County to declare an internal disaster, which closes them to all ambulance traffic.The problem, Ghaly said, is a shortage of the oxygen canisters needed so patients can return home while receiving treatment, as well as the breakdown of aging hospital pipes that are buckling under huge demand.
At Los Angeles County-USC Medical Center, the situation reached “massive crisis” mode Sunday evening, according to chief medical officer Dr. Brad Spellberg.
There was not one available bed for at least 30 patients who needed intensive or intermediate levels of care, Spellberg said, and the hospital had to shut
Patients, including some who were very sick and required intensive oxygen, experienced wait times as long as 18 hours.Conditions at the hospital — one of the largest trauma centers in the western U.S. — have been steadily worsening since Thanksgiving, with an average of 10 new COVID-19 patients arriving each day.
And the expected “Christmas bump” hasn’t even begun.“When you walk into the ICU, and you see every bed occupied by a ventilated COVID patient, with tubes coming in all orifices of their body, you begin to understand that we are not dealing with what we were dealing with 10 months ago,” Spellberg said.
Should the medical system be stretched too far, officials warn, there may not be sufficient staffing or resources to provide critical care to all who need it, which would significantly increase the mortality rate.
“The sad reality is that all indicators tell us that our situation may only get worse as we begin 2021,” said L.A. County Public Health Director Barbara Ferrer. “The rate of community transmission remains extraordinarily high, and this has taxed our hospital system, as more COVID-19 patients continue to stream in, on top of the thousands of patients already fighting for their lives.”
-------------------------------------------
Huntington Hospital in Pasadena Warning of Grim Possibility of Rationing In an Information Sheet for Patients and Their Families.https://www.huntingtonhospital.org/our-services/emergency-trauma/hospital-preparedness-covid-19-information/care-during-a-public-health-emergency/...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 and will use the same decision criteria that is being used nationally and throughout California on all patient cases.”
“This unburdens bedside staff from making any decisions about triaging care when resources are scarce, and instead delegates those to a committee who will follow an ethical framework for decision-making,” hospital officials added in a statement Monday. “Importantly, no one person will make a caregiving decision, and the committee will be given no information about patient race, ethnicity, religion, citizenship, insurance or any other information unrelated to the patient’s health. ...
-----------------------------------------
... In Southern California, Kaiser is not scheduling any new elective surgeries through the end of January.
“We are facing an unprecedented surge of patients with COVID-19, and the number of available ICU beds continues to dwindle,” Kaiser officials said in a statement Monday.
“Last week, 52% of our hospitalized patients in Southern California were being treated for COVID-19. Today, that number has soared to 82%.”Given the sheer number of patients, Kaiser is “converting and using every available space possible, including former conference rooms, waiting rooms, recovery areas and other nontraditional areas in the hospital.”
... As of Sunday, the most recent day for which complete data are available, there were 19,766 COVID-19 patients hospitalized statewide — an all-time high, and 45% more than two weeks ago. Of those patients, 4,228 were in intensive care, also a record.
There’s real fear that a post-holiday “surge on top of a surge” could be too much for overworked hospital staff.
“It is a very, very different and infinitely more dangerous situation to have hospitals experiencing a surge when the staff are exhausted, they’re stretched thin, and they’re already caring for more patients than they can safely handle,” Christina Ghaly said.
-----------------------------------------
San Diego Hospital Morgues Overflow as Coronavirus Surge Increaseshttps://www.latimes.com/california/story/2020-12-28/hospital-morgues-overfilling-as-hospitalization-surge-increasesSan Diego County’s healthcare system reached a stark milestone over the weekend as dwindling hospital morgue capacity forced the county medical examiner to begin storing the deceased.
A medical examiner transport vehicle removed five bodies from Sharp Grossmont Hospital in La Mesa over the weekend, officials confirmed in an email, after the facility’s morgue filled past capacity.
Dr. Steven Campman, San Diego County’s interim medical examiner, said in an email Monday that four hospitals have notified his office recently that their morgues were near capacity. The situation has unfolded as San Diego County experiences its most significant surge in COVID-19 deaths to date.
“They were ultimately able to handle the situation after contacting local funeral homes,” Campman said. Sunday “was the first day a hospital exceeded its capability, so the facility management plan has been put into use, and the county is storing some of the decedents from that hospital.”
... “They don’t want to put the [refrigerated] trucks all over the place, but they will help us if it gets to that point,” she said.
It was about two weeks ago, said Dr. Ghazala Sharieff, chief medical officer of clinical excellence and experience at Scripps Health, that one of the system’s hospitals faced a similar situation with all morgue storage full. As Campman indicated, the situation was resolved through calls to mortuaries, which were able to provide temporary storage, Sharieff said.
... As of Monday, COVID-19 patients occupied 393 of 617 ICU beds. The ICU bed capacity in the county is 743, though that number does not reflect the number of beds for which staffing was immediately available. Over the past two weeks, the remaining number of staffed adult ICU beds has been estimated at fewer than 40. COVID-19 patients have outnumbered patients without the disease in ICU beds since Dec. 15.
Sharieff said Scripps, like its healthcare colleagues, is preparing for the moment when treatment capacity becomes so overwhelmed that the system shifts into “crisis care” mode. At that point, she said, Scripps and all other acute-care hospitals will begin following state-specified triage guidelines, which provide a framework to help specially designated “triage teams” decide who should get ICU beds and mechanical ventilators and who should go without.
Teams will also be asked to decide who should be removed from critical care resources if they are not progressing under intensive care.Hospitals received a special letter from the state Monday evening directing them to notify their public agencies the moment they shift into crisis mode.
https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/AFL-20-91.aspx