LOS ANGELES – Increasingly desperate California hospitals are being “crushed” by soaring coronavirus infections, with one Los Angeles emergency doctor predicting Friday that rationing of care is imminent.
The most populous state recorded more than 41,000 new confirmed cases and 300 deaths, both among the highest single-day totals during the pandemic. In the last week, California has reported more than a quarter-million cases and 1,500 deaths.
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“I’m not going to sugarcoat this. We are getting crushed," said Dr. Brad Spellberg, chief medical officer at Los Angeles County-USC Medical Center, which has more than 600 beds and is one of the largest in the county.
It's a scene playing out across California. According to state data Friday, all of Southern California and the 12-county San Joaquin Valley to the north had exhausted their regular intensive care unit capacity and some hospitals have begun using “surge" space.
Statewide, the available ICU capacity on Friday was a miniscule 2.1%.
Dr. Anthony Fauci, the country’s top infectious-disease expert, discussed California's predicament during an event organized by the California State University system.
He warned that unless people curtail their holiday travels and gatherings, “it is very likely we’re going to get what I call a surge upon a surge” that is particularly dangerous “in the state of California, which is just right at that cusp of getting overrun in some areas of the state.”
Many emergency rooms already have been using outdoor tents to make more space, said Dr. Marc Futernick, an emergency room physician in Los Angeles who is on the board of the California chapter of the American College of Emergency Physicians. One hospital that has maxed out its outdoor overflow tent is expanding into a nearby gym, he said.
Yet coronavirus cases have not reached their peak in this third and most devastating wave, and that means more drastic measures are on the horizon. Statewide, about 16,000 coronavirus victims are hospitalized — more than double the previous peak reached in July — and a state model that uses current data to forecast future trends shows the number could reach an unfathomable 75,000 by mid-January.
“Even though it is true that I don’t think anyone is doing this kind of rationing of care, or feeling truly overwhelmed in this exact moment, there’s no doubt it is right around the corner,” Futernick said. “There’s no feasible way for this to be avoided. The numbers are too big.”
Corona Regional Medical Center southeast of Los Angeles has converted an old emergency room to help handle nearly double the usual number of ICU patients. It's using space in two disaster tents to triage ER patients because the emergency room is filled with patients who need to be hospitalized. Ambulances can sit for two hours unless they are bringing in patients with critical, life-or-death emergencies.
“There’s no room at the inn, so to speak,” hospital chief executive Mark Uffer said. “Literally every nook and cranny of the hospital is being used.”
He and Spellberg said it only feeds health workers’ angst when they see people not following state-mandated safety precautions to slow the virus' spread when disaster seems imminent.
“Whatever’s coming, I don’t think any of us are going to be able to manage it,” Uffer said. “You have a dam that’s about to break, and you’ve got to stop putting water into the dam.”
Spellberg said that every day for the last week at his hospital has begun with no available intensive care beds and a scramble to find room in spaces that don't usually handle critical patients, like post-surgery recovery areas.
Los Angeles County Health Services Director Dr. Christina Ghaly said hospitals “are adding three beds to a room that maybe was a double room, or turning a single room into a double room,” dangerously stretching staff.
John Chapman, president and chief executive at San Antonio Regional Hospital in Upland, said telemetry nurses who monitor vital signs of patients should be overseeing no more than four people but could wind up taking on five or six because of the crush of cases.
“It definitely increases the risk of something going wrong," he said.
Nearly all of California is under a new health order that includes an overnight curfew for all but essential workers and errands, and shutters or restricts operations in virtually all businesses. Newsom and health officials have implored people to stay home and wear masks and socially distance whenever around others outside their household.
“We are battling our way through the peak of this third wave,” Newsom said in a 14-minute video posted on his Facebook page Friday. He said the state expects to receive 672,000 doses of the Moderna vaccine as early as next week, on top of 233,000 doses of Pfizer vaccine.
“We need the public to listen to these mitigation strategies to slow the spread or we will completely run out of beds,” Spellberg said.
Meanwhile, emergency rooms are filling up with patients who should be hospitalized but can’t be because there’s no space. Ambulance providers are planning for how to handle the rising caseload and may have to start triaging patients in the field rather than bringing them in except in the most critical cases, Futernick said.
“I am fearful it will be worse than what we saw in New York,” he said. “When New York’s hospitals became overwhelmed, health care providers poured in from around the country.”
“None of that is happening right now, and there’s no way for it to happen because every place is busy," Futernick said. “There’s no cavalry coming.”
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Taxin reported from Orange County. Associated Press writers Adam Beam and Don Thompson contributed from Sacramento.