Intensive care units in Southern California and the Central Valley are at risk near full capacity on Tuesday, with officials turning to increasingly desperate measures to stop the state’s coronavirus from killing more and more patients.
Hospital admissions continue at an unprecedented level, and officers have limited options to increase capacity. Tools include: canceling scheduled surgeries; Keeping critically ill patients in the emergency room; Previously sending ICU patients to step-down units; Training nurses from elsewhere in hospitals to help with intensive care; And ICU nurses can treat by increasing the number of patients.
There are 1.65 million coronavirus cases in California and more than 21,400 Covid-19 deaths have been reported. The state has far fewer cases and mortality per capita than other states, but the increase in epidemic fatigue and Thanksgiving-related infections has resulted in the worst wave of epidemics.
Ambulances wait six hours in hospitals
In Los Angeles County, emergency rooms are so crowded that some ambulances are forced to wait up to six hours for a load of patients, said Kathy Chidestar, director of the Los Angeles County Emergency Medical Services Agency. Some patients arriving by ambulance are asked to sit in the lobby of the emergency department so that the ambulance can depart.
California, but also in places like Costa Mesa, Porterville, Sacramento and Imperial, is opening up field hospitals to care for patients other than ICUs, looking for more medical personnel from foreign countries, perhaps farther than Australia; Other facilities are on standby status in Riverside, Richmond, Fresno, San Diego and San Francisco.
Officials around the state said hospitals were sinking into a state of emergency, but there has not yet been a widespread tremendous incident.
Santa Clara County Health Officer Dr. “Our healthcare system has expanded quite a bit: not yet at a breaking point, but definitely moving to that point,” said Sarah Cody, a Santa Clara County Health Officer. Sara Cody said
Some regions, including Los Angeles County, have the capacity for physical beds, but they are running much less than the staff needed to care for patients.
Limit to increase the capacity of the hospital
But there are limits to how many hospitals can be expanded. They can expand like a water balloon to meet a certain level of demand, said Dr. Ahmed Kamal, director of health preparedness in Santa Clara County. But they have already expanded a great deal, and yet “more and more stress is being put on these hospitals.
“And like a water balloon, when it explodes, it’s not subtle.”
On Tuesday, the California Department of Public Health said the available ICU capacity in Southern California is only 1.7%, down from 2.7% a day earlier. The situation was particularly dire in Riverside County, where ICU availability was at zero until Tuesday. The available ICU capacity in the San Joaquin Valley was also effectively increased and has been fluctuating between zero and 1.6% since Saturday.
Some counties have asked the state for help with additional staff, but not enough staff available for the overwhelming demand. “They’re not able to fill in all the requests we’ve received,” said Shane Richards, a spokesman for Riverside County’s emergency management department.
“The situation is obviously deteriorating,” Richard said. “It doesn’t matter if you stay politically. It’s quite undeniable that when people start gathering and gathering on holidays, and after that, we see a similar bump in the number of cases.”
‘We Have Very Dark Days’
The state’s supply of nurses has been focused on skilled nursing facilities for good reason, Kamal said, but those hospitals leave it to their own when it comes to all staff beds.
Staff shortages can simply mean that tired doctors, nurses and respiratory therapists just work harder, risking errors and poor care, given that they are 10 months ahead of the epidemic.
“We have a very dark day,” Condy said Tuesday in a tearful comment to the Santa Clara County Board of Supervisors. “We’ve been in this epidemic for a very, very long distance, really in the worst place.”
The nightmare is that the capacity of the ICU has increased so much that instead of two or three patients assigned to each ICU nurse, they are forced to focus on seven patients – a kind of overwhelming workload that increases mortality for not just Covid-19. Patients may also have other seriously ill patients. Hospitals around the world have become overcrowded during epidemics such as New York City and northern Italy, where the death toll was severe.
A big challenge is that covid is growing in so many places that there are fewer places to help officers.
“The problem right now is that obviously, it’s an epidemic – so it’s everywhere,” said Chidster of the Los Angeles County Emergency Medical Services Agency.
Expect to get worse before the epidemic improves
“All hospitals are affected. And not just in LA County, but all the hospitals in California. And then not just in California, but you can’t send anyone to Arizona, “Chidaster said. “If there was an earthquake, you would have hospitals 20 miles away that weren’t affected, and you could send patients to those hospitals.”
Hospitals are launching strategies that typically include nurses working in the emergency room or step-down units where critically ill patients return to the ICU after undergoing some training. Licensed professional nurses and certified nursing assistants will then play a larger role elsewhere.
Chidaster still urges people who need to come to the room urgently to do so; Anyone with a heart attack needs to call 911.
L.A. The county has condemned Kovid-19 patients so much that during the Sunday period, some of the 81% of patients received from 911 calls were forced to relocate to some of the hospitals they received, said Dr. Christina Galli, LA County Director of Health Services. .
More than 4,600 people have been hospitalized in COVID-19 in LA County, and officials said that number could rise to 5,000 by the end of the week.
“We need to convince ourselves that this [hospital] The number of cases has not yet reached its peak and will continue to grow, ”Gali said.
As more people become infected during the Thanksgiving holiday, state medical officials expect the situation to worsen before it improves. It is hoped that the stay-and-order in the state will eventually turn into a recruitment drive, but it is expected to pick up before the daily coronavirus cases begin to rise or fall easily by Christmas or New Year.
Critical testing for hospitals in two weeks
California Health and Human Services Secretary Dr. “We’re concerned about our ability to provide the same level of high-quality care,” said Mark Galli. “It’s two weeks from now that we’re really preparing.”
Government Gavin News said the state was to order an additional 5,000,000 body bags, and urged residents to take the virus seriously and stay home as long as possible. “We are not on the finish line yet,” he said. “So please, please, please be mindful.”
Fresno County Interim Public Health Dr. Fischer Dr. Ra. Raees Vohra said on Tuesday that he expects a clumsy set of weeks before and after the new year, given only the trends we are seeing. Unfortunately, we’ve just got a lot of infections and a lot of ongoing infections [and] We are still very hard pressed to meet that challenge. “
Fresno County has about 1 million people, but on Monday there were only 16 available ICU beds. Some of the largest hospitals in the region have zero available ICU beds and one has been forced to keep five ICU patients in the emergency department.
Vora said staff shortages in Fresno County already feel like New York City faces the same in the spring. He said
It makes perfect sense that Fresno County would need to use more alternative care sites and tents if “if we’re running people out of places in the hospital and we just need to make room.”
In addition to alternative care in Porterville, which opens Monday, another staffed 50-bed care site is opening this week, next to the Community Regional Medical Center in Fresno. It can take patients in place, freeing up space in step-down units where critically ill patients recover, which in turn frees up space in the ICU.
‘People are dying who don’t need to die’
Deteriorating conditions in hospitals and doctors contribute to concerns about long-term care by cutters, nurses and others.
U.C. The head of the San Francisco Department of Epidemiology and Biostatistics, Dr. “This creates the same situation that we are very concerned about for health care people,” said Kirsten Bibbins-Domingo. “The level of anxiety you hear from ER, from first-line healthcare providers, is completely different from March …. None of us ever want to be in a situation where the kind of care we provide is not there. The highest care. “
In Ventura County, Intensive care unit Capacity has dropped to 1% and officials are speaking out against parties, indoor church services and youth sports events which they say the crisis is getting worse. COVID-19 in the county has broken the record for at least 10 days of hospitalization.
The county health officer, Dr. “These numbers are becoming astronomical,” said Robert Levine. “People are dying who don’t need to die.”
Two weeks ago, about 80 football players gathered in a park in Simi Valley. “Sports tournaments are held in other counties involving players from Ley Lib Ball and Bezab., And people could not wear masks in those situations,” Levine said. Some church services are still being held indoors in violation of state regulations, with devotees sometimes sitting shoulder to shoulder.
Levin said there were reports of hundreds of people gathering to sing Christmas carols at the Oaks Mall in Thousand Oaks, many without masks. And he has heard of parties of about 200 people attending a drive-in concert – clearly planned to allow social distance – just to get out of their cars.
Singing is a very high risk activity and has been documented to spread coronavirus. A singing practice left Dozens of infections And two deaths in Washington state.
“What’s so understandable about this?” Said the frustrated Levin News conference. “None of these justifications are acceptable despite the epidemic. We all need to work together, in the same way we will fight a war.
Dr. Mark Lepore, an intensive care physician at Ventura County Medical Center, said he expects the county hospital to exceed its capacity, “and what appears to be more than capacity shows the hospital and does not or should not have a room.” A staff member to take care of you. “
He urged people not to gather for Christmas: “Just tell them you will see them next Christmas. This is important: We do not want your family members to get sick and lose care. ”
Lynn, report from San Francisco, money from Long Beach.
The story originally appeared in the Los Angeles Times.
