With intensive care units completed and hospitalized through the new year with large cost estimates, Southern California’s medical system faces the potential to not be able to provide critical medical care to everyone in need, which will significantly increase patients’ mortality. As they wait for help.
Already, hospitals are scrambling for equipment to continue, placing overflows of ICU patients in other parts of hospitals not designed for them, clearing critical care wards of surviving patients elsewhere and in some cases keeping patients in ambulances up to eight. Hours until space becomes available.
But as the growth of the Covid-1 surge shows signs of slowing, more ranching choices may be ahead, and there is little hope of an army of additional medical professionals arriving, which could greatly expand the availability of intensive care units by the end of the year. .
Many hospitals are preparing for the prospect of rationing care in the coming weeks as patient care exceeds their staff’s capacity to care. A document obtained by the Times, which shows how to allocate resources in an emergency situation, was recently circulated among doctors at four hospitals run by Los Angeles County.
Guidelines change mindsets that are unfamiliar to many medical providers.
Instead of making every effort to save the patient, their goal during an emergency is to rescue as many patients as possible, meaning that those who are less likely to survive will not receive as much care as they would otherwise. From now on, save cutters will not only go out all the stops to save lives but will also devise strategies to save as many people as possible from destruction.
“Some compromise of the care standard is inevitable; It is not that any entity, system or locale chooses to limit resources, it is that resources are not clearly available to provide regular care, ”the document reads.
The director of LA County Health Services, Dr. Christina Ghali said in an email that the guideline was not set until Friday night but that it needed to be developed as it increased and that “the bad is yet to come.”
“We have enough beds, supplies and equipment for now, but we do not have enough trained staff for the number of patients in need of care. “We have brought in new staff, re-trained and re-employed employees from other areas of the system, and requested additional resources from the state,” Gweli wrote. “But these measures are not expected enough to meet the ever-increasing number of patients present in the county for care.”
UC San Francisco Chair of the Department of Epidemiology and Biostatistics, Dr. Across the country, hospitalization with COVID-19 symptoms has become more difficult today than it was a few months ago, said Kirsten Bibins-Domingo.
The epidemic raises the possibility of a deadly C-2 previously seen in hard-hit areas in China, Italy and New York – hospitals are so crowded that people have to be very sick before they can be admitted, at which point, rescue may be delayed.
At the onset of the epidemic, some less critically ill patients in the hot zone were told to return home instead of being admitted to a more crowded hospital. Some people broke into the house and later died. If they had been admitted earlier, if the hospital had been less crowded, they would have been much more likely to have survived.
In Wuhan, China, a steel worker told the Times this year that his father was out of the ICU at the time he got the hospital bed, and no nurse was available. Her father died a week after she was admitted. In April, a physician in the emergency room in New York City told the Times that patients were advised to stay away from the hospital until the last minute, but then it would take three to four hours for the ambulance to arrive. At that point the patient’s condition may vaguely decrease.
“When hospitals start running out … we change our threshold for admitting someone to a side effect,” Bibins-Domingo said. “So maybe last month, we could say, ‘Wow, you’re not getting enough oxygen. Let’s get you to the hospital because we want to be more careful. ‘And when the full spittle is full, there are times when we can say,’ Well, why don’t we wait another day and how do you do it? ‘
Symptoms can worsen so quickly that when a person realizes they are seriously wrong, they may be late for help, or once they return, some sick patients may second-guess whether they should return to the hospital. .
“We want to operate a system in such a way that anyone who is sick who is in the hospital can find a place in the hospital, and if they are seriously ill, a bed can be found in the ICU,” said Dr. Robert Kim-Farley, Medical Epidemiologist and Infectious Diseases Specialist at UCLA Fielding School of Public Health.
A study published this summer in the JAMA Internal Medicine Journal found that patients admitted to hospitals with fewer ICU beds had a higher risk of death.
County Memo said the shortage is not likely to be due to equipment such as ventilators but rather highly trained personnel rather than respiratory therapists, ICU nurses and complex care physicians. The decision will be taken by the designated triage officer. For patients receiving a rare resource, they will be given two days to see if it helps, at which point they should be re-evaluated to determine if treatment should continue.
If the patient has not shown improvement or has worsened, the resource can be rearranged to someone else.
“Ethical support કે is that in a public health crisis when there are not enough critical care resources for all, the goal of maximizing population outcomes is jeopardized, allowing indefinite use of scarce resources if patients are unlikely to survive, the document states. Is.
Meanwhile, if the condition of the patients waiting for these resources deteriorates, they can move on to the queue and according to the guidelines, they are determined to be more needy. If there is a dispute the decisions will be taken by the trio officer and the potential facility chief executive.
The chief medical officer of LA County’s main public hospital warned that although the county has yet to face catastrophic consequences, it is “now moving toward becoming an epicenter of the epidemic” and that our hospitals will collapse if we do not stop the spread. ”
“If you have a heart attack, if you have a car accident, if you fall down a ladder, or if you have a stroke, we can’t keep a bed for you,” said LA County Chief Medical Officer Dr. Said Brad Spielberg. -USC Medical Center.
He added: “I’m not going to sugarcoat this: we’re crushing.”
The spring surge in New York flooded medical infrastructure and led to a large increase in deaths, as some people simply could not get the care they needed. Since then, the treatment of covid-1 of has progressed significantly, with new procedures that have reduced mortality and new drugs that have been helpful to sick patients. Hospitals have more supplies and have better techniques to increase oxygen levels in patients.
However, the increase in autumn has been worse than anyone imagined in California, as many Californians decided they were done with social distance and mask-wearing guidelines, and the request to cancel a large Thanksgiving gathering by officials was ignored.
If the people of California did not stop meeting with others, the implementation of house orders in most of the states would take place just before mid-Dec, December, the state could still avoid the fate of New York, according to some experts.
Dr. George R. Ford, an epidemiologist and infectious disease specialist at UC San Francisco, said that if the people of California complied with the order, there would be early signs of a reduction in new daily cases starting Monday and the following day. “I would say we have three more weeks of pressure on hospitals,” Rutherford said. “Hopefully, some vaccines can relieve some of the pressure from nursing homes.”
Rutherford said he doubted “people will do the right thing.” But anything is possible. “What will happen with Christmas? You see how trustworthy we are with Thanksgiving. ”
Los Angeles County Chief Medical Officer Dr. Jeffrey Gunznuzer said they were keeping a close eye on hospital admissions in the rapidly growing Seaweed-19. He said he is waiting for the point of inflation, the moment when the growth rate starts to pinch.
“We did not kill him. It’s still fast. The number of people going to hospitals is increasing exponentially every day. It’s not just getting bigger – it’s getting bigger, ”he said.
Gunzenhauser said that once the county hits the point of inflation, it will still be a while before it reaches the top. And once it reaches the top, there will be even more thousands of people who continue to be hospitalized as the numbers begin to dwindle.
LA County continues to know the single-day coronavirus case number in or near daily records. On Friday, an independent Times reported that LA County reported 15,749 coronavirus cases, the second-highest single-day on record; On Wednesday, 22,469 cases were reported. About 13,600 coronavirus cases a day were reported in LA County last week, more than three times the comparable figures on Thanksgiving.
On Friday, 87 deaths were reported in LA County, which is now the average one-day death toll in the past week, more than double the Thanksgiving figure.
As of 9 a.m. Friday, there were fewer than 70 ICU beds available in LA County, a point-in-time daily reported that actually fluctuates from one hour to one hour, a significant drop from about 100 at the start of the week.
Vigilance for further strengthening of additional medical personnel has so far been largely unanswered, as state officials have warned that no more medical personnel are available across the country to treat tsunami patients admitted to Covid-19 hospital.
California broke the record for most coronavirus cases in a single day on Friday, with a set high on Wednesday, while 52,330 cases were reported, according to the Times County-by-County Survey. The state has now recorded more than 1,000,000 new coronavirus cases in a single day in the last week, a new record, 10 times more than on Halloween.
The number of Californians hospitalized for COVD-19 has broken a record 20 consecutive days, rising to 16,019 by Thursday, including 3,447 people in intensive care units. The number of COVID-19 hospitals has increased sevenfold since the end of October.
The state recorded 265 COVID-19 deaths on Friday, its only fourth-largest number. California now has an average of 226 deaths, a new record and a five-fold figure since the beginning of November.
The LA County Public Hospital’s D-Cutter said this week that there are zero ICU beds left for patients, forcing the hospital to move to server mode. The hospital staff was also asked to postpone any leave for the next six weeks, the physician said. The doctor expects the death toll to double by January and the hospital to treat patients in a way in which one employee cares for several members.
“With the steady increase in cases and the sheer number of ways in which the curve shows no signs of slowing down, we’ve gotten worse,” said Dr. Cather. “We fear that California is moving towards New York spring conditions at this rate.”
A nurse at Kaiser Permanent Hospital in LA County said her facility runs out of bed quickly, as she and other staff work six days a week. Patients without conivirus-19 are being placed wherever possible to make room for a crush on coronavirus patients.
“We are expected to get the vaccine soon, but there is no word on exactly when it will come,” he said. “It’s very busy and stressful to change constantly day by day.”
Times staff writers Meredith Black, Luke Money and Alice Y. Sue contributed to this report.
