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ICU availability in Southern California at 0%, and it's going to get worse, officials warn

The LA Times logo The LA Times 12/18/2020 Luke Money, Rong-Gong Lin II, Soumya Karlamangla
a kitchen with a sink and a mirror: Michelle Goldson, RN works with a COVID-19 patient in the ICU at Martin Luther King, Jr. Community Hospital on Thursday. ICU availability in Southern California is at 0% amid a deluge of coronavirus patients. (Francine Orr/Los Angeles Times) © Provided by The LA Times Michelle Goldson, RN works with a COVID-19 patient in the ICU at Martin Luther King, Jr. Community Hospital on Thursday. ICU availability in Southern California is at 0% amid a deluge of coronavirus patients. (Francine Orr/Los Angeles Times)

The availability of intensive care unit beds throughout Southern California reached critical mass Thursday with 0% open, and officials warned that conditions in hospitals are expected to erode further COVID-19 continues to spread unchecked.

With ICU filled, hospitals will step up measures to ensure the sickest patients still get the highest levels of care possible during the crisis. That often means moving some patients who would typically be in intensive care to other areas of the hospital like the emergency room.

The can work to a point. But the more critically ill patients are denied ICU care, the greater the chances of them not getting the specialized care they need. And that can lead to increases in mortality.

Once ICU beds are full, hospitals go into surge mode, which can accommodate 20% over its usual capacity. Officials have been also training medical person from other parts of hospitals to allow them to work in ICUs and seeking nurses from outside the United States.

But new projections from Los Angeles County suggest that hospital ICU could blow past even those contingencies in the coming weeks.

There were nearly 1,000 people with COVID-19 in L.A. County’s intensive care units this week. Forecasts say that by early January, there could be between 1,600 to 3,600 COVID-19 patients in need of ICU beds if virus transmission trends remain the same.

There are only 2,500 licensed ICU beds in L.A. County.

“There are simply not enough trained staff to care for the volume of patients that are projected to come and need care,” Dr. Christina Ghaly, the county’s director of health services, said. “Our hospitals are under siege, and our model shows no end in sight.”

There are about 600 new patients with COVID-19 needing hospital admissions daily, and officials expect that that could rise to anywhere from 750 new COVID-19 patients a day to 1,350 a day by New Year’s Eve.

“If the numbers continue to increase the way they have, I am afraid that we may run out of capacity within our hospitals,” said Dr. Denise Whitfield, associate medical director with the L.A. County emergency medical services agency and an emergency room physician at Harbor-UCLA Medical Center near Torrance. “And the level of care that every resident in Los Angeles County deserves may be threatened just by the fact that we are overwhelmed.”

Though officials have noted that the number of available ICU beds changes constantly as new patients are admitted or stabilized, the number of unoccupied beds in California's most populous region has steadily eroded as hospitals have been flooded by unprecedented numbers of COVID-19 patients.

ICU availability throughout Southern California — which the state defines as Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties — had been a scant 0.5% Wednesday before falling further Thursday.

The San Joaquin Valley — which has hit 0% availability in its ICUs a few times in recent days, most recently Wednesday — saw that number tick up slightly Thursday, to a still-perilous 0.7%.

California is now opening temporary field hospitals to help with overflow patients. The field hospitals will care for non-ICU patients in places such as Costa Mesa, Porterville, Sacramento, Imperial and Orange County; other facilities are on standby status in Riverside, Richmond, Fresno, San Diego and San Francisco.

The number of people hospitalized in California for COVID-19 has broken records for 18 consecutive days. On Tuesday, the most recent data available, 14,939 people across the state were in hospitals with coronavirus infections — more than six times larger than the comparable number on Halloween.

Because of the lagging nature of the novel coronavirus, it can take two to three weeks for spikes in cases to trigger a corresponding increase in hospitalizations. When that happens, though, the consequences can be sudden and severe. State officials have previously estimated that 12% of newly diagnosed coronavirus cases are likely to require hospitalization, with 12% of those eventually ending up in the ICU.

That means, the most recent record-high hospitalizations do not account for the sky-high numbers of new infections, a chilling prospect for the state's stretched-thin hospitals and healthcare workers.

Hospitals in L.A. County are desperately trying to free up hospital beds by discharging recovering patients as quickly as possible, but there is only so much longer that hospitals can stretch their staff to meet the demand until the quality of patient care starts to worsen.

“Many hospitals have already broken nurse staffing ratios, and their staff are not necessarily getting either the breaks or rest that they’re supposed to be getting,” Ghaly said.

Whitfield said over the past weekend, Harbor-UCLA was still able to manage its COVID patients but overcrowding meant that some patients needed to stay in the emergency department when they should’ve been transferred elsewhere in the hospital.

“What that means is that when a patient needs to be admitted to the hospital, requiring either an ICU or an inpatient bed, that we just don’t have the staffing or the the actual bed space to to to care for them,” Whitfield said.

A backed-up emergency room then makes it harder for emergency physicians and nurses to take care of patients with other emergencies, including strokes, heart attacks and trauma.

Whitfield said she’s been an emergency room doctor for a decade, but the past weekend was the first time where she felt the overcrowding situation “has actually threatened that the the level of care that we can provide for our patients.”

“And so looking at ... how these numbers are increasing throughout the county, it’s really, really quite frightening to me,” Whitfield said.

The surge in coronavirus cases continues to reach record proportions. For the first time, a Los Angeles Times county-by-county tally found more than 50,000 new coronavirus cases and nearly 400 deaths in California reported in a single day. The Times survey Wednesday night found 51,724 new coronavirus cases reported in a day, shattering the state’s single-day record set on Monday, when 42,088 cases were reported.

The Times tally also found 393 COVID-19 deaths Wednesday across California, breaking the record set Tuesday, when 295 deaths were recorded. Cumulatively, California has now reported 1.7 million coronavirus cases and 21,887 COVID-19 deaths.

The state is now recording an average of 203 COVID-19 deaths a day over a weekly period, and 35,200 daily cases — both records, and both quadruple the numbers from mid-November.

San Francisco issued a travel order effective Friday requiring anyone visiting the city from outside the Bay Area to quarantine for 10 days.

The order takes effect at 12:01 a.m. Friday. Violating the order is a misdemeanor. Medical workers, first responders and essential workers are exempt.

San Francisco’s travel order follows one issued by Santa Clara County in late November, requiring people to quarantine for 14 days after returning from travel of more than 150 miles.

This story originally appeared in Los Angeles Times.

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