This winter, hospitals throughout Southern California are on watch: the Omicron variant of the enduring coronavirus outbreak, combined with an influx of Delta and “traditional” flu cases, could culminate in a worst-case scenario for regional hospitals if preventative measures are not taken, officials warn.

The region’s medical leaders doctors and care squads have learned much from nearly two years of pandemic and they believe they are ready for the new wave of cases. But they also worry about they staff members they lost in recent months — and the team members they fear they will lose — as stress, workload and burnout take their toll on front-line healthcare workers.

On Dec. 22, Los Angeles County Public Health director Barbara Ferrer reported 6,509 new cases of COVID-19 across L.A. County — more than double the reported cases from the previous day.

“This steep increase, one of the steepest rises we’ve ever seen over the course of the pandemic, reflects the increased circulation of Omicron,” Ferrer said. “These numbers make it crystal clear that we’re heading into a very challenging time over the holiday.”

Omicron isn’t the only concern: Hospitals have to be prepared, in addition, for a potential influx of Delta variant and “traditional” flu cases, the latter of which tend to peak during the winter months.

Peter Chung, a medical doctor at UrgentMED in Downtown L.A., said breakthrough cases could be a problem moving forward.

“I’m seeing patients who are fully vaccinated with booster shots getting breakthrough infections and also patients who are recently infected with the Delta variant getting breakthrough infections with the new variant,” he said. “That’s the main concern.”

For public health officials and medical professionals, this moment feels like déjà vu — and despite being armed with vaccines, masks, and social distancing — some have resounding concerns that hospitals will once again be caught flat-footed by an oncoming surge.

“It’s in the forefront of everybody’s minds,” said Dr. Bernard Klein, chief executive of Providence Holy Cross Medical Center in Mission Hills. “We’re definitely seeing a significant increase.” The question: “How bad is it going to be?”

The virus is spreading, even amongst the vaccinated 

Omicron’s spread is concerning, says the Centers for Disease Control and Prevention, who recently announced that the variant is responsible for an estimated 73% of new reported cases in the United States — a six-fold increase of Omicron infections in just one week.

News on the #OmicronVariant: National genomic surveillance estimates Omicron accounts for around 73% of #COVID19 cases. This sharp rise is similar to what has been seen in other countries. CDC continues to closely monitor Omicron & respond to this surge. https://t.co/JcBaMq47bt pic.twitter.com/QEDinY23Uc

— Rochelle Walensky, MD, MPH (@CDCDirector) December 21, 2021

It’s more contagious than its second-wave COVID predecessor, Delta, and is able to infect those who’ve developed immunity — either by way of previous infection, or vaccination — although officials note that those who have received vaccinations and boosters are more protected than those who have not.

The severity of infection caused by Omicron, though, is still unclear.

The CDC says that even if the variant’s infections turn out to be mostly mild, the sheer amount of people that could be infected in a short period of time could put a significant burden on the healthcare system.

“Very high case numbers can easily cause significant stress to our healthcare system, if even a small percent of those infected experience and require hospital care,” Ferrer said. “Stress on our hospitals places all of us in a terrible position, since care can end up compromised” for non-COVID related care, including injuries, heart attacks, and cancer.

Klein, who has seen the COVID-patient population at Holy Cross triple in the past three weeks, said he thinks “it is alarming how quickly the numbers are going up and how contagious Omicron is, even to those who have been vaccinated.”

A key advantage today, compared to last winter, is that so many in the county have been vaccinated. But despite the protection vaccines and boosters offer against severe illness and death, Omicron’s breakthrough transmission rates are a cause for concern, according to health officials.

Over the past week, Dr. Thomas Yadegar, ICU medical director at Providence Cedars-Sinai Tarzana Medical Center said, “we’ve seen a significant increase in calls from outpatients who tested positive.

Although Yadegar’s staff has been dealing with a series of COVID-19 waves, he expected new challenges this year due to dealing with not just one, but two highly-contagious variants.

“The fact that these two variants are so much more transmissible, we’re still going to have a significant amount of patients who are going to need care in the hospital,” he said. “If you haven’t gotten your vaccine, both Delta and Omicron are going to find you.”

In Torrance, Dr. Brad Balridge, director of the Emergency Department for Providence Little Company of Mary, said the pandemic has been a long learning curve as the medical and scientific community tried to determine how best to respond.

“This disease is very difficult because we haven’t seen something like this before and we didn’t have the infrastructure in place,” Baldridge said. “We’ve fumbled in a variety of ways, which is to be expected if you take the long view. Advice has changed, but we really didn’t know anything about this virus.”

Along with opening new overflow treatment areas, the hospital has a surge plan in place that was implemented last time, along with a command center with daily meetings on staffing and bed availability.

“We are vigilant at this point and I think it’s understood this may get worse before it gets better,” he said.

In the South L.A. area, however,  hospital officials are confident that vaccines will prevent hospitals from being overwhelmed like they were last year.

“With so many members of our community now vaccinated, patient volumes are very unlikely to reach the crisis level experienced during last winter’s surge,” said Jennifer Bayer, the communications manager for Lakewood Hospital and Los Alamitos Hospital. “We can safely and appropriately care for our patients.”

And in Long Beach, Dr. Graham Tse, the physician in charge of COVID-19 response at Long Beach Medical Center and Miller Children and Women’s Hospital, said he and his staff are monitoring the new rise in Omicron cases, but agrees this surge may not be as bad as last winter’s.

“We have the experience and guidelines in our practices engrained to handle COVID patients,” he said in a Wednesday phone interview.

Even if cases do spike, he said he believes his hospitals will be prepared to handle a sudden influx of new COVID-19 patients.

“We anticipate some increase in cases, though most of us feel it is not likely to reach the levels of last December and January,” he said. “We are optimistic and prepared to handle whatever comes our way.”

LaVasha Floyd, an assistant hospital administrator at Harbor-UCLA Medical center — an integrated health care system consisting of four flagship hospitals and over 26 clinics in L.A. County — said medical professionals are doing everything they can to prepare for a possible surge.

“The reality is we can’t afford a repeat of last year’s surge,” wrote Floyd in an email Wednesday. “Past surges in COVID-19 hospitalizations have provided us with the opportunity to quickly develop and activate protocols to help increase beds available across all our hospitals and the staffing necessary to provide care to all who may need it.”

Floyd added: ““There is no reason why we need to revisit what we experienced last year. The best way to support our doctors and nurses is for everyone to get a vaccine if they haven’t already, to get a booster shot, and follow masking regulations so we can mitigate a possible winter surge.”

Staffing concerns and burnout 

Several hospital officials, in interviews Wednesday, said staffing shortages and worker burnout could play a key role in shaping the response to the surge.

“Our staff is exhausted,” said Holy Cross Executive Director of Critical Care Elizabeth Chow. “Some left after our big COVID surge. Some were burned out.”

While officials at Holy Cross say they’ve done better than many in retaining staff, COVID-19 has taken its toll on its hospital staff throughout the region.

In a recent survey obtained by this newspaper, SEIU 121RN, a union representing 9,000 nurses and licensed medical professionals in California, found that 72% of registered nurses and medical professionals polled in L.A., Riverside and Ventura County, say that burnout is a “very serious” problem.

It also found that nearly 70% have seriously considered leaving the profession in the past year, much in part because of the pandemic’s toll.

Dr. Nancy E. Gin, regional medical director of Quality for Kaiser Permanente — which serves 4.8 million members and operates 15 hospitals throughout Southern California — said staffing is a concern going forward.

“What’s different about this year is facing this challenge of staffing,” Gin said, referring to the “great resignation” trend that has seen many leave the workplace during the pandemic. “It’s a very real challenge.”

And, she said, staff has had a very hard two years already.

“Staff is really tired, they really are,” she said. “In the fall it looked a little more hopeful that with good vaccines we might have a better winter (than 2020-21). But then Omicron came to town.”

For now, she said, Kaiser facilities are doing “OK” and have the necessary staff. Still, Gin said, Kaiser could be challenged should there be another surge in California.

Currently, the hospital is at about 85% capacity and contingency plans are always in place, Gin said. “We’ve learned a lot from last year and how to (create more wards) very quickly.”

Yadegar says he’s seen the impacts of worker burnout first hand.

“After 18 months of fighting with this virus, a lot of healthcare providers and healthcare staff are exhausted,” he said. “We’ve had quite a bit of turnaround in our nursing staff as well as physicians. And these are people with years and decades of experience dealing in critical care units and they can’t be replaced.”

He added that it’s been hard to replace physicians, nurses and respiratory therapists who decided to change their careers or transferred from intensive-care units to other areas of the hospital due to burnout and exhaustion.

“Everyone is tired of going, ‘Oh man, an increase in cases,’” Tse added, saying that his hospitals have mental health programs to help staff cope, including in-person counseling, online support and group sessions.

Chow, Holy Cross’ executive nurse, reflected on an exhausted staff, who so often over the last two years served as the last point of contact for patients dying of Covid, holding up iPads so families could say their last goodbyes or holding their hands in the final moments.

“My only plea to the public is…please get vaccinated,” Chow said. “Please be careful in social gatherings. Your healthcare workers really can’t take the additional load. We want to take care of people who are sick. But we also want to go home to our own families.”

Looking forward

Ferrer said fully-vaccinated and boosted individuals, in small groups, should feel safe enough to enjoy their holiday celebrations. But, she added, vigilance is required — stay home if you’re sick, get tested often, and wear a mask when necessary.

Like many in the medical field, Gin said vaccination and booster rates need to increase.

And beyond that, she said, there “will always” be another variant.

“That’s what viruses do,” Gin said, “they are designed to survive and they will continue to find ways to change and evade (immunity). Our goal is to try to keep one step ahead of that.”