LA County officials warn surge upon surge could come next

The staggering rise in coronavirus cases, hospitalizations and deaths across Los Angeles County in recent weeks could be a prelude an even grimmer scenario, health officials warned on Monday, Dec. 21, with the next two weeks — marked by Christmas and then the new year — leading to a surge-upon-surge that could force hospitals to activate crisis planning.

That dire warning came the same day Gov. Gavin Newsom said the region will likely remain under stay-at-home orders beyond next week.

“As we approach the holidays, we really can’t afford to repeat the mistakes of Thanksgiving,” said Public Health Director Barbara Ferrer. “The extremely high numbers of cases, hospitalizations and deaths that we’re experiencing are from too many gatherings, too many people traveling and too many people letting down their guard.”

Daily new cases averaged more than 14,000 last week, so, Ferrer said, county hospitals should expect COVID-19 patients to soon reach 7,000 — and an estimated 110 people could die every day.

The county’s 83-acute care hospitals were caring for 5,866 as of Monday, based on a state dashboard that reports the census figures a day earlier than the county. Among them, 1,202 were in intensive-care units, nearly half the county’s total number of ICU licensed beds.

Based on the state dashboard, the county had 354 ICU beds available as of Monday, though the L.A. County Department of Health Services put the number at 30 as of Sunday. Either way, county officials said, hospitals were dangerously close to entering a crisis stage, where health care providers would need to make dire choices about who receives care and who doesn’t based on triage guidelines — similar to when confronted with a natural disaster scenario. Patients with lower chances of survival could be left to receive subpar care as nurses shift to save other lives.

Despite some ICU beds remaining available in LA County, the state considers the Southern California region’s adult ICU bed capacity to be 0%; adult ICU bed capacity is the metric used for the new regional stay-at-home order, with 11 counties comprising Southern California, including LA, Orange, Riverside and San Bernardino.

Newsom, who reportedly entered a 10-day mandatory quarantine after a staffer tested positive for the coronavirus, said during a midday briefing Monday that Southern California, as well as the neighboring San Joaquin region, would likely see the stay-at-home order extended, though he did not elaborate on how long.

Southern California is nearing the end of the initial three-week shutdown, set to end Monday, Dec. 28, that went into effect when its ICU bed capacity dipped below 15%, forcing multiple industries to either shutter or reduce their operations — including bans on in-person dining and hair salons.

California Health and Human Services Secretary Dr. Mark Ghaly said Monday the state would make the final judgement in the coming days whether to keep the two regions under stay-at-home orders, though he did not anticipate them being lifted.

Under the statewide rules, a region would remain under stay-at-home orders until its four-week projections show adult ICU bed capacity to be at least 15%.

But, Ghaly said, state officials would also use tools that consider transmission rates, average new cases, current ICU capacity and other factors.

“It’s not just about what is the ICU number in that region today,” Ghaly said. “It’s a lot about the various individual behaviors and decisions that have manifest in the case numbers.”

And each region has the ability to add about 20% ICU beds under surge planning, which was happening now in the form of alterations at individual hospitals as well as a small number of field hospitals in certain areas.

Hospitals were currently in the contingency stage, where they were exhausted and stretched thin but have not yet needed to activate the crisis stage, said Dr. Christina Ghaly, director of the county’s Department of Health Services. Several hospitals have received waivers, however, to increase nurse-to-patient ratios and staffing continued to be the primary issue. beyond physical bed space, Christina Ghaly said.

“There is not any situation I have seen,” she said, “where hospitals all across the board are affected the way they are right now.”

Making matters worse, more than 2,100 health care workers tested positive for the coronavirus last week, up from more than 1,400 each of the past previous weeks.

To bring home the point, the county’s Ghaly told the story of a family treated after a severe car crash at a DHS hospital. Despite being overwhelmed with COVID-19 patients, hospital staffers still found time to treat this family — because they had to. But she openly worried that the quality of care could soon be compromised if conditions continue at the current pace.

From Nov. 1 to Dec. 15, daily new cases by episode date increased 862% in L.A. County, to more than 14,000. Daily hospitalizations for COVID-19 over the same period grew 481%. And deaths increased 369% up to 61 deaths on average per day.

“Without efforts to stem the surge,” Ferrer said, “we can expect this tragic trajectory to keep climbing.”

Officials still urged people to use the emergency room for warranted emergencies, such as symptoms of heart attack and stroke, but at the same time, encouraged people to make especially sure they were experiencing something that couldn’t be handled elsewhere.

The county reported on Monday that an additional 56 people had died of coronavirus-related causes, bringing the death toll to 8,931 — and making December the deadliest month of the pandemic, surpassing July.  The county also reported 11,271 new cases, bringing, the total since the pandemic began to 634,849.

Long Beach, which has its own health department, saw the coronavirus surge continue there as well. That city on Monday reported that eight more residents have died from coronavirus-related causes, bringing the death toll to 319. Long Beach also reported 1,659 more coronavirus cases on Monday, contributing to yet another record new daily case rate of 117.1 cases per 100,000 people — up from 106.4 on Friday — and bringing the total since the pandemic began to 26,281.

Pasadena, which also has its own health department, reported another 109 new cases on Monday, bringing the total there is 5,728. The city reported no new deaths, keeping the total at 145.

Ferrer also warned people against gathering over the holidays, calling the logic that folks can take a coronavirus test in order to gather flawed and could lead to unnecessary infections.

“By the time you get a negative test result, you may no longer be negative,” Ferrer said. “If we don’t change now, we are going to experience a surge on top of a surge on top of a surge.”

Despite the severe numbers, the county was still facing pushback to its health officer orders, most notably when it came to outdoor dining. Ferrer acknowledged Monday that county inspectors faced harassment at various locations from restaurant owners — so much so that officials were looking at changing its safety guidelines for inspectors in the field.

“I am troubled this is still the conversation,” Ferrer said, “when our numbers are so horrific throughout the county.”

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