Though better braced after 2 years of pandemic experience, hospitals fear swift-spreading omicron wave
The highly contagious omicron variant drove the daily caseload to record levels during the holidays, and hospitals across Los Angeles County are braced for a post-holidays influx of patients.
With the pandemic entering its third year, the hospitals are dealing with burnout and fatigue among healthcare workers coupled with staff shortages as more frontline medical professionals get infected themselves.
Meanwhile, the demand for testing is intensifying countywide as people return to work and students return to campus — and officials find themselves stretched to keep pace. A common scene played out Monday, Jan. 3, as a line stretched for blocks at a testing site at the San Fernando Recreation Park. Similar sights are popping up at hospitals, schools and public testing clinics — and many complain that at-home testing kits are getting harder to find.
“We dread the surge and it’s anxiety-provoking,” said Elizabeth Chow, Holy Cross’ executive director of critical care services. “We know that we can handle it now because we’ve done it and we’ve learned so much. It’s just the horrible feeling: ‘oh no. We’re doing it again.’”
Even as the surge worsens, officials cling to fibers of hope, including the increasing number of people vaccinated, a deeper stockpile of protective gear than during last winter’s spike and evidence that omicron is not as virulent as its predecessors.
Over the weekend, Los Angeles County recorded nearly 45,000 new coronaries cases following local holiday gatherings and rekindled travel to long-delayed family reunions. On Monday — when case and fatality numbers are traditionally low due to reporting delays from the weekend — the county announced eight more COVID-related deaths and 16,269 new cases.
Hospitalizations, meanwhile, spiked sharply to 1,994 on Sunday — more than doubling the rate of 904 last week.
Research hints that the omicron variant may be milder than previous variants and causes less damage to the lungs, but officials warn the massive surge could nonetheless overwhelm hospitals and their spread-thin, weary response teams.
To mitigate the potential shortage of healthcare workers, the Centers for Disease Control and Prevention revised its guidelines, shortening the isolation time for healthcare personnel who tested positive for COVID-19, allowing them to return to work after seven days, instead of 10 days if they tested negative.
When the COVID-19 cases surged last year, Chow of Holy Cross said she often started her morning shifts in the ICU units, comforting her staff scrambling to save their patients’ lives, while witnessing people losing a parent or a spouse.
“This year we haven’t gotten there yet but everyone knowing that that’s a possibility to happen again, it makes everyone anxious about the future,” Chow said, adding that her staff was often acting as therapists and counselors in addition to their daily tasks as families were banned from visiting their sick relatives.
The main challenge this year, Chow said, is handling the real-life math problem of treating more patients with fewer staff members.
“So many of them are infected,” she said. “It’s just kind of a double punch.”
Most of the staff have been vaccinated but there were still breakthrough infections, she added. Several travel nurses were going to join her team this week and more were scheduled to join later this month.
“We are hoping that will give us enough to kind of hold on right through this surge,” she said. “We’re hoping it’s not going to be as bad as last year.”
Registered nurse Robin Gooding at Providence Holy Cross Medical Center in Mission Hills said “there is a nursing shortage right now — so that is a problem.”
But despite the shortages, she added, “there is no great fear that we had last year now that people are vaccinated and there’s much more knowledge about it and there’s a lot of PPEs for protection.”
Dr. Nicholas Testa, chief medical officer at Dignity Health Southern California Division, said what’s different this year was that the “healthcare workforce is really tired.”
“Everybody is just exhausted and has been dealing with COVID for now almost two years,” he said, “it’s very fatiguing and it really tires out our staff.”
While almost the entire staff has been vaccinated, he added, the number of infected medical personnel has jumped significantly over the last two weeks.
The Memorial Hospital of Gardena has seen an increase in COVID patients, a spokesperson from the hospital said, but luckily, during this surge, the majority of those folks were well enough to be discharged home to quarantine themselves.
Staff at the hospital screens all patients upon arrival outside in tents, separating people with COVID-19-like symptoms. Like at many hospitals, there are currently no visiting hours at Memorial and elective surgeries have been canceled.
Dr. Brad Baldridge, chair of the Emergency Department at Providence Little Company of Mary Medical Center in Torrance, said his frontline workers, while fatigued, are prepared to confront the surge.
Inpatient cases of the disease have risen from approximately 15 to 45 over the last couple of weeks, Baldridge said. What’s different about this round of COVID cases, Baldridge said, is the different symptoms they’re presenting — less pneumonia, more upper respiratory issues and gastrointestinal tract issues like vomiting and diarrhea.
“This same virus can present in different ways,” Baldridge said. “I think it’ll probably be the same constellation of symptoms for this round, and then we’ll see what comes next.”
Baldridge said that despite the rapid increase in cases, he’s confident the hospital is equipped to handle it — especially because patients are showing far fewer signs of severe illness.
In addition, Little Company’s administrative staff have been proactive about staffing, according to Baldridge. “They’ve done a very good job of acquiring more nurses so we can meet the challenge.”
There are other mitigation measures on the table: Baldridge said the hospital may consider reopening a rapid triage system, to ensure that patients are seen and managed in a timely manner.
Despite the hospital’s preparedness, though, Baldridge says there is still a sense of underlying burnout among frontline workers.
“In the emergency department every day is a little bit different —sometimes it seems really quite intense, other days not as much so,” Baldridge said. “So I think there is some sort of general fatigue about it, but when you’re on shift and sick patients come in, those sort of underlying feelings are less important than taking care of the immediate sick people.”
Kimberly Shriner, MD, medical director of infection prevention and control at Huntington Hospital, said the increasing numbers are creating “unprecedented staffing pressures” that have impacted hospitals nationwide.
“I’m not only worried about our increase in COVID-19 hospitalizations, but I’m worried about the strain of the pandemic on our caregivers and staff – in all areas of the hospital,” she said. “We were all hoping to have holidays with our families, but omicron had a different plan.”
“We are seeing shifts in our staffing that correlate with what the greater healthcare community is experiencing,” said Nancy Lee, senior vice president and operations chief nursing officer for Beverly Hospital of Montebello. “To offset these shifts, we continue to partner with clinical programs whose students are available to help support direct patient care and assist with vaccine clinics,” she said. “We have cross-trained our team members to have the competency to assist where needed throughout the hospital, especially in high-volume departments.”
“The majority of patients who test positive are going home to isolate themselves and do not require hospitalization,” said Kevin Koga, director of marketing and communication for PIH Health, which runs hospitals in Downey, Los Angeles and Whittier.
“While our census of hospitalized patients is increasing, this number is much smaller than our inpatient census at our peak last winter,” he said.
Also, Koga said, PIH has learned a lot from past surges. “We have gained significant experience and knowledge since the pandemic began and we are applying all of those learnings to the current surge,” he said. “Our physicians and staff have strong expertise in caring for COVID-19 patients.”
PIH, like all hospitals, is experiencing staffing shortages, mainly due to staff members being out sick themselves.
Dr. Graham Tse, who oversees the COVID-19 response at Long Beach Medical Center and Miller Children and Women’s Hospital, says the hospitals’ teams are keeping pace, but the worst may be yet to come.
Given holiday gatherings and the cold weather, he said he would anticipate the number of positive cases and hospitalizations to increase in the coming weeks.
But after two years of the pandemic, he added hospital staff have gotten more adept at managing COVID’s waves. They now know how to adapt different hospital units to take an increase in patient loads and they know how to better implement infection control to prevent the spread of the virus, he said.
But some staff are tired, he admitted. Two years of this pandemic have drained nurses, doctors and technicians. And Tse himself is frustrated with those unwilling to get vaccinated.
“With vaccinations so readily available and the data so compelling that it prevents severe disease, they’re putting themselves and their loved ones at risk,” he said.