California again broke the one-day record for COVID-19 deaths on Tuesday, recording 442 deaths in a county-by-county count of local health jurisdictions – a number equivalent to someone dying from the disease every three minutes.
According to The Times’ survey, more than half of the deaths – 242 – are residents of Los Angeles County. This is a record high in a single day for the country with the largest population, a score that is partly reinforced by a backlog reports over the Christmas weekend.
At this rate, cumulative COVID-19 deaths are likely to exceed 25,000 in California on Wednesday and 10,000 in LA County by New Year’s Day. As of Tuesday night, California had 24,987 deaths and LA County, 9,806. In the past week, the state has averaged 240 deaths a day, and LA County, 111.
The rising death toll has changed daily life in Los Angeles. In eastern LA, the continental funeral home has seen its typical consequences more than quadruple, with 80% of the services honoring people killed by COVID-19. The LA County College of Nursing and Allied Health is postponing the admission of nursing students for the spring semester because faculties and staff have been redeployed to provincial hospitals.
The “health care situation has never been so critical and the need for health workers is at its peak”, wrote Mildred Gonzales, dean and program director of the College of School of Nursing, in a letter calling the situation an “unprecedented critical situation”. named. “
As the intensive care units in California are overcrowded, health care providers have already been forced to take steps to limit the amount of hospital care.
Southern California hospitals in crisis
“We definitely know that hospitals in Southern California are in crisis,” said Dr. Mark Ghaly, the secretary of health and human services in California, said. And because some people are likely to ignore pleas to keep New Year’s Eve at home, officials expect hospitalization to deteriorate again in the coming weeks, especially during mid to late January.
Even now, paramedics and emergency medical technicians do not want to transport less serious patients who can take them to the hospital under normal circumstances.
In Los Angeles County, EMTs assess patients and leave them free to stay at home because they are not completely sick enough to require hospital-level care. “If they did get to the hospital, they might not get the attention they would expect,” Ghaly said.
This is an example of the unusual measures that health care professionals were forced to take amid a systemic overcrowding of hospitals not seen in modern California history, following the worst pandemic in more than a century. For the first time, the number of people admitted to the hospital throughout COVID-19 exceeded 20,000, which is eight times higher than that on 1 November.
The overcrowding is already causing the quality of health care to decline, Ghaly said.
A plan to promote and ration hospital care
Government officials have yet to hear reports of the most dire circumstances, such as a hospital having to choose who gets the last ventilator.
Nevertheless, some LA County hospitals have low oxygen supplies, treat patients in conference rooms and gift shops, and leave patients in ambulances for eight hours until they can be taken to the emergency room.
Hospital systems are already devising triage plans, which should prioritize the time of highly trained staff – such as respiratory therapists, ICU nurses and doctors in critical care – to keep so many people alive. This means that those who are less likely to survive may not receive the same care they would otherwise have had.
Most hospitals in California can no longer offer regular hospital services, but are moving to “emergency care,” Ghaly said. Staff are asked to work longer shifts, and hospital rooms are set up to contain more beds than originally intended, scarce supplies are stored or even reused, and the movement of patients within the hospital is delayed due to lack of space or staff.
Prepare for ‘crisis care’
Even worse is the “crisis care” if patients are placed on beds instead of standard hospital beds; patients normally grouped in one unit were spread across the facility; and certain supplies, therapies, and personnel must be rationed, Ghaly said.
If some hospitals in a region declare that they are in ‘crisis care’ mode, other hospitals in the region will be asked to share their resources to alleviate the worst-hit facilities, Ghaly said.
Kim McCoy Wade, director of the California Department of Aging, said Tuesday that difficult decisions about the provision of medical care should be based on the likelihood that [a patient] survive in the short term. Such decisions may not be based on age, race, disability, chronic medical conditions, gender, sexual orientation, gender identity, ethnicity, national origin, language, ability to pay, weight, socioeconomic status, insurance status, perceived self-esteem, perceived quality of life, immigration status, incarceration status, homelessness or the use of resources in the past or in the future, she said.
The state Department of Public Health on Monday issued a memorandum on its “California Crisis Care Continuum Guides,” which they must follow ethical principles, health goals and civil rights laws. Facilities that need to start rationing resources for critical care should notify local and state public health departments immediately.
Choose who gets care
According to a government note issued in June, in a situation where there are severe shortages of medical resources and a patient has a poor immediate survival prognosis, healthcare providers may need to decide to provide palliative care aimed at relieving patients to give when they die. , rather than improving their prognosis.
When deciding who is eligible for ICU admission or should have access to a ventilator, patients who are likely to survive with such care will be given preference.
A hospital-appointed triage officer is expected to make decisions to benefit patient populations, “although these decisions may not necessarily be in the best interests of some individual patients,” according to the memorandum.
Health officials fighting fatalism and denial
Hospitals and health officials across the state are reporting serious problems. In the Gilroy agricultural community in Santa Clara County, every common ICU bed in the St. Louise Regional Hospital is occupied and patients are now in overflow beds, said Gloria de la Merced, chief operating officer of the hospital.
“This level of hospitalizations has never occurred in my career,” she said. ‘If we exceed the capacity to live, everyone will be affected. More people in our community will know someone who has died. ‘
In Fresno County, emergencies are so pressing that paramedics drop off patients in the hallway of the hospital where other emergency services workers or in the waiting room care for them. Officials are struggling with a sense of fatalism in the general public that nothing can be done about the pandemic or denial of the record hospitalizations and death toll.
“It’s really unfortunate. “We really have a choice, and we can really try to protect ourselves in our communities with the choices we make, ‘such as wearing masks and canceling New Year’s parties,” said Dr. Rais Vohra, the interim health officer in Fresno County, said. “Whenever you choose to ignore science, we’ll really get in trouble.”
In rural Northern California, Humboldt County became the first county in some time to see conditions improve sufficiently to move from the state’s most restrictive purple level to a less restricted red level, which it makes it possible to reopen indoor restaurants, indoor gyms and cinemas, although it is limited.
Local health officials, however, criticized the state for moving Humboldt to a less restrictive level, saying the continuing trends suggest the country could fall back to the most restrictive level in the coming days.
“Our case percentages are the highest they have ever been, and our contact investigation teams are monitoring more cases, not less. It’s unfortunate that we did not consult with the state before this decision was made, ‘said Humboldt County Health Officer Dr. Ian Hoffman, said in a statement Tuesday.
Times authors Emily Baumgaertner, Andrew J. Campa, Andrea Castillo, Jaclyn Cosgrove, Adam Elmahrek, Marisa Gerber, Soumya Karlamangla and Ryan Murphy contributed to this report.