“This is a tragedy,” said Dr. Nida Qadir, co-director of the medical intensive care unit at Ronald Reagan UCLA Medical Center, said about the MLK statistics. Her hospital has death rates ‘much lower than that,’ she said, though the hospital did not make that figure public. A new study of patients at 168 hospitals found that about half of Covid’s patients died on ventilators, and that survival varied widely among hospitals.
Dr. Theodore J. Iwashyna, a critical care physician at the University of Michigan, said the differences in hospital outcomes reflect a ‘system choice’. He and others studied patients with complex lung conditions and found that those treated in smaller hospitals with fewer resources and less experience in managing them tended to have poorer survival rates. “Large hospitals had to accept the patients and pull the patients out of it” from MLK, he said.
During the boom in Los Angeles, hospital deaths also increased because fewer mild patients were admitted to the hospital, Dr. Roger J. Lewis, a professor of emergency medicine at Harbor-UCLA Medical Center, who helps analyze Covid data for the country, said. This was probably even more the case in small hospitals like MLK in areas with a high percentage of chronic diseases, he said.
The medical team has Mr. Flores’ wife was invited to the hospital, which was usually closed to visitors during the pandemic. She finds her husband startled and frightened. He did not get enough oxygen, a doctor explained and without a ventilator he could die within two days. Mr. Flores told her he wanted to go home, and then change his mind. He was exhausted and had chest pains, he said. He would try the ventilator because he wanted to live longer for his family.
Yet its oxygen levels remained low. Doctors gave him steroids and drugs that counteract blood clots. They turned him on his stomach and even paralyzed him for a while to make the fan work more efficiently. But nothing seems to make a difference. Mr. Flores has ‘cut and dry Covid lung failure’, said dr. Prasso said.
Some Covid patients have one last option: treatment with a machine that gives the lungs a chance to rest and hopefully recover. The procedure, extracorporeal membrane oxygenation, or ECMO, is usually only offered in larger hospitals to patients who meet strict criteria.
Mr. Flores might have been a candidate for it at some point, according to Dr. Christopher Ortiz, a specialist in critical care UCLA, a hospital with the highest rank, who walked into MLK, but dr. Prasso said he had stopped considering treatment. Earlier in the pandemic, he insisted on transferring some MLK patients to hospitals providing ECMO, but eventually gave up.
“We’ve never been successful,” he said. “Nobody wants their insurance.”