LA doctor overwhelmed by intensely ill COVID-19 patients

Many Californians spent New Year’s Eve in a safe place with immediate family. Dr Nick Kwan, the assistant medical director of emergency services at Alhambra Hospital in Los Angeles County, spent it with a COVID-19 patient who went into code blue five times – cardiac or respiratory arrest.

Code blue requires the medical staff to respond quickly and intensely to revive the patient.

“It’s mentally, physically and emotionally exhausting,” said Kwan, who has struggled to articulate the toll a monthly surge of COVID-19 patients places on his and other Los Angeles County hospitals.

“It’s a complete category 10. … It’s literally World War II,” he said.

“It’s not the amount of patients,” he said. ‘This is the intensity and illness of the patients. I never thought that some of these numbers are compatible with life, and that patients come in sicker than you might think.

Across LA County and much of Southern California, hospitals are struggling with an influx of intensely ill COVID-19 patients and a lack of resources, including staff and important infrastructure, such as oxygen pipelines.

On Friday, the state summoned the U.S. Army Corps to assist six hospitals facing serious challenges in providing oxygen to patients in need.

Alhambra Hospital was not one of those, but it was nonetheless stretched by COVID-19 and the emotional toll it placed on all involved.

“I do not think many people outside see what we see,” Kwan said. “It’s hard until you’re there, until your family and loved ones are there.”

Since Thanksgiving, the 144-bed hospital that serves as a melting pot of the San Gabriel Valley, many of whose residents are first- and second-generation Latino and Asian immigrants, has seen a steady wave of patients with breathing.

Kwan said he, in addition to the Alhambra, knows that several other hospitals along Highway 210 are full and under the burdens of the current boom.

The waiting room at Alhambra Hospital is now a COVID ward. Ordinary beds were quickly converted to ICU beds. And ambulances are waiting outside with oncoming patients because ‘physically we can not accommodate the patient’, Kwan said. ‘It’s across the board. The virus does not care who you are. You can be sick, healthy, young, old. ”

Younger patients died and a patient in her 90s walked out of the hospital with an oxygen tank.

“It’s so unpredictable in every case,” he added.

“On November 29 and 30, we started seeing the boom, and it has been uninterrupted ever since,” Kwan said. ‘It’s easy to say it’s holiday gatherings – or maybe the colder weather. … Christmas and New Year scare me, and I think the worst is yet to come. ”

A state-sponsored nurse recently showed up to combat the patient’s burden, and it was a vital boost to morale, Kwan said. Yet staff fear that the December avalanche is a harbinger of a long, deadly winter.

‘For the next month, I do not see the end. It will keep piling up, and we need to be ready. ”

It was a similar picture in Santa Clara County, where hospitals remained extremely stretched, with 50 to 60 patients sitting in emergencies every day waiting for a hospital bed.

According to Dr. Marco Randazzo, an emergency physician at O’Connor Hospital in San Jose and St. Gilroy.

“This has been the state of the pandemic for the past few weeks, and it shows no signs of disappointment,” said Dr. Ahmad Kamal, director of health preparedness in Santa Clara County, said. The daily incidence of coronavirus is more than ten times as high as on October 30th. “What we see now is not normal.”

At Alhambra Hospital, the virus hit staff directly: one doctor in the hospital was killed by COVID-19, and a nurse who contracted the virus was out for months, Kwan said.

“Everyone is exhausted. Our CEO is exhausted. Our entire medical staff is exhausted, “said Kwan.

Kwan and other staff members had to get used to being the last person a patient sees before he dies, with families being kept away from loved ones.

‘You cry with the patients’ family. It’s just sad, “he said. “It feels like this virus is attacking our entire humanity.”

Behind the fatigue and stress on resources is the fact that COVID-19 patients stay in the hospital longer than the average patient and need more resources.

There is constant concern about whether there will be adequate fans, and that the oxygen tanks sometimes run low. But a big problem is simply the space: “It doesn’t matter if it’s Cedars, USC or Alhambra – the hospital is just as big.”

Morgue space, he said, is also ending – and a constant concern.

‘When was the last time I thought we were going to run out of mortuary space? I never thought it would worry me. ”

Many patients who get into routine ailments – such as family members who brought their baby to the ER on New Year’s Eve – are treated in the car park, sometimes even in their vehicles.

Kwan said he knows the toll the pandemic is taking: businesses closing, family and friends restricting social gatherings. He has not seen his mother since February and his father since March. His children waited until five days after Christmas to open presents and celebrate with their father.

‘I would tell people out there that it’s serious. “Help us fight this war,” he said. “It’s a group effort – we can ‘t fix it ourselves. It’s really about public awareness and a concerted effort to overcome it. ”

Kamal, the doctor in Santa Clara County, begged the public not to stop wearing masks, to stay socially distant and to cancel events. There are indications in the Bay and elsewhere the measures have helped stop the spread.

“We know,” he said, “that our decisions and actions drive the curve of this pandemic.”