How bad is going to get in the next few weeks?
The number of COVID-19 deaths in California and Los Angeles County – an epicenter of the pandemic – is setting records almost daily. There is clear evidence that the increase in cases after Christmas is getting worse in the case as the numbers continue to increase, especially in LA County.
But the big question is whether this new wave of cases will lead to a similar increase in hospitalizations as occurred during the reception after Thanksgiving, which drove hospitals to the breaking point, leading to frightening staff shortages and certain supplies. influencing the quality of medical care given to critically ill patients.
Around Thanksgiving, about 300 new COVID-19 patients a day were admitted to LA County hospitals; the number rose sharply about a month and finally stabilized around Christmas Eve at about 750 to 800 new hospitalizations per day. Another doubling or doubling of new hospitalizations per day would be catastrophic.
Because as dire as the crisis has become, most hospitals have yet to enter a sustained, widespread period of rationed care. But that would probably come if Christmas is dramatically worse.
Tension officers – usually led by critical care and emergency physicians – must be fully activated. Faced with the shortage of staff and supplies, they would be forced to make the heartbreaking decisions: to determine who receives the most aggressive life-saving care and the limited time of the best trained professionals and equipment, and who gets a smaller chance on survival and treatment provided to comfort them when they die. How hospitalizations break this week will give officials a sense of what to expect.
“We are all waiting with some degree of anxiety to see how hospital admissions unfold over the coming days,” said Dr. Roger Lewis, director of COVID-19 hospital demand modeling for the Department of Health Services in LA, said.
‘The hospital system is literally at the breaking point, where a significant increase in demand could lead to situations in which we could not provide the care to people that we would all expect or could receive if we were critically ill. , “he added.
Patients suffering from COVID-19 and now entering hospitals are mostly infected in the period after Thanksgiving, before Christmas. The flattening of new hospitalizations was probably the result of the introduction of stay-at-home orders issued by the country and the state.
But the effects of holiday gatherings over Christmas will soon begin to appear in hospitals. Soon, a certain percentage of people who have been infected and tested positive over Christmas will become so ill that they need hospital care. As the number of new daily hospital admissions for COVID-19 patients deteriorates, it is a major sign of problems.
It is possible that the increasing hospitalizations can be moderated if, for example, they are mostly younger, otherwise healthier people who have been infected during the holiday season, and have quarantined or isolated themselves to prevent older family and friends from being infected with a higher risk. to dying.
But it is also likely that the defenseless and elderly attended Christmas and New Year’s gatherings or were later infected by younger people who did not stay away from them – something that happened during the Thanksgiving holiday.
‘The fear, or intuition, of most people who do predictive modeling is that it’s going to get worse. The uncertainty is in how much worse. “In order to quantify how much worse it is, we need the data that will only be available to us next week,” Lewis said.
The increase in new cases of coronavirus increases after Christmas. LA County’s average number of coronavirus new cases on Thursday, Friday and Saturday was about 18,000 – well above the average of about 14,000 new cases per day over the past week.
“This is very clearly the latest boom of the winter holidays and the new year – there is no doubt about it,” said LA County Chief Scientific Officer Dr. Paul Simon, said. ‘It started gradually earlier this week, but [definitely] here in the last day or two. ”
About 1 in 5 coronavirus tests performed daily in Los Angeles County return positive, a huge increase from early November, when about 1 in 25 tests confirmed an infection. And if the spread of communities is so productive, officials warn that activities that seemed mundane months ago pose a greater risk of infection than ever before.
Simon said the increase in daily cases of coronavirus is likely to continue for the next week or two, leading to even worse hospitalizations and more deaths. The number of daily deaths from COVID-19 is already breaking records; in early December, about 30 people a day in LA County die on average over a seven-day period from COVID-19; now about 200 people die a day.
The number of people dying from COVID-19 daily now exceeds the average number of deaths in LA County for all other causes, including heart disease, cancer, stroke, diabetes, car accidents, suicides and homicides, which is about 170 deaths per day. .
Some veteran epidemiologists suspect that higher levels of hospitalizations and deaths will actually materialize and that hospitals will be forced to adopt ‘crisis standards for care’, in which doctors of triage must choose who receives life-saving treatment.
“I expect that among the increasing number of cases we are seeing – which will lead to an inevitable increase in the number of hospitalizations and ICU patients – we will be forced to work according to crisis protocols, which may include the rationing of care,” said UCLA medical epidemiologist and doctor Robert Kim-Farley.
Kim-Farley said he suspects there will soon be a new increase in hospitalizations that will increase until the end of January. A fraction of the people will not survive their illness, and a peak in daily deaths from COVID-19 is likely to occur in mid-February, Kim-Farley said, due to the delay between initial hospitalization and death.
It was wise for government officials to be ready to distribute dozens of large cool trailers that could serve as temporary mortuaries for corpses sent to provinces, Kim-Farley said. Funeral services across the state are already being overwhelmed by the increase in bodies and some have been forced to turn away families.
“Unfortunately, the resurgence capacity for mortuaries is needed,” Kim-Farley said.
LA County has now reached new milestones in the pandemic: more than 12,000 deaths from COVID-19 and more than 900,000 cases of coronavirus.
On Saturday, 218 COVID-19 deaths were reported in LA County. It happened the day after the country set a one-day record of 318.
LA officials on Saturday confirmed three additional cases of the coronavirus-related inflammatory disease in children known as MIS-C. A total of 54 children in LA County contracted the serious illness and one died. The disease can cause fever and infect the heart, lungs, kidneys, brain, skin, eyes and gastrointestinal organs. The disease is excessive among the children of Latino, accounting for about 3 of the 4 reported cases.
In LA County, available ICU beds in each of the following regions have dropped to zero over the past few days: central LA, the Westside, southeastern LA County, San Gabriel Valley, and Antelope Valley. The South Bay and Long Beach region has had just three available ICU beds in recent days, and the San Fernando Valley as few as six.
In Santa Clara County, with about 2 million inhabitants, about 20 to 25 available ICU beds remained Friday; in Fresno County, with about 1 million inhabitants, only 10 beds were available.
Dr. Rais Vohra, the interim health officer of Fresno County, said hospitals are preparing for a very hard rest of January and possibly February, including a scramble to find supplies related to providing oxygen treatments and ways to infuse antibodies from perform to prevent patients requiring hospitalization.
Some assistance has begun to arrive: U.S. Department of Defense personnel, as well as state-recruited nurses, have been deployed to hospitals in the region, said Dan Lynch, director of the Fresno County Medical Emergency Services Agency. And one San Mateo County hospital has offered to admit critically ill patients from Fresno County.
But it will not be easy to carry out the transfers in practice. “It’s a risky step if you move it for a long distance,” Lynch said.
Although the current pandemic boom in California is severe, the state has one of the lower cumulative numbers of COVID-19 deaths per capita, and is ranked 38th out of 50 states, probably due to the early establishment of the homeless order. in the spring and summer closure of certain high-risk businesses. New Jersey’s cumulative death toll COVID-19 has tripled that of California; Arizona’s is double.
Times Murphy author Ryan Murphy contributed to this report.