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California hospitals are grappling with an unprecedented surge of COVID-19 patients, further straining a healthcare system already struggling to keep up.
Experts say it typically takes two to three weeks for a person who contracts the coronavirus to become sick enough to require hospital care. And California is now reporting two to three times more cases than it was at the beginning of December, according to data compiled by The Times.
As of Saturday morning, Harbor-UCLA Medical Center in Torrance was treating 97 patients for COVID-19, according to hospital Chief Executive Anish Mahajan. For the past 10 days, the hospital has been using a large section of the emergency room as a makeshift intensive care ward, with a dozen patients on ventilators.
If the surge in cases continues, Harbor-UCLA will likely convert the area of the hospital usually designated for patients recovering from surgery into a critical-care ward, Mahajan said.
The nursing staff is stretched extremely thin due to the huge influx of patients, Mahajan said. So the hospital has redeployed 100 nurses from other areas — even those on the administrative side who have critical-care skills — to join the ICU team.
Contributing to the staffing shortage is the increasing number of hospital employees who have contracted the virus, Mahajan said. Hospital contact tracing efforts show that the majority of staff likely picked up COVID-19 outside of work, he said.
“Also, people are exhausted, dealing with stress-related conditions, and they need a break,” Mahajan said.
The state logged 53,326 new cases of the virus Friday, according to the Times’ tally, topping the previous record of 52,330 cases set Wednesday and marking the third consecutive day that new cases surpassed 50,000.
Before Wednesday, the state had never added more than 50,000 cases in a single day. The state’s previous single-day record for new cases, set Monday, was 42,088.
California is now averaging more than 40,000 new coronavirus cases a day over the last week, a new record and more than triple the figure from three weeks ago, when the state was reporting about 13,000 new cases a day.
California is averaging 226 deaths a day, also a new record, and five times the comparable figure from early November.
The rise in cases has resulted in a tsunami of patients. There were 16,465 COVID-19 patients in California hospitals Friday, according to data released by the state Saturday, an increase of nearly 635% from two months before, when there were 2,241 patients.
Los Angeles County, which one health official said is on the verge of becoming the epicenter of the pandemic, reported 5,549 COVID-19 patients as of Friday, according to the state.
Orange County, which has also broken records for new cases and hospitalizations, had 1,601 patients in its hospitals. The county Saturday reported 3,445 new cases and 26 deaths.
The availability of intensive care unit beds throughout Southern California and the San Joaquin Valley remained at 0% Saturday, and officials warned that conditions in hospitals are expected to erode further if the coronavirus continues to spread unchecked.
L.A. County-USC Medical Center was treating 160 COVID-19 patients, 65 of them in the ICU. Of the hospital’s 600 beds, about 100 of them are ICU beds capable of handling COVID-19 patients, meaning that less than half of them remain available to be used by other critically ill or injured patients, said Dr. Brad Spellberg, chief medical officer.
Many mornings over the past seven to 10 days, hospital workers have come in to find there are no available ICU beds, and as soon as one opens up, a patient in the emergency department is often waiting to use it, Spellberg said.
“We are scrambling to move people around, to find places for people to go,” he said.
The hospital has on several occasions resorted to using a triage station set up in a tent outside its emergency department and has outfitted an area that doesn’t usually house severely ill patients with beds and staff to provide care, he said.
But the main challenge is staffing, not physical space, he said. The hospital has scaled back outpatient clinic visits and elective procedures, withholding care for these noncritical services so it can reassign staff “to allow us to tread water so we don’t go under,” Spellberg said.
“This is the level of what we call contingency care, where we’re scrambling to maintain care standards,” he said. “We’ve not progressed yet to crisis care but it’s getting close.”
If that happens, he said, the hospital will have to do things like break the acceptable ratio of staff to patients and assign people to provide levels of care they don’t have specific expertise in.
“We won’t have a choice,” he said. “Hospitals can only react to what comes to us.”
Already on Dec. 11, the California Department of Public health began granting waivers that permit hospitals to increase the number of patients nurses can treat at one time. For ICU nurses, that means they are now expected to treat three patients instead of the customary two.
The California Nurses Assn. has decried this move, saying it will impact the quality of care patients receive.
“Heavier patient assignments sharply cut the time nurses can provide individualized patient care, properly monitor a patient’s condition, and increase the likelihood of mistakes, as studies have documented for years,” said Zenei Cortez, a registered nurse and president of California Nurses Assn. “In a pandemic, that’s an open invitation to increase the risk of spreading the virus to other patients and other staff.”
The California Hospital Assn. has rebuffed the nurses’ union’s opposition to the waiver, pointing to a statewide shortage of critical care nurses.
“In times like these, California’s healthcare providers need, without exaggeration, every hand on deck to save people’s lives,” Carmela Coyle, CEO of the California Hospital Assn., said in a statement.
The waivers affect not only ICU nurses. Nerissa Black, a registered nurse at Henry Mayo Newhall Hospital in Valencia and a California Nurses Assn. member, works in a COVID-19 unit that treats 29 patients. Her patient load jumped from four to six last week.
Black’s patients aren’t in critical condition, but the new patient-to-nurse ratio has still taken a toll. Before the change, she spent 15 minutes with every patient each hour; now she has 10 minutes.
“That includes putting on our PPE, documenting my interventions, reviewing lab results and imaging results and any abnormal findings,” she said. “So there are some things that slide. We don’t get to brush their teeth, wash their hair, talk to them about their lives and how we can help them better at home.”
Whether it’s necessary for hospitals like L.A. County-USC to move to crisis care mode, increasing employees’ workloads even more, depends entirely on whether new cases begin to slow, Spellberg said.
“If cases stay at this level and then start to decline, we’ll hold on by our fingernails,” he said.
But, he said, if there’s a significant further rise, “we’re going to have patients in the hallways and we’re going to be starting to make tough decisions about who’s going to get care.”
Hospital officials are simultaneously scrambling to provide the first doses of COVID-19 vaccine to their workers.
In L.A. County, hundreds of healthcare workers at county-run hospitals have received a vaccine dose so far, and that number was expected to hit roughly 6,000 by Christmas, officials said earlier this week.
The vaccinations have been one bright spot amid the grueling days at Harbor-UCLA, Mahajan said. Nearly 600 hospital staff, from doctors to X-ray technicians to custodial staff, were vaccinated Friday morning.
“There was an amazing atmosphere of relief,” Mahajan said. “People were jovial in a way I hadn’t seen in so long.”
Another 1,000 will be vaccinated next week, Mahajan said, and several thousand more will be inoculated after Christmas.
While the vaccine’s arrival has some expressing cautious optimism, it’s expected to take months for enough doses to be available for anyone who wants one. Members of the general public who aren’t healthcare workers, essential workers or members of medically high-risk groups may be able to get vaccinated in the spring or summer.
“While it’s critical to see the light at the end of the tunnel because it give us hope and renewed energy, we’re not there yet,” Spellberg said.
“And if the public doesn’t honor and respect public health instructions and stay away from each other — don’t go into crowded environments, wear your mask, please don’t congregate for December holidays like Thanksgiving — we’re not going to make it to the light. We’re going to crash and burn before we get there.”
Times staff writer Rong-Gong Lin II contributed to this report.
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