US-NEWS-CORONAVIRUS-LA-HOSPITALS-LA

Hospital doctors and nurses work treat COVID-19 patients in a makeshift ICU wing at Harbor UCLA Medical Center on Dec. 29 in Torrance.

LOS ANGELES – The coronavirus crisis battering Los Angeles County’s medical system is reaching increasingly desperate levels, with health care providers running low on equipment, ambulance operators being told not to bring patients who have virtually no chance of survival to hospitals and officials scrambling to ensure they can provide enough lifesaving oxygen for critically ill patients.

The number of COVID-19 patients in the county’s beleaguered hospitals has hit an all-time high, according to data released Monday, and officials say they expect the situation to worsen in the coming weeks as a new surge of people who were infected during the holidays become ill.

With available resources being stretched thin, hospitals are trying to discharge patients as quickly as possible to free up space for those most in urgent need of care.

But there are limits to this strategy because the number of new cases continues to grow so rapidly. Around Christmas, more than 700 people with confirmed or suspected coronavirus infections were entering LA County hospitals every day, but only about 500 people were leaving – either through discharge or death – on a daily basis.

Already, officials report shortages of available ambulances, people in need of hospitalization being forced to wait in ambulances for as many as eight hours to get into emergency rooms and grim calls by doctors and nurses about who gets treated first and who must wait for care.

“Many hospitals have reached a point of crisis and are having to make very tough decisions about patient care,” Dr. Christina Ghaly, the LA County director of health services, said Monday.

Across the county, doctors and nurses said they are dealing with once unimaginable conditions. At Harbor-UCLA Medical Center near Torrance, the ICU is running at 150% of its normal capacity.

Chief medical officer Dr. Anish Mahajan said the hospital is approaching the end of its supply of ventilators as well as dialysis machines to care for patients with kidney problems. Two refrigerated trucks are parked in back of the hospital because the morgue regularly runs out of space for more bodies.

“As hospitals go over capacity ... all supplies and equipment get stretched as well, in addition to the people,” he said. “We are basically overrun with critically ill patients.... It’s extraordinarily difficult. People are exhausted.”

The hospital is expecting more staffing help on Thursday, this time from the U.S. Department of Defense. Harbor-UCLA will receive six combat medics, three respiratory therapists and 11 nurses who will help treat the influx of patients at the hospital for at least the next 30 days. Additional staffing will go to LA County-USC Medical Center, the county’s flagship public hospital on the Eastside.

But because the COVID-19 surge is hitting so much of the country at once, officials have said before that they expect relatively few reinforcements – even as the number of patients keeps increasing.

The LA County Emergency Medical Services Agency issued a directive Monday that ambulance crews should conserve oxygen by administering it only to patients who have oxygen saturation levels below 90%. To reduce demand on hospitals, the agency recently issued memos directing ambulance staff not to transfer to hospitals most patients who have virtually no chance of survival.

In pre-pandemic times, those with slim odds of pulling through were taken to the hospital, as there was capacity to accommodate even the most unlikely recovery scenarios.

Patients who are not to be taken to hospitals include those whose hearts have stopped and, despite efforts at resuscitation, have no signs of breathing, movement, a pulse or blood pressure and would be declared dead at the scene. Paramedics and emergency medical technicians are to continue to try to resuscitate in the field until a pulse can be restored, after which a patient could be stabilized and taken to a hospital.

Emergency rooms are so overburdened that some patients are having to wait inside ambulances for as long as eight hours before entering the hospital. That backlog ties up ambulances and keeps them from being able to respond to other emergency calls.

To deal with the shortage, officials have devised an emergency plan to create temporary “ambulance-receiving spaces” – set up just outside the emergency room entrance and often covered by tents or canopies – to accept patients.

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