COVID patient in los angeles hospital where workers have to ration care
In this Dec. 22, 2020, file photo, medical workers prepare to manually prone a COVID-19 patient in an intensive care unit at Providence Holy Cross Medical Center in the Mission Hills section of Los Angeles. California surpassed 25,000 coronavirus deaths since the start of the pandemic, reporting the grim milestone Thursday, Dec. 31, 2020, as it continues to face a surge that has swamped hospitals and pushed nurses and doctors to the breaking point as they brace for an anticipated surge after the holidays. (AP Photo/Jae C. Hong, File)

The COVID-19 crisis is battering already-distressed Los Angeles County hospitals, and health officials warn the worst is yet to come.

Los Angeles County is now so overwhelmed by COVID-19 cases that hospitals are forced to ration care.

The situation in the nation’s largest county has spiraled out of control since Thanksgiving, making it the latest coronavirus epicenter in the United States. The county has more than doubled its number of total cases from 400,000 on November 30 to more than 827,000 as of Tuesday morning. Nearly 3,000 residents have died of COVID-19 during that time, and the number of people hospitalized with the virus has almost quadrupled over the same period. According to the LA County Department of Public Health, about 21% of people hospitalized with the virus are in the ICU, but now many more of the county’s sick won’t make it that far. 

On Monday, Dr. Marianne Gausche-Hill, medical director of the Los Angeles County Emergency Medical Services Agency, issued two memos instructing ambulance operators not to bring patients who have little chance of survival to hospitals and to cut back on their use of oxygen amid a dwindling supply. 

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The memo recommends that medical workers not transport those with no breathing signs or a pulse and do not respond to at least 20 minutes of resuscitation. If a pulse is restored, the patient can be stabilized and taken to the hospital. According to the memos, if efforts at resuscitation fail, the patient would be declared dead at the scene and no longer taken to the hospital. The agency also limits EMS personnel to administering supplemental oxygen only “to patients with oxygen saturation below 90%,” even though pulse oximeters notoriously give erroneously higher rates for Black people.

The new protocols represent a desperate bid to focus on patients with a better chance of survival amid a growing tidal wave of new cases and hospitalizations in the county, where one out of every five people tested for the virus are found positive.

To prevent this post-Thanksgiving surge, local officials issued a new stay-at-home order in late November. The order drew backlash for what some considered inconsistencies, such as leaving malls and retail stores open at limited capacity while banning outdoor gatherings between members of separate households. Predictably, holiday shoppers inundated malls and retail locations.

Now, the region’s hospital systems are paying the price. Los Angeles County hospitals have had to place patients in conference rooms and gift shops and divert ambulances for hours at a time, delaying care for sick patients for as long as eight hours. 

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“We are waiting two to four hours minimum to a hospital, and now we are having to drive even further, then wait another three hours,” Jimmy Webb, an emergency medical technician, told CBS Los Angeles. Some seriously ill patients have even waited up to 18 hours to be admitted to the ICU, according to the Los Angeles Times. LA County Supervisor Hilda Solis on Monday described the situation as a “human disaster.”

To manage the crisis, hospitals have begun releasing still-sick patients earlier to clear beds for those most urgently in need of care. As of Monday, there were fewer than 600 total available hospital beds and only 47 available ICU beds in the county. Many hospitals are running over capacity. The Harbor-UCLA Medical Center’s ICU is running at 150% of its standard capacity, the LA Times reported. Other hospitals have been forced to treat dying patients in hallways due to the lack of ICU beds.

The situation is expected to get worse in the coming weeks, as patients who contracted the virus over the Christmas and New Year’s holidays show up for care. 

“The increases in cases are likely to continue for weeks to come as a result of holiday and New Year’s Eve parties and returning travelers,” Los Angeles County Director of Public Health Barbara Ferrer said during a briefing on Monday. “We’re likely to experience the worst conditions in January that we’ve faced the entire pandemic, and that’s hard to imagine.”

Ferrer and Los Angeles Mayor Eric Garcetti have repeatedly urged city residents to stay home and avoid gathering with people outside their households.

“Everyone should keep in mind that community transmission rates are so high that you run the risk of an exposure whenever you leave your home,” Ferrer said. “Assume that this deadly invisible virus is everywhere, looking for a willing host.”