Southern California's Hospitals Are Overwhelmed, and It May Get Worse

A triage tent outside St. Mary Medical Center in Apple Valley, Calif., Helps cope with coronavirus patient overflow on December 17, 2020. (Ariana Drehsler / The New York Times)
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LOS ANGELES - If this had been another year, members of the Los Angeles Opera would have sung Christmas carols this week in the wards of the Martin Luther King Jr. Community Hospital, which serves the largely poor and Latin American communities of southern Los Angeles. Instead, a street choir from Skid Row stepped in with a video to bring vacation joy to the growing number of dying coronavirus patients and traumatized employees.
So many patients are pouring in at the hospital that trolleys have been placed in the gift shop, and the entire lobby is now a patient treatment room. The waiting room is a tent outside.
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"Everything is secured except for the street," said Dr. Oscar Casillas, medical director of the hospital's emergency department, which is set up to accommodate around 30 people at a time, but has seen more than 100 patients a day in the past week.
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In the High Desert region of northeast Los Angeles, hospital health workers receive their first shots of a coronavirus vaccine in a cheerful conference room with Christmas decorations. Christmas music and "Home Alone 2" are played on a screen. As soon as the needle is out of her arms, there is the next “Code Blue” or the next FaceTime goodbye between a dying patient and a grieving family.
"Every day is scary," said Lisa Thompson, an intensive care nurse at the Providence St. Mary Medical Center Hospital in Apple Valley. "We're all stressed out before we even get to work. Tons and tons of patients. We can't even keep up with the number of patients who come to the hospital."
In increasingly urgent tones this week, health officials and political leaders in Southern California have urged people to stay home for the vacation in desperate hopes of preventing another surge in infections, on top of the current post Thanksgiving crisis.
Barbara Ferrer, director of the Los Angeles Department of Health, said the only way "to pay tribute to the spirit of the holidays" is to stay home.
So far, however, very little has slowed the spread of the virus.
Each day in California became the first state to register 2 million cases of virus this week brings a startling new take on tragedy - more cases, more illness, more death. Southern California, the most populous area of ​​the most populous state, is on the verge of disaster. In Los Angeles County, a vast region with a population roughly the size of Michigan's, approximately 6,500 people are being hospitalized with COVID-19, a four-fold increase from last month. The number of patients in intensive care units is close to 1,300, twice as high as a month ago.
And Thursday in the county reported 146 new deaths, roughly one every 10 minutes, and the highest total number of pandemics, according to a New York Times database. Virtually every hospital has exceeded its capacity, putting new beds in every place it can find, and preparing for the opportunity to ration supplies - essentially making extremely difficult decisions about who will die and who will live.
However, the availability of beds isn't even the most pressing issue. With so many employees falling sick or taking vacations after months of treating coronavirus patients, hospitals are struggling to find enough workers.
"Especially in the beginning, you saw all these pictures and videos from New York and you think, 'Oh my god, things can never get this bad here," said Mendy Hickey, Quality Director at St. Mary's. "Even though we all have supplies that we need, it's so bad here and we don't have any staff to look after the patients. "
Hickey, a former nurse, has recently been taking on shifts in addition to her administrative duties, tending to patients in the intensive care unit, sometimes working 23 hours a day. She planned to work late Christmas Eve and hopes to spend at least Christmas morning with her three daughters before returning to the hospital.
With the holiday season coinciding with the height of the pandemic in Southern California, there is little joy for frontline healthcare workers who adjust to the near certainty that things are only getting worse. California Governor Gavin Newsom has forecast hospital admissions would hit nearly 100,000 in January if residents weren't locked for the holidays. California reported 351 deaths on Thursday.
"I can only imagine what will happen after Christmas and New Years if we don't tell the community how to stay home and be safe," said Thompson, the St. Mary nurse.
After what she sees in her community after another traumatizing day in intensive care, she's not optimistic.
"We're all talking about mid-January when we expect both holidays to see a big surge," she said. "It's kind of scary."
California was the first state to put a lockdown in the spring and appeared to be handling the pandemic much better than other places for a while. But in the face of the crisis it has long feared, the pain is being distributed unevenly.
Infection rates are far higher in south Los Angeles, where the Martin Luther King Jr. Community Hospital provides low-income communities with grocers and bus drivers who live in overcrowded households and are forced to mingle with the public every day. In Los Angeles County, about 15% of coronavirus tests are positive in the past few days; At a test site on the hospital campus, the rate is around 25%.
As a result, the burden from the surge is much higher at this hospital than in the more affluent areas of Los Angeles. According to recent statistics, 66% of the hospital's capacity has been used by COVID-19 patients, making it practically the epicenter of the epicenter. Across the city, on the whiter and richer West Side, 11% of the bed capacity at the Ronald Reagan UCLA Medical Center was filled with coronavirus patients.
Officials at the Martin Luther King Jr. Community Hospital, where most patients are on Medicaid or not, say they have difficulty getting patients to larger hospitals when they need high levels of care, such as neurosurgery or a cardiac procedure.
"What we're seeing is a significant difference between commercial insurance patients and Medicaid," said Dr. Elaine Batchlor, the hospital's manager. "Those with commercial insurance get out faster."
She added, "We have talked a lot about systemic racism and social justice and everyone is saying they want to do something about it, but our health system is a big reflection of separated and unequal." And the COVID pandemic is showing the same patterns. "
Thompson, who worked from 7 a.m. to midnight for a few days, is grateful that she has Christmas Day off and that she will spend it with her four children. Her parents, who live nearby but who she didn't mingle with during the pandemic, will be on Zoom.
But the vacation will only be a short break, and it is planned that she will work over the New Year, passing a wave the end of which is not in sight.
"Trying to do all this overtime and then keep up with all of the death and dying and keep your face straight and keep moving forward is exhausting," she said.
This article originally appeared in the New York Times.
© 2020 The New York Times Company
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