She lay behind a glass barrier that was heavily sedated and kept alive by a machine that blew oxygen into her lungs through a tube that was taped to her mouth and stuck in her throat. It had deteriorated rapidly since arriving shortly before.
“Your respiratory system is failing and your cardiovascular system is failing,” said Dr. Luis Huerta, an expert in intensive care in the intensive care unit. The chances of survival for the patient, who could not be identified for privacy reasons, are poor, said Huerta.
The woman in her sixties was among 50 patients so sick with COVID-19 that she needed constant medical attention this week in intensive care units at Los Angeles County + USC Medical Center, a 600-bed public hospital on LA’s Eastside . A large majority of them had diabetes, obesity, or high blood pressure.
Another 100 COVID patients, who were at least less ill for the moment, were in other parts of the hospital and the number was rising. In the five days that ended Wednesday, eight COVID patients died in the hospital – twice as many as in the previous five days.
Since COVID patients have flooded LAC + USC in the past few weeks, they have placed an immense strain on the capacity and staff in the intensive care unit – especially since non-COVID patients with gunshot wounds, overdoses, heart attacks and strokes also need intensive care.
There are no more beds available in the intensive care unit, said Dr. Brad Spellberg, the hospital’s chief physician.
Similar scenes – jam-packed wards, overworked medical workers, rushed administrators, and grieving families – are unfolding in hospitals across the state and across the country.
In California, only 3% of ICU beds were available as of Thursday. There were no ICU beds open in the 11 counties of Southern California, and only 0.7% in the San Joaquin Valley.
Los Angeles County, the largest in the country, was dangerously close to zero capacity.
The county’s health officials reported Wednesday that the number of new COVID cases, deaths and hospitalizations increased past their previous highs throughout the pandemic.
LAC + USC has had severe COVID exposures since the pandemic began, largely because the low-income, predominantly Latin American community it serves has been hit so hard. Latinos make up about 39% of California’s population, but are responsible for nearly 57% of the state’s COVID cases and 48% of COVID deaths, according to data updated this week.
Many people who live near the hospital have important jobs and “cannot work from home. They go out there and expose themselves because they have to earn a living, ”said Spellberg. And he said, “They don’t live in huge houses where they can isolate themselves in one room.”
The worst cases lie in the middle of a tangle of tubes and bags in rooms in the intensive care unit, which are supposed to prevent air and virus particles from flowing into the hall. The sick among them, like the woman described above, need machines to breathe for them. They are fed through nasal tubes with their bladders draining into catheter bags, while intravenous lines deliver fluids and medication to relieve pain, keep them calm, and raise their blood pressure to levels necessary for life.
In order to relieve the intensive care units somewhat, the hospital opened a new “step-down” unit this week for patients who are still very ill but can be treated with a little less care. Spellberg hopes the unit can accommodate up to 10 patients.
The hospital staff also scoured patients’ insurance plans to see if they could be moved to other hospitals. “But at this point it has become almost impossible because they are all filling up,” said Spellberg.
Two weeks ago, a lower percentage of COVID patients in the emergency room showed signs of serious illness, which meant fewer hospitalized or intensive care units than during the surge in July. That helped, as Spellberg put it, to keep the water below the top of the dike.
But not anymore.
“In the last 10 days I have the clear impression that the severity has worsened again, and that is why our intensive care unit has filled up quickly,” said Spellberg on Monday.
The total number of COVID patients in hospital and intensive care units is now well above the July high – and both are almost six times what it was at the end of October. “This is the worst that has ever happened,” said Spellberg. And it will only get worse in the coming weeks as people travel over Christmas and New Years and gather with their extended families like they did on Thanksgiving.
“Think of New York in April. Think about Italy in March, ”said Spellberg. “Things could get that bad.”
They’re bad enough. Nurses and other medical workers are exhausted from long months of extremely arduous patient care that is becoming increasingly intense, said Lea Salinas, a nurse manager at one of the hospital’s intensive care units. In order not to have too few staff, she asked her nurses to work overtime.
Typically, ICUs are assigned two patients per shift. But a really sick COVID patient can take on practically the entire shift – even with the help of other nurses. Jonathan Magdaleno, an intensive care nurse, said he may have to spend 10 hours during a 12-hour shift at the bedside of an extremely ill patient.
Even at best, he said, he usually has to enter a patient’s room every 30 minutes because the bags that deliver medication and liquids empty at different rates. Every time nurses or other care providers enter a patient’s room, they must put on cumbersome protective equipment and then remove it when leaving.
One of the most delicate and difficult tasks is a maneuver known as “proning,” which involves turning a patient with acute shortness of breath on their stomach to improve lung function. Salinas said it could take half an hour and require up to six nurses and a respiratory therapist, as the hoses and wires have to be disconnected and then reconnected – not to mention the risks of moving an extremely fragile person . And they have to do it twice because any stricken patient has to be turned back later in the day.
For some nurses, working in the COVID ward at LAC + USC is very personal. Such is the case of Magdaleno, a native Spanish speaker who was born in Mexico City. “I grew up in this church,” he said. “Even if you don’t want to, you see your parents, you see your grandparents, you see your mother with these patients because they speak the language.”
He planned to spend Christmas only with members of his own household and urged everyone else to do the same. “If you lose a member of your family, what is the purpose of Christmas?” he asked. “Is it worth going to the mall now? Is it even worth getting a present for someone who is likely to die? “
That the darkest hour of the pandemic should come exactly when the COVID vaccines arrive is particularly poignant, said Dr. Paul Holtom, chief epidemiologist at LAC + USC.
“The tragic irony is that the light is at the end of the tunnel,” he said. “The vaccine is in the process of being launched, and people just have to keep themselves alive until they can get the vaccine.”
This story was produced by KHN publishing the California Healthline, an editorially independent service of the California Health Care Foundation.
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