The days when outraged local mayors demanded California’s governor allow Disneyland to reopen seem very long ago.
As Orange County continued on Tuesday to set new records for new Covid-19 infections and hospitalizations, a very different type of facility was being readied for visitors. Orange County officials were rolling out mobile field hospitals to handle the surge in coronavirus patients.
Those field hospitals will be housed in large trailers and include canvas tents with hard flooring and temperature-controlled units that feature running water, toilets, showers and generators as well as air purifiers.
Fountain Valley Regional Hospital will get 50 such beds, St. Jude’s in Fullerton will receive 25 beds and UC Irvine will get 50 beds.
County Supervisor Doug Chaffee said he received a text message from a medical professional at St. Jude Medical Center last night that indicated the hospital is at “99% capacity.”
The hospital’s 301 beds are full with 138 COVID-19 patients, said Chaffee.
“The ICU is at 105% capacity,” Chaffee said. “They’re using every available bed. The emergency department has an overflow…All the Orange County hospitals are in the same situation. It is dire, so they’ll soon be erecting a tent in the parking lot, probably for triage. I think what we’re seeing is not a surge, but a tsunami.”
“I am fearful,” said Dr. Clayton Chau, the county’s chief health officer and director of its Health Care Agency, of the surge in patients. “I lose sleep every night. I am afraid…I’ve never been so afraid of Christmas and New Year’s in my whole life…I can’t imagine what it would be like after the holidays if people don’t listen and don’t comply.
In Los Angeles, hospitals were accommodating a massive Covid spike by canceling elective procedures. “Hospitals have started to some extent to curb non-essential procedures,” said L.A. Director of Health and Human Services Dr. Christina Ghaly.
Another method of regulating bed capacity is “diversion,” in which an ambulance is diverted to a hospital — possibly farther away — that has more beds. “We are aware that there are certain hospitals in the county where offload time can exceed four hours,” revealed L.A. County Public Health Director Barbara Ferrer. “That’s why we need the diversion system.”
On Sunday, a day when emergency departments are traditionally not as busy, 81% of the 911-receiving hospitals in L.A. asked to have advanced-life-support ambulance traffic diverted to other medical facilities due to overcrowded ERs. The average of hospitals requesting diversion this time of year is normally 10% to 15%, Ghaly said last week.
The next step for local hospitals, said Ghaly, would be to “break ratio,” or implement team-based nursing. The state mandates nurse-to-patient ratios, but in emergency situations the number of nurses per patient can be lessened.
On Friday, Governor Gavin Newsom did just that. He issued emergency permission for ICU units to increase the number of patients for each nurse from 2:1 to 3:1. Newsom also went over additional staffing that has been secured and aid requests that have gone out to the federal government.
When asked about the USNS Mercy, which had been sent to L.A. during the summer spike, Newsom said he had not made the request. “One of the most significant resources is not the beds [on the ship], but the staff,” said Newsom, echoing health officials who, for months have said the ICU crunch is not about beds, but nurses and doctors trained in acute care.
Ghaly said the Mercy had rules about patients that made it hard to get acute care patents on board, including restrictions against patients with substance abuse issues or mental disorders.
California’s top medical officer said on Tuesday that the hospitals were also looking at the possibility of “rationing” care.
“We have worked with our hospitals over the past few months about what is called ‘crisis care.’ We need to look at that in case we need to implement it,” said the state’s director of Health and Human Services.
Tempering the excitement generated by the delivery of Covid-19 vaccines, Governor Newsom on Tuesday offered a grim reminder of the increasing death toll, saying the state has ordered 5,000 more body bags for distribution to morgues in three counties, including Los Angeles.
Los Angeles County on Tuesday reported the highest number of new coronavirus-related deaths since the summer, at 86. California as a whole has averaged 163 people lost to the virus over the past 7 days. The all-time high number of deaths related to the virus was the 225 reported on Friday.
The county is also reporting 11,194 new cases of COVID-19. The number of people hospitalized due to the virus is now 4,403, with 21% of those people in ICU beds.
According to L.A. County Health officials, “During this time of extraordinarily high number of cases and hospitalizations and increasing numbers of deaths, it is more important than ever that County businesses carefully follow the Public Health requirements and be fully compliant with the safeguards and modifications in the Health Officer Order and protocols.”
Orange County on Monday set new records for new coronavirus-related infections —- 3,250 —- and hospitalizations, with the county’s adjusted intensive care unit capacity reaching zero.
On Tuesday, the county logged 2,173 new COVID-19 infections. Hospitalizations jumped from 1,287 Monday to 1,371 Tuesday, another record. There were 296 ICU patients, up from 288 the previous day, another new record. That has become a daily occurrence since last week.
The county’s Covid-adjusted ICU bed availability actually increased on Tuesday from zero to 1.4%. That likely reflects efforts to increase capacity — possibly via the mobile field hospitals — since the tally of ICU patients actually increased. The state created the adjusted number to reflect the difference in beds available for COVID-19 patients and non-coronavirus patients.
The overall percentage of ICU beds available in the 11-county Southern California region stood at 1.7% as of Monday night.
Orange County’s test positivity rate increased from 10.6% to 13.2% on Tuesday. Officials reported one new fatality was reported Tuesday in Orange County, hiking the death toll to 1,695.
Prior to this month, the record for ICU patients in Orange County was 245 during a mid-July surge. Overall hospitalizations have been breaking records daily since Dec. 2.
As has been the case for months, dozens of residents appealed to the board of supervisors on Tuesday to defy the state’s stay-at-home order. Orange County counsel Leon Page explained that Gov. Gavin Newsom’s executive order is the final word and the county can’t do anything to change it.
Dr. Chau made an emotional appeal to residents to adhere to physical distancing and face-covering mandates to help curb the spread of coronavirus.
County health officials are particularly struggling with housing the elderly with dementia, who are infected but do not exhibit symptoms, Chau said.
“We can’t send them to a hospital…They don’t need that level of care,” Chau observed. “And we can’t send them to a nursing facility…and we can’t send them to a hotel.”
Those patients will likely be housed at Fairview Developmental Center in Costa Mesa, which is expected to open on Thursday.
“But we only have the availability of 50 beds,” Chau said. “We’re going to run out of options to take care of these people.”
“Right now we are feeling the impacts of the Thanksgiving surge,” said Orange County Supervisor Lisa Bartlett. “And with Christmas holidays and New Year’s we’ve got to plan for even more cases coming.”
“The message is very simple,” Chau added. “In the United States today, every minute there’s two people who have died in the United States of COVID-19. Every minute we talk someone lost a loved one…It is an astounding number and just an embarrassing number from an American perspective because we’re supposed to be the best in what we have in medical care.”
Orange County Supervisor Andrew Do, whose father died unexpectedly over the weekend, noted the
crush of patients he saw in the hospital where his father was treated.
“I can tell you from personal observation every single bed was taken,” Do said. “As I contacted funeral homes for my father they said their business has increased by 300% this year. The wait time and lack of availability of services whether they’re for viewings or cremation it is unbelievable. They’ve never seen that kind of scarcity before.”
Newsom said 142 coronavirus-related deaths were reported statewide in the past 24 hours. Over the past week, the state averaged 163 deaths per day — up from 41 per day one month ago.
“Think about if we continue down the path we’re on, what that January 14th number might look like if we do not do what we need to do, which is not just to avail ourselves when we can to the vaccine, but to continue to wear these face coverings and minimize mixing to the extent possible because of what’s occurred in the last 30 days,” said Newsom.
According to the governor, the state has 60 53-foot refrigerated storage units on standby in counties California for use if local facilities become overwhelmed by virus fatalities.
“We just had to order 5,000 additional body bags…and we just distributed them down to San Diego, Los Angeles, Inyo counties,” he said. “That should be sobering. I don’t want…to scare folks, but this is a deadly disease. And we need to be mindful of where we are in this current journey together to the vaccine. We are not at the finish line yet.”
City News Service contributed to this report.
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