Covid-19 Crisis: Orange County Health Care System Now Limiting Medical Care Amid Fears Of Emergency Capacity Collapse

An emergency room entrance Todd Berkey/The Tribune-Democrat via AP

With Covid-19 hospitalizations at an all-time high, Orange County hospitals were directed on Thursday to implement surge plans and cancel elective surgeries in response to a “crisis” situation that could cause the emergency medical system to “collapse.”

Elective surgeries can include serious procedures, such as the installation of a stent or a heart valve replacement. The phrase refers to any surgery that is scheduled ahead of time.

The number of patients hospitalized in Orange County rose from 974 on Wednesday to 1,025 on Thursday, a new record which includes 257 in intensive care, up from 239 on Wednesday, also a new record. The previous peak was 245 in mid-July.

The Orange County Health Care Agency reported 1,521 new coronavirus diagnoses on Thursday, raising the cumulative to 94,647. The county’s test positivity rate increased from 8.8% to 10.6%.

The agency also reported seven new fatalities, raising the death toll to 1,640. One of the deaths was a skilled nursing facility resident.

Late Wednesday night, the HCA sent a letter to hospitals, ambulance providers and 911 paramedic providers, saying the county’s health care system is “now in crisis” due to the surge in Covid patients, with more hospitals requesting diversion of ambulances to other medical centers due to patient volumes.

According to the letter, “This results in dangerous delays in initial patient assessments to ensure they don’t have an emergency medical condition. Hospitals are overwhelmed with admitted patients to both the floors and the ICUs. At the current rate of deterioration, the EMS system may collapse unless emergency directives are implemented now.”

The letter from Dr. Carl Schultz, HCA’s EMS medical director, urges hospitals to activate surge plans, establish alternate treatment areas in emergency departments to expand capacity, cancel all elective surgeries, apply for state waivers in support of surge plans and establish emergency operations centers.

“To those who have chosen not to take this painful but necessary actions, there is still time, but you must act now,” wrote Schultz.

Orange County Supervisor Lisa Bartlett said the county is likely now just experiencing a surge of cases from Thanksgiving.

“This is basically a Hail Mary pass,” said Andrew Noymer, a UC Irvine associate professor of population health and disease prevention, of the county’s directive to hospitals. “It illustrates the gravity of the situation.”

The statistics this week are reflecting Thanksgiving gatherings, he confirmed.

The county’s percentage of available ICU beds went from 11.2% to 11.3% Thursday, but according to a new state metric for “adjusted” ICU bed availability, the rate went from 4.9% to 3.5%, according to the HCA.

Kim said the adjusted ICU number essentially reflects the estimated number of beds available for COVID-19 patients when factoring in the number of beds needed for patients without the coronavirus.

The 11-county Southern California region’s available ICU capacity diminished from 9% to 7.7% on Thursday.

Orange County’s more urban neighbor to the north on Thursday reported 12,819 new cases, smashing the record set on Sunday.

To drive home the point, Mayor Eric Garcetti dropped another staggering statistic. “In Los Angeles, someone is dying of COVID-19 every 20 minutes,” he said.

There were 3,634 virus-infected people hospitalized in L.A. County on Thursday. That’s a 6% increase just since Wednesday and a new high.

“It’s very possible that in two weeks we could see the daily number of people hospitalized at 4,000 a day,” said L.A. County Public Health Director Barbara Ferrer on Tuesday. Overall beds were running at about 75% full, said Ferrer, before revealing that some hospitals in the L.A. network were already out of ICU beds.

L.A. County Direcor of Health and Human Services Dr. Christina Ghaly said on Thursday that with the high rate of admission means looming shortages in available and staffed general beds and ICU beds, county hospitals are likely to be moving into surge plans.

She also noted that on Tuesday, 77% of Los Angeles County hospitals implemented two-hour ambulance diversions due to overcrowded emergency room conditions. On a normal day this time of year, normally only 10% to 15% of hospitals call for such diversions.

The news came on the same day that California saw its highest number of COVID-related deaths ever at 220. The nation at large on Wednesday suffered its highest daily number of coronavirus-related deaths ever at over 3,000.

City News Service contributed to this report.

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