California virus deaths increase as ICU space tightens



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SACRAMENTO, Calif. (AP) – The administration of California Governor Gavin Newsom and the State Hospital Association disagree on how best to create space for critically ill coronavirus patients in medical facilities already energized that could soon be overwhelmed by the expected surge in new cases of holiday gatherings.

A wave after Halloween and Thanksgiving produced record hospitalizations and now the most seriously ill of these patients are dying in unprecedented numbers. California health officials on Thursday reported 583 new deaths and a record two-day total of 1,042.

The state has deployed 88 refrigerated trailers, up from 60 a few weeks ago, for use as makeshift morgues, mostly in hard-hit southern California.

Hospitalizations are approaching 22,000 and state models predict that number could reach 30,000 by February 1. Already, many hospitals in Los Angeles and other hard-hit areas are struggling to keep pace and have warned they may need to ration care as intensive care beds dwindle.

Earlier this week, state health officials caught hospitals off guard and left them scrambling with new orders limiting non-essential surgeries and forcing hospitals with little intensive care space to accepting patients from those who are exhausted, an order that can require transferring patients hundreds of miles.

The California Hospital Association has said the orders don’t go far enough to resolve a crisis that “cannot be overstated.” He wants changes, including cutting red tape that he says cuts the daily hours of nurses who would otherwise treat patients.

Carmela Coyle, president and chief executive of the association, said the group had negotiated with state officials but they were not acting fast enough.

“We really need to move quickly to coordinate and see if we can remove the burden from the health care delivery system – focus on nothing but saving lives for the next few weeks,” she said.

State epidemiologist Dr Erica Pan responded on Thursday that the administration was “determined to continue to coordinate closely and build partnerships with hospitals and local leaders.” She said state officials “appreciate any suggestions from those who fight this pandemic every day.”

In the meantime, seeking to keep people closer to home, the Newsom administration has issued a more strident travel advisory stating that out-of-state residents are “strongly discouraged” from entering California and that Californians should avoid non-essential trips of more than 193 kilometers. of the House.

The state’s notice in November encouraged people to stay at home or in their area without giving a specific number of kilometers. It outlined quarantine guidelines for out-of-state travelers, but did not explicitly discourage travel.

Dr Rajiv Bhatia, an affiliate assistant professor of medicine at Stanford University and former director of the San Francisco Department of Public Health, questioned the effectiveness of a distance requirement, noting that it will be difficult to enforce and that people might ignore another article. of the orientation of the State. He said California, on the whole, did not provide sufficient data to support the restrictions.

“They just don’t want to give anyone the chance to interact,” he said.

People traveling more than 120 miles are more likely to access commercial services such as hotels, a spokesperson for the California Department of Public Health said, noting that the distance is designed to be fair for rural residents. and urban.

Coyle said the orders affecting hospitals that were issued on Tuesday do not provide the help hospitals desperately need.

Most hospitals affected by the order of non-essential surgeries have already canceled the type of procedures banned by the state, such as elective spine or carpal tunnel release surgeries, she said. It only applies to hospitals in 14 of 58 counties, all located in Southern California and the agricultural San Joaquin Valley, two areas with the most severe shortage of critical care beds.

Coyle said it was also unclear how often the transfer order will be used. While that could mean sending patients hundreds of miles to northern California by ambulance, rescue helicopter, or other plane, it will likely facilitate transfers between neighboring counties, she said.

In an earlier push, patients from Imperial County along the border with Mexico were sent to hospitals all the way to the San Francisco Bay Area. But the current outbreak is so widespread that only 11 predominantly rural counties north of Sacramento and San Francisco exceed the state’s threshold of at least 15% capacity for coronavirus patients in intensive care beds. Those below this level are subject to more stringent business restrictions.

UC Davis Health, which owns the main trauma center in the Sacramento area, said it had not received any transfer requests. A spokesperson there and the Sutter Health System both addressed questions to the hospital association, while Kaiser Permanente did not immediately comment.

“If we can put patients in the right environment to begin with, it will minimize the need to transfer patients after the fact, and that’s frankly better for patient care,” Coyle said.

This means California should start coordinating patient care at the state level, where officials can have an overview of the best-equipped hospitals at all times, instead of allowing local dispatchers to follow the practice. usual to send ambulances to the nearest facility, she said.

“Yes, transferring patients is important, but we have a number of major issues that need to be addressed,” she said. This includes the temporary suspension of regulations which she says can force nurses to paperwork for hours and make it difficult to use a team approach to deliver intensive care when hospitals don’t have a number. sufficient number of nurses trained in critical care.

California Nurses Association director of government relations Stephanie Roberson said team nursing was a cost-cutting measure that would jeopardize patient care after hospitals did not properly prepare for the surge.

“It is a slap in the face to the safety of patient care to call mapping and documentation ‘red tape’,” she said.

Pan said the state’s actions “will save lives” as officials seek staff and resources in hospitals.

State health officials did not respond to questions about how they expected health orders to be enforced or how many patients or hospitals could be affected.

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Associated Press writer Kathleen Ronayne in Sacramento, John Antczak and Christopher Weber in Los Angeles, and Janie Har in San Francisco contributed to this story.

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