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Since mid-October, doctors and nurses at Loma Linda University Medical Center have been watching with suspicion reports of a peak in COVID-19 patients in the Midwest. They knew that sooner or later their own hospital would be hit hard. They just didn’t know when.
Last week they found out. In a 24-hour period, 15 COVID-19 patients were admitted to Loma Linda in what Dr. Michael Matus, chief of hospital medicine, described as “a huge rush of patients”.
“We immediately filled one room and half of another,” said Matus. “It immediately put a strain on the nursing staff. And then the doctors. We are trying to allow doctors to see up to 16 patients. That day was until 24 … It was our biggest day of the last month.
A new wave of COVID-19 is hitting Southern California, weighing on exhausted healthcare workers, increasing anxiety levels in hospital wards, and fueling fears that there are not enough staff and staff supplies for the difficult weeks ahead. The upcoming holidays only make the situation worse.
The recent increase in the number of COVID-19 patients in the center of the country has sapped the national supply of nurses and doctors, as well as masks, gloves and other protective gear. The good news about vaccines offers hope for the future, but it’s the present that worries those caring for California’s sickest patients.
For the week ending Thursday, according to the most recent statistics available, the number of COVID-19 hospital patients increased by 40% in Los Angeles County. In San Bernardino County, home of Loma Linda, the number has jumped 45%; in Riverside County, it increased 34%.
“We are facing one of the most dangerous times of this pandemic,” Barbara Ferrer, director of the Los Angeles County Department of Public Health, noted in a briefing Wednesday.
An exhausted Matus does not need a reminder.
“Every morning we go over our overall resources and how to manage patients,” he said. “Staffing is problematic. No system leaves qualified doctors or nurses waiting.… There were several days in the morning when the registry [of available nurses] is completely empty. “
Although the new therapies “give us a fighting chance in the majority of patients,” said Matus, it’s hard to see “the stress in everyone’s eyes. [Patients] come to the hospital out of breath. They meet me fully masked. Everyone is just petrified.
Dr Anil Perumbeti, medical director of Eisenhower Health’s intensive care unit at Rancho Mirage, said staff were proud to be able to work at a rapid pace and at a high standard throughout the pandemic. But there is a cost.
“There is definitely [been] two-week periods when nobody comes out of the COVID ICU, nobody is better enough to be transferred, there are several deaths, there are no success stories, nobody is better ”, a- he said. “I don’t think there is any experience that makes this correct or makes you feel like you’ve done your best.”
At Keck Medicine of USC, healthcare workers recently talked about reducing the capacity of the COVID-19 unit so that there would be more space for other patients if the number of cases began to decline. Instead, he started over.
Los Angeles University Hospital “definitely” sees an increasing trend in COVID-19 patients, said Dr. Neha Nanda, medical director of infection prevention. “I don’t have a crystal ball, but I expect that in the coming weeks it will continue to increase.”
Nanda said she feared hospitals would “run out of beds soon” as the number of patients in the region increased.
The capacity issue is complicated, said Carmela Coyle, president of the California Hospital Assn. She noted that, during a press briefing in early November, Governor Gavin Newsom said the state was only using 4% of its hospital bed capacity for COVID-19 patients. Last week, that number rose to 6%.
She said, however, that in Imperial County, for example, nearly a quarter of all hospital beds had patients with COVID-19 and that in Kings County the rate was 16%.
“With epidemics, you can have zero [patients] today and quite a few tomorrow, ”Coyle said. “I was on the phone with a [hospital] CEO. They went from seven patients yesterday to 20 COVID patients overnight … We are talking about the percentage of beds with COVID patients. But it is not a question of mattresses, pillows and bed frames.
Dr Alan Williamson, According to Eisenhower’s chief medical officer, the pandemic underscores the compromises hospitals make in providing care while reducing costs. Health care systems in the United States have moved to a “just in time” model, so they don’t keep many supplies on hand. And they’ve consolidated their purchases because gloves, masks, and isolation gowns are cheaper if they put all of their stuff in one source. But if that provider runs out, there is no backup.
“It’s a constant concern every day about what’s going to break next in the supply chain,” said Williamson. “A hallmark of the pandemic is exposing that we have precarious supply chains.”
The Coachella Valley is a destination for snowbirds and the population can double in winter. Eisenhower is heading into his busiest season while preparing for the next outbreak of the virus. The hospital has already seen an increase in patients.
Tina Wallum, director of intensive care and inpatient dialysis units, says the latest outbreak is different from previous ones at Eisenhower. Patients are admitted with complications from the virus, such as respiratory failure. But the virus has become so “endemic in the community” that the unit also has patients with coronavirus who are admitted for non-COVID reasons, such as congestive heart failure or sepsis. They cannot be put among the general population of the hospital for fear of spreading the virus.
“The whole team is emotionally tired from this marathon,” Wallum said. “A lot of it is because families are far from loved ones… I have never seen anything like this in my nursing career. These patients are some of the sickest patients I have ever seen.
Eisenhower instituted virtual counseling and social distance debriefing sessions for nurses to address the emotional impact of caring for COVID-19 patients for so long and with no end in sight.
Wallum, who is a nurse, said the session she attended was “very useful”. She said she realized that she probably didn’t talk enough with “people who could help me” about the more difficult aspects of her job, such as enforcing the no-access policy in the ICU, which means it must stand between the dying and their loved ones.
Family members can communicate with loved ones virtually, but “it’s not the same as walking in and holding someone’s hand,” Wallum said. “It was the most heartbreaking for me.”
Perumbeti said his hospital was prepared for the outbreak because “we’ve never really taken a break” since the start of the pandemic. “Nurses feel this tremendously.”
He is one of three intensivists regularly scheduled at Eisenhower’s ICU. Times like this, he said, are what he and other members of the unit “have been training our whole lives for … that’s where we love to be.” We don’t want to stay home when things are busy.
Yet, he said, the challenge of caring for critically ill patients leads to fatigue and “everyone really feels it.”
Tinny Abogado, a nurse at Kaiser Permanente Los Angeles Medical Center, worries that she doesn’t have enough masks to do her job safely and that her hospital is not ready for the surge ahead.
“You don’t know what to expect,” she said. “It’s coming this way… We’re not prepared at all. Besides being exhausted, I also feel nervous.
Patricia Wilson is very worried about bringing the virus home. She is 33, has been a nurse for four years, and started a job at Riverside University Health System amid the pandemic. The virus and the devastation it has caused have taken a toll on his mental health.
Wilson said she predicted that with the onset of flu season and the fatigue of the quarantined public, the job would be busy. With the coronavirus outbreak, she said, she believes she will be on COVID-19 in the future.
She had trouble sleeping and having anxiety. She then suspects that she is trying to stay healthy while protecting her patients, her husband and her 20-month-old daughter. She says her heart sinks and her eyes are full of tears “when I see my husband come in for a hello kiss when I get home, but then hesitate at the very last second as I turn my cheek to him to avoid kissing my mouth directly.
She disinfects her car and her glasses after every shift. She lies to people when they ask what she is doing. Being a nurse “was once admirable,” she says. It “now feels like a risk. I hate it … I feel like an outcast.
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