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How serious will the next few weeks be?
The death toll from COVID-19 in California and Los Angeles County – an epicenter of the pandemic – is setting records or almost every day. It is clear that the spike in cases after the Christmas holidays is getting worse, as the numbers continue to climb, especially in LA County.
But the big question is whether this new wave of cases will lead to a rise in hospitalizations similar to that of the post-Thanksgiving outbreak, which has pushed hospitals to the breaking point, leading to terrifying shortages of staff and some supplies and affecting the quality. medical care for critically ill patients.
Around Thanksgiving, around 300 new COVID-19 patients per day were admitted to LA County hospitals; that number increased precipitously for about a month, eventually leveling off at around 750 to 800 new hospitalizations per day around Christmas Eve. Another doubling or tripling of new hospitalizations per day would be catastrophic.
Because as dramatic as the crisis has become, most hospitals have not yet entered a prolonged and generalized period of rationed care. But that would likely happen if the Christmas wave were dramatically worse.
Teams of triage workers – usually led by intensive care and emergency physicians – should be fully activated. Faced with a shortage of staff and supplies, they would be forced to make the most heartbreaking decisions: determining who receives the most aggressive life-saving care and limited time from the best-trained professionals and equipment, and who has the least chance of success. do it. survival and provided them with treatment to comfort them at the time of their death. The break in hospitalizations this week will give officials an idea of what to expect.
“We are all waiting with some anxiety to see how the hospital admission data plays out in the days to come,” said Dr. Roger Lewis, director of COVID-19 hospital demand modeling for the LA County Department of Health Services.
“The hospital system is literally at the breaking point, where a substantial increase in demand could lead to situations in which we cannot provide people with the care that we would all expect to be able to provide or receive when we are critically ill. ,” he added.
The COVID-19 patients who now enter hospitals were mostly infected in the post-Thanksgiving period, before Christmas. The flattening of new hospitalizations likely resulted from the imposition of stay-at-home orders issued by county and state.
But the effect of Christmas holiday gatherings will soon begin to show in hospitals. Soon a certain percentage of people who are infected at Christmas and test positive will start to get so sick that they will need hospital care. If the number of new daily hospital admissions for COVID-19 patients worsens, that’s a big sign of trouble.
Now it is possible that the increase in hospitalizations will be moderate if, for example, it was mostly younger, if not healthier people who were infected during the holiday season, and went into quarantine or isolated for avoid infecting older families and friends who are at a higher risk of dying.
But it’s also plausible that the vulnerable and the elderly attended Christmas and New Years gatherings or were later infected by younger people who didn’t stay away – which happened during the Thanksgiving holiday.
“The fear, or intuition, of most people who do predictive modeling is that it will get worse. The uncertainty is in how much worse. And to quantify the worst, that requires the data that won’t be available until next week, ”Lewis said.
The post-Christmas surge in new coronavirus cases is increasing day by day. The average number of new coronavirus cases in LA County Thursday, Friday and Saturday was around 18,000 – significantly higher than the average of around 14,000 new cases per day over the past week.
“This is very clearly the last wave of the winter and New Years holidays – no doubt about it,” LA County Department of Public Health Scientific Director Dr. Paul Simon said. “It had gradually started earlier in the week, but [definitely] here in the last day or two.
About 1 in 5 coronavirus tests performed daily in Los Angeles County come back positive, a huge increase from early November, when about 1 in 25 tests confirmed infection. And when community transmission is so prolific, officials warn that activities that seemed trivial months ago carry a higher risk of infection than ever.
Simon said the increase in daily coronavirus cases would likely continue over the next two weeks, resulting in even worse hospitalizations and more deaths. The number of daily deaths from COVID-19 is already breaking records; by early December, about 30 people per day in LA County were dying from COVID-19 on average over a seven-day period; today, around 200 people die every day.
The number of people who die each day from COVID-19 now exceeds the average number of deaths in LA County for all other causes, including heart disease, cancer, stroke, diabetes, stroke. car, suicides and homicides, or about 170 deaths per day. .
Some veteran epidemiologists suspect that higher levels of hospitalizations and deaths will in fact materialize and that hospitals will be forced to adopt “crisis care standards,” in which triage physicians may have to choose who will receive. life-saving treatment.
“I predict that with the increase in the number of cases that we see – which will result in an inevitable number of hospitalizations and intensive care patients – hospitals will be forced to operate under crisis protocols that may include rationing.” care,” said Dr. Robert Kim-Farley, medical epidemiologist and infectious disease specialist at UCLA.
Kim-Farley said he suspected there would soon be another increase in hospitalizations that would continue to rise until the end of January. A fraction of those people will not survive their illness and a peak in daily COVID-19 deaths is likely to occur in mid-February, Kim-Farley said, due to the time lag between initial hospitalization and death.
It was wise for state officials to be prepared to hand out dozens of large refrigerated trailers that can serve as temporary morgues for bodies being sent to counties, Kim-Farley said. Funeral homes across the state are already overwhelmed by rising corpses and some have been forced to turn away families.
“Unfortunately, the ramp-up capability of the mortuaries will actually be needed,” Kim-Farley said.
LA County has now reached new milestones in the pandemic: more than 12,000 deaths from COVID-19 and more than 900,000 cases of coronavirus.
As of Saturday, 218 deaths from COVID-19 were reported in LA County. This came the day after the county set a single-day record of 318.
LA County officials on Saturday confirmed three more cases of the coronavirus-related inflammatory disease in children known as MIS-C. A total of 54 LA County children contracted the critical illness and one died. The disease can cause a fever and inflame the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal organs. The disease disproportionately affects Latino children, who account for around 3 of the 4 reported cases.
In LA County in recent days, available intensive care beds have fallen to zero or one in each of the following regions: Central Los Angeles, Westside, Southeast LA County, San Valley Gabriel and the Antelope Valley. The South Bay-and-Long Beach area had just three intensive care beds available in recent days, and the San Fernando Valley only six.
In Santa Clara County, which has a population of some 2 million, about 20 to 25 available intensive care beds remained on Friday; in Fresno County, with approximately 1 million people, only 10 beds were available.
Fresno County Acting Health Officer Dr Rais Vohra said hospitals were preparing for “a very difficult January and possibly February” rest, including the search for supplies related to the provision of oxygen treatments and the provision of means to perform antibody infusions to prevent patients requiring hospitalization.
Help has started to arrive: U.S. Department of Defense personnel, as well as state-recruited critical care nurses, have been deployed around hospitals in the region, said Dan Lynch, director of the Fresno County Emergency Medical Services Agency. And a San Mateo County hospital has offered to take seriously ill patients from Fresno County.
But it will not be easy to make these transfers in practice. “It’s a risky move when you move them a long distance,” Lynch said.
Although California’s current pandemic outbreak is disastrous, the state has one of the lowest cumulative numbers of COVID-19 deaths per capita, ranking 38th out of 50 states, likely due to the early imposition of stay-at-home orders in the spring and summer, closures of some high-risk businesses. New Jersey’s COVID-19 cumulative death rate is three times that of California; Arizona is twofold.
Times editor Ryan Murphy contributed to this report.
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