Spreading with astonishing speed

COVID-19 spreading with astonishing speed - 100,000 new cases in L.A. County in little more than a week

Alex Wigglesworth and Laura Newberry

Los Angeles County has recorded 100,000 new coronavirus cases in little more than a week as the infections continued to multiply with astonishing speed not seen at any other point of the pandemic.

COVID-19 showed no signs of slowing in L.A. or across the state, which posted record numbers all week, heightening concerns that already overwhelmed hospitals will get even more strained in the coming weeks.

Experts say it typically takes two to three weeks for a person who contracts the coronavirus to become sick enough to require hospital care. And California is now reporting two to three times more cases than it was at the beginning of December, according to data compiled by the Los Angeles Times.

As of Saturday morning, Harbor-UCLA Medical Center in Torrance was treating 97 patients for COVID-19, according to hospital Chief Executive Anish Mahajan. For the past 10 days, the hospital has been using a large section of the emergency room as a makeshift intensive care ward, with a dozen patients on ventilators.

If the surge in cases continues, Harbor-UCLA will likely convert the area of the hospital usually designated for patients recovering from surgery into a critical-care ward, Mahajan said.

The nursing staff is stretched extremely thin because of the huge influx of patients, Mahajan said. So the hospital has redeployed 100 nurses from other areas — even those on the administrative side who have critical-care skills — to join the ICU team.

Contributing to the staffing shortage is the increasing number of hospital employees who have contracted the virus, Mahajan said. Hospital contact tracing efforts show that the majority of staff likely picked up COVID-19 outside of work, he said.

“Also, people are exhausted, dealing with stress-related conditions, and they need a break,” Mahajan said.

The state logged 53,326 new cases of the virus Friday, according to the Times’ tally, topping the previous record of 52,330 cases set Wednesday and marking the third consecutive day that new cases surpassed 50,000.

California is now averaging more than 40,000 new coronavirus cases a day over the last week, a new record and more than triple the figure from three weeks ago, when the state was reporting about 13,000 new cases a day.

California is averaging 226 deaths a day, also a new record.

There were 16,465 COVID-19 patients in California hospitals Friday, according to data released by the state Saturday, an increase of nearly 635% from two months before, when there were 2,241 patients.

Los Angeles County, which one health official said is on the verge of becoming the epicenter of the pandemic, on Saturday recorded 13,521 new cases of the virus and 64 deaths, according to The Times’ independent tally, bringing its total to 610,907 cases and 8,822 deaths.

“We are bearing witness every day to the terrible suffering caused by a virus that is spreading out of control throughout the county,” County Public Health Director Barbara Ferrer said in a statement. “Following the safety measures saves lives and is our only way to protect essential workers and our hospitals.”

Orange County, which has also broken records for new cases and hospitalizations, had 1,601 patients in its hospitals. The county Saturday reported 3,445 new cases and 26 deaths.

The availability of intensive care unit beds throughout Southern California and the San Joaquin Valley remained at 0% Saturday, and officials warned that conditions in hospitals are expected to erode further if the coronavirus continues to spread unchecked.

L.A. County-USC Medical Center was treating 160 COVID-19 patients, 65 of them in the ICU. Of the hospital’s 600 beds, about 100 of them are ICU beds capable of handling COVID-19 patients, meaning that less than half of them remain available to be used by other critically ill or injured patients, said Dr. Brad Spellberg, chief medical officer.

Many mornings over the past seven to 10 days, hospital workers have come in to find there are no available ICU beds, and as soon as one opens up, a patient in the emergency department is often waiting to use it, Spellberg said.

“We are scrambling to move people around, to find places for people to go,” he said.

The hospital has on several occasions resorted to using a triage station set up in a tent outside its emergency department and has outfitted an area that doesn’t usually house severely ill patients with beds and staff to provide care, he said.

But the main challenge is staffing, not physical space, he said. The hospital has scaled back outpatient clinic visits and elective procedures, withholding care for these noncritical services so it can reassign staff “to allow us to tread water so we don’t go under,” Spellberg said.

“This is the level of what we call contingency care, where we’re scrambling to maintain care standards,” he said. “We’ve not progressed yet to crisis care but it’s getting close.”

If that happens, he said, the hospital will have to do things like break the acceptable ratio of staff to patients and assign people to provide levels of care they don’t have specific expertise in.

“We won’t have a choice,” he said. “Hospitals can only react to what comes to us.”

Already on Dec. 11, the California Department of Public health began granting waivers that permit hospitals to increase the number of patients nurses can treat at one time. For ICU nurses, that means they are now expected to treat three patients instead of the customary two.

The California Nurses Association has decried this move, saying it will impact the quality of care patients receive.

“Heavier patient assignments sharply cut the time nurses can provide individualized patient care, properly monitor a patient’s condition, and increase the likelihood of mistakes, as studies have documented for years,” said Zenei Cortez, a registered nurse and president of California Nurses Assn. “In a pandemic, that’s an open invitation to increase the risk of spreading the virus to other patients and other staff.”

The California Hospital Assn. has rebuffed the nurses’ union’s opposition to the waiver, pointing to a statewide shortage of critical care nurses.

“In times like these, California’s health care providers need, without exaggeration, every hand on deck to save people’s lives,” Carmela Coyle, CEO of the California Hospital Association, said in a statement.

The waivers affect not only ICU nurses. Nerissa Black, a registered nurse at Henry Mayo Newhall Hospital in Valencia and a California Nurses Association member, works in a COVID-19 unit that treats 29 patients. Her patient load jumped from four to six last week.

Black’s patients aren’t in critical condition, but the new patient-to-nurse ratio has still taken a toll. Before the change, she spent 15 minutes with every patient each hour; now she has 10 minutes.

“That includes putting on our PPE, documenting my interventions, reviewing lab results and imaging results and any abnormal findings,” she said. “So there are some things that slide. We don’t get to brush their teeth, wash their hair, talk to them about their lives and how we can help them better at home.”

Whether it’s necessary for hospitals like L.A. County-USC to move to crisis care mode, increasing employees’ workloads even more, depends entirely on whether new cases begin to slow, Spellberg said.

“If cases stay at this level and then start to decline, we’ll hold on by our fingernails,” he said.

But, he said, if there’s a significant further rise, “we’re going to have patients in the hallways and we’re going to be starting to make tough decisions about who’s going to get care.”

Hospital officials are simultaneously scrambling to provide the first doses of COVID-19 vaccine to their workers.

In L.A. County, hundreds of health care workers at county-run hospitals have received a vaccine dose so far, and that number was expected to hit roughly 6,000 by Christmas, officials said earlier this week. The county received an initial allotment of the Pfizer-BioNTech vaccine last week and will receive a second batch next week; both are earmarked for workers at acute care hospitals.

The vaccinations have been one bright spot amid the grueling days at Harbor-UCLA, Mahajan said. Nearly 600 hospital staff, from doctors to X-ray technicians to custodial staff, were vaccinated Friday morning.

“There was an amazing atmosphere of relief,” Mahajan said. “People were jovial in a way I hadn’t seen in so long.”

Another 1,000 will be vaccinated next week, Mahajan said, and several thousand more will be inoculated after Christmas.

Next week L.A. County expects to receive doses of the vaccine developed by Moderna and the National Institutes of Health, which the Food and Drug Administration recently authorized for emergency use. They will be reserved for staff and residents and skilled nursing facilities, frontline EMTs and paramedics, and those who administer vaccines, public health officials said Saturday.