LA COVID-19 hospitalizations are increasing, bringing gloomy projections

The pace of new COVID-19 hospitalizations is growing so fast in Los Angeles County that it is now literally taken off the top, forcing officials to redraw the graphics used to illustrate the bleak projections for what is to come.

In October, fewer than 150 coronavirus-infected patients were hospitalized daily.

By the end of November, that number had doubled to about 300 patients a day – as large as it has ever been in the entire pandemic.

And now it has doubled again, to about 700 new hospital patients a day, just days before Christmas. This rate brings the crisis to LA County.

If the behavior of the disease does not change, a projection issued by the County Department of Health Services says that LA County could be targeted between 700 and 1,400 new patients hospitalized per day until New Year’s Eve.

COVID-19 daily hospitalizations could increase tenfold compared to October

“The model suggests that we could easily see 10 or more daily hospitalizations than we saw in October,” said Dr. Roger Lewis, COVID-19 Hospital Application Modeling Director for the County Department of Health Services and Professor of Medicine. at Harbor-UCLA Medical Center in West Carson.

The graph shows the growing projection of new daily hospitalizations for COVID-19 starting December 16, 2020

The project of the County Department for Health Services of the new daily hospitalizations for COVID-19 starting with Wednesday.

(Los Angeles County Department of Health Services)

Already, the number of people in LA county hospitals with COVID-19 has been nearly 5,900 since Sunday – more than double the summer peak during the second pandemic wave, in which no more than 2,232 people are injured. they were in the hospital with the disease on any given day.

The graph shows the number of people hospitalized each day with COVID-19 in Los Angeles County

The graph shows the number of people hospitalized each day with COVID-19 in Los Angeles County.

(Los Angeles Times)

This means that by the end of the year, we could see up to 9,000 people with COVID-19 taking hospital beds in LA County.

And by mid-January, there could be 14,000 if there is no change in transmission behavior.

Projections of the demand for hospital beds in LA county starting Wednesday, December 16, 2020

Projections for the demand for hospital beds in LA County starting Wednesday.

(Los Angeles County Department of Health Services)

Particularly alarming is the graph showing the prognosis of intensive care applications.

“We have no ICU beds available”

Last week, LA County effectively depleted the capacity available for the ICU bed for patients with COVID-19 – the first time this has happened in this pandemic.

The graph predicts forecasts of demand for ICU beds in LA County starting Wednesday.

The available capacity of the intensive care unit for patients with COVID-19 actually dropped to zero last week.

(Los Angeles County Department of Health Services)

“We don’t have ICU beds available for additional patients at this time,” Lewis said.

More than 1,200 COVID-19 patients in Los Angeles County were in intensive care on Sunday, more than three times the number since the end of November.

“Now, that does not mean that hospitals do not continue to do everything they can to increase capacity. But there is a limit to what can be done, “Lewis said Friday. “I believe that the biggest challenge facing hospitals in the next week or two will be the staff needed to care for patients with COVID-19, which requires higher levels of care.”

On Monday, the director of public health, Barbara Ferrer, said LA County is about to record 110 COVID-19 deaths a day in a few weeks. Currently, the county has an average of 84 deaths per day.

So what do hospitals do when there are no more beds available in the ICU?

Lots of options to deal with an ICU deficiency – none ideal

Options for finding ways to treat critically ill patients when the ICU is full:

  • Asking nurses to care for more intensive care patients than usual. Normally, an intensive care nurse cares for one or two patients at a time. Nurses may be asked to care for three or four at a time.
  • Placing patients with critical illnesses in physical locations outside the ICU, such as keeping them in the emergency room longer. But “it’s not ideal to be in a physical location built to provide that level of care,” Lewis said.

“Having the system accommodate this growing demand and doing our best with what we have will not give as good patient results as we could get if we had a lower demand for care,” Lewis said. “Everyone does things differently than we would ideally like to do, because there are more patients than we can take care of.”

And that means patients are at risk for poorer outcomes. “This includes longer periods of hospital stay, longer periods of time on the ventilator, and ultimately mortality,” Lewis said.

When there are too many patients for the medical staff available, “there will not be the same quality of monitoring,” said Dr. Robert Kim-Farley, an epidemiologist and infectious disease expert at UCLA Fielding School of Public Health.

Other temporary measures are not ideal. Keeping seriously ill patients who need to be in the emergency room waiting in the emergency room not only results in a degraded quality of care, Kim-Farley said, but also creates a ripple effect that keeps patients from wait in ambulances for hours outside the hospital. This leaves fewer ambulances available to answer calls.

Exhaustion concerns

Exhaustion is another key concern. Nurses are in the bed of intensive care patients and are now required to work in higher-intensity care settings than usual, caring for more patients, “and they will be required to do this for weeks. in turn, Lewis said.

To date, newly diagnosed coronavirus cases continue to increase in LA County and statewide, to or near record daily levels. This means that the rate of infections that occurred during the Thanksgiving holiday and in people who became infected with those people is still increasing.

Finally, a fraction of those who tested positive this week will need hospital care – the state estimates that about 12 percent of those who tested positive statewide and 10 percent in LA County – and the duration average hospital stay is six days before recovery or death.

So the system will be asked to care for even more patients than it is today at least in the next two weeks, at least, Lewis said.

Two to three weeks to observe a change in behavior

“If everyone starts paying extra attention today and the transmission is significantly reduced, then the benefits of this – which would be great – would start to become apparent in about three weeks from now,” Lewis said Friday. So in the rest of December, we expect to see … more hospitalizations and growing challenges for the health care system to provide the best possible care for most people.

In general, it can take about two to three weeks from when someone is exposed to the virus to get so sick that they need to be hospitalized.

“What we have in control is what happens in January,” Lewis said. “If we do the right thing now, January may be” no worse “than December. But if we continue to see the broadcast as it was in the last month or so, then January will be even worse. “

When can we see evidence that the home stay order works?

A big question is whether the regional home stay order that went into effect for most Californians on Dec. 7 works.

Dr. George Rutherford, an epidemiologist and infectious disease expert at UC San Francisco, said that when the COVID-19 blocking orders went into effect in France, the United Kingdom and Spain, “they lasted about two to three weeks until the blocking effects start. “

So this week, Rutherford will begin analyzing daily case rates to see if cases start to flatten or may drop.

Ferrer said he will start looking at trends around Christmas to see if daily cases start to decline.

It will take until around New Year’s Day for the effect of the home stay order to begin to be reflected in hospitalizations, Lewis said.

Kim-Farley said it would be essential for people to say no to social gatherings during the winter holidays. “Are you invited to a party?” Just say no. Are you invited to friends for dinner at home? Just say no. That way, when you need a bed for intensive care, the hospital won’t tell you “No.”

Maura Dolan, Times Times writer, contributed to the report.