He was behind a glass screen, heavily sedated, alive by a machine that introduced oxygen into his lungs, through a tube attached to his mouth that reached the back of his neck. She had been hospitalized a few days ago and was rapidly getting worse.
“His respiratory system and cardiovascular system are deficient,” said Dr. Luis Huerta, a specialist in critical care in the intensive care unit (ICU). The chances of survival for the patient, who was not identified for privacy reasons, were low, Huerta said.
The 60-year-old woman was one of 50 patients with COVID-19 who, during the week of December 13, required constant medical care in the intensive care units of Los Angeles County Medical Center + USC (LAC + USC), a 600-bed public hospital in East Los Angeles. The vast majority of these patients suffered from diabetes, obesity or hypertension.
Another 100 patients with COVID, less ill at this time, were in other wards of the hospital. And the number has increased. Between Saturday 12 and Wednesday 16, eight COVID patients died, double the number in the last five days.
The avalanche of COVID patients at LAC + USC in recent weeks has put immense pressure on the capacity of the unit and its staff; Especially since non-COVID patients, such as those arriving with gunshot wounds, drug overdoses, heart attacks and strokes, also need intensive care.
No more beds were available in the ICU, said Dr. Brad Spellberg, the hospital’s chief physician.
Similar scenes – crowded rooms, overworked medical staff, press administrators and grieving families – are seen in hospitals across the state and across the country.
On Christmas Day, there were no ICU beds available in the 11 counties in the Southern California region or in the San Joaquin Valley.
On Thursday, the 24th, the county health officials reported that the number of new deaths through COVID increased for the second consecutive day, beyond the previous highs for the entire pandemic.
LAC + USC has suffered a heavy burden from COVID since the beginning of the pandemic, in part because it serves a low-income, predominantly Latino community that has been severely affected. Latinos make up 39% of California’s population, but have suffered 56% of the state’s COVID cases and 48% of deaths, according to data updated on December 22.
Many people who live near the hospital do essential jobs and “cannot work from home. They go out and expose themselves because they have to earn a living, ”Spellberg explained. “I don’t live in huge houses where they can be isolated in one room,” he added.
The worst cases end up in a bed, in the middle of a tangle of tubes and bags, in the ICU sections designed to prevent air and viral particles from escaping into the hallways.
The sickest, like the woman described above, need respirators. They are fed through nasal tubes, their blisters drain into catheter bags, while the intravenous lines deliver fluids and medicines to relieve pain, keep them sedated and increase blood pressure to the level necessary for life.
To ease the pressure in the ICU, the hospital has just opened a new “minor unit” for patients who, despite being very ill, can be treated with a slightly lower level of care. Spellberg said he hopes the unit can accommodate up to 10 patients.
Hospital staff also check patients’ health insurance to see if they can be transferred to other hospitals. “But now, it’s almost impossible, because everyone is filling up,” Spellberg said.
Five weeks ago, of the COVID patients who came to the emergency room, only a small percentage showed severe symptoms of the disease, which meant fewer hospitalizations and intensive care than during the July increase. . This helped keep the disease at bay, Spellberg said.
But not anymore.
“In the last 10 days, I have a clear impression that things have gotten worse again and that’s why our ICU has filled up so fast,” Spellberg said on December 14th.
The total number of COVID patients hospitalized and the number of intensive care drugs is now well above the peak in July and both are almost six times higher than at the end of October. “It’s the worst I’ve ever seen,” Spellberg said. He added that things would get worse in the coming weeks if people travel and reunite with their families for Christmas and New Year, as they did for Thanksgiving.
Think of New York in April. Or Italy in March, “Spellberg said. “That’s the way it could be.”
And they’re pretty bad. Nurses and other members of the medical staff are exhausted for long periods of time, patients requiring thorough care. And the work is becoming more and more intense, explained Lea Salinas, the director of health care in one of the ICU departments of the hospital. To avoid understaffing, he asked the assistants to work overtime.
Usually, nurses receive two patients in return. But a severely ill COVID patient can take on virtually all change, even with the help of other nurses. Jonathan Magdaleno, one of the ICU nurses, explained that a seriously ill patient may need 10 hours of care during a 12-hour shift.
Even in the best cases, he said, you usually have to enter a patient’s room every 30 minutes because the bags that administer drugs and fluids are emptied at different rates. Every time nurses or other caregivers enter a patient’s room, they must wear uncomfortable protective equipment and then take it off.
One of the most delicate and difficult tasks is a maneuver known as “pronation”, in which the patient with acute respiratory problems is started on the stomach to improve lung function. Salinas said this can take half an hour and may require up to six nurses and a respiratory therapist, as the tubes and cables must be disconnected and then reconnected, not to mention the risks involved in moving an extremely fragile person. . And he has to do it twice, because each patient has to rotate again at the end of the day.
For some, working in the COVID room at LAC + USC is very personal. This is the case of Magdaleno, a Spanish-speaking nurse who was born in Mexico City. “I grew up in this community,” he said. “And even if you don’t want to, you see your parents, grandparents, mother in these patients, because they speak the same language.”
Magdalene intends to spend Christmas only with members of her household and asks us to do the same. “If you lose a member of your family, then that is the purpose of Christmas [o Año Nuevo]? “I ask. Is it worth going to the mall right now? Is it really worth buying a present for someone who’s probably going to die?”
That the darkest hour of the pandemic comes just as COVID vaccines begin to arrive is particularly heartbreaking, said Dr. Paul Holtom, chief epidemiologist at LAC + USC.
“The tragic irony is that the light is at the end of the tunnel,” he said. “The vaccine is distributed as we talk, and people just have to stay alive until they can get the vaccine.”
Article by Kaiser Headline News.