Southern CA Deploys Field Hospitals, May Ration Care – Deadline

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The days when outraged local mayors demanded that the governor of California allow Disneyland to reopen seems very distant.
As Orange County continued to set new records for new Covid-19 infections and hospitalizations on Tuesday, a very different type of facility was being prepared for visitors. Orange County officials were deploying mobile field hospitals to deal with rising numbers of coronavirus patients.

These field hospitals will be housed in large trailers and will include canvas tents with hard floors and temperature-controlled units that include running water, toilets, showers and generators as well as air purifiers.

Fountain Valley Regional Hospital will receive 50 such beds, St. Jude’s in Fullerton will receive 25 beds, and UC Irvine will receive 50 beds.

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County supervisor Doug Chaffee said he received a text message last night from a health professional at St. Jude Medical Center saying the hospital was at “99% of capacity.”

The hospital’s 301 beds are full of 138 patients with COVID-19, Chaffee said.

“The ICU is at 105% of its capacity,” said Chaffee. “They use all available beds. The emergency department has overflowed … All the hospitals in Orange County are in the same situation. It’s a disaster, so they’re going to put up a tent in the parking lot soon, probably for the yard. I think what we are seeing is not a wave, but a tsunami.

“I’m afraid,” said Dr Clayton Chau, county health director and director of his health care agency, of the outbreak patients. “I lose sleep every night. I’m scared… I’ve never been so scared of Christmas and New Years in my life… I can’t imagine what it would be like after the holidays if people don’t listen and submit.

In Los Angeles, hospitals have greeted a massive Covid spike by canceling elective procedures. “Hospitals have started to curb non-essential procedures to a certain extent,” said Christina Ghaly, director of health and human services in Los Angeles.

Another method of regulating bed capacity is “diversion,” in which an ambulance is diverted to a hospital – perhaps further away – that has more beds. “We know there are some hospitals in the county where the unloading time can exceed four hours,” LA County Public Health Director Barbara Ferrer revealed. “That’s why we need the diversion system.”

On Sunday, a day when emergency departments are usually not as busy, 81% of hospitals receiving 911 in Los Angeles requested that advanced survival ambulance traffic be diverted to other medical facilities due to the overcrowding emergencies. The average of hospitals requesting a diversion at this time of year is normally 10% to 15%, Ghaly said last week.

The next step for local hospitals, Ghaly said, would be to “break the ratio” or implement team nursing. The state imposes nurse-patient ratios, but in emergency situations, the number of nurses per patient may be reduced.

On Friday, that’s exactly what Gov. Gavin Newsom did. He issued an emergency authorization to the intensive care units to increase the number of patients for each nurse from 2: 1 to 3: 1. Newsom also reviewed the additional staff that were obtained and requests for help. that were sent to the federal government.

Asked about the USNS Mercy, which was sent to Los Angeles during the summer peak, Newsom said he had not made the request. “One of the most important resources is not the beds [on the ship]but staff, ”Newsom said, echoing health officials who for months said the critical care crisis was not about beds, but nurses and doctors trained in acute care.

Ghaly said Mercy had patient rules that made it difficult to obtain acute care patents, including restrictions against patients with substance abuse issues or mental disorders.

California’s top medical official said on Tuesday that hospitals were also considering the possibility of “rationing” care.

“We have been working with our hospitals over the past few months on what is called ‘crisis care’. We need to look into this in case we need to implement it, ”the state director of health and social services said.

Tempering the excitement generated by the delivery of Covid-19 vaccines, Governor Newsom on Tuesday offered a grim reminder of the rising death toll, saying the state had ordered 5,000 more body bags for distribution to morgues in three counties , including Los Angeles.

Los Angeles County on Tuesday reported the highest number of new coronavirus-related deaths since the summer, at 86. California as a whole has an average of 163 people lost to the virus in the past 7 days. The record number of virus-related deaths was the 225 reported on Friday.

The county is also reporting 11,194 new cases of COVID-19. The number of people hospitalized with the virus is now 4,403, including 21% in intensive care beds.

According to LA County health officials, “During this time of extraordinarily high numbers of cases and hospitalizations and rising numbers of deaths, it is more important than ever that county businesses closely follow the requirements of public health and fully comply with the guarantees and modifications in force. the health worker prescription and protocols. ”

Orange County set new records for new coronavirus-related infections – 3,250 – and hospitalizations on Monday, with the county’s adjusted intensive care unit capacity reaching zero.

The county recorded 2,173 new COVID-19 infections on Tuesday. Hospitalizations fell from 1,287 Monday to 1,371 Tuesday, another record. There were 296 ICU patients, up from 288 the day before, another new record. It has become a daily occurrence since last week.

The availability of intensive care beds adjusted by Covid in the county actually increased from zero to 1.4% on Tuesday. This likely reflects efforts to increase capacity – possibly via mobile field hospitals – as the number of intensive care patients has actually increased. The state created the adjusted number to reflect the difference in beds available for COVID-19 patients and non-coronavirus patients.

The overall percentage of available intensive care beds in the 11-county area of ​​Southern California was 1.7% as of Monday night.

Orange County’s test positivity rate rose from 10.6% to 13.2% on Tuesday. Officials reported that a new death was reported in Orange County on Tuesday, bringing the death toll to 1,695.

Prior to this month, the record for intensive care patients in Orange County was 245 in a surge in mid-July. Overall, hospitalizations have been breaking daily records since December 2.

As has been the case for months, dozens of residents appealed to the supervisory board on Tuesday to challenge the stay-at-home state order. Orange County attorney Leon Page explained that Gov. Gavin Newsom’s executive order was the last word and there was nothing the county could do to change it.

Dr Chau made an emotional appeal to residents to adhere to the physical distancing and face covering mandates to help curb the spread of the coronavirus.

County health officials are particularly struggling to house elderly people with dementia, who are infected but do not have symptoms, Chau said.

“We can’t send them to the hospital… They don’t need this level of care,” Chau observed. “And we can’t send them to a nursing home… and we can’t send them to a hotel.”

These patients will likely be accommodated at the Fairview Developmental Center in Costa Mesa, which is scheduled to open on Thursday.

“But we only have 50 beds available,” Chau said. “We’re going to run out of options to take care of these people.”

“Right now we are feeling the effects of the Thanksgiving wave,” said Lisa Bartlett, Orange County Supervisor. “And with the Christmas holidays and the New Year, we have to plan for even more cases to come.”

“The message is very simple,” Chau added. “In the United States today, every minute two people died in the United States from COVID-19. Every minute we speak, someone has lost a loved one… That’s an amazing number and just an embarrassing number from an American perspective because we’re supposed to be the best at what we have when it comes to medical care.

Orange County Supervisor Andrew Do, whose father passed away suddenly over the weekend, noted the
crushing patients he saw at the hospital where his father was being treated.

“I can tell you from personal observation that every bed was taken,” Do said. “When I contacted my father’s funeral homes, they said their business had grown 300% this year. The wait time and the lack of availability of services, whether for visits or cremation, is incredible. They have never seen this kind of shortage before.

Newsom said 142 coronavirus-related deaths have been reported statewide in the past 24 hours. Over the past week, the state has recorded an average of 163 deaths per day, up from 41 per day a month ago.

“Think if we continue down the path we are taking, what this January 14 issue might look like if we don’t do what we need to do, not only to use the vaccine when we can, but to continue to carry these. masks and minimize mixing as much as possible because of what has happened in the past 30 days, ”Newsom said.

According to the governor, the state has 60 53-foot refrigerated storage units waiting in California counties to use if local facilities are overwhelmed by deaths from the virus.

“We just had to order 5,000 more body bags… and we just distributed them to San Diego, Los Angeles, Inyo counties,” he said. “This should give some food for thought. I don’t want to… scare people, but it’s a fatal disease. And we need to keep in mind where we are on this current vaccine journey. We are not yet at the finish line. ”

City News Service contributed to this report.

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