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Record numbers of covid-19 patients push hospitals and staffs to the limit

One public hospital in Los Angeles is at a level below triage when it will have to discourage people from coming altogether

Medical staff perform a tracheotomy on a covid patient intensive care unit at the United Memorial Medical Center in Houston. (Go Nakamura/Getty Images)

In Boston, pediatric wards are being consolidated to fit all the adults battling covid-19. Philadelphia hospitals are once again barring family visitors due to transmission worries. And in Los Angeles, a public hospital canceled elective and scheduled surgeries because it cannot spare ICU beds.

Mounting hospitalizations in these and other states are pushing some hospital systems to near breaking points, with many scrambling to reconfigure themselves to handle a crush of patients streaming in after holiday gatherings and the arrival of flu season.

Hospitals reported more than 110,000 coronavirus patients on each of the past two days, a record count for the pandemic, according to tracking by The Washington Post. That is more than three times the number they treated in September and nearly double that reported at the height of the spring surge.

In hard-hit California, officials activated a mutual aid program for coroners, designed to help local authorities cope with “mass fatality.” Gov. Gavin Newsom (D) said at a news conference Tuesday that the state had ordered 5,000 more body bags and 60 refrigerated storage units were on standby.

“I don’t want people to scare folks, but this is a deadly disease,” Newsom said. “And we need to be mindful of where we are in this current journey together, to the vaccine. We are not at the finish line.”

The southern region of California, which includes Los Angeles County, has emerged as one of the state’s bright-red hot spots, with 0.5 percent availability of intensive-care beds, according to the state’s coronavirus dashboard. Covid-19 patients at the Los Angeles County-University of Southern California Medical Center, a 600-bed public hospital, have “blown past” its earlier record in July, said Brad Spellberg, the hospital’s chief medical officer. The hospital has 150 covid-19 patients and 50 in the ICU.

“This is not the time to come to us for a hangnail,” Spellberg said. The hospital still has the capacity to treat heart attacks, strokes, car crashes and other emergencies, he added, but that’s about it. Even when treating such patients, it may take longer than normal to find beds for them.

He said the hospital is a step away from crisis triage levels when people will be discouraged from coming to the hospital altogether.

In the last week, 18 states have set single-day records in patients hospitalized for covid-19, the disease caused by the coronavirus, as cases soar all over the country.

Besides California, mounting cases and hospitalizations in Arizona, Pennsylvania, Ohio and North Carolina continue to push some regions and hospital systems to crisis conditions, while the Upper Midwest and Plains states are finally seeing plateaus.

“Now the entire country is one big red hot zone,” said Arizona Medical Association President Ross Goldberg. “That red map that shows the really bad places for covid — now it’s just red.”

That the current surge is so widespread means health-care systems have not been able to share the burden as they have in the past. Those in rural areas, in particular, have been grappling with overflow conditions because some of their larger partners in urban centers have stopped accepting transfers. Such facilities are dependent on formal or informal partnerships with other institutions to handle critically ill patients after decades of financial challenges forced many to close or greatly reduce their intensive care units.

Many have only one ventilator for the entire facility and they are typically only used short-term — for a few hours or a day — until the patient can be sent to another facility. This process helped streamline operations in normal times, but has become a major vulnerability during the pandemic.

“Efficiency has been the mantra for health-care systems over the last decade but those efficiencies don’t work well in a pandemic,” said Brock Slabach, senior vice president for the National Rural Health Association.

That situation has left communities that might have only one ambulance without one for whole days so that people who suffer heart attacks or strokes may not have access to first responders, he said.

“Some in the public may think, ‘Well, I don’t have covid so this doesn’t affect me,’ ” Slabach said, “but this situation is unfortunately impacting all medical conditions now. We’re seeing a tremendous stretching of our entire emergency medical system’s capacity.”

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With outbreaks in a local nursing home and prison, Norton County, Kan., with a population of 5,400, has seen some of the nation’s highest per capita rates of infection this fall. The 25-bed Norton County Hospital has had to greatly expand the distance it sends patients as the larger systems that typically take its patients have intermittently turned them away, said community relations director Katie Allen Wagner.

Normally, the hospital sends patients needing a higher level of care an hour and-a-half away by ambulance to Hays Medical Center, a regional hub that is so packed that it turned away more than 100 patients in November alone. Now, as a result, Norton County Hospital must send critical patients three-and-a-half hours away Wichita as well as to Omaha, which is five hours away. One patient was sent all the way to Denver, six hours away.

“There are a lot of other hospitals just like us in our situation,” Wagner said.

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For health-care systems large and small, officials say staffing is the biggest challenge, with health-care workers out sick themselves with coronavirus infections and nursing registries used in the past to find temporary workers now tapped out.

Julie Huron, president of the West Virginia Nurses Association, said many nurses have used up all of their paid time off, because they needed it earlier in the year to recover after catching the coronavirus. Some have launched crowdfunding petitions to help with medical bills incurred as patients themselves. Others are “relying on the good nature of their providers to give them samples of inhalers.”

In North Carolina, which for the past three days has set daily records for the number of hospitalized covid-19 patients, nursing staff is the No. 1 concern, said Tatyana Kelly, vice president of planning and strategy at the North Carolina Healthcare Association.

“There’s no pool to pull from,” either from within the state or among its neighbors, she said. “Our front-line workers are exhausted and have been at maximum response for months on end.”

Ten months into the pandemic, that sense of exhaustion was echoed among many front-line workers struggling to keep on through what has become the pandemic’s darkest stretch.

Dora Anne Mills, chief health improvement officer at MaineHealth, described the surge in patients like the waves coming in over and over — and over — again at the Bay of Fundy which is known for its high tides. She said several of the system’s 10 hospitals are so overstretched that staff have spent the past week calling patients to cancel non-urgent appointments past the new year.

“The problem is all the numbers indicate we are very early in the surge,” Mills said. “We are very worried about what things are going to look like in three to four weeks.”

Lewis Kaplan, head of the Society of Critical Care Medicine, said he and his colleagues say this surge feels different because some believe the country is no longer “all in this together.” He said there is palpable frustration that so many Americans are flouting public health guidelines, coupled with unspeakable grief over having to watch so many patient deaths they consider needless.

“After having spent so many months dealing with all the pandemic-related things without a break, you’re now asked to do it once more,” he said. “That’s part of our commitment as doctors, and yet a not-very-small part of you asks, ‘Did it have to be this way?’ And in your heart of hearts you’re sure it really didn’t.”