COVID-19: Basic medical care suffers amid Los Angeles surge

Coronavirus patients are overwhelming many Los Angeles County emergency rooms and intensive care units, and hospitals are seeing ripple effects that harm operations and care across the medical network.

With 700 nurses from primary care clinics diverted to hospitals and other critical needs, county officials have been forced to temporarily shut five public primary care clinics across the county and reduce hours at most of the others, which provide children with immunizations and where people with chronic diseases have their medications managed.

“We have kept a skeleton crew to continue to work in our outpatient clinics,” said Dr. Christina Ghaly, the L.A. County director of health services. “But overall, our capacity for outpatient services is much less than it is in routine times.”

This means that patients with chronic illnesses will be at greater risk of needing to go to the emergency room if they become more seriously ill because of the lack of outpatient care.

“But in the absence of sufficient staff to care for our inpatients, we don’t have a better option,” Ghaly said.

Paramedics are now regularly deciding not to transport non-critical patients to overcrowded hospitals, hoping to free up space for those most in need. This has forced people who might otherwise go to the emergency room to look elsewhere for care.

Hospitals are scrambling to find staff. Sometimes emergency medical technicians are asked to work in hospitals. Older hospitals are being reconfigured to house far more patients than they ever anticipated holding.

Patients, suffocating from their inflamed lungs, are demanding oxygen to the extent that some hospitals are losing air pressure needed for the oxygen delivery system to work. “Running low of oxygen and oxygen tanks is an issue,” said Cathy Chidester, director of the L.A. County Emergency Medical Services Agency.

A chronic shortage of oxygen tanks is a problem for hospitals trying to discharge recovering COVID-19 patients as fast as possible, as they often need to be sent home with oxygen tanks.

“There’s only so much oxygen equipment and vendors that do these supplies of home oxygen therapy,” Chidester said. It has also been difficult to transfer patients from smaller hospitals who need more specialized care from larger hospitals who can better care for patients suffering from things such as trauma, heart attacks and strokes, Chidester said.

Sometimes, there are no beds available in hospitals better equipped to handle those types of patients.

“We’re experiencing extreme conditions in L.A. County,” said L.A. County Public Health Director Barbara Ferrer. “Our hospitals continue to be overwhelmed. As more and more people are rushed to hospitals, the tragic fact is that hundreds more people will die every week from COVID-19. These trends, unfortunately, will continue into January.”

As more deaths occur in L.A. County, there are some troubling trends. A greater percentage of people in L.A. County are dying of COVID-19 without having any underlying health conditions, Ferrer said. Earlier in the pandemic, more than 90% of those who died had underlying health conditions; now, 86% of those who died had underlying health conditions.

“There are more people than ever not only passing away, but passing away without any underlying health conditions,” Ferrer said.

The threat to relatively young adults was hammered home nationwide this week when Luke Letlow, Louisiana’s newest Republican member of the U.S. House, died Tuesday night from complications related to COVID-19, only days before being sworn into office. Letlow was 41 and reportedly had no underlying health conditions.

In Los Angeles County, the ripple effect is being seen at many medical facilities.

The crush of patients has led the county to allow certain types of ambulance patients to be offloaded into the waiting room instead of the emergency room, according to memos issued by the EMS agency.

Additionally, 911 patients who have a do-not-resuscitate directive will not be taken to acute-care facilities such as a hospital, nor will certain trauma patients whose hearts have stopped.

The agency is also allowing emergency medical service providers to decline to take low-risk patients to hospitals with mild respiratory illnesses.

Many hospital morgues are now filled with bodies, and officials are trying to move them into temporary storage at the county medical examiner-coroner’s office. Mortuaries have also run out of space and are turning away grieving families. Single-day COVID-19 death records have been broken every day for the last three days of the year, with 242 deaths reported Tuesday, 262 on Wednesday and 291 on New Year’s Eve.

Alarmingly, the daily rate at which coronavirus test results are coming back positive has climbed to 22%, more than five times the rate from Nov. 1, when it was less than 4%.

“This high positivity rate remains alarming and tells everyone that the coronavirus is very prevalent and persistent across all corners of the county,” Ferrer said.

On Thursday, county officials said lengthy delays in offloading patients at Los Angeles County’s critically overcrowded hospitals are increasingly keeping ambulances from being able to respond to other emergency calls.

Sometimes as many as 10 ambulances are queued up waiting to drop off patients, and “we’ve had patients waiting in ambulance bays outside of [emergency departments] for seven hours, eight hours,” the EMS agency’s Chidester said.

At Providence Holy Cross Medical Center in Mission Hills, patients are being treated in places that usually don’t house beds, such as the gastrointestinal lab, the outpatient area for same-day surgeries and even at the end of hallways, on gurneys surrounded by privacy curtains.

“It’s pretty bad,” said Jodi Hein, the hospital’s chief nursing officer. “We have two additional morgue trailers we’ve not had to use before that we are using now.”

The hospital was short 12 registered nurses on Wednesday because of the overflow of patients. The nurses who usually care for patients coming into and out of surgeries and elective procedures — all of which have been canceled — have dispersed to other units, Hein said.

Because of a shortage of phlebotomists, nurses have also been helping draw blood throughout the hospital. The ICU itself has been short several nurses for weeks, Hein said. But in addition to COVID patients, the department is beset with typical traumas. Within a 10-minute span on Tuesday, two trauma patients arrived needing blood transfusions. Another was admitted for a stroke, yet another for a heart attack.

“We get encumbered really easily in the emergency department, especially right now,” Hein said.

Physicians have been releasing patients earlier than they usually would to make room for new patients, Hein said. A patient in normal times might stay in the hospital for an additional eight hours for more tests and consultations, but doctors are scheduling those for later dates if they aren’t urgent.

Because visitors are not permitted in the hospital, doctors have even helped patients connect with their families through iPads over the holidays — usually the job of chaplains, who have been busier than ever.

“Everyone is just exhausted,” Hein said. “But we’re making it, we’re doing it, and I think the staff is just really trying to be as positive as possible.”

Times staff writer Andrew J. Campa contributed to this report.