California broke the single-day record for COVID-19 deaths yet again Tuesday, logging 442 fatalities in a Times county-by-county tally of local health jurisdictions — a number equivalent to someone dying of the disease every three minutes.
More than half of those deaths — 242 — were of Los Angeles County residents, according to The Times’ survey. That’s a record high in a single day for the nation’s most populous county, a count boosted in part by a backlog of reports from the Christmas weekend.
At that rate, cumulative COVID-19 deaths will likely exceed 25,000 in California on Wednesday and 10,000 in L.A. County by New Year’s Day. As of Tuesday night, California had a cumulative 24,987 deaths and L.A. County, 9,806. Over the past week, the state averaged 240 deaths a day, and L.A. County, 111.
The climbing death toll has changed daily life throughout Los Angeles. In East L.A., the Continental Funeral Home has seen its typical caseload more than quadruple, with 80% of its services honoring people who died from COVID-19. The L.A. County College of Nursing and Allied Health is postponing the admission of nursing students for the spring semester because faculty and staff have been redeployed to county hospitals.
The “healthcare situation has never been this critical and the need for healthcare workers is at its peak,” Mildred Gonzales, dean and program director of the college’s School of Nursing, wrote in a letter, calling the current time an “unprecedented critical situation.”
With intensive care units across California overcrowded, healthcare providers have already been forced to take steps limiting how much hospital care is given.
Southern California hospitals in crisis
“We certainly know that Southern California hospitals are in crisis,” said Dr. Mark Ghaly, the California health and human services secretary. And with some people likely to ignore pleas to stay home for New Year’s Eve, officials expect hospitalizations to worsen again in the coming weeks, particularly during mid- to late January.
Even now, paramedics and emergency medical technicians are declining to transport some less severely ill patients whom they might take to the hospital under ordinary circumstances.
In Los Angeles County, EMTs “are assessing patients and releasing them to stay at home, because they aren’t quite sick enough to need hospital-level care. … If they did come to the hospital, they may not get the type of attention that they might expect,” Ghaly said.
That’s an example of the unusual measures healthcare personnel have been forced to take amid a systemwide overcrowding of hospitals not seen in modern California history, a result of the worst pandemic in more than a century. For the first time, the number of people hospitalized for COVID-19 statewide has exceeded 20,000, a figure eight times higher than that on Nov. 1.
The overcrowding is already causing the quality of healthcare to suffer, Ghaly said.
A plan to triage and ration hospital care
State officials have yet to hear reports of the direst circumstances, such as a hospital having to choose who gets the last ventilator.
Nonetheless, some hospitals in L.A. County are running dangerously low on supplies of oxygen, treating patients in conference rooms and gift shops, and leaving patients waiting in ambulances for as long as eight hours until they can be taken into the emergency room.
Hospital systems are already coming up with triage plans, which entail prioritizing the time of highly trained staff — such as respiratory therapists, ICU nurses and critical care doctors — in a way to keep as many people alive as possible. That means that those less likely to survive might not receive the same level of care they would have otherwise.
Most hospitals in California are no longer able to offer regular hospital services, switching instead to “contingency care,” Ghaly said, in which staff are asked to work longer shifts, hospital rooms are reconfigured to hold more beds than originally intended, scarce supplies are conserved or even reused and the movement of patients within the hospital is delayed because of a lack of space or staff.
Preparing for ‘crisis care’
Even worse is “crisis care,” when patients are placed on cots instead of standard hospital beds; patients normally grouped in one unit are scattered across the facility; and certain supplies, therapies and staff need to be rationed, Ghaly said.
If some hospitals in a region declare that they’re in “crisis care” mode, other hospitals in the region will be asked to share their resources to relieve the worst-hit facilities, Ghaly said.
Kim McCoy Wade, director of the California Department of Aging, said Tuesday that tough decisions on how to allocate medical care must be “grounded in the likelihood of [a patient] surviving in the near term.” Such decisions cannot be based on age, race, disability, chronic medical conditions, gender, sexual orientation, gender identity, ethnicity, national origin, language spoken, ability to pay, weight, socioeconomic status, insurance status, perceived self-worth, perceived quality of life, immigration status, incarceration status, homelessness or past or future use of resources, she said.
The state Department of Public Health on Monday issued a memo about its “California Crisis Care Continuum Guidelines,” which, they said, must follow ethical principles, health equity goals and civil rights laws. Facilities that need to begin to ration critical care resources must notify local and state public health departments immediately.
Choosing who gets care
According to a state memo issued in June, in a situation where there’s a severe shortage of medical resources and a patient has a poor immediate survival prognosis, healthcare providers may need to decide to give palliative care aimed at providing patients relief from pain as they die, rather than improving their prognosis.
When it comes to deciding who is eligible for ICU admission or should have access to a ventilator, patients who are more likely to survive with such care will receive priority.
A hospital-appointed triage officer is expected to make decisions to benefit populations of patients, “even though these decisions may not necessarily be best for some individual patients,” according to the memo.
Health officials battling fatalism and denial
Hospitals and health officials throughout the state are reporting severe problems. In the agricultural community of Gilroy in Santa Clara County, every regular ICU bed at St. Louise Regional Hospital is occupied, and patients are now in overflow beds, said Gloria de la Merced, the hospital’s chief operating officer.
“This level of hospitalizations has never happened during my career,” she said. “If we go beyond the surge capacity, everyone will be affected — more people in our community will know someone who died.”
In Fresno County, emergency rooms are so crowded that paramedics are dropping off patients in hospital hallways, where they’re cared for by other emergency workers, or in the waiting room. Officials are battling a sense of fatalism in the general public that nothing can be done about the pandemic or denial about the record hospitalizations and death toll.
“That’s really unfortunate. … We really do have a choice, and we really can try to protect ourselves in our communities with the choices that we make,” such as wearing masks and canceling New Year’s parties, said Dr. Rais Vohra, the Fresno County interim health officer. “Whenever you choose to ignore the science, that’s when we really get into trouble.”
In rural Northern California, Humboldt County became the first county in some time to see conditions improve enough that it was moved from the state’s most restrictive purple tier to a less restrictive red tier, enabling it to reopen indoor restaurant dining, indoor gyms and movie theaters, although at a limited capacity.
Local health officials, however, criticized the state for moving Humboldt into a less restrictive tier, saying that ongoing trends suggest the county could fall back into the most restrictive tier in the coming days.
“Our case rates are the highest they’ve ever been, and our contact investigation teams are tracking more cases, not fewer. It’s unfortunate that we didn’t get to have a conversation with the state before this decision was handed down,” the Humboldt County health officer, Dr. Ian Hoffman, said in a statement Tuesday.
Times staff writers Emily Baumgaertner, Andrew J. Campa, Andrea Castillo, Jaclyn Cosgrove, Adam Elmahrek, Marisa Gerber, Soumya Karlamangla and Ryan Murphy contributed to this report.