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December 21, 2020

No ICU capacity: How hospitals are responding to the worst Covid-19 surge yet

Daily Briefing

    Hospitals in coronavirus hot spots throughout the United States are seeing a surge in Covid-19 hospitalizations, which is straining their ICU capacity.

    Spikes in coronavirus cases overwhelm ICUs in hot spots

    Thursday marked the 20th consecutive day Covid-19 hospitalizations rose to a new high, with the total number of Americans hospitalized for Covid-19 on Thursday reaching 114,237, including 21,900 patients who were receiving care in an ICU and 7,847 who were on a ventilator.

    The recent surge in Covid-19 hospitalizations is straining U.S. hospitals, particularly those in coronavirus hot spots. For example, data compiled by the Los Angeles Times showed the number of Californians hospitalized for Covid-19 as of Wednesday had broken records for 19 consecutive days, and the number of Californians diagnosed with Covid-19 in ICUs had reached record levels for 14 consecutive days.

    As a result, California's ICU availability in several regions of the state had fallen to less than 15%, with many of the state's hospitals reporting their ICUs were at or near capacity, NPR reports. On Thursday, for instance, the availability of ICU beds in Southern California—which includes Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura counties—dropped to 0%, and officials warned that hospital conditions could deteriorate if the novel coronavirus continues to spread without mitigation.

    "Hospitals and health care workers continue to be stretched to the limit, as we continue to surge beyond even what we anticipated. And we're not even through the holidays yet," said Adam Blackstone, a spokesperson for the Hospital Association of Southern California.

    How hospitals are responding to spikes in Covid-19 hospitalizations

    To cope with the recent spike in Covid-19 hospitalizations, experts expect that hospitals will start implementing measures to ensure the sickest patients continue to receive the highest levels of care possible, the Times reports.

    For instance, hospitals in San Joaquin Valley, California, ran out of ICU beds and implemented "surge capacity," the Washington Post reports. According to the Times, surge mode enables hospitals to care for 20% more patients than their usual capacity.

    Hospitals in some areas will free up capacity by moving patients who would typically be treated in ICUs to other parts of their hospitals, including their EDs or recovery areas, which would allow the patients to continue to receive intensive care.

    In St. Louis, where ICUs are nearly 90% full, Alex Garza, head of the St. Louis Metropolitan Pandemic Task Force, said hospitals have doubled up patients in ICU rooms and have taken nurses out of ORs to treat severely ill patients.

    In California, officials have opened temporary field hospitals in Imperial, Orange, Porterville, and Sacramento counties to treat non-ICU patients, and facilities in Fresno, Richmond, Riverside, San Diego, and San Francisco are currently on standby, the Times reports.

    At St. Mary Medical Center in Southern California's Apple Valley, providers are triaging patients outside in tents. Randall Castillo, St. Mary Medical Center's CEO, said the center has had to resort to treating some patients on gurneys or chairs in the halls because there's nowhere else to treat them. The hospital also has set up temporary walls in its lobby to create more space to treat Covid-19 patients.

    In Los Angeles County, hospitals are freeing up beds as quickly as possible by discharging patients as soon as they've recovered, the Times reports. According to the Associated Press, some hospitals have resorted to transferring their adult patients to pediatric hospitals or sending lower-risk Covid-19 patients home with oxygen and monitors in order to free up beds for seriously ill patients.

    In addition to bed capacity, hospitals are having to flex staffing capacity. For instance, some hospitals are training their medical personnel who treat patients in other areas of the hospital to work in ICUs and seek the support of nurses from outside of the United States, the Times reports.

    In Fresno County, meanwhile, the hospital system hired an outside group of 31 physicians, nurses, and other support staff to help treat patients in a makeshift ward, the AP reports.

    "Many hospitals have already broken nurse staffing ratios, and their staff are not necessarily getting either the breaks or rest that they're supposed to be getting," Christina Ghaly, director of the Los Angeles County Department of Health Services, said.

    Providers warn patients may soon exceed ICU capacity

    Experts warn that the number of patients with Covid-19 in ICUs may eventually reach levels too high for the country's limited number of ICU health care providers, which could result in patients being unable to access the specialized care they need, the Times reports.

    According to forecasters, 1,600 to 3,600 patients with Covid-19 in Los Angeles County could need ICU beds by early January if the coronavirus's current transmission remains the same, the Times reports. However, there are only 2,500 licensed ICU beds available in the county.

    "There are simply not enough trained staff to care for the volume of patients [who] are projected to come and need care," Ghaly, said. "Our hospitals are under siege, and our model shows no end in sight."

    "If the numbers continue to increase the way they have, I am afraid that we may run out of capacity within our hospitals," said Denise Whitfield, associate medical director with the Los Angeles County Emergency Medical Services Agency and an ED physician at Harbor-UCLA Medical Center. "And the level of care that every resident in Los Angeles County deserves may be threatened just by the fact that we are overwhelmed" (Booker/Campbell, NPR, 12/17; Owens, "Vitals," Axios, 12/18; Heavey/Bernstein, Reuters, 12/17; Money et al., Los Angeles Times, 12/17; Durkin Richer/Antczak, Associated Press, 12/17; Thebault, Washington Post, 12/17).

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