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January 5, 2021

'A point of crisis': In Los Angeles, ambulances are told not to bring patients with virtually no chance of survival

Daily Briefing

    An influx of new Covid-19 patients is overwhelming hospitals throughout the United States, including in Los Angeles, where officials have advised paramedics to cut back on their use of oxygen and not bring to hospitals patients who have virtually no chance of survival.

    America grapples with persistently high rates of new coronavirus cases, deaths

    The strain on hospitals comes as the United States continues to see persistently high rates of new coronavirus cases, hospitalizations, and deaths—which public health officials expect to spike again in the next few weeks because of Americans gathering with others over the recent holidays.

    According to data compiled by the New York Times, U.S. officials as of Tuesday morning had reported a total of about 20.8 million cases of the novel coronavirus since America's epidemic began—up from about 20.6 million cases reported as of Monday morning.

    According to the Times, the United States' average daily number of newly reported coronavirus cases over the past week was 214,270—which is about the same as the average from two weeks ago, the Times reports.

    As of Tuesday morning, data from the Times showed that the rates of newly reported coronavirus cases were "staying high" in Puerto Rico; Washington, D.C.; and 37 states that have had a daily average of at least 15 newly reported cases per 100,000 people over the past week. Those states are Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, and West Virginia.

    Meanwhile, the Times' data showed that, as of Tuesday morning, the daily average number of newly reported cases over the past seven days was "going down" in 12 states that had been seeing comparatively higher rates of coronavirus transmission. Those states are Colorado, Idaho, Iowa, Michigan, Minnesota, Montana, North Dakota, Pennsylvania, South Dakota, Tennessee, Wisconsin, and Wyoming.

    In Guam, Hawaii, and the U.S. Virgin Islands, meanwhile, rates of newly reported coronavirus cases were "staying low" as of Tuesday morning, the Times' data showed.

    U.S. officials as of Tuesday morning also had reported a total of about 353,730 U.S. deaths linked to the novel coronavirus since the country's epidemic began, up from about 351,682 deaths reported as of Monday morning. According to the Times, U.S. officials on Monday reported about 2,048 new deaths tied to the coronavirus.

    Covid-19 hospitalizations reach new peak, straining hospitals throughout the US

    U.S. hospitalizations for Covid-19, the disease caused by the novel coronavirus, also have been rising—and the number of hospitalized Americans with Covid-19 reached a new high on Monday, according to data from The Atlantic's COVID Tracking Project. The data showed that 128,210 Americans with Covid-19 were hospitalized for treatment on Monday, including 23,435 who were receiving care in an ICU and 7,930 who were on a ventilator. According to the Washington Post, the number of Americans hospitalized with Covid-19 increased by about 2,800 in a single day on Monday.

    The influx of Covid-19 patients is straining hospitals throughout the United States. In California, for example, the state's number of Covid-19 hospitalizations has more than doubled over the past month—and California Gov. Gavin Newsom (D) on Monday said Covid-19 hospitalizations in the state over the past two weeks have increased by 18% to 20,618.

    The increases have led to crowded ICUs across the state, officials said. In Los Angeles, for example—where nearly 7,900 Covid-19 patients were hospitalized as of Sunday, including 1,627 who were receiving care in an ICU—"many hospitals have reached a point of crisis and are having to make very tough decisions about patient care," Christina Ghaly, director of the Los Angeles County Department of Health Services, said Monday.

    "The volume being seen in our hospitals still represents the cases that resulted from the Thanksgiving holiday," Ghaly said. "We do not believe that we are yet seeing the cases that stemmed from the Christmas holiday. This, sadly, and the cases from the recent New Year's holiday, is still before us, and hospitals across the region are doing everything they can to prepare."

    As part of those preparations, Marianne Gausche-Hill, director of the Los Angeles County Emergency Medical Services Agency, on Monday issued two measures aimed at increasing hospital capacity and triaging care to focus on treating the sickest patients. In a directive, Gausche-Hill said ambulance crews in Los Angeles County should administer bottled oxygen only to patients who have oxygen saturation levels below 90%. The measure is intended to conserve the state's oxygen supply.

    In addition, Gausche-Hill in a separate memo directed paramedic crews to not transfer patients who have experienced cardiac arrest and have virtually no chance of survival to hospitals, in an effort to reduce hospital strain. According to the directive, paramedics should transfer patients who have experienced cardiac arrest to hospitals only if spontaneous circulation can be restored on the scene.

    During an interview with a CBS affiliate in Los Angeles, Gausche-Hill said paramedics will continue to try to resuscitate patients and take other steps to attempt to save patients' lives. "We are not abandoning resuscitation," Gausche-Hill said. "We are absolutely doing best practice resuscitation and that is do it in the field, do it right away. [We] are emphasizing the fact that transporting these patients arrested leads to very poor outcomes. We knew that already and we just don't want to impact our hospitals."

    In other parts of California, hospitals are reporting bed, staffing, and supply shortages. "We ran out of beds last week," said Chris Van Gorder, CEO of Scripps Health in San Diego.

    At Kaiser Permanente Baldwin Park Medical Center, officials have converted offices into exam rooms as Covid-19 patients have nearly exhausted the medical center's ED capacity. And providers are sending many of the hospital's patients who are not being treated for Covid-19 to a tent outside for care.

    "We have patients waiting 12 hours to get seen. A lot of patients give up and go home," said Dicky Shah, assistant chief of the ED at Baldwin Park Medical Center. "It feels like we're in wartime."

    Hospitals in other states are similarly struggling to treat patients. For instance, Jeff Barnhart, CEO of Deaf Smith County Hospital District, said his hospital in Texas is transferring patients out of state to hospitals in Albuquerque and Oklahoma City, because there are no beds available for patients at hospitals in nearby cities, including Dallas.

    "It's all about just trying to find a bed," Barnhart said (Lin et al., Los Angeles Times, 1/4; Diaz, NPR, 1/5; Tompkins et al., New York Times, 1/4; Evans et al., Wall Street Journal, 1/3; Noori Farzan et al., Washington Post, 1/5; Maxouris, CNN, 1/5; New York Times, 1/5; "The COVID Tracking Project," The Atlantic, accessed 1/5).

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