by Steven Felschundneff | steven@claremont-courier.com

Southern California hospitals are filling up with coronavirus patients so quickly that many are at the breaking point and have begun putting off care for people with non-critical medical needs. 

“Today I want to be very clear: our hospitals are under siege and our model shows no end in sight. I have not said this before because Los Angeles County has not been in this situation in the pandemic before but the worst is still before us,” Los Angeles County Department of Health Services Director Dr. Christina Ghaly said during a news conference on Wednesday.

“Hospitals adapt and surge. They add staff, they clear out beds. They discharge patients whenever they can. They cancel surgeries, they cancel procedures that can wait. They flex their staffing resources. These actions, while critical, cannot continue indefinitely. There are simply not enough trained staff to care for the volume of patients that is projected to come,” Dr. Ghaly said.

She warned that as cases continue to rise and people seek medical care, hospital and emergency medical systems will not be able to provide the level of care that residents have come to expect, “for ourselves or our loved ones.” This includes both those with COVID-19 and those who have other illnesses or injuries.

It will take longer for patients to receive care, either waiting in ambulances to be admitted, or in emergency departments waiting to get to a proper room. Healthcare workers will be asked to care for more patients, stretching those resources thin and exposing risk of poor patient outcomes. In extreme situations this could result in the rationing of ICU or other hospital beds, according to Dr. Ghaly.

“The system simply does not have the ability and staff to provide the care for all those who need it, and all of this means that we will have an increase in deaths in the days and weeks to come,” she said.

“Our emergency rooms cannot keep up when they are functioning as an ICU, and our operating rooms cannot perform as many surgeries as they should when those staff are needed to care for COVID patients,” Dr. Ghaly said.

Pomona Valley Hospital Medical Center is not immune to the stresses on the countywide hospital system, but it has not yet reached the breaking point.

“Along with many hospitals throughout our region, Pomona Valley Hospital Medical Center (PVHMC) has experienced a surge in COVID-19 hospitalizations in recent weeks; however, it continues to effectively manage its intensive care unit bed capacity,” hospital officials said in a statement.

The hospital has a surge plan in place to provide safe, high-quality care to all patients requiring treatment in intensive care units, as well as those in need of emergent and specialty care. Doctors are continuing to perform outpatient elective surgeries and procedures; however, the hospital postponed all elective surgeries and procedures which require post-operative admission to the hospital.

PVHMC is prepared to further expand its surge capacity should it continue to experience increases in COVID-19 patient admissions.

“The hospital remains a safe place to seek care. Please do not delay emergency care due to fear of contracting COVID-19 in a healthcare setting. If you are experiencing moderate to severe COVID-19 symptoms, it is crucial that you seek immediate emergency medical care,” the statement read.

Hospital staff has been actively planning for the increased volume of coronavirus patients and has plans in place to successfully maintain staffing. “This includes developing an internal resource pool of registered nurses who can be deployed to units in need, hiring traveling nurses and new graduate registered nurses and bringing on nursing students who are finishing up their last semester in nursing school.”

Last Wednesday Sara Kahn, president of medical staff at San Antonio Regional Hospital sent an email to medical staff providers declaring, “We are in internal disaster mode.” 

“The hospital is experiencing its worst surge yet, we have 141 hospitalized COVID patients at this time, we are short on staff, on beds and especially TELE beds. The ER is currently holding approximately 50 patients who have been admitted and who we have not been able to make room for, and the patients and the ambulances keep coming,” Dr. Kahn wrote.

She implored her colleagues to do whatever they could to avoid sending patients to the hospital including “observation admissions.” She also announced that all elective procedures and surgeries for the following day were canceled.

The COURIER spoke with San Antonio Hospital President and CEO John Chapman who confirmed the seriousness of the situation at the hospital. 

December 9 was an extraordinary day for people seeking treatment, including COVID-19 patients. Hospital staff had to open up “surge wards” to accommodate all of the patients who were admitted. He said all of the 50 people admitted that day who initially did not have beds were eventually accommodated but the greater problem is staffing.

“Yesterday was a surge day,” Mr. Chapman said. “And we need help.”

The recent staggering increase in patients is the unfortunate result of people getting together during the Thanksgiving holiday, according to Mr. Chapman. He said it takes three to seven days for symptoms to begin but most people who become sick assume they will get better on their own and don’t seek care. However, by the seventh day of the illness many begin experiencing shortness of breath and that is when they end up in the hospital.

“Just walk it backwards and what you have is Thanksgiving,” he said.

He said that the following day was a “like a trough in a wave” with fewer COVID patients than the day before but, like the waves, they keep coming. 

Wednesday in Los Angeles County was certainly not a trough but a tsunami, with the department of public health reporting a record 22,422 new cases. There were 4,656 people with COVID-19 currently hospitalized, 21 percent of whom were in the ICU and 15 percent on ventilators. Hospitalizations have increased four-fold since November 16. According to the state, ICU capacity in Southern California currently stands at 1.7 percent.

Without help from overwhelmed county and state agencies, and with all Southern California hospitals at or near capacity, the only help our local hospitals can hope for is from the community. It’s of critical importance that people take the risk of contracting the coronavirus seriously and heed the health department order to stay home as much as possible, while avoiding gathering with people not in their immediate household. Wear a mask when in public, practice physical distancing and wash your hands.

“The only partner we have in this is the community,” Mr. Chapman said. On Wednesday of this week he updated the situation at San Antonio.

“We remain with all ICU beds full, with our ER treating and caring for several additional ICU patients. Our total inpatient COVID-related census is at 174 patients. I believe that is the most in SB County.”