'A huge burden': Los Angeles hospitals strained by COVID outbreak, very bad flu season

‘A huge burden’: Los Angeles hospitals strained by COVID outbreak, very bad flu season

A “triple epidemic” of COVID-19, influenza and RSV is hitting Southern California hard, sending patients to the emergency room in droves and presenting a daunting new challenge for a healthcare system already strained by nearly three years of pandemic.

“When you have the convergence of three very serious respiratory viruses, it puts a huge burden on the emergency services and also on the hospital itself,” said Dr. Kimberly Shriner, medical director of infection prevention at Huntington. Health.

At Pomona Valley Hospital Medical Center, the emergency room recently reached a record number of patients in a single day – 382 – according to Darlene Scafiddi, executive vice president of patient care.

“Normally at this time of year we would see around 270,” she said.

To manage the high numbers, the hospital has set up a makeshift flu clinic in an auditorium near the emergency room, staffed with doctors and nurses who can quickly assess and treat patients who can then recover at the House.

“If we had a doctor who didn’t focus on patients who could turn around quickly, they could take care of a sicker patient” and delay the attention of those who could be quickly treated and discharged, said Scafiddi.

At the Huntington emergency department in Pasadena, Shriner estimated that twice as many people as usual were coming in daily. For patients arriving with less serious illnesses or injuries, this can mean “very long” wait times, ranging from six to 11 hours.

“It’s a very long ordeal for people if they come in with something that’s not really a life-threatening emergency,” she said.

Huntington has set up heated tents outside its emergency department to triage patients, and “we have tried to hire as many staff as possible”, with medical staff working overtime and traveling nurses joining their ranks, Shriner said.

Along with the growing number of people going to the emergency room, Huntington is also under pressure as he tries to refer patients to skilled nursing facilities that are also understaffed, Shriner said.

Patients who need skilled nursing “stay stuck in the hospital”, she said. “We can’t unload them until we have a place to put them. And so that you can see what’s going on, it’s just going backwards. And then we don’t have enough beds. And then people sit in the emergency room for 10 hours.

At Ronald Reagan UCLA Medical Center, “we are very busy at our hospital,” said Dr. Annabelle M. of St. Maurice, co-chief of infection prevention for UCLA Health.

Some single rooms have been converted to accommodate two patients, meaning more people could find themselves sharing rooms, she said.

The situation unfolding in Southland is in some ways a manifestation of a long-standing fear.

Officials have worried throughout the pandemic about the potential risks of another disease circulating widely alongside COVID-19. But while previous “twin epidemics” failed to materialize in the face of disastrous coronavirus surges, California is now simultaneously facing a spike in coronavirus transmission, an early attack of respiratory syncytial virus, or RSV, and a historically strong start to the flu season.

According to the U.S. Centers for Disease Control and Prevention, the nationwide cumulative rate of flu hospitalizations is higher for this time of year than for every season since 2010. The agency considers levels California flu rates are “very high” and among the worst in the country. .

The number of flu hospital admissions nationwide has doubled in a week, and the CDC estimates that 4,500 people have died from the disease since early October. During the same period, around 25,000 deaths from COVID-19 have been reported.

It’s unclear whether this early onslaught will lead to an earlier than usual end to the flu season or if it’s a harbinger of tough months ahead.

Hospitals have also been grappling for weeks with RSV, which can cause severe illness, respiratory distress and even death. Young children and the elderly are particularly at risk.

“We were seeing viruses hitting pretty hard before RSV hit. And then RSV hit on top of that. And now the flu and COVID are hitting on top of that,” said Dr. Coleen Cunningham, senior vice president and chief pediatrician at Children’s Health of Orange County.

At Orange Hospital, “the numbers are truly unprecedented,” and the emergency room sees more than 400 children every day, said Cunningham, who is also chair of pediatrics at UC Irvine.

“Everyone in the pediatric community — whether at CHOC or other institutions — is really stepping up, but getting stretched,” she said. “It’s been going on for a while and people are starting to get tired.”

At CHOC, to help move children through hospital rooms more quickly, a theater where hospitalized children had been able to watch films has been repurposed as an ‘exit lounge’ for those ready to go home but waiting. a ride or instruction for their families.

Games rooms have been set up for patients. Beds have been set up in the emergency room hallway with privacy screens around them, she said. The viral stack means the hospital must be careful not to house children together, complicating its space race.

The number of coronavirus-positive patients hospitalized statewide has increased rapidly in recent weeks. Wednesday’s tally – 4,387 – is up 52% ​​since Thanksgiving.

At the height of last summer’s Omicron wave, as many as 4,843 coronavirus-positive patients were hospitalized statewide on any given day.

Based on previous statewide trends, about 55% of these people are likely not hospitalized specifically for COVID-19, but have tested positive when seeking care for another reason.

Either way, officials point out that people infected with the coronavirus can put additional strain on healthcare facilities because they need additional resources to ensure they don’t pass the virus on to others.

So far, the current wave of coronavirus is nowhere near as large as the last two fall and winter surges. And there is optimism that a high level of vaccine coverage along with the availability of updated boosters and effective therapeutics will prevent this surge from reaching those same heartbreaking heights.

However, the ultimate confluence of COVID-19, influenza, RSV and other respiratory illnesses remains unclear.

In Los Angeles County, rates of coronavirus cases and hospitalizations continue to worsen, raising the possibility of a new order for indoor masks in indoor public places as early as early January.

For the first time since the summer, LA County entered the high community level for COVID-19 on Thursday — in which the CDC recommends universal masking in indoor settings. But there are initial signs that the rate of increase in cases and hospitalizations is slowing.

“The rate of increase has actually come down over the last three days,” county director of public health Barbara Ferrer said Thursday. “I have more hope that our parameters can improve. I really do. I could be wrong, and that’s why crystal ball questions are so difficult.

The rate of new positive coronavirus admissions over the past week climbed 24%, a softer jump than the previous 38% week-over-week increase. And the share of staffed hospital beds used by coronavirus-positive patients rose 23% from the previous week, a softer increase than last week’s 40% jump.

It’s unclear when LA County would hit the final trigger that could begin a two-week countdown for an indoor mask order. The most recent estimate was for a few days before Christmas, but recent improvements push that date later, if at all.

Pomona Valley has seen its number of COVID-positive patients roughly triple from a month ago, Scafiddi said, and the majority are sick with COVID-19 rather than being accidentally infected. A growing number of people are also hospitalized for influenza and RSV.

This surge has affected children and adolescents differently. As COVID-19 cases spiked last winter, Pomona Hospital closed its pediatric unit to make room for adult patients, according to Scafiddi. This year, as COVID-19 and other viruses spread, he’s had up to 18 pediatric patients at one time, triple the usual number for this time of year, she said. .

The hospital hasn’t had to cancel surgeries or set up a tent outside, and Scafiddi said officials weren’t worried about supplies or had staffing issues, thanks to the arrival of itinerant nurses. The hospital is also well stocked with Paxlovid to treat patients with COVID-19, she said.

De St. Maurice, who is also an associate professor of pediatric infectious diseases at UCLA, urged families to get children vaccinated against the flu and COVID-19 and to be more careful about sending children to daycare or gatherings if they have symptoms.

“Even if they may test negative for COVID, that doesn’t mean they’re clear,” because influenza, RSV and other viruses are circulating, she said.

In Huntington, Shriner said that as hospitals prepare for another winter with COVID-19, “we certainly know better how to handle it and we’re in much better shape now than we ever have been before. But it’s difficult.

She urged people to get a flu shot and take other precautions: “There are so many things we can do, not the least of which are simple. Wear a mask. Get tested a lot.

“We know how to do this,” Shriner said, but “nobody wants to do this. “They want it to be like before COVID. Well, here we go. Now we know what this thing can do. And there are other viruses, not the least of which is the flu.

Cunningham urged people to avoid exposing their children to sick people, to keep sick children home from daycare or school, to wash their hands frequently and to wear masks indoors, if possible.

“Now is not the right time to tax the system,” she said, “because we are already pushed enough.”

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