He was behind a glass screen, heavily sedated, alive by a machine that introduced oxygen into his lungs, through a tube attached to his mouth that reached to the back of his throat. He had been hospitalized for a few days, and was rapidly getting worse.
“His respiratory system and cardiovascular system are failing,” said Dr. Luis Horta, a critical care specialist at the Intensive Care Unit (ICU). The patient’s chances of survival, which was not identified for privacy reasons, were low, Horta said.
The woman, 60, was one of 50 patients with COVID-19 who, in the week of December 13, required constant medical attention at the ICU at the Los Angeles County Medical Center + USC (LAC + USC), a 600-bed public hospital east of Los Angeles. The vast majority of these patients suffered from diabetes, obesity, or hypertension.
Another 100 COVID patients, less ill at the moment, were in other sections of the hospital. And the numbers were growing. Between Saturday 12 and Wednesday 16, eight COVID patients died, twice as many as in the previous five days.
The avalanche of COVID patients at LAC + USC, in recent weeks, has put immense pressure on the capacity of the unit and its staff; especially because non-COVID patients, such as those arriving with bullet wounds, drug overdoses, heart attacks, and strokes, also need intensive care.
There were no more beds available at the ICU, said Dr. Brad Spellberg, the hospital’s chief physician.
Similar scenes — crowded wards, overworked medical staff, pressured administrators, and grieving families — are seen in hospitals across the state, and across the nation.
On Christmas Day there were no ICU beds available in the 11 counties of the Southern California region, nor in the St. Joachim Valley.
On Thursday 24, county health officials reported that the number of new COVID deaths had skyrocketed for the second day in a row beyond their previous peak levels throughout the pandemic.
LAC + USC has suffered a heavy burden of COVID since the beginning of the pandemic, in part because it serves a low-income, predominantly Latino community that has been severely affected. Latinos make up 39% of California’s population, but have suffered 56% of the state’s VOCID cases and 48% of deaths, according to data updated Dec. 22.
Many people who live near the hospital do essential work and “can’t work from home. They go out and expose themselves because they have to make a living,” Spellberg explained. “They don’t live in huge houses where they can isolate themselves in a room,” he added.
The worst cases end up in a bed, in the middle of a tangle of tubes and bags, in ICU rooms designed to prevent air and viral particles from escaping into the hallways.
The sickest, like the woman described above, need machines to breathe. They are fed through nasal tubes, their bladders drain into catheter bags, while the intravenous routes deliver fluids and medications to relieve pain, keep them calm, and raise their blood pressure to the level needed to live.
To relieve the pressure in the ICU, the hospital has just opened a new “smaller unit” for patients who, despite being very ill, can be treated with a slightly lower level of care. Spellberg said he expects the unit to be able to accommodate 10 patients.
Hospital staff also check patients ’health insurance to see if they can be transferred to other hospitals. “But right now, it’s almost impossible, because everyone is filling up,” Spellberg commented.
Five weeks ago, of the patients with COVID who arrived in the emergency room, only a small percentage showed severe symptoms of the disease, which meant a lower number of hospital and ICU admissions than during the wave. of July. This helped keep the disease at bay, Spellberg said.
But not anymore.
“In the last 10 days, I have a clear impression that things have gotten worse again, and that’s why our ICU has filled up so quickly,” Spellberg said on Dec. 14.
The total number of patients admitted with COVID to the hospital, and the number in their ICUs, are now well above the July peak, and both are almost six times higher than at the end of October. “It’s the worst we’ve seen,” Spellberg said. And he added that things will get worse in the coming weeks if people travel and reunite with their families for Christmas and New Year, as they did for Thanksgiving.
“Think of New York in April. Or Italy in March,” Spellberg noted. “That’s how ugly things could be put.”
And they’re pretty bad already. Nurses and other members of the medical staff are exhausted for long months with patients requiring very laborious care. And the work is getting more and more intense, explained Lee Salines, director of nursing in one of the hospital’s ICU sections. To avoid staff shortages, he has asked his nurses to work overtime.
Usually, ICU nurses are assigned two patients per shift. But a severe patient with COVID can occupy virtually the entire shift, even with the help of other nurses. Jonathan Magdaleno, one of the ICU nurses, explained that a serious patient may require 10 hours of care, during a 12-hour shift.
Even at best, he said, you usually have to go into a patient’s room every 30 minutes, because the bags that administer medications and fluids empty at different rates. Whenever nurses or other caregivers enter a patient’s room, uncomfortable protective equipment should be put on and then removed when leaving.
One of the most delicate and difficult tasks is a maneuver known as “pronation”, in which the patient with acute respiratory problems on his stomach is rotated to improve lung function. Salinas said this can take half an hour and require up to six nurses and a respiratory therapist, because the tubes and cables need to be disconnected and then reconnected, not to mention the risks involved in moving an extremely fragile person. And they have to do it twice, because each patient needs to be rotated again at the end of the day.
For some, working in the COVID room at LAC + USC is very personal. This is the case of Magdaleno, a Spanish-speaking nurse who was born in Mexico City. “I grew up in this community,” he said. “And even if you don’t want to, you see your parents, your grandparents, your mother in these patients, because they speak the same language.”
Magdaleno plans to spend Christmas only with members of her household and asks us to do the same. “If you lose a member of your family, then what is the purpose of Christmas [o Año Nuevo]? “ask.” Is it worth going to the mall right now? Is it even worth buying a gift for someone who will probably die? “.
That the darkest hour of the pandemic will arrive just as COVID vaccines begin to arrive is especially poignant, said Dr. Paul Holtom, chief epidemiologist at LAC + USC.
“The tragic irony is that the light is at the end of the tunnel,” he said. “The vaccine is being distributed as we talk, and people just have to stay alive until they can get the vaccine.”
Article by Kaiser Headline News.