Orange County’s skyrocketing coronavirus hospitalizations saw a record jump on Wednesday, with an increase of 115 people in one day, with county public health officials now deploying field hospitals to help ease the burden.
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As of Wednesday, 1,486 county residents were hospitalized, including 319 people in intensive care units — the highest levels this year.
On Tuesday, 1,371 people were hospitalized, including 296 in intensive care units.
Gov. Gavin Newsom said in a Wednesday press conference that OC’s worsening situation, along with Southern California, forced him to adjust nurse-to-patient ratios in the ICU up from one nurse for two patients, to one nurse for three patients.
“We need to be creative, we need to temporarily, very short term … look a little bit differently in terms of our staffing,” Newsom said at a Tuesday news conference. “So just stretching resources.”
But the statewide nursing union, the California Nurses Association, immediately rang alarm bells.
“To roll back those standards now means we are running patient to patient. It means we do not have time to respond to each patient’s rapidly changing conditions, to monitor their subtle conditions. That could mean they live to see another day or die the next day,” said union president and registered nurse Zenei Cortez at a Wednesday news conference.
St. Joseph Hospital and Mission Hospital’s Medical Director of Infection Prevention, Dr. Charles Bailey, said the patient ratio change isn’t ideal, but needed to handle the spiking hospitalizations.
“It certainly wouldn’t be recommended, or allowed outside of a crisis situation. But given the limited resources, namely experienced ICU nurses, it’s a step that’s necessary. The nurses are supported by other personnel — patient care technicians and LVNs in some cases who can do some of the tasks not requiring the RN. It’s a necessary step, a temporary step. It’s something that has been done before,” Bailey said in a Wednesday phone interview.
In a late Tuesday news release, the county Health Care Agency said they’re rolling out field hospitals to help alleviate some burden on hospitals.
“The OC Health Care Agency will deploy mobile field hospitals (MFHs) to local hospitals this week to support the Orange County (OC) health care system as it responds to a surge in COVID-19 patients. OC hospitals may receive emergency waivers from the California Department of Public Health to request the use of the MFH facilities,” reads the release.
A situation report from OC Emergency Services said UCI Medical Center, St. Jude Medical Center and Fountain Valley Regional Hospital are getting the field hospitals. The report indicates Hoag Hospital in Newport and St. Joseph Hospital may also get field hospitals.
While the county public health officials are setting up field hospitals, which are essentially tents with beds, state public health officials are sending additional body bags and refrigerated trucks to Southern California to help brace for the impending deaths.
“We have to be mindful of how deadly this disease, this pandemic is. Here’s what we’ve just done: we have orders for 60 53-foot refrigerated storage units that are currently standing by in counties and hospitals. We just had 5,000 additional body bags they just purchased for the state. And we distributed them down to San Diego, Los Angeles and Inyo counties. That should be sobering,” Newsom said.
While it’s unclear if body bags or refrigerated trucks will end up in the county, OC has been hit harder than San Diego County.
Orange County has 380 more people in hospitals than San Diego and roughly 500 more deaths.
As of Wednesday, the virus has killed 1,718 county residents out of 111,168 confirmed cases, including 23 new deaths reported today, according to the county Health Care Agency.
Due to reporting issues, the new deaths can stretch back up to three weeks.
The county also saw an additional 3,231 new virus cases reported Wednesday.
OC has averaged roughly 2,500 new cases a day for the past week.
State public health officials estimate 12 to 13% of new cases end up hospitalized two to three weeks down the road.
The virus has already killed over three times as many people in Orange County as the flu does on an average yearly basis.
For context, Orange County has averaged around 20,000 deaths a year since 2016, including 543 annual flu deaths, according to state health data.
According to those state death statistics, cancer kills over 4,600 people, heart disease kills over 2,800, more than 1,400 die from Alzheimer’s disease and strokes kill over 1,300 people.
The county is on track to surpass its average yearly deaths with over 19,000 people dead as of October, the latest available state health data.
It’s a difficult virus for the health care community to tackle because some people don’t show any symptoms, yet can still spread it. Others feel slight symptoms, like fatigue and a mild fever. Others end up in ICUs and people eventually die from the virus.
“That is one of the differences in this virus is that it seems more capable of transmitting prior to symptoms or people who don’t show symptoms. And that’s where the vaccine is going to come in,” Bailey said.
He also said it also creates a challenge to get people to follow the public health protocols.
“The ones who maybe aren’t doing that as well as we have recommended are continuing to spread it. And once the vaccine has been administered to a large number of that group, then the ability for asymptomatic spread will be blunted. But it is a challenge,” Bailey said.
Local epidemiologists question how much more the county’s hospital system can take.
“We have some really amazing hospital centers in Orange County — they’re extremely competent and they’re well resourced and they’re on top of things right now, but it’s really hard to imagine how things are going to be as numbers continue to skyrocket,” UC Irvine epidemiologist Sanghyuk Shin said in a Monday phone interview.
Shin and doctors are urging residents to follow public health protocols — masks, six-foot physical distancing and avoid hanging out with people outside of immediate households — to help curb the spikes.
“I really think it’s important for Orange County residents to understand we really need to start taking public health measures seriously, we needed to do that months ago. Unfortunately we haven’t done that — it’s better late than never,” Shin said. “We have two more weeks until Christmas and between now and then it’s all hands on deck on trying to curb this disease, this pandemic.”
Dr. Shruti Gohil, an infectious disease expert who treats patients in the ICU at the UCI Medical Center, said although a vaccine is on the horizon, it won’t stem the second wave that’s crashing down on hospitals.
“We shouldn’t just think that the vaccine is, okay, great, now my job is done,” Gohil said in a Tuesday phone interview. “What we should be thinking is how we minimize the impact of the wave hitting us now and how I can get my vaccine down the road. ”
OC’s first doses of vaccine were administered to health care workers Wednesday at St. Joseph’s Hospital in Orange.
County health officer Dr. Clayton Chau has said the first shipments of vaccines won’t cover all of Orange County’s health care workers, which are who the doses are slated for.
Gohil, who’s also associate medical director of Epidemiology and Infection Prevention at UCI Medical center, said public health measures should continue to be followed because the vaccine is still new and experts aren’t sure how long it lasts or how it can be widely distributed.
“Even once it gets out there, we don’t know how long immunity is going to last,” Gohil said. “About 70% of the population has to get vaccinated before we really consider it to end this thing, to really beat it. So 70% of the population is a really big number.”
Meanwhile, hospitals are being pushed to their limits.
“It is really challenging on the capacity front. Our ICUs are very close to full,” said Jeremy Zoch, the chief executive of St. Joseph Hospital, one of the largest hospitals in OC.
At the vaccine news conference, Zoch said he expects the situation to get worse.
“We have struggled to keep up with the demand. We still see our numbers continuing to increase,” he said.
Bailey said St. Joseph Hospital and Mission Hospital are still able to handle the spike, for now, because of surge planning.
“I think we still do have the staff and beds to manage it. Obviously we have the capability to limit or cancel elective surgical procedures and I think that’s been done in most situations where that move would help the response to COVID,” Bailey said. “We have the capacity to go above 100% of our licensed ICU capacity and that’s being done where it’s needed.”
He also said he’s never seen a situation like this in his career.
“It’s really unlike anything I’ve experienced. I was involved when HIV/AIDS first burst upon the scene, but for the most part those people were not needing ICU care in such numbers all at once,” Bailey said. “Even a bad flu season is going to be a relatively short burst of activity (in ICUs), it’s not going to be sustained, which is the challenge with COVID.”
Spencer Custodio is a Voice of OC staff reporter. You can reach him at firstname.lastname@example.org. Follow him on Twitter @SpencerCustodio
Reporter Nick Gerda contributed to this story.