The landslide of coronavirus patients on Orange County hospitals is forcing the health care system and public health officials to make unprecedented moves, like building field hospitals and requiring ambulance admissions on overcrowded emergency rooms.
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Dr. Jim Keany, an emergency medicine physician at Mission Hospital in Mission Viejo, fears hospitals could soon be overrun if trends continue.
“From all indications the way things are headed now, there’s no question that the medical systems in our area will be overwhelmed,” he said in a Wednesday phone interview. “In a matter of weeks.”
He said it’s an unprecedented situation.
“In the last 30 years, I have not seen anything that compares to this,” Keany said.
As of Thursday, 1,519 county residents were hospitalized, including 343 in intensive care units.
Hospitalizations have reached a point where OC Emergency Medical Services Director, Dr. Charles Schultz suspended ambulance diversion, which is when hospitals turn away an ambulance because their emergency rooms are full — forcing the ambulance to find another hospital.
“In our current COVID-19 situation, due to overwhelming numbers of patients presenting to the emergency departments for care across the county, almost all hospitals were going on diversion. If nothing was done, ambulances would soon run out of hospitals to take their patients. Therefore, we temporarily suspended ambulance diversion,” reads a late Wednesday statement from Schultz.
It’s a move likely never before seen in Orange County.
“To the best of our knowledge, this has never happened before,” reads the statement, posted on the county Health Care Agency’s Twitter account.
Schulz directive, issued Wednesday, warns the trends are unsustainable.
“In the last 24 hours, we have seen EMS hospital diversion increase to extreme levels with 20 hospitals being on diversion for a total of 213 hours. This is not sustainable,” reads the directive, which will last for three days. “If the situation remains at its present state, this suspension of diversion will continue.”
And OC Health Care Agency officials are rolling out field hospitals — tents with beds — to severely impacted hospitals across Orange County.
“Yesterday, the HCA announced the deployment of mobile field hospitals to support our local health care system, which is experiencing a surge in COVID-19 positive patients,” County health officer Dr. Clayton Chau said in a Wednesday news release.
The virus has now killed 1,731 county residents out of 113,783 confirmed cases, including 13 new deaths reported Thursday.
That’s more than three times the average flu deaths for OC.
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.
“A doctor can take up to two weeks to submit the death certificates, so those are delayed findings as well,” Keany said about the state death data.
He expects the death rate to increase.
“I think that not only will we have an increased death rate to the extent we’re having COVID cases, but we will have increased death rates that are seemingly unrelated to COVID as people suffer from stroke and heart attacks that were really COVID induced,” Keany said.
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 for days and weeks before making it out, while other people eventually die from the virus.
Chau’s been ringing alarm bells, giving an impassioned plea at Tuesday’s Board Supervisors meeting, nearly begging residents to follow public health protocols like wearing masks, staying home as much as possible and avoid hanging out with people outside of immediate households.
“Every day we break the record of the number of people who have [been] infected. So I’m pleading with the community: Please. Please. Do not gather. And make sure you follow the public health guidance,” Chau said during the supervisors’ virus update Tuesday.
OC saw an additional 2,615 confirmed cases Thursday and has averaged roughly 2,700 new cases a day for the past week.
State public health officials estimate 12 to 13% of newly infected people end up in hospitals within two to three weeks.
Chau repeated his warning in the Wednesday news release.
“This sounds alarming because it is alarming. I implore our residents not to gather with other households and limit upcoming holiday celebrations to those you live with,” Chau said.
St. Jude Medical Center in Fullerton, Fountain Valley Regional Hospital and the UC Irvine Medical Center in Orange are slated to get tents to help handle the surge of virus patients.
Keany, a former chief of staff for the hospital, said the parent company — Providence Health and Services — has scouted an additional 120 nurses to come to the Southern California region, with 220 more nurses down the road.
“That’s outside other resources we could potentially get from state and federal officials, even the National Guard,” Keany said.
Currently, the hospital is still able to treat non-virus patients, he said.
But the overall hospital system may have to rethink who they’re treating during the skyrocketing increases, Keany said.
“I think we’re there. I think we are at the point where it would be foolish to have wishful thinking and not make those plans,” Keany said. “Speaking to other hospitals — at Mission Hospital we’re not there, yet — but I know at other hospitals have reached the point where they can no longer meet the demand.”
UC Irvine Medical Center’s Dr. Shruti Gohil, an infectious disease doctor who treats ICU patients, also said non-virus treatment may have to be cut back at some point.
“Suppose you’re a patient and happen to have bone surgery you were hoping to get done and wasn’t emergency and necessary immediately … those kinds of conversations are happening,” Gohil said in a Tuesday phone interview. “That hasn’t happened en masse for us, thankfully.”
She said they’re able to send stabilized virus patients home and can be monitored through telehealth visits.
“Increasingly, we have kind of upscaled our ability to send patients who can be monitored at home to have safe care at home. There’s been a fair amount of effort put into the assessments that would allow for home oxygen and general care to be done by telemedicine, as needed, for a chunk of the population that has been admitted,” Gohil said.
And the UCI Medical Center is still able to juggle coronavirus treatments and non virus treatments because they’ve expanded their capacity, Gohil said.
Meanwhile, Schultz is urging hospitals to cancel elective surgeries — non emergency surgeries, like hip replacements — in order to free up beds for virus patients. He also is calling on hospitals to enact surge plans and establish emergency operations centers.
“To those facilities that have activated these initiatives, all healthcare partners and the citizens of Orange County are grateful. To those who have chosen not to take this painful but necessary actions, there is still time, but you must act now,” reads a directive Schultz issued last Wednesday.
While he didn’t direct hospitals to enact surge plans or cancel elective surgeries, he did direct ambulances to drive to the nearest emergency room if they’re waiting outside with a patient for more than one hour.
Doctors and epidemiologists fear the upcoming Christmas and New Year holidays could add even more cases to the surge — a spike on top of a spike — like the massive case increases following Thanksgiving.
“We’re at the boiling point and if we continue to add fuel to the fire that’s extremely concerning and if people expect to have normal social holidays this year, then we’re in for a prolonged event,” Keany said. “It’s going to be bad.”
Gohil said the cases are growing exponentially already and fears the upcoming holidays will keep adding more cases and hospitalizations.
“It’s not like we’re increasing by a rate that’s predictable,” Gohil said. “It will increase by 1.5 fold, then 2.5 fold and so on.”
“The bottom line on that is I fully expect that we’re going to continue to keep surging as a county, a state, a nation fully through January, Maybe February.”
Spencer Custodio is a Voice of OC staff reporter. You can reach him at firstname.lastname@example.org. Follow him on Twitter @SpencerCustodio