Orange County hospitals are bracing for even more coronavirus patients as doctors and epidemiologists fear another holiday spike with Christmas and New Years coming up, while some hospitals are cutting back on non-emergency treatments.
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“I would say the alarming thing is the trend has really continued unabated. The case rate is up — the number of positives in our system. We continue to set records, we set one a couple days ago with the most positives through testing and we know that 10 to 12% of those will end up in the hospital,” said emergency medicine physician Dr. Todd Newton in a Friday phone interview.
As of Friday, 1,557 county residents were hospitalized, including 358 in intensive care units.
A month ago, Nov. 20, there were 333 people hospitalized.
That marks a nearly 368% increase in hospitalizations over the last 30 days.
Newton, who’s the OC medical director for Kaiser Permanente, said the daily numbers don’t paint the whole picture because hospitals are discharging stabilized patients as fast as possible, using treatment techniques learned during the first wave.
“When we look at our aggregate number of patients it looks like it goes up 10,20, whatever the number is — but that means we turned over a tremendous number of people to free up those beds,: Newton said, adding it could mean hospitals have discharged hundreds of stabilized virus and non-virus patients.
He also said OC hasn’t even seen the peak of the second wave yet.
“We’re projecting regionally that if nothing changes — if everything stays on the course we’re seeing now, we could be seeing 100%, 150% even 200% more cases than we’re seeing now,” Newton said.
UC Irvine epidemiologist Sanghyuk Shin also said he fears what Christmas might bring.
“People are making reservations for travel, not quite at 2019, but getting close to it. The fact that large numbers of the population are not taking COVID-19 seriously is a huge failure on the part of the leadership, perhaps on the part of the public health community like myself,” Shin said in a Tuesday phone interview. “It’s a failure on all of us. It’s just really grim.”
Dr. Jim Keany, an emergency physician at Mission Hospital in Mission Viejo, said he expects hospitals to max out in “a matter of weeks.”
But that doesn’t mean hospitals will stop taking patients.
“Our approach is not to expand the emergency room into an intensive care unit, that’s not the goal. The goal is to create ICU spaces in other areas of the hospital,” Keany said in a Thursday interview. “It’s a very much coordinated dance between administrators, facility experts, physicians … we’re full on paper, but we can create ICU care beds in other spaces.”
Although hospitals are able to create spaces and reorganize staffing assignments as they’re being pushed to the brink, doctors, nurses, technicians and a host of other critical medical workers are a limited resource that’s in high demand across the country.
A tsunami of coronavirus patients, coupled with medical workers being stretched thin, can create delays in treatment.
“What the problem is — you saw this in New York and Italy — is when people have to wait. When they have to wait, they get sicker. Because a small subsect of those people are really sick and they need to come in now,” Newton said. “The concern becomes you get a New York-style situation and you have patients everywhere and nurses and staff are stretched so thin.”
Although, the doctors say everyone will get treated eventually.
It’s just a matter of time.
“The care can be delayed. The circumstances where we’re providing the care could be less than optimal,” Newton said. “That’s what we’re trying to avoid. We have plans for that … we already know what we’re going to do on the staffing side, physician side, facility side.”
The virus has now killed 1,734 OC residents out of 116,377 confirmed cases, according to the county Health Care Agency.
And OC saw another 2,594 cases reported Friday, averaging roughly 2,700 new cases a day for the past week.
State officials estimate roughly 12% of all new cases will end up in hospitals within two to three weeks.
The virus has already killed more than three as many people as the flu does on a yearly average.
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.
“I will take on any one who wants to claim that this is normal. There’s nobody in the medical profession, in their right minds — unless they have an axe to grind — who will say that this is normal,” Newton said.
It’s a difficult virus for the medical 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.
Keany said the current virus wave feels like a natural disaster response.
“To me it feels very much like a disaster response at this point. Because unlike a traditional operation, where you always have enough resources, you may not have enough resources as you’d like, but you have enough resources to meet the demands in one way or another,” Keany said.
But unlike in a massive earthquake or tornado, nearby resources are also stretched thin.
“Because those (disasters) are regional,” Keany said. “This is our entire state and all of our neighboring states. So any additional resources are very hard to come by.”
Although Mission Hospital’s parent company — Providence Health and Services — is scouting hundreds of critical medical workers to help beef up staffing at the hospitals in the region, Keany said.
Newton said Kaiser is doing similar things with its recently retired physicians and nurses, as well as rearranging staff from other areas of the hospital under the supervision of critical care doctors.
Meanwhile, non-emergency treatments and procedures are being cut back at some hospitals in order to free up beds and medical workers to handle the spike in virus patients.
“Our system right now is not at capacity, because capacity is a moving target because we can shift into other rooms, we can decrease our elective surgeries and procedures and we’re doing that. And we can put up tents — mobile field hospitals — which is what we’re seeing at our sister hospitals,” Newton said.
The situation has deteriorated to the point where Orange County 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,” Orange county health officer Dr. Clayton Chau said in a Wednesday news release.
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.
“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.
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.
It’s likely an unprecedented move in OC.
“There’s never been anything like this in the history of our country in the last 100 years. Period. That’s the bottom line. And I’ve been doing this job now for 25 years,” Newton said. “The worst winter doesn’t even come close to what we’re seeing now. How many times have we had to set up tents? We set one up during the H1N1 years and we didn’t have to use it.”
He also said he’s never seen hospitals being forced to take ambulance patients, even if they’re full.
“They said there’s no diversion now, we’re going to come to you and you’re going to take the patient,” Newton said. “I’ve never seen that happen.”
“I’ve never seen ambulances report having to wait two or three hours to drop patients off at hospitals in Orange County,” Newton said. “We never had to talk to surgeons about the possibility of coming in and taking care of COVID patients — we’re not there yet, but we’re planning for it”
Spencer Custodio is a Voice of OC staff reporter. You can reach him at email@example.com. Follow him on Twitter @SpencerCustodio