Hospitals say California officials too slow in COVID-19 crisis

"The numbers are extraordinary, said Carmela Coyle, president and CEO of the California Hospital Association. "We're not going to dodge this math. We need the state's help."
LOS ANGELES -- California reported its second-highest number of daily coronavirus deaths Wednesday with 459 lives lost, bringing the death toll to 2,504 in the last week as more than a quarter-million new weekly cases portended a continued overwhelming crush on hospitals and intensive care units strained to the breaking point.

"The numbers are extraordinary, said Carmela Coyle, president and CEO of the California Hospital Association. "We're not going to dodge this math. We need the state's help."

Gov. Gavin Newsom's administration should immediately remove bureaucratic red tape that is hobbling medical workers for hours at a time and begin coordinating patient care at a statewide level, upending its usual decision-making process, she said.

It's not enough for California to ban certain elective surgeries in the hardest hit hospitals or order hospitals to accept patients from others that have exhausted their intensive care beds, she said.

State officials did not immediately respond to her criticism of the public health order issued late Tuesday without prior notice to hospitals that are now scrambling to comply.

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Coronavirus cases have exploded across the nation since Thanksgiving, with Arizona now topping California, the most populous state, in cases per resident.

California avoided surging cases for months, but now the virus is raging out of control. And vaccinations being administered at what Newsom said is too slow a pace will take weeks or months to slow the spread.

The southern part of the state has been hit hardest, though most of the state is reporting no or minimal normal intensive care beds as patients spill into corridors, tents and cafeterias.

Conditions will only worsen in coming weeks as about 12% of new positive cases inevitably deteriorate into needing hospital care, and 12% of those hospitalized need increasingly scarce intensive care.

Los Angeles County alone on Wednesday recorded 258 new deaths. The rate of new cases in the state's most populous county is nearly double that of December.

"This is a health crisis of epic proportions," said Barbara Ferrer, the county public health director.

So far, no hospital reported rationing patient care, said Dr. Christina Ghaly, director of the LA county Department of Health Services.

LA County's Methodist Hospital of Southern California has convened an in-house triage team that makes daily evaluations "about the severity of critically ill patients that allows us to distribute resources to those who need it the most," said chief strategy officer Cliff Daniels.

The hospital is not rationing care, Daniels said, and "we hope we don't get there. But ... we haven't yet seen the surge from Christmas and New Year's. Times are going to get tougher."

Guidelines posted on the hospital's website warn, "If a patient becomes extremely ill and very unlikely to survive their illness (even with life-saving treatment), then certain resources ... may be allocated to another patient who is more likely to survive."

To the south, San Diego County Supervisor Nathan Fletcher said authorities anticipate an increase in cases based on travel data over the Christmas and New Year's holidays and the spread of a highly contagious virus variant. There are 28 confirmed cases of the variant and 12 probable cases in the county.

To the north, officials in Santa Clara County pleaded for residents to heed health guidelines to prevent hospitals from having to ration care during the worst surge in the county of 2 million people since the pandemic began.

About 1,000 people in the county are testing positive for COVID-19 each day and 100 of them are being admitted to hospitals daily, said Dr. Ahmad Kamal, the county's director of Healthcare System Preparedness.

"And as awful as it is, it could get worse," Kamal said. "We haven't had a situation where two people are out of breath and one person gets a ventilator. We could get there."

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Hospitals in California are so swamped by the coronavirus pandemic that the state has ordered those with room to accept patients from others that are out of intensive care beds.



Coyle, of the state hospital association, and Ferrer in Los Angeles both said a big problem is that hospitals are accepting more patients than they can discharge.

State officials should thus override decisions by many county health officers that prevent recovering coronavirus patients from being released to skilled nursing facilities, despite fears that they could spread the virus, Coyle said.

She said the state should accept children's hospitals' offer to take patients up to 27 years old.

It should issue blanket waivers allowing hospitals to use a team approach to providing ICU services when there aren't enough regular intensive care nurses. That would build on a temporary suspension of nurse-to-patient ratios that the California Nurses Association warns is endangering patient care.

And it should suspend the usual requirements for nurses to apply for annual updates of their certifications or spend an average of two- to three-hours each day filling out reports on their patients, Coyle argued.

"There is a bucket of these things that make sense in a normal environment that need to be all put aside for the next handful of weeks until we get through this crisis," Coyle said. "Focus on nothing other than saving lives for the next few weeks."

Instead of requiring hospitals to accept patient transfers, as state health officials did late Tuesday, the state should better coordinate regionwide care so patients go to the best available hospital in the first place, she said.

And instead of allocating scarce state-mustered health care workers on a first-come, first-served basis, the state should allocate them to whichever facility needs them most, she said.

That means upending California's usual mutual aid system that allows requests for help to percolate up from counties to state officials, she contended.

"We really need to move with alacrity to put in place some of the changes in how we are allocating scarce resources," Coyle said. "It will require an evaluation of where the resources are needed over a much broader geography."
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