US California hospitals discuss rationing care as virus surges

With about 98 percent of intensive care beds full, California hospitals are making contingency treatment plans.

St Mary Medical Center resorts to using triage tents outside to handle the overflow at its 200-bed hospital during the COVID-19 outbreak in Apple Valley, California [Mike Blake/Reuters]

On the West Coast of the United States, California’s overwhelmed hospitals are setting up makeshift extra beds for coronavirus patients, and a handful of facilities in hard-hit Los Angeles County are drawing up emergency plans in case they have to limit how many people receive life-saving care.

The number of people hospitalised across California with confirmed COVID-19 infections is more than double the state’s previous peak, reached in July, and a state model forecasts the total could hit 75,000 patients by mid-January.

Plans for rationing care are not in place yet, but they need to be established because “the worst is yet to come”, said Los Angeles County’s health services director, Dr Christina Ghaly.

While shipments of the vaccine are rolling out to many healthcare workers and nursing homes across the country, it could be months before the shots are available to the general public. Until then, four hospitals run by Los Angeles County are weighing what to do if they cannot treat everyone because of a shortage of beds or staffers.

Emergency room technician Brenda de la Cruz, right, and RN Janet Hays work outside St Mary Medical Center in the triage tents as they handle the overflow from the 200-bed hospital [File: Mike Blake/Reuters]

A document recently circulated among doctors at the four hospitals proposed that instead of trying to save every life, their goal could shift to saving as many patients as possible — meaning those less likely to survive would not get the same kind of care.

“Some compromise of standard of care is unavoidable; it is not that an entity, system or locale chooses to limit resources, it is that the resources are clearly not available to provide care in a regular manner,” said the document obtained by the Los Angeles Times.

Many hospitals in California have already implemented emergency procedures to stretch staff and space.

Corona Regional Medical Center southeast of Los Angeles has converted an old emergency room to handle nearly double the usual number of ICU patients. It is also using two disaster tents to triage emergency room (ER) patients.

Overall, the state’s ICU capacity was just 2.1 percent on Sunday. Some hospitals have cancelled non-essential elective surgeries, such as hip replacements, that might take up beds that could soon be needed for COVID-19 patients.

A patient in the COVID area at St Mary Medical Center is viewed through a door window of a temporary walled off area inside the hospital during the outbreak of the coronavirus disease in Apple Valley, California [File: Mike Blake/Reuters]

Nurses say the crush of cases means they have less time to spend with patients, many of whom are sicker than they have ever been.

“The more patients we have, the more there’s a risk of making a mistake, especially if we’re rushing,” said Wendy Macedo, a nurse at UCLA Health Santa Monica Medical Center. ”Obviously we’re trying to avoid that, but we’re only human.”

California was experiencing “some of the darkest days of our COVID-19 surge”, Governor Gavin Newsom said, but there was some light on Sunday as a group of scientists and experts endorsed a vaccine developed by Moderna. The step clears the way for the drug to be distributed throughout California and other Western states that reviewed it separately from the Food and Drug Administration.

Pharmacy chains CVS and rival Walgreens started providing shots last week at some long-term care locations in Connecticut and Ohio, and both companies said they would expand their programmes in 12 states starting this week. Those states include Florida, Kentucky, Maine, Maryland, Nevada, New Hampshire, New York, Oklahoma, Oregon and Vermont, CVS Health said on Monday.

CVS plans to make three visits to each site to give residents and staff their initial shot and then a booster. It expects to complete the programme in about three months.

But with vaccines in limited supply until about midyear, political leaders are calling on people to stay at home and wear masks.

New York Governor Andrew Cuomo has asked airlines flying into his state from the United Kingdom to make all passengers take a coronavirus test before they get on board. At least one airline, British Airways, has agreed, the Democrat said.

Cuomo wants the US government to temporarily halt flights from the UK because of the emergence of a new strain of the virus in that country.

Tennessee Governor Bill Lee on Sunday announced new social gathering restrictions while still refusing to implement a mask mandate despite pleas from front-line healthcare workers. Tennessee, one of a dozen states without a mask mandate, is experiencing the highest new cases per capita in the country.

Instead of a mask mandate, the Republican signed an executive order limiting public gatherings to 10 people. However, places of worship, weddings and funerals are exempt.

Source: AP