Dr. Charles Bailey, medical director for infection prevention at two Providence hospitals in Orange County, sees the current influx of patients sweeping into hospitals across the Southland not as a second wave of coronavirus infections, but the first wave they had been preparing for all along.
Bailey, who oversees infection prevention at Mission Hospital in Mission Viejo and St. Joseph Hospital in Orange, said surge plans are working and, in general, Orange County’s hospitals have been able to absorb the influx of coronavirus patients by shifting resources around.
“We’re equipped in terms of hospital capacity,” Bailey said last week. “We’ve opened new units, we’ve juggled things around in order to accommodate the influx of patients, and we’re better prepared in terms of our knowledge — in terms of our clinical experience in patients we do get.”
Five months into the coronavirus pandemic, with the virus still spreading across Southern California, hospitals across the region are experiencing this month sustained numbers of patients at their highest levels yet. Though medical teams report being tired and overworked, hospital administrators continue to say they’ve got the surge under control.
The reasons include readiness — as the outbreak endures, teams are learning more about how to prepare.
Also, the wave of patients has not arrived all in one place. Instead, the surge has been shifting, first with hospitalizations and deaths coming mostly from nursing homes and now to a younger group, though the vast majority of those dying are still older. This trend has also meant in some cases a change from patients arriving at hospitals in more suburban areas to those in urban centers.
Dr. Nicholas Testa, chief medical officer for CommonSpirit Health, part of Dignity Health, said the shift was especially noticeable among the hospital system’s four L.A. hospitals.
In April, patients mostly showed up at Dignity’s Northridge Hospital where more nursing homes are located. But then over the past month, more younger and Latino patients began arriving at its downtown California Hospital, mirroring countywide data, Testa said.
“The advantage of having high volumes of hospitalized patients for the past few months is that we’ve gotten better at managing situations,” Testa said.
Last week in L.A. County, those aged 18 to 40 accounted for the highest increase in new patients, up nearly 30% from a month ago, according to the Department of Public Health. Average deaths per day over a seven-day period have risen slightly in recent weeks to 30 per day, down from highs of 45 people per day in April.
Where geographically the virus is spreading has also changed, shifting from the more populated Los Angeles County to higher rates of growth in neighboring regions. The rate of new hospitalizations, for instance, has been far greater over the past month in counties other than Los Angeles.
The number of people in San Bernardino County hospitals who tested positive for COVID-19 is almost three times higher now than it was in mid-June. The numbers have more than doubled in Riverside County and Orange County hospitals. But they’ve risen by a more moderate 72% in L.A. County.
The overall levels of hospitalizations continue to hover around their highest in each of the four counties, though they have generally stabilized over the past week or two as more strict health orders were put in place, based on an analysis of the data. Riverside reported significant declines on Monday, but some of that could be due to changes in how hospitals are reporting data.
Los Angeles County, which bore most of the original surge back in April, continues to record the most cases of any county in America, but that is mainly due to the size of the population, experts say. At roughly 10 million people, the county is nearly twice the size of the second-most populous — Cook County, Illinois.
Comparing cases per-capita, L.A. County ranks 13th in the state — with Orange, Riverside and San Bernardino close behind when comparing rates over the past two weeks. Those three counties, however, are adding new cases at faster rates than L.A. County. In the past two weeks, the cumulative number of cases has risen 47% in Orange and San Bernardino counties, 35% in Riverside County and 33% in L.A. County.
Riverside County continues to see a surge in coronavirus patients, with 534 COVID-19 hospitalizations as of Friday. Especially concerning, according to the county’s Director of Emergency Management Bruce Barton, were use of intensive care unit beds, which reached a single-day peak on July 22 with 155 COVID-19 positive patients and 28 suspected cases.
“Hospitals continue to implement their surge plans to expand capacity and are able to meet the current healthcare needs of our communities,” Barton said. “The (county’s) emergency operations center … is coordinating ongoing supply, equipment and staffing support for hospitals to assure needs are met.”
Dr. Geoffrey Leung, ambulatory medical director for the county-run Riverside University Health System hospital in Moreno Valley, said last week that hospitalizations for COVID-19 have doubled across Riverside County in the previous five weeks.
The number of patients requiring intensive care has risen sharply, too, he said. As a result, Leung said the county hospital boosted the number of beds in its intensive care unit from 36 to 54.
“And if we need to, we can go higher than that,” he said.
Leung said that, although there was more anxiety in March and April about the virus’s rapid spread, total COVID-19 hospitalizations are higher now countywide than they were then.
In perhaps a positive side note, however, the proportion of hospitalized patients requiring intensive care is smaller, Leung said.
“We’d like to think it’s because we know more about COVID and have a better idea of how to take care of them,” he said.
In the past few days, hospitalizations have leveled off, Leung said, possibly indicating the governor’s recent orders to wear masks and close bars, indoor dining and malls are having an impact.
“Only time will tell, but we’re hopeful that that signals the beginning of a change,” he said.
Leung said, in general, people are being responsive by covering their faces and keeping their distance when they go to work or shop at the grocery store. But he said contact tracing has shown they aren’t as careful in the company of people they know well.
“We tend to let our guard down when we are with our close family and friends,” Leung said. “It wouldn’t occur to someone that their cousin or their grandfather or their best friend could be COVID positive.”
L.A. County Public Health Officials said last week that the spread of the virus was stabilizing.
On Thursday, more than 2,200 people were reported at L.A. County hospitals — the most since the pandemic began — though officials said there were signs that transmission rates were slowing. On Monday, the number dropped to 2,017 due in part to a change in federal reporting requirements, which state and county officials said affected the numbers at the end of the week.
“The current number of beds is likely to be adequate over the next four weeks, though ICU beds could be a problem,” said L.A. County Director of Health Services Dr. Christina Ghaly on Wednesday, July 22. “ICU beds remain our most valuable hospital resource.”
L.A. County as of Monday had 1,369 available intensive care unit beds and 2,670 unused ventilators, according to the Department of Public Health.
At Providence hospitals across 11 Southern California facilities and two affiliated hospitals, there were more than 500 admitted patients with coronavirus or awaiting testing — accounting for 18% of the hospital system’s total bed capacity, as of Tuesday, July 21.
“This allows us to safely manage the influx while continuing other essential services to avoid delays in care for anyone in need,” a company statement read. “We also have an advantage as a large system of sharing resources, including the ability to transfer patients to another of our hospitals if one should near capacity.”
Testa, the CMO at Dignity, said L.A. County never really had a respite in hospital patients.
“Cases went up and they stayed pretty high and then in June we started seeing this uptick of cases again as social distancing was relaxed,” Testa said.
For the medical teams at Dignity, he said they were buoyed by support from the community.
“We all are tired,” he said, “but I think we’ve all been inspired that society has taken this pause to say we really need you right now and it’s really impressive.”
