Holiday COVID surge pushes hospitals and ambulance crews to their breaking point

The holiday season has now manifested itself into California’s worst surge of new COVID-19 cases since the beginning of the pandemic and is forcing the state’s hospitals and ambulance crews to make life-and-death decisions on who to treat.

Confirmed new coronavirus cases shattered records in the first week of the year, with more than 74,000 people testing positive on Monday alone. The state continued reports of astonishing tallies, ending the week with a reported 695 deaths on Saturday, setting a new record for the state’s single-day death toll. Since early last year, more than 2.5 million have tested positive for COVID-19 in the state, and nearly 28,000 people have died from the disease, according to Johns Hopkins University.

“There’ve been a lot of days when during your shift, after your shift, you’re just kind of scratching your head while you’re appreciating how fast it’s spinning, trying to get a handle on everything that is happening around you,” Dr. Sam Torbati, an emergency physician and medical director of the Ruth and Harry Roman Emergency Department at Cedars-Sinai Medical Center told Yahoo News. “Patients are so incredibly sick and there’s so many of them.”

Los Angeles County has seen the lion’s share of the post-holiday surge, with an average of roughly 13,500 new cases reported per day and 184 daily deaths from COVID-19 over the last week. That’s the equivalent of someone dying of COVID-19 every eight minutes.

L.A. Mayor Eric Garcetti said Thursday that 259 people died from COVID-19 on Wednesday, more than all of the homicides recorded in the city in 2019. More than 11,000 people, 40 percent of the state’s total, have died from COVID-19 in Los Angeles County. Officials are expecting that alarming rate to rise since many testing sites were closed over the New Year’s Day holiday.

“We’re likely to experience the worst conditions in January that we’ve faced the entire pandemic, and that’s hard to imagine,” L.A. County Public Health Director Barbara Ferrer said during a briefing on Monday, adding that the increase in numbers will have a ripple effect attributable to holiday parties and returning travelers.

On Thursday, California Governor's Office of Emergency Services responded to the growing emergency by distributing 88 refrigerated trailers to be used as makeshift morgues.

Hospitals in the state, particularly Southern California, has been described by Dr. Nicole Groningen of Cedars Sinai Medical Center as being at their “breaking point,” and health care workers warn that the health care system may be on the brink of collapse.

California Gov. Gavin Newsom said at a coronavirus state briefing on Monday that 96 percent of L.A. County hospitals diverted ambulances to other facilities at some point over the weekend due to overcrowding in emergency rooms.

“This latest surge has been incredible with the numbers coming in. They’re young, they’re older. They’re all over the spectrum,” Torbati says.

“I’ve never seen a health care system pushed to the level we’re at.” said Scott Brickner, a nurse in Cedars Sinai Medical Center’s medical intensive care unit, his voice breaking with emotion. “Coming to work is ... really stressful, to say the least, when you have to motivate yourself mentally to just be ready for anything.”

It’s been more than two weeks since the state reported its intensive care units had reached maximum capacity. Hospitals are now starting to feel the brunt of the holiday outbreak, as numbers have only just begun to flood in from Christmas and the New Year. In Los Angeles County alone, more than 7,400 COVID-19 patients are hospitalized as of Tuesday, with 21 percent requiring treatment in intensive care units.

In response to the dire situation, L.A. County’s Emergency Medical Services Agency issued a directive on Monday to cease transferring patients to hospitals if they could not be resuscitated, instructing paramedics to “use their existing authority to declare a patient’s death in the field if there is no pulse, rather than transporting the individual to a hospital” so as to conserve limited resources.

Cathy Chidester, director of the L.A. County Emergency Medical Services Agency, told Yahoo News in a Wednesday statement that “transporting these patients to the emergency department is futile and further impacts the hospitals.”

In a separate memo on Monday, the county directed emergency personnel to ration concentrated oxygen, which is in short supply, prioritizing its use for patients with an oxygen saturation level below 90 percent.

“Paramedics make that determination after a full assessment, which includes a measurement of oxygen saturation in the blood, and consideration of certain known or suspected underlying medical conditions,” Chidester said.

“We were already beginning to think through care allocation,” Torbati said. “Having the county also think through issues of resource management and appropriateness is appropriate. The objective in a pandemic and a crisis is always to try to help as many people as possible, but now it’s even more important for us to make sure that we don’t do it if it’s not going to work. We still believe in heroics, but right now we just need to make sure that the heroic efforts we may carry out for one individual doesn’t end up hurting 10 others.”

Last week, the stay-at-home order was extended indefinitely for L.A. County and the rest of Southern California. The county has also instituted a 10-day quarantine period for anyone who has traveled outside of the region. Officials continue to repeat the same public guidance that they’ve delivered for months: Wear a mask, socially distance, avoid gatherings and wash your hands.

“If they break the rules, there’s consequences,” Torbati warns, adding that there is hope on the horizon. “Hang in there for another six months, allow time for the vaccines to be provided and readily available to the large population and we’ll get through this. We just need everybody to be on the same page.”