Southern California hospitals resort to ‘crisis care’ practices amid COVID surge

As California surpasses 2 million COVID-19 cases, Health and Human Services Secretary Dr. Mark Ghaly on Tuesday said some Southern California hospitals have begun making choices that affect patient care.

He said the state is working to keep hospitals from operating in “crisis care” mode for “as long and as much as possible,” and that the state has not seen instances in which health care providers have to decide how to care for two patients with just one ventilator.

But he said hospitals are diverting ambulances and making decisions about whether to provide certain treatment for patients who are likely to die. He said more than 95% of Los Angeles hospitals have diverted ambulances in the last 24 hours.

“Some hospitals in Southern California have put in place some practices that would be part of crisis care, whether those are decisions about how ambulances are received into the facility or how stretched staff become to care for patients, looking at the effectiveness of certain treatments for certain patients who are unlikely to survive,” he said during a press conference. “That is happening in facilities in Southern California.”

Most hospitals in the state are not operating as they traditionally do, he said. They may be asking health care workers to work longer shifts and re-use supplies as well as seeing delays in some patient care, he said.

In Southern California, he said, hospitals are running out of staff and wait times are much longer than normal — “a critical difference” between Northern and Southern California, Ghaly said.

“We need to be prepared for some hospitals to resort to crisis care,” where certain supplies and medical care are rationed, he said. “Medical professionals have to make hard choices and relocate resources.”

If care rationing is necessary, Kim McCoy Wade, director of the California Department of Aging, said California guidelines emphasize that medical decisions cannot be based on factors like race, gender, sexual orientation, immigration or insurance status.

“Medical decisions primarily are grounded in the likelihood of surviving in the near term,” she said. “That is the appropriate basis of these decisions. These other factors are not.”

Over the last two weeks, COVID-19 related hospitalizations in the state have increased by 36.5% and COVID-19 ICU hospitalizations have increased over 35.1%.

About 31,245 more COVID-19 cases were reported on Monday, according to state data. The state’s 14-day positivity rate sits at 12.6%.

Ghaly said hospitals are preparing for even worse conditions into late January as cases surge and people become sicker after the holidays.

“We are worried about a rapidly accelerating increase and pressure on our hospitals,” he said.

Since the ICU capacity in the San Joaquin Valley and Southern California are not improving, the regions’ stay-at-home orders will remain in place, Ghaly said.

The San Joaquin Valley and Southern California regions each face a 0% ICU capacity, meaning that hospitals are using surge beds to treat any new patients, in some cases working to deliver oxygen in areas not typically set up to do so.

The greater Sacramento region’s ICU capacity sits at 19.1%.

Ghaly said regional stay-at-home order projections are based on four factors, including a region’s current ICU capacity, 7-day average case rate, transmission rate, and rate of ICU admission.

As New Year’s Day approaches, Ghaly pleaded for Californians to celebrate virtually to help stem the current COVID-19 surge.

“Together, we could stop this surge,” he said. “Much of what we’re dealing with is avoidable.”.

This story was originally published December 29, 2020 at 2:55 PM.