With coronavirus surge, L.A. County may run out of ICU beds

With coronavirus surge, L.A. County may run out of ICU beds

Los Angeles County health officials issued a dire warning Monday that conditions amid the COVID-19 pandemic are deteriorating rapidly and the highly contagious virus is spreading swiftly in the nation’s most populous county.

They said they are now faced with one of their biggest fears: that the reopening of L.A. County would coincide with sudden jumps in disease transmission that have the potential to overwhelm public and private hospitals.

L.A. County has long been the epicenter of the coronavirus in California — with nearly 98,000 confirmed cases and more than 3,300 deaths — but officials said Monday that the outbreak is worsening.

Barbara Ferrer, the director of public health for L.A. County, said that new data show “alarming increases in cases, positivity rates and hospitalization.”

“There’s so much at stake, since these continued increases will result in many more people becoming seriously ill, and many more deaths of COVID-19,” she said.

“We are seeing an increase in transmission. We’re seeing more people get sick and go into the hospital. This is very much a change in the trajectory of the epidemic over the past several days. It’s a change for the worse and a cause for concern,” said Dr. Christina Ghaly, L.A. County’s director of health services.

With a predicted increase in hospitalizations, for the first time since the coronavirus crisis seemed to ease locally, L.A. County is now projecting the possibility of running out of hospital beds in two to three weeks. Likewise, the number of intensive care unit beds could be exhausted sometime in July.

If the increased disease transmission rate continues as it has done so over the last few weeks, it “suggests that we are at risk of running out of hospital beds if we don’t take steps to increase that capacity within the next two to three weeks,” said Dr. Roger Lewis, a biostatistician, director of the COVID-19 demand modeling unit for L.A. County and chair of the emergency department at Harbor-UCLA Medical Center.

The county is able to meet hospital demand currently, but many of the patients who have already been exposed to the virus will now be filling the beds in the coming weeks. It can take three to four weeks after exposure to the virus for infected people to become sick enough to be hospitalized, and four to five weeks after exposure for some of the most vulnerable patients to die from the disease.

“So even if steps are taken immediately to reduce the spread in the community, we do expect to see a continued uptick in the next two to four weeks,” Lewis said.

All public and private hospitals in L.A. County need to be prepared to treat more patients based on these projections, Ghaly said. Hospitals can create new capacity by reducing elective procedures and surgeries and take steps to expeditiously discharge patients who no longer need hospital care.

Hospitals can also add more beds beyond their normal licensed capacity, typically 20% to 40% over, by creating space they normally wouldn’t utilize for in-patient care, such as emergency departments, recovery rooms, and pre- and post-operative care units, Ghaly said. Some hospitals can also reopen previously licensed or staffed wards.

The effective transmission rate of the coronavirus has now increased. Previously, through the beginning of May, for every one person infected, fewer than one other person on average was infected — a testament to the success of the stay-at-home order. But by early June, as the reopening accelerated, the coronavirus transmission rate had crept above 1, meaning for every one person infected, an additional 1.26 people are infected on average.

“We expect the number of cases to rise quickly,” Ghaly said.

Although this rate is lower than what L.A. County saw earlier in the pandemic, when every one infected person on average infected three other people, the current rate can still cause a much larger number of new cases “because of the much broader base of infected individuals that we have today,” Ghaly said.

The increase in transmission likely occurred sometime around the week of Memorial Day week or shortly thereafter. At the time, L.A. County officials decided to gradually reopen the economy because the data was stable, with no increases in hospitalizations and a decline in new deaths, Ferrer said.

But unfortunately, people and businesses haven’t been adhering to health orders to wear masks in public and stay away from crowded situations. Half of the restaurants visited by county inspectors are not complying with the new rules, and officials have seen examples of overcrowding at public spaces.

“I’ve had an explosion of new outbreaks in workplaces. One that got shut down this past weekend, it had over 115 infections. Again, very little compliance with the directives on how to operate a factory with as much safety as possible,” Ferrer said.

“And we’ve had numerous examples of outbreaks happen because families are getting together with extended family members and friends to celebrate weddings, things they had postponed, and again, created higher risk, and there was transmission,” Ferrer said.

Ferrer also said that, according to data by Foursquare, that the weekend after June 20, the day when bars reopened in L.A. County, 500,000 people visited nightlife spots. And the county has observed a 40% increase in coronavirus cases among younger people, between the ages of 18 and 40, in the last two weeks.

Read More