Thanksgiving Surge Begins; O.C. Hospitals Told to Add Space, Cancel Surgeries
SANTA ANA (CNS) - With COVID-19 hospitalizations at a high, Orange County hospitals were being directed today to implement surge plans and cancel elective surgeries in response to a “crisis” situation that could cause the emergency medical system to “collapse.”
The number of patients hospitalized rose from 974 on Wednesday to 1,025, a new record which includes 257 in intensive care, up from 239 on Wednesday, also a new record. The previous peak was 245 in mid-July.
The Orange County Health Care Agency (HCA) also reported 1,521 new coronavirus diagnoses on Thursday, raising the cumulative to 94,647.
The agency also reported seven new fatalities, raising the death toll to 1,640. One of the deaths was a skilled nursing facility resident.
Late Wednesday night, the HCA sent a letter to hospitals, ambulance providers and 911 paramedic providers, saying the county's health care system is “now in crisis” due to the surge in COVID patients, with more hospitals requesting diversion of ambulances to other medical centers due to patient volumes.
According to the letter, “This results in dangerous delays in initial patient assessments to ensure they don't have an emergency medical condition. Hospitals are overwhelmed with admitted patients to both the floors and the ICUs. At the current rate of deterioration, the EMS system may collapse unless emergency directives are implemented now.”
The letter from Dr. Carl Schultz, HCA's EMS medical director, urges hospitals to activate surge plans, establish alternate treatment areas in emergency departments to expand capacity, cancel all elective surgeries, apply for state waivers in support of surge plans and establish emergency operations centers.
“To those facilities that have activated these initiatives, all healthcare partners and the citizens of Orange County are grateful,” Schultz wrote. “To those who have chosen not to take this painful but necessary actions, there is still time, but you must act now.”
"Hospitals are overwhelmed with admitted patients to both the floors and the ICUs. At the current rate of deterioration, the EMS system may collapse unless emergency directives are implemented now."<br>From a letter from the Orange County Health Care Agency to hospitals.
Schultz's letter was a recommendation at this time, but could precede an order from Dr. Clayton Chau, the county's chief health officer and director of the Health Care Agency, said Orange County Supervisor Lisa Bartlett.
Bartlett, who is also on the Orange County Fire Authority board, said ambulance services are experiencing delays in transferring patients.
“When you get a 911 call and a patient is coming into the ER ... and they say they're completely full and we're referring you to another hospital, there could be a 15- to 20-minute delay getting that patient into another hospital,'' Bartlett said. “When you get a 911 call, time is critical and every minute makes a difference.”
Bartlett said the county is likely now just experiencing a surge of cases from Thanksgiving.
“It further emphasizes my point that it's not things like outdoor dining at restaurants causing Covid surge. It's small- to medium-sized gatherings,” Bartlett said.
“This is basically a Hail Mary pass,” said Andrew Noymer, a UC Irvine associate professor of population health and disease prevention, of the county's directive to hospitals.
“It illustrates the gravity of the situation,” Noymer said.
The statistics this week are reflecting Thanksgiving gatherings, he said.
“There will be people who strictly didn't get it from a Thanksgiving gathering, but are getting it from someone who was at a Thanksgiving gathering,” he said.
The county has seen a uptick in ambulance requests, said Orange County Fire Authority Capt. Thanh Nguyen.
“We have noticed a slight increase in the time it takes to offload some patients at hospitals, but so far it hasn't affected our ability to provide service at all,” Nguyen said. “But if it continues down this route we do have a surge plan in place.”
Part of that plan includes increasing paramedic staffing, Nguyen said.
“The public health implications caused by the pandemic have no doubt been challenging,” said Anaheim police Sgt. Shane Carringer, a spokesman for the city's fire department as well. “Anaheim Fire and Rescue is continuously gathering information from the county and we will consider all appropriate measures, including considering a change in personnel deployments, to meet the potential needs of our community and the medical needs to patients. This instance serves as a reminder to those in our community of the importance of personal responsibility and taking the appropriate precautions to slow the spread of the virus.”
The county's percentage of available ICU beds went from 11.2% to 11.3% Thursday, but according to a new state metric for “adjusted” ICU bed availability, the rate went from 4.9% to 3.5%, according to the HCA.
Kim said the “adjusted” case rate essentially reflects the estimated number of beds available for COVID-19 patients when factoring in the number of beds needed for patients without the coronavirus.
The county has 53% of its ventilators available.
The 11-county Southern California region's available ICU capacity diminished from 9% to 7.7%.
Orange County's adjusted daily case rate per 100,000 rose Tuesday to 30.3, up from 22.2 last week, with the positivity rate increasing from 8.8% to 10.6%.
The county's Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, rose from 13% last week to 16.2% this week.
All of the county's metrics now fall within the state's most- restrictive, purple, tier of the four-tier coronavirus monitoring system.
County officials are again focusing on a surge in coronavirus cases in skilled nursing and assisted living facilities, Kim said.
There are two dozen skilled nursing facilities in the county that have reported two or more cases of COVID-19 in the past two weeks, and 22 assisted living facilities with two or more cases in the past 14 days.
County officials were asked to provide personal protective equipment, more training or staffing to help curb the spread of COVID-19 in those facilities, where the main reason for the spread is likely from employees who contract the virus off-site, Kim said.
Top Image: Two healthcare workers in full PPE. | iStock via Getty Images