LA moves to ration healthcare if COVID-19 hospital crisis worsens

Los Angeles [US], December 21 : As cases continue to spike in the United States that is resulting in hospitals reaching full capacity, intensive care units in Southern California's medical system is not being able to provide critical medical care to people.
Many hospitals are preparing for the possibility of rationing care in the coming weeks as the number of patients exceeds their staffs' abilities to care for them, wherein the guidelines call for a shift in mindset that is unfamiliar to many medical providers, Los Angeles Times reported.
The overflow of patients in ICU (Intensive Care Unit) and other critical wards keep the patients on ambulances for as long as eight hours until space is available.
According to Los Angeles Times, there is hope for the arrival of an army of additional medical professionals who can greatly expand intensive care unit availability through the end of the year.
The goal during the ongoing crisis is to save people as much as possible, patients with less likely to survive will not receive the same level of care which others will get. Doctors will strategize to keep people save as many as possible.
"Some compromise of the standard of care is unavoidable; it is not that an entity, system, or locale chooses to limit resources, it is that the resources are clearly not available to provide care in a regular manner," Los Angeles Times quoted a document obtained by the newspaper that highlights how to allocate resources in a crisis situation was recently circulated among doctors at the four hospitals run by Los Angeles County.
"In an email that the guidelines were not in place as of Friday night but that they were essential to develop given the surge has arrived and "the worst is yet to come," The Los Angeles Times quoted Dr Christina Ghaly, LA County Health Services Director as saying.
"We have enough beds, supplies, and equipment for now, but we don't have enough trained staff for the number of patients who need care. We have brought in new staff, retrained and redeployed staff from other areas of the system, and have requested additional resources from the state," Ghaly said adding "But these measures are not anticipated to be enough to meet the continuously escalating number of patients that are presenting across the county for care."
Across the nation, it has already become harder to get admitted to the hospital with COVID-19 symptoms today than it was a couple of months ago, Dr Kirsten Bibbins-Domingo, UC San Francisco chair of the department of epidemiology and biostatistics said.
"When hospitals start to get full ... we subtly change our thresholds for admitting someone to the hospital," Bibbins-Domingo said.
"So maybe last month, we might say, 'Wow, you're not getting enough oxygen. Let's admit you to the hospital because we want to be more cautious.' And when a hospital is full, that is a time when we might ... say, 'Well, why don't we wait another day and see how you do?" Bibbins-Domingo added.
"We want to have a system functioning such that anyone who is sick enough that should be in the hospital is able to find a place in the hospital, and if they are severely ill, to have a bed available in the ICU," Los Angeles Times quoted Dr Robert Kim-Farley, a medical epidemiologist and infectious-diseases expert at the UCLA Fielding School of Public Health as saying.
The patients admitted to hospitals with fewer ICU beds had a higher risk of death, according to a study published in the summer in the journal JAMA Internal Medicine said.
The county memo said the shortages are unlikely to be of tools like ventilators but instead of highly trained staff, specifically respiratory therapists, ICU nurses, and critical care physicians. Decisions would be made by an appointed triage officer. For patients who receive a scarce resource, they will be given up to two days to see if it is helping, at which point they should be reassessed to determine whether the treatment should continue, Los Angeles Times reported.
However, if the patient has not shown improvement or has gotten worse, the resource may be reallocated to someone else.
The chief medical officer of LA County's flagship public hospital warned that the county has not yet suffered catastrophic consequences, it "is now moving towards becoming the epicenter of the pandemic ... and if we don't stop the spread, our hospitals will be overwhelmed."
"If you have a heart attack, if you get into a car accident, if you fall off a ladder, or have a stroke, we may not have a bed for you," said Dr Brad Spellberg, chief medical officer of LA County-USC Medical Center.
California on Friday broke a record with regard to the most coronavirus cases in a single day with 53,326, Los Angeles Times reported.