Photograph: Frederic J Brown/AFP/Getty Images
Los Angeles is becoming the center of America’s out-of-control coronavirus pandemic in these final days before the new year, with officials warning that a meteoric rise in infections is crushing the healthcare system in one of the country’s largest metropolitan regions.
LA county has faced an onslaught of terrifying Covid developments in recent days, including a surge in deaths, dire shortages of hospital resources, and fears that doctors will have to make agonizing choices to ration care.
“Do we need to start filming people dying?” said Marcia Santini, a nurse at the University of California, Los Angeles (UCLA), medical center, who is recovering from a brutal Covid-19 infection that forced her to be hospitalized at her own workplace. “People need to understand, there is no place to take care of you. You can’t have this mindset that this isn’t going to happen to you. It doesn’t work like that any more. The virus is rampant.”
An uncontrolled ‘viral tsunami’
Heading into the darkest holiday season some have ever endured, there were grim reminders across the LA region that the virus is spreading uncontrolled. The city’s mayor briefed the public while in quarantine after his daughter became infected. Hospitals were setting up triage tents. Residents waited in line for hours for Covid tests at Dodger stadium. The region recently ordered more body bags.
Outbreaks were afflicting grocery stores, restaurants, stores, shopping malls, Amazon warehouses, manufacturing plants, government buildings, police and fire departments, jails and prisons and film sets.
A mobile field hospital is set up at UCI medical center on Monday in Orange, California, near Los Angeles. Photograph: Jae C Hong/AP
Officials in LA county estimated that one in 95 residents were currently infectious, and that two residents were dying of Covid every hour. More than 6,000 Covid patients are in the hospital, and intensive care units (ICU) are filled to capacity.
And yet the region is continueing to obliterate records. LA is now reporting an average of more than 14,700 cases each day, a 78% increase from two weeks ago, according to LA Times data. Seven hundred people are hospitalized daily; in October there were fewer than 150 daily hospitalizations. By January, officials say it could be 1,400 admissions each day. More than 9,000 people have died.
“We’ve moved from having waves to now having a viral tsunami occurring here in Los Angeles,” said Dr Robert Kim-Farley, a medical epidemiologist at UCLA, who said for the first time his family would not gather for the holidays.
The horror inside hospitals: ‘So many dying alone’
LA’s crisis is close to resembling the catastrophe that New York endured in the spring. The situation inside some hospitals this week became untenable, and workers were bracing for it to get worse.
“We’re not only seeing the numbers of Covid patients increasing, we’re also seeing longer wait times for people,” said Yolanda Tominac, a critical care nurse at West Hills hospital, where workers recently threatened to strike over staffing concerns. “It’s physically draining, it’s mentally draining. Morale is so low.”
Ventilator tubes are attached to a Covid-19 patient at Providence Holy Cross medical center in the Mission Hills section of Los Angeles last month. Photograph: Jae C Hong/AP
With shortages of beds and staff growing, hospitals are starting to have previously unthinkable discussions about how they may ration care if there are too many patients. It could mean a decline in the quality of care for all people facing emergencies, and an increase in deaths.
“We hope not to have to make those kinds of decisions,” said Dr Jorge Reyno, vice-president of population health at Martin Luther King Jr community hospital (MLKCH), which has one of the highest rates of Covid patients in the county. “Every institution that is hit hard has to have those conversations.”
MLKCH, a 131-bed hospital in a predominantly Black and Latino area in South LA, is caring for 200 patients, requiring doctors to use tents and waiting rooms for patient care, and forcing some staff to do frontline work outside of their normal positions, Reyno said on Wednesday. The hospital went from one Covid unit to three and is now seeking more ventilators: “We are just seeing an unrelenting and crushing volume of very sick patients,” he said.
The suffering inside MLKCH was a painful reminder of the inequality of the crisis, Reyno said, noting the average age of his Covid patients was in the 40s. “We had an epidemic of chronic disease before the pandemic,” he said.
Santini, the UCLA nurse, has been an outspoken advocate since the spring for more personal protective equipment. Then the virus came for her. She was hospitalized last week when her oxygen levels dropped. She posted video of herself struggling to breathe on Facebook, begging people to stay home.
Health workers are seen at the Florence medical clinic, where coronavirus tests are administered. Photograph: Anadolu Agency/Getty Images
In an interview from home, where she is slowly recovering, she said she had posted the footage because she didn’t think she would survive: “I had to tell people to wake up.”
Santini, 58, left the hospital after a day and a half: “I knew how many people were waiting in the ER. The guilt of taking up that room was far worse than how I felt.” She said it was emotional to be treated by her colleagues and the experience gave her new perspective on patients suffering without family nearby: “I think about all the people dying alone, and I can’t stand it.”
‘Who is going to take care of people?’
Jury Skomorovsky, an ICU nurse at Hollywood Presbyterian medical center, who lost a colleague to Covid in April, said it was painful to witness many in LA being lax about the latest surge: “In the beginning, we were very steadfast about closures and very serious about social distancing, and somewhere down the line we dropped the ball.
“How many of us need to die for people to take this seriously?” he added. “If we just keep dropping, who is going to take care of people?”
Related: Lost on the frontline: US healthcare workers who died fighting Covid-19
Even though he and some colleagues were recently vaccinated, it was hard to feel optimistic while witnessing so much death, Skomorovsky said: “We’ve had people break down … but you have to wipe those tears away after three seconds and get back in there.”
In March, LA and California issued some of the earliest shutdowns in the nation, which helped slow the spread and saved hospitals from becoming overwhelmed. But with the US government failing to provide a second round of stimulus amid mass unemployment, officials rushed to reopen in early summer – a move that had devastating consequences in LA.
Large sectors of the economy reopened, but the economic crisis – and many restrictions – persisted, leading to severe fatigue among residents at the same time that Covid surged due to holiday travel and gatherings.
The response from local officials has been a confusing partial lockdown. Officials have issued emotional pleas for people to stay home but have allowed LA’s malls to remain open, leading to packed stores and infections among employees. The county shut down all dining but has allowed Hollywood to continue film shoots.
Katie Ramirez, left, watches as her mother, Claudia Campos, swabs the mouth of another daughter, Hailey, at a testing site in Los Angeles this month. Photograph: Jae C Hong/AP
The data suggests the public health messaging is not working – and that LA’s essential workers are paying the price.
“It’s just been really hard to reinforce what kind of dire situation we are in now,” said Dr Kirsten Bibbins-Domingo, a UC San Francisco epidemiologist. “Ten months into the pandemic, individuals and businesses are hurting financially, and that is a drive for people to continue to be out.”
LA’s affordable housing crisis, which forces many to live in crowded conditions, also makes the region vulnerable to spread, said Bibbins-Domingo. Her research found that early lockdowns did not protect Latinos or people without high school degrees, probably because they were forced to work.
Barbara Hughes, a 61-year-old cashier at a Food 4 Less grocery store, said customers often did not wear masks properly and failed to keep their distance, especially during busy holiday hours, causing her anxiety. At least 21 of her co-workers, including multiple managers, have recently contracted Covid.
“I don’t want to take the virus home to my family,” said Hughes, who participated in a protest calling for hazard pay. She wears two pairs of gloves and two masks but fears she won’t be able to protect herself much longer.