SANTA ANA (CNS) — With COVID-19 hospitalizations at a high, Orange County hospitals were being directed Thursday 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 coronavirus patients hospitalized rose from 974 on Wednesday to a record 1,025 Thursday, including a record 257 in intensive care, up from 239 on Wednesday. The previous record was 245 in mid-July.
The Orange County Health Care Agency also reported 1,521 new coronavirus diagnoses on Thursday, raising the cumulative total to 94,647.
The agency also reported seven new fatalities, raising the death toll to 1,640. One of the deaths was of a skilled nursing facility resident.
The HCA sent a letter to hospitals, ambulance providers and 911 paramedic providers late Wednesday night, 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 health care 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."
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.
Andrew Noymer, a UC Irvine associate professor of population health and disease prevention, called the county's directive to hospitals, "basically a Hail Mary pass."
"It illustrates the gravity of the situation," Noymer said.
The statistics this week are reflecting Thanksgiving gatherings, Noymer 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," Noymer said.
And that is what appears to have happened with an outbreak in Orange County's jails. Orange County Sheriff Don Barnes said that on Wednesday two inmates Theo Lacy Facility in Orange showed COVID-19 symptoms, prompting authorities to begin testing the wing where they were housed.
That led to 72 more inmates testing positive. The jails now have 102 infected inmates, including 28 newly booked inmates, Barnes said.
Most of the inmates are not showing any symptoms, Barnes said.
"We don't know exactly where they got infected," Barnes said. "At least two were at court recently, but we are working our way through that... to narrow it down to where they had gotten it, I'm not sure."
Overall, only three inmates have had to be hospitalized for COVID-19 since the pandemic began and none have died. Any inmate who tests positive is put in isolation, while any inmates who has been exposed to someone who is infected is placed in quarantine conditions.
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 Department 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."
Chau said the letter from his agency to hospitals was triggered by recent reports of patients waiting in an ambulance for more than an hour before being sent to another hospital because it was full.
"If we do have patients sitting in an ambulance for more than an hour then we will divert them to the next closest emergency room," Chau said.
Chau pleaded with residents to stay at home as much as possible and wear a face covering when mixing with anyone outside of their household.
"Please do not mix households," Chau said. "Let me repeat that -- do not mix households... Please do not travel. You need to stay put. You need to stay home."
Orange 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.
With the first shipment of vaccines arriving this month in the county, Barnes warned residents to beware of fraudulent sales pitches. The vaccines will be distributed for no charge, the sheriff said.
The county's home test-kit program has been growing, Chau said. So far since the program launched in Santa Ana and Anaheim on Nov. 19, the county has sent out 19,233 of the home test kits for no charge, and since it was opened up to the rest of the county this week the county has received 4,866 orders for them, Chau said.