Already on its knees because of COVID, California braces for more

LOS ANGELES – How bad will the next few weeks get?

The number of COVID-19 deaths in California and Los Angeles County — an epicenter of the pandemic — is setting records or near-records almost daily. There is clear evidence that the post-Christmas holiday surge in cases is worsening as the numbers continue to spike, particularly in L.A. County.

But the big question is whether this new wave of cases will result in a similar increase in hospitalizations as occurred during the post-Thanksgiving surge, which has pushed hospitals to the breaking point, resulting in terrifying shortages of staffing and certain supplies and affecting the quality of medical care given to critically ill patients.

Around Thanksgiving, about 300 new COVID-19 patients a day were admitted into hospitals in L.A. County; that number rose precipitously for about a month, finally stabilizing at 750 to 800 new hospitalizations a day around Christmas Eve. Another doubling or tripling of new hospitalizations per day would be catastrophic.

For as dire as the crisis has become, most hospitals have yet to enter a sustained, widespread period of rationed care. But that would probably come if the post-Christmas surge is dramatically worse.

Teams of triage officers — usually led by critical care and emergency doctors — would have to be fully activated. Faced with shortages in staff and supplies, they would be forced to make the most heart-wrenching decisions: determining who receives the most aggressive lifesaving care and the limited time of the best-trained professionals and equipment, and who is given a lesser chance of survival and provided treatment to comfort them as they die. How hospitalizations break this week will give officials a sense of what to expect.

"We are all waiting with a certain amount of anxiety in seeing how the hospital admission data unfold over the coming days," said Dr. Roger Lewis, director of COVID-19 hospital demand modeling for the L.A. County Department of Health Services.

Patients suffering from COVID-19 who are now entering the hospitals were mostly infected in the post-Thanksgiving, pre-Christmas period. The flattening of new hospitalizations probably resulted from the imposition of stay-at-home orders issued by the county and state.

But the effect of holiday gatherings over Christmas will soon begin to show up in hospitals. Soon, a certain percentage of people who got infected over Christmas and have tested positive will begin getting so sick they'll need hospital care. If the number of new daily hospital admissions for COVID-19 patients worsens, that's a big sign of trouble.

Now, it's possible that the increasing hospitalizations could be moderated if, for instance, it's mostly younger, otherwise healthier people who got infected over the holiday season and quarantined or isolated themselves to avoid infecting older family and friends who are at a higher risk of dying.

But it's also plausible the vulnerable and elderly people attended Christmas and New Year's gatherings or were later infected by younger people who didn't stay away from them — something that happened over the Thanksgiving holiday.

"The fear, or the intuition, of most of the people doing predictive modeling is that it is going to get worse. The uncertainty is in how much worse. And in order to quantify how much worse, that requires the data that will only be available to us next week," Lewis said.

"This very clearly is the latest surge from the winter holidays and New Year's — no question about it," said the L.A. County Department of Public Health's chief science officer, Dr. Paul Simon.

About 1 in 5 coronavirus tests performed daily in Los Angeles County are coming back positive, a huge increase from early November when about 1 in 25 tests confirmed an infection.

Simon expects worse hospitalizations and more deaths in the next week or two. The number of daily COVID-19 deaths is breaking records; in early December, about 30 people a day in L.A. County were dying of COVID-19 on average over a seven-day period; now, it's about 200 people a day.