California struggles under a staggering 2.5m coronavirus cases

By Guardian staff and agencies

As the coronavirus in California rages out of control, staff in the state’s overwhelmed medical centers are warning they are increasingly struggling to keep up and may need to ration care as intensive care beds dwindle.

Only Arizona tops California in cases per resident and, with nearly 40 million residents, the huge coastal state is seeing staggering caseloads: more than 2.5m confirmed infections.

A surge following Halloween and Thanksgiving produced record hospitalizations, and now the most seriously ill of those patients are dying in unprecedented numbers. California health authorities reported 583 new deaths on Thursday, and a record two-day total of 1,042. Hospitalizations are nearing 22,000, and state models project the number could reach 30,000 by 1 February.

The grim warnings come amid new serious questions about the accuracy of coronavirus tests used for months in Los Angeles, which is among the worst-hit counties in the state.

Lawmakers and public health officials have repeatedly praised medical workers as heroes as they struggle to treat the infected. Many nurses already stretched thin are now caring for more patients than typically allowed under state law after the state began issuing waivers that allow hospitals to temporarily bypass a strict nurse-to-patient ratio law.

“This past week has been probably the hardest week for me physically and emotionally,” said Donna Rottschafer, a nurse in the Covid-19 unit of St Joseph Hospital in Orange, California. “I’ve been here 21 years, and I’ve seen more people pass away in the last week – in the past couple weeks really – than almost, like, combined in all of my career as a nurse.”

To the north in Los Angeles county, figures released on Thursday showed a new daily caseload of nearly 20,000, a 66.5% increase over the previous day, said Eric Garcetti, the Los Angeles mayor.

The more than 8,000 people hospitalized was the largest number since the pandemic began early last year, Garcetti said. The county has a quarter of the state’s population but accounts for about 40% of Covid-19 deaths.

This week, the Food and Drug Administration (FDA) issued a warning that the test by Curative, an LA-based startup, could produce false negative results, and also should be “limited to symptomatic individuals”.

With thousands using the test daily in the nation’s second-largest city, there are increasing fears that infected people without symptoms are getting negative results and then spreading the virus. Curative defended the quality of its tests, and city officials noted that the tests had identified 92,000 asymptomatic positive people.

Los Angeles is one of 14 counties in the two hardest-hit regions – southern California and the agricultural San Joaquin Valley – that for about two weeks have essentially run out of intensive care unit beds for Covid-19 patients.

Intensive care availability at San Francisco Bay area hospitals fell to the lowest levels yet, dropping from 7.4% to just 3.5% as of Wednesday, according to state data. The northern California region, which includes 11 mainly smaller and rural counties, had the best capacity at nearly 25%.

Earlier this week, state health officials caught hospitals off guard and left them scrambling with new orders limiting non-essential surgeries and requiring hospitals that have scarce ICU space to accept patients from those that have run out, an order that may require transferring patients hundreds of miles.

During an earlier surge, patients in Imperial county along the border with Mexico were sent to hospitals as far away as the San Francisco Bay area. But the current outbreak is so widespread that only 11 mostly rural counties north of Sacramento and San Francisco are above the state’s threshold of having at least 15% capacity for coronavirus patients in ICU beds. Those below that level are under tighter restrictions for business operations.

The biggest fear is that hospitals will be tipped into rationing care in a few weeks when people who ignored social distancing rules to gather with friends and relatives for Christmas and New Year’s Eve start showing up for medical care.

Officials urged people to avoid mixing households or travelling in hopes of slowing the infection spread and preventing what has been called a surge on top of a surge.
In an effort to keep people closer to home, the Newsom administration issued a more strident travel advisory that says people from out of state are “strongly discouraged” from entering California, and Californians should avoid non-essential travel more than 120 miles (193 kilometers) from home.

“This next two or three weeks will define everything for us,” said Garcetti, the Los Angeles mayor. “Our own behavior will dictate everything that we do.”