First published in the Jan. 15 print issue of the Glendale News Press.
As the Glendale area began to exhibit COVID-19 fallout from holiday gatherings this week, its hospitals are also — again — starting to feel the pressure of the disease.
The spike in ill residents is not yet repeating last year’s winter surge, which left Los Angeles County with no intensive care unit availability for many days. Still, emergency departments have found themselves inundated in recent weeks, with the patient load being exacerbated by staffing shortages as a result of the Omicron variant’s rapid spread.
“We’re definitely in the same boat as all the other surrounding hospitals,” said Dr. David Tashman, the emergency department director at USC Verdugo Hills Hospital. “We’re all kind of feeling pretty much exactly the same situation. It’s really hitting the ER the hardest.”
Speaking this week, Tashman, a 20-year veteran of USC-VHH’s emergency room, said patients concerned about potential or confirmed COVID-19 infections have added 30% to the typical ER volume at the medical center. Though many are ultimately sent home with mild or no symptoms, they still have to see a nurse or doctor before they’re discharged.
“We’re sending a lot more home, but we’re just as busy,” Tashman said. “The EMS and 911 system are just as overwhelmed as they were a year ago.”
As the more-easily-spread Omicron variant of the coronavirus began to overtake the deadlier Delta variant in December, county hospitals initially reported that many of their COVID-19 patients were being treated for something else and only found incidentally to have the virus. In the wake of Christmas and New Year’s Eve gatherings, however, that has begun to shift. Additionally, daily new deaths — which, like hospitalizations, are a lagging indicator — are now on the rise again.
“Illness just started spiking two weeks ago so we’re just starting to see hospitalization numbers now,” Tashman said. “It’s still relatively small. This time last year, we had 80 hospitalizations, so it’s a lower magnitude. But, the curve is basically the same. We might have 80 next week. Who knows?”
On Wednesday this week, USC-VHH had 32 inpatients with COVID-19, of whom three were in intensive care.
Hospital officials have expressed a similar struggle at Adventist Health Glendale, where there are three outdoor tents to handle the influx of ER visits for COVID-19 symptoms and a makeshift observation overflow wing set up on the third floor of a tower. There were two tents during last year’s surge.
“Our emergency room is absolutely swamped,” said Dr. Elizabeth Marlow, an infectious disease specialist with Adventist. “Last year, the primary difference was that we had to open up more ICUs. We were creating them wherever we could.”
While Adventist’s ICU is not yet feeling adverse pressure, Maslow said its telemetry unit — where inpatients are hooked up to electrocardiograms and monitored regularly — has been busier than usual throughout the Omicron wave. More of the hospital’s COVID-positive patients are also beginning to need medical care for the disease at this point.
Maslow said, personally, she is seeing positive patients who have been vaccinated but have not yet received their booster dose. While those patients tend to recover fairly easily (save for those with various comorbidities or immune system disorders, who remain at heightened risk for complications), she said she continues to see the “worst outcomes” among unvaccinated patients.
“The majority of those who are vaccinated and boosted never need to come into the hospital at all, from my own eyes,” Maslow said.
Dr. William Wang, the chief medical officer at Glendale Memorial Hospital, echoed his peers. In a statement, he noted that although Memorial’s ICU numbers remain manageable by comparison, the hospital’s ER is seeing higher usage and there are more and more patients being admitted for COVID-19 treatment.
“Like hospitals across the country, the surge is putting a strain on our staffing and resources, exacerbating the problem,” Wang wrote.
Staffing shortages at hospitals are being driven by doctors, nurses and technicians catching the disease and needing to quarantine from five to 10 days, depending on whether they show symptoms. This may become a serious problem if ICUs begin to fill up again, as intensive care bed availability is driven as much by available medical staff as much as by physical space.
“This would be difficult under normal circumstances, but on the back end, our staff are getting sick now,” Tashman said. “We are short-staffed pretty much every shift and I know every hospital is in the same situation. We’re trying to do more with less, and it’s definitely stressful for everybody. Wait times are actually worse than last year because of the staff shortage. It’s pretty tough right now.”
Maslow said on top of that, the nursing staff at Adventist has fallen to about a third of where it was last year. Some nurses have left the profession altogether, and a few have left because of the vaccination mandate, she said, but most of the departures have been to take up lucrative offers to become travel nurses.
“[Travel nursing] is great for a young person, but it has left the hospital in dire straits,” Maslow said. “We knew this was coming. We did our very best to get travelers, to get nurses from other places. We did everything humanly possible to ensure that we had a nurse staffing a bed.”
And the nurses who remain, Maslow added, often are confronted by impatience and even hostility from patients and their families, seemingly motivated by the long waits or the lack of options for COVID-19 treatment.
“When I go there every day and I see all these nurses I’ve known for so long, all I can say is thank you,” said Maslow, who has been with Adventist for 26 years. “They’re under so much stress. They’re just taking all this abuse from patients’ families who want to do their own thing. It’s just amazing that we have as many nurses as we do.”
Maslow speculated on Tuesday that the Omicron wave could peak in between five and 21 days. Dr. Kimberly Shriner, the director of infection prevention and control at Huntington Hospital in Pasadena, made a similar prediction. Shriner added that Huntington’s trauma center, the only one in the area, remained capable of taking patients in spite of ER and inpatient numbers at the hospital.
“I think we can squeak by without a collapse,” she said. “Huntington is a really robust hospital.”
Those experiencing COVID-19 symptoms or who believe they may have the disease are being urged to avoid emergency rooms unless they’re experiencing breathing difficulties, significant weakness or severe fevers. Those with mild symptoms should seek care through personal doctors or urgent care clinics, and those seeking tests should consult the county’s website. Hospitals are not currently giving COVID tests to the general public.
And if one does test positive and has mild or even no symptoms?
“Hunker down, stay home, drink fluids. Isolate yourself. Don’t spread it,” Tashman said. “Reserve the emergency department really for emergencies.”