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Plenty Of Vaccines, But Few Nurses: How This COVID Surge Compares To Last Winter

Two paramedics stand in front of the open doors of an ambulance. A patient is inside on a gurney with an Emergency Medical Technician.
LAFD paramedics wear face masks as a preventive measure against the spread of the COVID-19 novel coronavirus.
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As the West Coast monitors the skyrocketing COVID-19 cases concentrated in the eastern half of the country, hospital administrators in Los Angeles are watching local case numbers creep higher.

Even with a surge in cases and a scramble for more testing, a smaller percentage of infected people are winding up in the hospital with COVID-19 symptoms, compared to earlier strains.

“This is not just us in Los Angeles, this is being seen all over the globe,” said Dr. Brad Spellberg, chief medical officer of LAC+USC Medical Center, one of the area's largest hospitals. He noted there is “a dissociation for the first time, really, between the number of COVID cases and the number of people who are sick enough to need to be hospitalized.”

At the end of 2020, more than 7,000 people with COVID were being treated in L.A. County hospitals. Fast forward one year and that figure is at about 960. Spellberg credits the vaccines.

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“They aren’t perfect, there are breakthrough [cases],” he said. “But I think given the level of protection the vaccine affords, it's unlikely we're going to get anything close to how horrific it was last winter.”

Spellberg reviews every COVID case that comes into two L.A. County hospitals, and says three-quarters of the people who test positive in the emergency room or urgent care center do not need to be admitted to the hospital, largely because they are vaccinated.

“But one-in-four, one-in-five end up in the ICU. Last winter 80% of the positives were sick enough to be admitted to the hospital and half of those went to the ICU,” he said. “So, it is somewhat reassuring that, while cases are surging in number, the large majority of them are not requiring intensive care unit level care. Those that are, are almost entirely unvaccinated.”

Vaccines don’t stop infections with omicron, but they do reduce the risk of hospitalization by about 70% — and with a booster shot that figure is even higher. But public health officials fear that the highly contagious variant will infect so many people that even a small percentage needing hospital care could strain systems.

“The way that we protect ourselves and our health system and people who need an ICU bed, when they fall off a ladder or have a heart attack, is to get vaccinated,” Spellberg said.

Fewer Nurses Mean Fewer Beds

L.A. County remains in the highest level of COVID risk. The positivity rate here has jumped to more than 15%, a three-fold increase since last week, while hospitalizations have increased by 30% since last Tuesday.

The high level of community transmission means more health workers are also testing positive.

The most recent data from the L.A. County Department of Public Health shows this troubling trend: During the week ending Dec. 18, a total 292 cases were identified among L.A. County health care workers, an increase of 26% from the previous week.

Meanwhile, almost half the hospitals in L.A. County say they have staffing shortages, compared with 20% at the outset of last winter’s case surge.

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“The one thing that is worse this winter is we have much less flexibility with staffing,” Spellberg said. “All of the registry agencies that you would normally call up and say, ‘I need a traveling nurse, I need five travelers,’ they don't have staff anymore. Even the registries are tapped out.”

Last winter’s surge saw overflowing ICU cases in L.A. Months of long hours and treating dying COVID patients caused many nurses to swap the high-pressure jobs for a career change, early retirement or less demanding health care assignments.

A report from the UC San Francisco Health Workforce Research Center on Long-Term Care projects the current nursing shortfall to continue for at least the next five years.

Spellberg says, in the short term, that gap will mean fewer ICU beds available during this winter’s surge.

“A normal ICU bed ratio is two patients to one nurse. If I want to open 10 new ICU beds, I need five nurses per shift for three shifts. That's 15 nurses per day,” he said.

“When we talk about running out of beds, we're not talking about running out of physical space. We're talking about running out of trained, expert nursing staff to care for patients in those beds.”

Local health officials no longer advise the public on hospital bed demand projections. The L.A. County Department of Health Services hasn't updated its predictive hospital modeling since May 2021. When asked if it would be reinstated, a DHS spokesperson responded: "We do not have our predictive model data available at this time. DHS is closely monitoring the current surge and will consider reinstating the data collection project in the future, depending on what we see over the next month."

We Already Have A Surge Roadmap

Lessons were learned during the previous surges, and Spellberg says he plans to respond to an increase in patients with a proportional approach.

“As we start seeing cases rise more, we would say, Do we need to open another pod? Maybe we close down these three clinics, pull those staff over. Maybe emergency room visits go up 20%? Let's set up a tent. We used to have two tents, we'll set up one,” he said.

Since the pandemic began, more than 27,500 people have died of COVID in L.A. County, and the full impact of the rising surge has yet to be felt. The biggest difference is ready access to the vaccines.

“I really have watched families get wiped out by this virus and the survivors experienced tremendous guilt, that they allowed their loved ones to become infected, many of whom went on to get severely ill because they chose not to get vaccinated,” Spellberg said.

“If you want this pandemic to end, get vaccinated.”

What questions do you have about the pandemic and health care?
Jackie Fortiér helps Southern Californians understand the pandemic by identifying what's working and what's not in our health response.