Coronavirus boosts hospitals. The next wave may break them

Looking east, California can imagine the future of coronavirus in a busy hospital ward in New York City. Looking to the west, hope can be drawn from the rapid decline of the disease in Asian countries that quickly imposed strict physical isolation measures on infected people.

Two months after the first fatal respiratory disease case was identified in California, the state is preparing to face what the public health authorities agree to be the cruelest month-April Foretells the peak of illness and death.

How cruel should be seen. Officials hope that severe restrictions on work and public activities, imposed by Governor Gavin Newsam on March 19, and since then surged in some cities and counties, will prevent the spread of COVID-19 racehorses doing.

Recent massive social re-engineering has closed businesses and emptied public places. But its ultimate effect remains one of several unknowns, relying on countless actions by millions of Californians.

In preparation for the worst, statewide hospital administrators continued on Friday to free all available beds for patient inflow. San Francisco has ordered priority tests for doctors and nurses to prevent sick healthcare workers from becoming ill hyperproliferators. Los Angeles County has closed all beaches Limit social interaction. And Navy hospital ship mercy Cruised to a port in Los Angeles with 1,000 beds and 800 staff members ready to treat infectious disease victims.

The number of coronavirus cases confirmed in California surged from 1,468 on Sunday to 4,598 on Friday, but deaths increased from 27 to 93. The disease is certainly much more widespread.

“The numbers can be huge, which means the impact on the healthcare system will be just as dramatic,” said Barbara Ferrer, director of public health in Los Angeles County. “Without delay, we could easily overwhelm the L.A. County system and the entire California health system.”

While overloading of the system remained a concern, one prediction by Washington University epidemiologists suggests that 9-day home order in California could keep hospital overload below catastrophic levels. Was suggested. Dr. Robert Kim Farley, a UCLA epidemiologist, said on Friday after a significant increase in cases. “I think you can see these numbers leveling off in a few weeks with physical distance measurements.”

The U.S. is currently showing the worst outbreak in any developed country in the world, but Nicholas Jewel, a professor of biostatistics at the University of California at Berkeley, has asked whether California has paid dividends for restrictions on work and public movement. Said to know soon.

Measuring the benefits of physical distance takes time, as there is a two-week delay between the transmission of the disease and the onset of symptoms. With a home order in California eight days after Friday, people reporting the disease may have been infected before the restriction.

“It takes another one or two weeks to really know if California’s fairly quick shelter has worked,” said Jewell. “It has the potential to make a huge difference. I know it mathematically … but I’m not sure.”

Some experts continue to worry that the disease curve may flatten, but at dangerous levels, many patients are sent to hospital for months. “The problem is not the peak of the epidemic,” said John Ioanidis, an infectious disease expert at Stanford University. “The question is: how much above the saturation point of the healthcare system?”

However, predictions from the University of Washington Health Metrics and Evaluation Laboratory indicate that California may reach a milder peak than New York.

By the second or third week of April, New York State was able to count the worst daily deaths from coronavirus, which numbered approximately 550. According to computer simulations, the worst deaths every day in late April, perhaps about 150 people can be killed in one day.

In the best scenario, two people die each day in California, and worst-case projections assume 370 deaths each day at the peak of late April.

Studies have acknowledged some possible outcomes. Overall, California suggests that there could be 6,109 deaths, with 898 deaths and 13,650 deaths. There are 10,243 deaths in New York, 5,167 deaths and 26,444 deaths. For example, deaths in the United States range from 38,000 to 162,000.

Researchers at the University of Washington warned that their predictions were carried with considerable uncertainty and were collected from thousands of computer simulation runs, producing a single, most likely result .

Unlike other models of the new coronavirus trajectory, this study relies on deaths in the United States and around the world. Scientists believe that these numbers are more reliable than counting the confirmed numbers of greatly different infections due to different testing rates in the United States and around the world.

Also, the variability in the number of hospital beds required in California has varied widely, from just 1,200 to 36,000. Demand for ICU beds also ranged widely, from a low of 90 to a high of 5700.

“What we see in our view is the fairly late peak of the California epidemic, because of a very slow growth trajectory—death and case in California,” said Chris, the author of the study. Dr. Murray said and of the Institute. “And it may be due to the initial social distance. I don’t know, but it’s certainly not the trajectory found in New York, Louisiana, Georgia, etc.”

Discussions of possible outcomes were brought into clear view in Silicon Valley, where the city of San Jose predicts death toll in the region, and estimates were immediately questioned by Santa Clara County officials.

City officials said during a discussion with the San Jose City Council on Thursday that they had predicted deaths from at least 2,000 and 16,000 high illnesses in Silicon Valley by the end of May. The following day, Santa Clara County issued a statement that it had not “created, reviewed, or examined” San Jose’s predictions.

According to Kim-Farley, a UCLA epidemiologist, the lesson from abroad seems to be that body isolation measures work.

Italy imposed strict orders to stay at home, but only after the coronavirus was widespread they appeared to have been put in place. “ I hope that within a week or two, the number of cases or deaths will decrease and eventually decrease, as seen in China, ” said Kim Farley. Farley said.

American experts will also investigate overseas what happens when social segregation rules are relaxed, as well as when China begins to resume work in the coming weeks. “I don’t want them to see a major second wave,” Kim Farley said. “That’s a $ 64,000 question. What happens?”

Uncertainty could not be easily accommodated by nurses, doctors, and other hospital workers preparing for the onslaught of the case.

Nurses in an emergency room at a large hospital in Los Angeles said fears were growing among staff as the number of COVID-19 patients increased, and fears were exacerbated by a lack of global protective gear.

“Many of us are really scared of going to work,” said a nurse who was not allowed to talk to the media from her facility. “Our family is literally afraid when we get home from work.” She gets angry when she sees people outside the hospital not following body distance rules.

“We wish we could stay at home,” said a nurse who did not give his name. “But you can’t.”

Nurses in the operating room at Kaiser Permanente Hospital in Los Angeles County shared their feelings, provided guidance on the best ways for workers to protect themselves every day, and said that the guidelines were not steadily strict .

“We’re all like,” What did we take in ourselves in the world? “, Said a nurse who asked not to name them. “We didn’t expect to be in the middle of the forest as a health worker working in a Third World country … confused.”

Burn This week we announced our research This predicts that up to 2,600 homeless people in Los Angeles alone can be caught in a hospital with a coronavirus, with about 900 requiring intensive care and potentially tying up critical resources .

Governor Gavin Newsom Implement an ambitious plan Move tens of thousands of homeless people to hotels and motels. But so far, only thousands of unprotected people across the state have been moved to shelters and hundreds of first available rooms — Newsom says more than 4,000 were leased or purchased Was.

Kim Farley urged the Californians to stay hopeful, stating: It is not an existential threat to humanity as a whole. Overcome this. “