OC issues unprecedented order to hospitals against diverting ambulances amid COVID surge

An unprecedented order has been issued in Orange County to prevent hospitals from diverting ambulances to other facilities. The move comes after the county shattered COVID-19 patient admittance records,

The county reported 23 fatalities on Wednesday, the same day frontline workers in the county received COVID-19 vaccinations. The most recent fatalities, which date back to earlier this month, raised the death toll to 1,718.

The region also logged 3,231 new diagnoses of COVID-19 on Wednesday, bringing the cumulative case total to 111,168.

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Hospitalizations jumped from 1,371 Tuesday to 1,486 on Wednesday, including 319 intensive care unit patients, up from 296 the previous day.

Both are new records -- a daily occurrence since last week.

The county's ICU bed availability dropped from 10.4% Tuesday to 9.5% in the unadjusted category, and from 1.4% in the adjusted'' metric to zero. The state created the adjusted metric to reflect the difference in beds available for COVID-19 patients and non-coronavirus patients.

The 11-county Southern California region's percentage of available ICU beds dropped from 1.7% to 0.5%.

Late Wednesday, the Orange County Health Care Agency issued an order suspending the ability of hospitals that take part in the 911 system to request a diversion of ambulances to other medical centers.

Dr. Carl Schultz, the agency's EMS medical director, said in a statement that hospital emergency rooms have become so overwhelmed due to the COVID surge that "almost all hospitals were going on diversion.''

"If nothing was done, ambulances would soon run out of hospitals that could take their patients,'' Schultz said. Therefore, we temporarily suspended ambulance diversion. While this will place some additional stress on hospitals, it will spread this over the entire county and help to mitigate the escalating concern of finding hospital destinations for ambulances.''

Schultz added: "To the best of our knowledge, this has never happened before.''

On Monday, Schultz issued a memo to authorize ambulance providers to take patients up to 29 years old to Children's Hospital of Orange, but another memo released Tuesday from Schultz scrapped that.

"Multiple logistic complications have occurred as a result of this directive and it would be in everyone's best interest to cease this activity, effective immediately,'' Schultz said.

Orange County's adjusted daily case rate per 100,000 rose Tuesday from 30.3 the previous week to 42.7, with the positivity rate increasing from 10.6% to 13.2%. The county's Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, rose from 16.2% last week to 18.8%.

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The county is testing 526.8 people per 100,000 on a seven-day average with a seven-day lag, which is an all-time high.

All of the county's metrics now fall within the state's most-restrictive purple tier of the state's four-tier coronavirus monitoring system.

Since Sunday, 38 deaths have been reported in Orange County. Last week, the county reported 62 fatalities, up from 41 and 26, respectively, in the two previous weeks.

Most of the fatalities reported since Friday were in the 75 and older category, but at least one was 25 to 34 years old.

Prior to this month, the record for ICU patients in Orange County was 245 during the mid-July surge. Overall hospitalizations have been breaking records daily since Dec. 2.

The county received its first shipment of Pfizer's coronavirus vaccine Wednesday. About 25,000 doses were delivered.

Dr. Paul Sheikewitz of Providence St. Joseph's Hospital in Orange, who was among the first to receive a vaccination Wednesday, told City News Service it has "been quite challenging'' to meet the surge of patients.

"The greatest challenge is the burden of the number of patients we see versus the number of staff able to take care of patients,'' Sheikewitz said. "Providence has done a wonderful job to expand service, but we're probably to the limit.''

Dr. Jeremy Zoch, the hospital's CEO, urged residents to stay at home as much as possible, especially over the holidays.

"When (the hospital's caregivers) are normally celebrating the holidays, they're taking extra shifts and working in unexpected roles,'' Zoch said. "Stay at home. Stay safe and help us reduce the spread so we can keep up and care for the community here.''

Dr. Clayton Chau, the county's Health Care Agency director and chief health officer, said, "We must all call on the community to not let our guard down now, not when we're so close to getting on the other side of the pandemic. Right now we have to pull together like never before.''

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Zoch said the latest surge of patients has been pretty incredible.''

"Last summer, when we had our surge over July, we had the National Guard in here helping us ... But, frankly, this surge we have 75% more patients than the last surge,'' Zoch said. "It has challenged us.''

Zoch said his hospital's ICU beds "are really close to full. We're fortunate we have CHOC Children's next to us and we've talked with them about giving us space to use if needed.''

Dr. Stephanie Chao, director of pharmaceutical services at Hoag Memorial Hospital Presbyterian in Newport Beach, said she experienced a "big sense of relief to see that big truck pull up'' to deliver the first doses of Pfizer vaccine Wednesday morning.

"I know that our department has been working hard ... and taking it day by day, supporting each other,'' Chao said. "We feel Hoag has done a lot of hard work to prepare to weather different surges.

"We have plans in place we can activate and are already activating, so as an organization we're just working hard, doing everything we can ... Some days we just run on adrenalin and hope there's some light at the end of the tunnel. As health care workers, we keep going because that's all we can do. But sometimes we do need a minute to gather and reflect.''

County health officials are particularly struggling with housing the elderly with dementia, who are infected and do not exhibit symptoms, Chao said.

"We can't send them to a hospital... They don't need that level of care,'' Chao said at Tuesday's Board of Supervisors meeting. And we can't send them to a nursing facility... and we can't send them to a hotel.''

Those patients will likely be housed at Fairview Developmental Center in Costa Mesa, which is expected to open on Thursday. "But we only have the availability of 50 beds,'' Chau said. "We're going to run out of options to take care of these people.''

"I lose sleep every night,'' he said. "I am afraid. ... I've never been so afraid of Christmas and New Year's in my whole life ... I can't imagine what it would be like after the holidays if people don't listen and don't comply.''

Gov. Gavin Newsom's latest restrictions are set to run through at least Dec. 27, but with the surge in cases and patients, "I don't think we can get out of it,'' Chau said.

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Supervisor Doug Chaffee said he received a text message from a medical professional at St. Jude Medical Center in Fullerton on Monday night that indicated the hospital is at "99% capacity.''

The hospital's 301 beds are full with 138 COVID-19 patients, Chaffee said.

"The ICU is at 105% capacity,'' he said. "They're using every available bed. The emergency department has an overflow ... All the Orange County hospitals are in the same situation.

"It is dire, so they'll soon be erecting a tent in the parking lot, probably for triage. I think what we're seeing is not a surge, but a tsunami.''

To address the need, mobile field hospitals are being set up and will be housed in large trailers and include canvas tents with hard flooring and temperature-controlled units that feature running water, toilets, showers and generators as well as air purifiers.

Fountain Valley Regional Hospital will get 50 more beds, St. Jude's 25 and UC Irvine Medical Center in Orange 50 beds.

An outbreak in the county's jails, which started last week, now has 627 inmates infected, up from 416 reported Monday. The county is awaiting results of 86 more tests.

Sheriff Don Barnes, who had earlier kept testing restricted to newly booked inmates, anyone showing symptoms or those exposed to an infected person, will now seek to test everyone in the jails, according to department spokeswoman Carrie Braun.

Inmates who test positive are restricted to a single cell in isolated status, and any others exposed are being quarantined together as they await test results, she said.

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Meanwhile, Barnes has been ordered by an Orange County Superior Court judge to reduce his jail population by half by Friday, meaning 1,800 inmates could be released to home confinement, ankle-bracelet monitoring or just fully set free.

The Board of Supervisors unanimously voted to hire outside counsel to help Barnes in the legal struggle with the American Civil Liberties Union, which sued to reduce the jail population.

The board also voted to sue the California Department of Corrections and Rehabilitation to challenge the departments to take convicted felons from the county's jails during the pandemic.

The county is also dealing with an uptick in outbreaks at skilled nursing and assisted living facilities. As of Tuesday, 32 skilled nursing facilities have had two or more confirmed cases of COVID-19, and 36 assisted living facilities had two or more cases.

County officials have been asked to provide personal protective equipment, more training or staffing to help curb the spread of COVID-19 in those facilities, where the main reason for the spread is likely from employees who contract the virus off-site, Kim said.
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