California braces for Omicron wave amid grim forecasts, concerns for hospitals

A medical worker prepares to give a girl a vaccine

Dec. 20, 2021 5 AM PT

With officials Sunday painting a grim picture of a winter in which the Omicron variant spreads with devastating speed, California hospitals are trying to do what they can to prepare for the weeks and months ahead.

Public health officials are expecting some kind of wave of new infections to sweep through during the winter, and depending on how large it is, that could tax the hospital system in a way not seen since the summer Delta surge.

Dr. Anthony Fauci, President Biden’s chief medical advisor on the pandemic, said Sunday the nation should be prepared for big spikes in hospitalizations and deaths, especially in areas with low vaccination rates, because of the remarkable spread of Omicron.

“We are going to see a significant stress in some regions of the country on the hospital system, particularly in those areas where you have a low level of vaccination,” he told CNN.

People who are vaccinated and have received booster shots are still expected to be well protected against hospitalization and death, even against Omicron. But Fauci and others say with Omicron’s spread, they expect more breakthrough infections among vaccinated people — meaning they are at higher risk for coming down with mild symptoms and being contagious.

Those who are unvaccinated will be at the highest risk in a winter surge, experts say, and there are still many of them. In addition, vaccinated people who haven’t gotten their booster shot will likely be at greater risk with Omicron of a breakthrough infection than with previous variants.

The limiting factor for many hospitals will not be beds, but people to staff them, said Dr. Nancy Gin, regional medical director of quality for Kaiser Permanente Southern California.

“What is going to be a concern for the entire medical community this year is that ‘Great Resignation’ that we’ve been hearing about with regard to healthcare personnel,” she said.

Besides Omicron, Gin said that Kaiser Permanente Southern California has been eyeing the effects of the seasonal flu, which was squelched last year by the precautions that people were taking to prevent COVID-19 — and could reemerge as a serious threat as people have let down their guard about masking, hand-washing and social distancing.

She urged people to get the flu vaccines, as well as COVID-19 shots and boosters, to give themselves more protection and help ease the strain on healthcare workers.

At hospitals, “people are tired. We have been at this for nearly two years,” Gin said. And “the emergence of Omicron has renewed concerns about surges and a difficult winter.”

Kaiser Permanente Southern California, which has 4.8 million members across Southern California, the Inland Empire and nearby areas, believes it is “well positioned to be able to absorb the volume at this time,” Gin said.

As it stands, “we’re only using about 15% of all of our ventilator capacity for Southern California,” Gin said — far lower than last winter, when some of its medical centers were at 60% or more of their ventilator capacity.

Some doctors are concerned that people are so fed up with the pandemic that they won’t wear masks at a time when transmission is expected to climb.

“My concern — and the concern across the country — is the fatigue with regard to mask wearing and social distancing” as the more transmissible Omicron variant spreads, said Dr. Stephanie Hall, chief medical officer for Keck Medicine of USC and USC Norris Comprehensive Cancer Center. “People are tired. And they’re not sticking with it.”

Hall urged people who are planning to gather with loved ones for the holidays to get tested for the coronavirus and isolate if they are positive, to avoid travel if possible, and to keep wearing masks in public spaces, washing their hands and adhering to social distancing.

At L.A. County’s massive public hospital system, COVID-19 hospitalizations “have remained steady over the last two months,” Health Services Director Dr. Christina Ghaly said in a statement.

“We are not seeing a rapid increase and we credit so far lower COVID-19 numbers this December to everyone who has gotten vaccinated, including getting the booster shot if eligible,” Ghaly said. “However, we recognize that other hospitals across L.A. County have begun to see some increases in inpatient volume and that other regions in the United States are experiencing a surge in patients.

“As we continue to manage this evolving pandemic, including the danger presented by a virus that continues to mutate, we cannot emphasize enough how critical it is for everyone 5 and older to get vaccinated and for those 16 years and over to get the booster shot if they are 6 months or more past their last dose,” Ghaly said. “We also encourage everyone to maintain vigilance over the holidays — for example, by limiting attendance at large gatherings and wearing a mask when in indoor public spaces.”

Dr. Francis Collins, head of the National Institutes of Health, offered a similar message Sunday on CBS: “A big message for today is, if you’ve had vaccines and a booster, you’re very well protected against Omicron causing you severe disease. So anybody listening to this who is in that 60% of Americans who are eligible for a booster but haven’t yet gotten one, this is the week to do it. Do not wait.”

Some hospital officials in Los Angeles and Orange counties expressed optimism about the coming winter.

Last winter, “we had far fewer tools in our tool belt. Almost nobody was vaccinated. We were only beginning to roll out the monoclonal antibody treatments,” said Dr. Richard Riggs, chief medical officer for Cedars-Sinai. And now, “we understand better about the low oxygen or hypoxia that may occur and how we can monitor that in certain people so they don’t have to be hospitalized.”

At two of the Providence hospitals in Orange County, elective surgeries are going on as usual and COVID-19 units are still using a typical allotment of beds.

It is a far cry from a year ago, when vaccines were not widely available, fewer therapies were at hand, and fewer people had gotten the virus and recovered to gain some immunity, said Dr. Charles Bailey, medical director for infection prevention with Providence Mission Hospital in Mission Viejo and Providence St. Joseph Hospital Orange.

But “we certainly have a game plan in place to rapidly increase capacity, should that need arise,” by converting other units in the hospital to accommodate COVID-19 patients, Bailey said.

His hope is that even if COVID-19 infections surge, more people can be treated outside of the hospital this time around.

New drugs “may be useful and — at least on paper — seem to be capable of dramatically decreasing the severity of illness and preventing hospitalization,” he said. “So hopefully, even if the COVID numbers go up, a smaller proportion than in prior surges will need to be hospitalized.”

And if people do need to be hospitalized, Bailey said, “I think we can treat people more efficiently and hopefully get them out of the hospital ... more expeditiously.”

At Ventura County Medical Center, COVID-19 hospitalizations have more than doubled in the last eight weeks, said Chief Executive Dr. John Fankhauser.

So far, “the numbers are still not taxing our capacity,” and the center has not scaled back on elective surgeries, Fankhauser said.

But the medical center has become more mindful about maintaining its supplies of personal protective equipment and eyeing where it needs to increase staffing. It is also stressing the importance of vaccinations and booster shots, not only in the community but for healthcare workers who were early to get vaccinated.

More is known this time around about combating the virus, Fankhauser said, but “our healthcare workers are really experiencing the impact of a sustained crisis.”

That means working more hours and putting off breaks, “but I think the biggest impact is really the emotional impact of having to be in harm’s way week after week after week,” especially when “a lot of the severe disease is vaccine-preventable,” Fankhauser said

“We see that in our community only 20% of our eligible community have not received any vaccination, and yet that group of people make up about 80-plus percent of the severely ill patients that are hospitalized in our county,” Dr. Fankhauser said. With another wave on its way, “if individuals are not yet vaccinated, now is the time.”

California braces for Omicron wave amid grim forecasts, concerns for hospitals

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