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Southern California is down to just 1.7% ICU capacity remaining [Updated: Now 0%]

Southern California is down to just 1.7% ICU capacity remaining [Updated: Now 0%]

Old Dec 15, 20, 6:54 pm
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Southern California is down to just 1.7% ICU capacity remaining [Updated: Now 0%]

From LAist:

Southern California is down to just 1.7% ICU capacity remaining.

Statewide, there is 5.7% of the state's ICU capacity remaining. Available capacity in other parts of the state include:
  • San Joaquin Valley: 1.6%
  • Greater Sacramento: 14.9%
  • Bay Area: 15.8%
  • Northern California: 29.8%
Southern California, the San Joaquin Valley, and the Greater Sacramento regions remain under regional stay-at-home orders, while the Bay Area entered those orders voluntarily. Over the weekend, the San Joaquin Valley hit 0% ICU capacity. ICU beds are filling up quickly and could be unavailable soon, Newsom said.
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Old Dec 16, 20, 9:46 am
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I have been following the LA County COVID dashboard since March, but I just can't seem to make any sense of the correlation between what is on the dashboard, vs what is being reported in the media. According to the County's metrics, very little has changed in terms of bed & ICU availability since June. Obviously, the number of beds can be increased to keep the percentage relatively fixed, but I just don't see the connection. There is no doubt that the number of patients is on the increase, but we are definitely not out of space yet. What am I missing here?





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Old Dec 16, 20, 10:06 am
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If you look at green line of the bottom half of the upper chart, there were only 78 available adult ICU beds on December 14 for a population of over 10M. That's down from almost 300 available adult ICU beds in mid April.

The bottom half of the lower chart shows that there are approximately 2,500 licensed adult ICU beds in the county, of which only 85 were available on average between December 6 and 12.

The 1.7% figure, which I cited above, is for the entire Southern California region with a population of over 20M. The region includes Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura Counties. On Monday, all of Orange County's ICU beds were occupied.
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Last edited by TWA884; Dec 16, 20 at 10:30 am Reason: Add information
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Old Dec 16, 20, 10:52 am
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But down from 125 in October (when everything was 'ok') to 85 now is hardly a significant change, certainly not on the scale of what they are reporting. Even back when they cleared out all of the hospitals and set up surge capacity in the spring, it was never over 200 available beds. A 65% reduction from the peak is certainly worth noting, but it doesn't quite constitute the dire warnings being issued. It is just interesting that many people are blaming LA county for dragging everyone else down, when the reality seems to be quite the opposite.
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Old Dec 16, 20, 6:28 pm
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My understanding is that "available beds" calculation is based not on actual beds but rather staffed beds. Staff is fungible and can be assigned elsewhere during low demand - hospitals are not gonna keep personel where its not needed.
Basically low capacity is definitely very alarming but numbers are likely somewhat stretchable as staff gets reassigned.
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Old Dec 17, 20, 4:50 am
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Originally Posted by azepine00 View Post
My understanding is that "available beds" calculation is based not on actual beds but rather staffed beds. Staff is fungible and can be assigned elsewhere during low demand - hospitals are not gonna keep personel where its not needed.
Basically low capacity is definitely very alarming but numbers are likely somewhat stretchable as staff gets reassigned.
Low demand? This is a very high demand period and there are staffing constraints which are serious and have no quick and easy workaround.

There is at least as much or way more of an issue with staffing resource availability than with physical beds in SoCal too. I don't know what percentage of SoCal doctors and nurses have been recently out due to such healthcare workers or someone close to them being Covid-19 positive, but I know there are a variety of medical facilities across the country where it's not been unusual for c. 15% of staff to be unavailable for work due to Covid-19 infections pretty recently. And even at levels of absences way lower than 15%, there are healthcare facilities across the US that are welcoming even token staff supplementation from the US armed forces.

I have relatives working as doctors in hospitals from San Diego up to San Francisco, so I'm going to ask around to see what their staffing issues are like now. But even in the spring many of them were saying the workload was increasingly exhausting due to Covid-19.
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Old Dec 17, 20, 10:25 am
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Originally Posted by downinit View Post
But down from 125 in October (when everything was 'ok') to 85 now is hardly a significant change, certainly not on the scale of what they are reporting. Even back when they cleared out all of the hospitals and set up surge capacity in the spring, it was never over 200 available beds. A 65% reduction from the peak is certainly worth noting, but it doesn't quite constitute the dire warnings being issued.
I will note that in October, when 124 ICU beds were available in Los Angeles County, the COVID ICU bed utilization rate was 15%. Last week, when only 85 beds were available, the COVID ICU bed utilization rate was up to 35%.
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Old Dec 17, 20, 11:20 am
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Originally Posted by GUWonder View Post
Low demand? This is a very high demand period and there are staffing constraints which are serious and have no quick and easy workaround.

There is at least as much or way more of an issue with staffing resource availability than with physical beds in SoCal too. I don't know what percentage of SoCal doctors and nurses have been recently out due to such healthcare workers or someone close to them being Covid-19 positive, but I know there are a variety of medical facilities across the country where it's not been unusual for c. 15% of staff to be unavailable for work due to Covid-19 infections pretty recently. And even at levels of absences way lower than 15%, there are healthcare facilities across the US that are welcoming even token staff supplementation from the US armed forces.

I have relatives working as doctors in hospitals from San Diego up to San Francisco, so I'm going to ask around to see what their staffing issues are like now. But even in the spring many of them were saying the workload was increasingly exhausting due to Covid-19.
what i meant is that the bottleneck causing very low available ICU bed appears to be due to existing staffing and unlike hardware staffing has more flexibility via reassignments, traveling nurses, coverage of more beds but existing staff etc...
Basically (random numbers here) we have 1500 ventilators, 1000 have nurses attached and 990 are used by patients so the calculation is 99% use. Definitely an alarming and stressful situation we should try to address but there appears to be more hardware available that statistics suggest. An of course there is a lot variability from hospital to hospital - some are setting up tents outside some operate with reasonable capacity...
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Old Dec 17, 20, 11:49 am
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Originally Posted by azepine00 View Post
what i meant is that the bottleneck causing very low available ICU bed appears to be due to existing staffing and unlike hardware staffing has more flexibility via reassignments, traveling nurses, coverage of more beds but existing staff etc...
ICU nurses are highly trained. Currently in California the accepted ICU staffing ratio is one nurse for two ICU patients. This morning, I heard on NPR that a Fresno hospital changed the ratio to three patients per nurse (the story has yet to be transcribed). El Centro Regional Medical Center in Imperial County is also requesting permission to to increase the number of patients each ICU nurse can care for.

As of Wednesday, December 16, Southern California's total ICU bed availability dropped to just 0.5%.
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Old Dec 18, 20, 12:07 am
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ICU availability in Southern California at 0%, and it’s going to get worse, officials warn
The availability of intensive care unit beds throughout Southern California hit 0% Thursday, and officials warned that conditions in hospitals are expected to erode further if the coronavirus continues to spread unchecked.

***
Once ICU beds are full, hospitals go into surge mode, which can accommodate 20% over usual capacity. Officials have also been training medical personnel who work elsewhere in hospitals to allow them to work in ICUs, and seeking nurses from outside the United States.

But the forecasted size of the surge of severely ill COVID-19 patients needing hospitalization in the coming weeks is now so large, it blew past projections issued just a few weeks ago. Officials were forced to redraw their charts to accommodate the enormous surges in projected ICU bed demand.

There are now more than 1,000 people with COVID-19 in L.A. County’s intensive care units, quadruple the number from Nov. 1. Forecasts say that by early January, there could be 1,600 to 3,600 COVID-19 patients in need of ICU beds if virus transmission trends remain the same. There are only 2,500 licensed ICU beds in L.A. County.

***
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Old Dec 18, 20, 12:44 am
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and that highlights the issue - it's not the shortage is ICU beds as we are being told - it's the shortage of trained staff. Or perhaps distribution of trained staff - some hospitals are overloaded while others are not. https://www.nytimes.com/interactive/...-near-you.html

There are 2500 beds available in LA county, we use 1000 and claim that 0% is left. It's a very questionable way to present data.


The availability of intensive care unit beds throughout Southern California hit 0% Thursday, and officials warned that conditions in hospitals are expected to erode further if the coronavirus continues to spread unchecked.

***
Once ICU beds are full, hospitals go into surge mode, which can accommodate 20% over usual capacity. Officials have also been training medical personnel who work elsewhere in hospitals to allow them to work in ICUs, and seeking nurses from outside the United States.

But the forecasted size of the surge of severely ill COVID-19 patients needing hospitalization in the coming weeks is now so large, it blew past projections issued just a few weeks ago. Officials were forced to redraw their charts to accommodate the enormous surges in projected ICU bed demand.

There are now more than 1,000 people with COVID-19 in L.A. County’s intensive care units, quadruple the number from Nov. 1. Forecasts say that by early January, there could be 1,600 to 3,600 COVID-19 patients in need of ICU beds if virus transmission trends remain the same. There are only 2,500 licensed ICU beds in L.A. County.
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Old Dec 18, 20, 1:45 am
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Originally Posted by azepine00 View Post
and that highlights the issue - it's not the shortage is ICU beds as we are being told - it's the shortage of trained staff. Or perhaps distribution of trained staff - some hospitals are overloaded while others are not. https://www.nytimes.com/interactive/...-near-you.html

There are 2500 beds available in LA county, we use 1000 and claim that 0% is left. It's a very questionable way to present data.
All 2,500 ICU beds in Los Angeles County are presently occupied; 1,000 or 40% with COVID-19 patients, the rest with patients suffering from other maladies. That's up from the 15% COVID ICU bed utilization rate in October.

The NY Times article which you linked was published on December 15 and the stats cited there are out of date.

[moderator's hat on]
This is an informational forum and thread. Further arguments about these statistics belong in OMNI/PR.
[moderator's hat off]
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Old Dec 18, 20, 11:29 am
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CA is also now actively seeking medical personnel from Taiwan and Australia to volunteer to help with the staffing shortages. Why those 2 countries? Not sure but probably have something to do with current low COVID case loads there and mutual recognition of medical license/degrees. Not every foreign licensed nurse or doctor can practice in the US, even in an emergency.
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Old Dec 29, 20, 10:53 pm
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Originally Posted by TWA884 View Post
All 2,500 ICU beds in Los Angeles County are presently occupied; 1,000 or 40% with COVID-19 patients, the rest with patients suffering from other maladies. That's up from the 15% COVID ICU bed utilization rate in October.

L.A. County hospitals turn away ambulances, put patients in gift shop: ‘I’ve never seen anything like this’
As of Monday morning, there were 54 available ICU beds across L.A. County, and half were for pediatric patients. Two-thirds of staffed ICU beds in L.A. County are filled with COVID-19 patients.
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