How one of the US’ busiest trauma centers is handling ‘daunting’ COVID patients

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LA County + USC Medical Center is currently full of patients with COVID-19 and other illnesses, says Dr. Brad Spellberg. Photo courtesy of LAC+USC Medical Center

LA County’s hospitalization rate has jumped more than 30% in the past three weeks, according to the LA Times. The county hit another milestone on Thursday with nearly 4600 new cases. That’s the highest single-day count so far. 

LA County + USC Medical Center (LAC+USC) is one of the busiest trauma centers in the world, and the only option for many of Southern California’s poorest residents. KCRW speaks with Chief Medical Officer Dr. Brad Spellberg.

KCRW: What is the COVID situation like right now at your hospital? 

Dr. Brad Spellberg: “Our hospital is full in part because we also have lots of non-COVID patients coming back. Our ER has become very busy again. Our ER is certainly open for business, and if people need medical care, they should come to us. But the number of COVID patients has become very, very daunting. 

… We are hovering at around 100 COVID positive patients, of which around ballpark 40 are in the ICU. 

And the real limitation is the ICU. It's not a regular ward bed. The ICUs have become very heavily impacted when you put 40 COVID patients in there. And we still have to take care of the heart attacks, and strokes, and car accidents, and traumas. It does create a strain on the system. And our staff are really working very hard and are … bearing up very well under the strain. But it's becoming very exhausting for them.”

Do you have enough staff to take care of everyone at the hospital? 

“We have enough staff. I think that it's very important for people to recognize the distinction between what happened in New York and what is playing out in LA. We have not been hit by a tidal wave, a sudden surge that overwhelmed our resources. When the county closed down a couple of months ago, our cases dramatically fell. They started to rise back up. And as reopening has occurred, they've risen further. 

And so it's been a slow, steady, week-by-week rise to the point where we’re not overwhelmed with resources. But we are … not far from the staffing limits of resources, with staff available now. And we have to figure out how to continue. 

We've done some very innovative things to improve our efficiency. And the time that public health has bought us has allowed us to adapt. There will be a point, if cases don't stop rising, where we will become stretched beyond currently available staffing.

… No one knows what's going to happen. And it bothers me when people say they know exactly what's going to happen. This virus is so new. We're still learning everyday about it. We had a couple of weeks where every day, there was more and more and more. Honestly, the last four days, things have leveled off. … We're doing the best we can.

… COVID is punching us in the mouth, and we're adapting. And we need the public to help us by following Department of Public Health instructions to slow the rate of rise.”

Dr. Brad Spellberg says, “COVID is punching us in the mouth and we're adapting. And we need the public to help us by following Department of Public Health instructions to slow the rate of rise.” Photo courtesy of LAC+USC Medical Center

What happens if you run out of ICU capacity? 

“We do have surge plans. … The limitation does, in my mind, turn out to be expert staff. We can create new ICU beds. Will they be staffed by experts that are equivalent to those who staff our other beds? It becomes increasingly difficult to find such people when you're in a crisis mode. We have the Department of Defense that is sending a team to help us out, and we're very appreciative of that. And that will help give us some staff. We’re looking at other staffing options. 

But again, the need is to slow the rise so that we have time to adapt our efficiency and management. And if needed, time to add the expert staff that are needed to keep up with demand.”

Would you have to send patients elsewhere? If so, where would they go? 

“We always are looking to redistribute to stay within capacity. And when we were disproportionately affected, and other hospitals weren't quite as heavily affected, that was certainly easier to achieve. 

We are finding it increasingly difficult to find non-impacted hospitals. ... There's [sic] 10,000 different pandemics burning across 10,000 counties in the United States. ... We all need to recognize that we all play a role, and that physical distancing, wearing your masks, washing your hands is part of a community sense of responsibility. 

We understand that you can't just shut the economy down forever because that will kill people too. And I don't envy leadership in trying to balance these forces. But when the health care system becomes overwhelmed, that's when really society runs into serious problems. ... Our doctors, and nurses, and respiratory therapists, and phlebotomists are coming to work every day going into the danger zone. We need the public to work with us to control the rate at which patients are coming to the hospital.”

Who’s most affected by COVID-19 in your hospital? Reports show that younger people are increasingly being hospitalized.

“We’re not seeing that. I've heard that repeatedly. We have not seen that. … We’ve had several 90 year olds quite recently. But we've all along had the 20, 30, and 40 year olds. So I don't think we've seen a shift in age here at this hospital.”

Are you seeing unhoused people contracting COVID-19? 

“We have more homeless patients than any other hospital in the county. We’re two miles from Skid Row. … Many of us have been surprised to not have been hit very heavily by the homeless population. … We certainly do see homeless patients, but not disproportionate to what we were seeing before COVID hit. I think homeless people have been … I can only imagine very responsibly socially distancing. 

More what we see are problems of spread within families that are living in crowded environments, where it's difficult to self isolate at home.

… We do have to be sensitive and respectful to the fact that there is economic damage that this virus causes. And people can die from the virus, but they can also starve to death, and people have to make a living. And that's that balance that's very hard to strike. But I think [it] becomes imbalanced when we allow the cases to progress at a rate that the health system simply can't handle anymore.”

What’s the morale among your staff? 

“We have a very mission-driven and resilient staff. … You come to work knowing why you're here. … Our staff have rallied. Our staff are banding together. They're doing what they need to do. 

But this is both a sprint and a marathon. And there is a point at which people start to become exhausted emotionally and physically. We're holding up, we're holding on, but we really do need the public to understand what our staff go through. Because we're all in this together.”

Does your staff have enough PPE? 

“We have had no problems with PPE. The department has done a magnificent job of sourcing PPE. We've had no shortage of PPE. So that has not been an issue.”

… What you want is to bring good from the bad. The reality is society has been through much worse than this. We've been through World Wars. We went through the 1918-1919 flu pandemic that infected several

billion people and killed 50 million people. And they didn't know what an ICU was. This is not as bad as that. 

We need to remember to stick together. If we stick together, we will get through this. … Part of sticking together is be respectful of the people we live with in our community.”

— Written by Amy Ta, produced by Brian Hardzinski

Credits

Guest:
Dr. Brad Spellberg - Chief Medical Officer at the LA County + USC Medical Center - @BradSpellberg

Host:
Madeleine Brand

Producers:
Sarah Sweeney, Michell Eloy, Amy Ta, Rosalie Atkinson, Brian Hardzinski, Caleigh Wells, Angie Perrin