Maria Arechiga, an ICU charge nurse, monitors the progress of two COVID-19 patients in the intensive care unit of Martin Luther King Jr. Community Hospital in Los Angeles. Gabriella Angotti-Jones for NPR hide caption
Maria Arechiga, an ICU charge nurse, monitors the progress of two COVID-19 patients in the intensive care unit of Martin Luther King Jr. Community Hospital in Los Angeles.
On a recent Friday afternoon, the critical care charge nurse at a South Los Angeles hospital tries to send another nurse off to grab lunch. Maria Arechiga is interrupted by the beeping of an alarm, the vitals of a patient declining, organs failing.
She dons a surgical gown and unzips a plastic tarp that hangs from the doorway of a hospital room a makeshift isolation room on this floor temporarily transformed into a larger intensive care unit to make space for the patients that just keep coming. She slips inside.
Dr. Stefan Richter follows her in, both telling the other nurse to get lunch now, because later may never come.
There are two patients in the room. Within an hour, both patients' organs are failing. Arechiga yells for someone to call a Code Blue, a medical emergency.
"May I have your attention please. Code Blue, Code Blue," booms from the PA system.
Reinforcements arrive. In the urgency, there is practiced calm. A team helps each nurse, doctor and respiratory therapist put on protective gear before they go in to try to resuscitate the patients.
They lose one patient, get the pulse back on another. And then another Code Blue is called. They begin again. Every single person in the critical care unit on this floor is COVID-19 positive.
Arechiga checks on an intubated COVID-19 patient. The floor was converted to an ICU unit the week before to help with the surplus of COVID-19 patients. Gabriella Angotti-Jones for NPR hide caption
Arechiga checks on an intubated COVID-19 patient. The floor was converted to an ICU unit the week before to help with the surplus of COVID-19 patients.
A deadly, predictable disaster
The intensive care unit at Martin Luther King Jr. Community Hospital is at the epicenter of the coronavirus surge that is ripping through Los Angeles County, the country's most populous.
One in three people in the county have been infected with COVID-19.
But at this hospital in Willowbrook, an unincorporated part of South L.A. neighboring Compton and Watts, the pandemic is preying on the inequities that disproportionately hurt Latino and Black communities. The neighborhoods are densely populated and multiple generations of families live together, making it hard to isolate.
It's a place where most people are on public health insurance and where chronic illnesses are much more prevalent because there is a systemic lack of access to quality health care. Add COVID-19 to that mix and it's a deadly but predictable disaster.
"This is a community that is largely low-income, people of color," says Dr. Elaine Batchlor, the CEO of MLK hospital. "This is where the essential workers live. These are the people that are stocking the grocery stores, driving our buses, cleaning up after the rest of us. And they are continuing to be exposed to COVID on the job."
The former gift shop at Martin Luther King Jr. Community Hospital had been converted into a meeting room and is now an overflow patient care area. Gabriella Angotti-Jones for NPR hide caption
The former gift shop at Martin Luther King Jr. Community Hospital had been converted into a meeting room and is now an overflow patient care area.
She speaks in her office where she has been managing the crisis.
"Our small hospital now has more COVID patients than hospitals that are three to four times larger in L.A. County," Batchlor says. "We have added beds to the hospital. We've doubled up single rooms. We've added five tents outside of the emergency department. The staff converted an entire medical floor into a critical care unit. So we've been doing everything we can to create enough capacity to care for all of the patients that have been coming in to see us."
"This is a community that is largely low-income, people of color," Dr. Elaine Batchlor, CEO of Martin Luther King Jr. Community Hospital, says. "This is where the essential workers live." Gabriella Angotti-Jones for NPR hide caption
"This is a community that is largely low-income, people of color," Dr. Elaine Batchlor, CEO of Martin Luther King Jr. Community Hospital, says. "This is where the essential workers live."
"We are in a crisis situation"
On Christmas Eve, Elaine Batchlor sent an urgent letter to California Gov. Gavin Newsom.
"I'm writing with a critical update on how the COVID-19 coronavirus is impacting our black and brown community in South Los Angeles," Batchlor wrote.
The data she cites in her letter is sobering. Sixty-six percent of patients in the hospital are COVID-19 patients, triple if not quadruple what other hospitals in the county are seeing. She describes a recent day when 70 patients were in the emergency department with just 29 beds. She writes about the meditation room below her office now filled with gurneys, a gift shop turned hospital room.
"We are in a crisis situation, with devastation wrought on caregivers and community alike," she wrote.
She pleaded not just for short-term solutions but also for fundamental change to the health care system that brought the community to this point.
She ends the letter: "It is time to address the separate and unequal health system that has been heartbreakingly exposed by COVID-19."
The state sent temporary help. Three National Guard Medical Strike Teams, some 90 nurses and respiratory therapists. This week, COVID-19 hospitalizations are finally going down but the number remains high.
Since the day MLK hospital opened in 2015, it has always served more people than it was built to help. The facility replaced a hospital that shuttered in 2007 over deadly conditions. Gabriella Angotti-Jones for NPR hide caption
Since the day MLK hospital opened in 2015, it has always served more people than it was built to help. The facility replaced a hospital that shuttered in 2007 over deadly conditions.
"We need to fix it"
Even as Batchlor works to get her hospital through this catastrophe, her focus remains on long-term reforms. Because when this pandemic is over, the systemic problems in health care that are visibly failing this community and communities like it across the country will still be here.
"Our goal is to create the health care structure that's missing here," she says. "We're advocating for the system to be adequately funded so that people in communities like South L.A. can access the same continuum of care that we see in other communities and the same quality."
This hospital has always served more than it was built to, since the day the luminous facility opened in 2015 to replace the hospital that shuttered in 2007 over deadly conditions.
"We've been seeing a bit of a public health crisis in this community for the past five years," Batchlor says.
An ICU nurse helps a COVID-19 patient speak to their family through an iPad. Gabriella Angotti-Jones for NPR hide caption
An ICU nurse helps a COVID-19 patient speak to their family through an iPad.
The year before the pandemic ripped through these neighborhoods and the world, the emergency department saw 110,000 people. It's only set up for some 40,000. The community the hospital serves has the fewest number of hospital beds per 100,000 people in Los Angeles County.
The most common procedures are diabetic amputations and treatment of diabetic wounds. Both are completely preventable with the proper care.
So this moment, this crisis, it's not a surprise, she says.
"We've created a tiered financing system for health care with commercial at the top and Medicaid and uninsured at the bottom," Batchlor says. "And we need to change that, because that's where many of our Black and brown communities are. And that's why they're being harder hit by something like COVID. We need to fix it."
The problem is glaringly obvious, she says. The majority of patients in this community are on public health insurance. And while a hospital gets supplemental funding if a patient is so sick they have to be admitted, it is a fraction of what private insurance pays for outpatient care. That includes the emergency department triaging below her office and the preventative medical care that keeps people healthy.
A COVID-19 testing site is set up near Martin Luther King Jr. Community Hospital. The hospital is in Willowbrook, an unincorporated part of South Los Angeles sandwiched between Compton and Watts. Gabriella Angotti-Jones for NPR hide caption
A COVID-19 testing site is set up near Martin Luther King Jr. Community Hospital. The hospital is in Willowbrook, an unincorporated part of South Los Angeles sandwiched between Compton and Watts.
"We're getting paid adequately to amputate someone's leg," she says. "But we're not getting paid adequately to prevent that leg from being amputated."
The hospital loses some $10 million a year operating the emergency department. It loses money for the specialty care and primary care programs it offers for things like behavioral health care or nutrition programs to prevent diabetes.
"You can't send these patients to other places, no other places will take them ... Why? Because we lose money on these patients," Batchlor says. "Our goal is to create the health care infrastructure in the community that's missing here."
To bridge the gap, the hospital relies on millions of dollars in philanthropic donations to subsidize doctors' and nurses' salaries, bring in cutting-edge technology and create disease management and prevention programs.
"This is not a sustainable model," she says. "This will not work forever. It works for a limited period of time when you have that philanthropic funding."
In the hospital's tented treatment areas, doctors find themselves having to make devastating decisions: Who should be moved inside next? Gabriella Angotti-Jones for NPR hide caption
In the hospital's tented treatment areas, doctors find themselves having to make devastating decisions: Who should be moved inside next?
Nowhere else for patients to go
Outside the hospital grounds, it's a health care desert. Doctors won't set up in communities where they can't make money.
"Physicians can't sustain a practice in a community like this. So that's why they aren't here," Batchlor says. "That's why we're missing 1,200 physicians."
So there's nowhere else for patients to go.
The lack of options is on display in the emergency department. The halls are lined with beds. An older woman yells out in Spanish "please, no." She's scared and alone. Nurses calm her as medical staff move quickly to tend to dozens of people.
Dr. Ryan McGarry compares this moment to battlefield medicine.
"We're surrounded here by multiple tents and tubes and lines and, effectively, temporary structures to handle overflow on overflow," he says. "Unfortunately, we're having to make sometimes decisions about who we can move inside or who's sickest between 10 sick patients. That's not an easy decision to make for anybody, let alone when you're trying to help everyone get through this."
Doctors and nurses treat patients in triage tents, makeshift ICUs and anywhere else they can make room. About a third of the population of Los Angeles County has been infected with the coronavirus. Gabriella Angotti-Jones for NPR hide caption
Doctors and nurses treat patients in triage tents, makeshift ICUs and anywhere else they can make room. About a third of the population of Los Angeles County has been infected with the coronavirus.
Despite the overflow, the hospital has found a system to expand what they have to accommodate what McGarry calls "a surge, on a surge, on a surge."
"If you need the ICU here, you're going to get it. It just means that maybe that ICU will be here in the emergency department," he says.
"It's been horrible"
Back in the ICU, Arechiga's shift has gotten progressively busier, progressively deadlier.
And this day is not the worst that she has seen.
"Tough is an understatement. It's been ..." Arechiga pauses. "It's been horrible."
Most of the patients who end up here, she says, look like her.
"I grew up in Compton," she says. "I know the community. So potentially, you know, this could be any of my family."
In addition to supervising nursing staff, tending to patients and recording vitals, Arechiga also finds herself translating.
"Some of our doctors don't speak Spanish and I feel like 90% of the population is Hispanic," she says. "I have to sit there or one of the nurses that speak English and Spanish with a straight face and tell them: 'Your family member is going to die.' It's just really hard."
Maria Arechiga (center) helps move an intubated COVID-19 patient to a private room. The patient died later that day. Multiple COVID-19 deaths in one day are not rare at the hospital. Gabriella Angotti-Jones for NPR hide caption
Maria Arechiga (center) helps move an intubated COVID-19 patient to a private room. The patient died later that day. Multiple COVID-19 deaths in one day are not rare at the hospital.
That bears out in the numbers. Take this Wednesday for example: More than half of the deaths reported that day in Los Angeles County were Latino.
In the tragedy, the nurses and doctors have found the bond that comes with getting through hardship together hardship the rest of the world may never understand. They console one another, some dealing with their own losses due to COVID-19, and then they keep going.
"I feel like this time around, people are coming in sicker and dying quicker," Arechiga says. She's comparing what she's seeing now to the smaller surges of patients that came before. This time, the deluge is unparalleled.
Trying to prevent things from getting worse
Nearby Dr. Stefan Richter goes back and forth to one room. He's monitoring a patient whom he expects will soon pass away.
"When her heart stops, we will be doing chest compressions, even though the understanding is that probably they aren't going to help," he says.
Most of the patients on this floor are on ventilators and many are on dialysis.
"We've been taking the brunt of a kind of medical epidemic for years," Richter says. "A lot of the diseases that we see here during nonpandemic times are preventable, but they've gone untreated for years and years and years. And so the fact that we're continuing to see the brunt of this pandemic doesn't really surprise me that much in a really unfortunate way."
The vaccine is a providing a sliver of hope, but the county rollout has been slow. Health care workers have gotten it here, but no one knows how long it will be before this community has access.
Exacerbating the COVID-19 crisis at the MLK facility is that it is essentially the only medical game in town as doctors are reluctant to set up a practice where they cannot be paid. Gabriella Angotti-Jones for NPR hide caption
Exacerbating the COVID-19 crisis at the MLK facility is that it is essentially the only medical game in town as doctors are reluctant to set up a practice where they cannot be paid.
By the end of the shift on this day, five people are dead. Four are Latino, one is African American. The hospital gives the families a one-time exception to visit when end of life is near.
Jason Prasso, an ICU doctor, is often the one that makes the call and breaks the news.
It's time to come in. Time to say goodbye.
"Modern medicine has a lot of a lot of interventions and a lot of therapies that we can offer, but this virus has proven resistant and extremely difficult to manage," he says. "Realistically speaking, there isn't a whole lot that I can offer besides supportive care as an ICU doctor and trying to prevent things from getting worse. It hurts as a doctor to say that."
Prasso is cut off by the sound of another Code Blue call.
"Excuse me," he says. It's a bad day, a familiar day.
President Biden stopped Americas withdrawal from the World Health Organization on his first day in office. The premise of his decision is that reforming international institutions from inside is more effective than leaving or withholding funds, and this theory will be tested quickly.
China has total control over the World Health Organization, Donald Trump said last year when announcing the U.S. would leave. That was typical hyperbole, but he had a point. WHO director-general Tedros Ghebreyesus fawned over Chinas response to the virusvery impressive, and beyond wordsas Beijing destroyed virus samples, neutralized whistleblowers, and spread conspiracy theories.
WHO officials privately considered speaking out but calculated that the Chinese Communist Party would be even less cooperative if criticized publicly. The agencys reticence didnt do much. A team of WHO experts went to Beijing to study the origins of the virus in February 2020when their chances of discovering how it transferred to humans from animals were significantly better than todaybut the Chinese government impeded them.
Negotiations with Beijing dragged on through 2020. This month Dr. Tedros finally mustered the spiritless complaint that he was very disappointed with the delays. The Chinese foreign ministry said it welcomed the investigators presence shortly before they began arriving in recent days. Take this as seriously as O.J. Simpsons vow to make finding the killer of his ex-wife my primary goal in life.
Media reports say Beijing pushed WHO to delegate critical initial investigatory work to Chinese scientists. The WHO team at best will get incomplete data, because research on Covid-19s origins cant be published in China without the Communist Partys approval. The Chinese government also approved the WHO missions members and agenda.
Fighting the pandemic will remain a top priority in 2021, not least for the biopharma companies working on the next generation of therapeutics and vaccines against COVID-19. But just because were in a pandemic doesnt mean all other diseases have stopped plaguing humanity. We asked executives which areas might see a resurgence this year, and neurology emerged as a popular horse to bet on.
Part of that interest could be down to Biogens once-failed Alzheimers disease candidate, aducanumab, which is slated for an FDA decision by March 7.
I think neurology will continue to be a big focus, at least in the first half of the year, while aducanumab is out there and all eyes are on the PDUFA, said Shehnaaz Suliman, M.D., president and chief operating officer of Alector, which is working on immuno-neurology approaches to neurodegenerative disease. There was a recent spate of high-priority deals done in the neuro spaceit signals appetite in Big Pharma and Big Biotech to do big value-creating deals.
RELATED: JPM: Alector, Annexon, Athira on what an aducanumab approval could mean for Alzheimer's R&D
Multiple executives agreed that aducanumab would not be a best-in-class drug but that its approval would give the whole field a boost, encouraging interest and investment in neurodegenerative disease R&D. Recent data for a similar drug, Eli Lillys donanemab, also offered hope.
I think its important to continue to go after neurology," said Doug Love, president and CEO of Annexon Biosciences. We are an aging population, and, of course, patients are going to have neurodegenerative disorders We need to think smart and branch out beyond Alzheimers. There are lots of neurodegenerative diseases. There are lots of kinds of dementia we can target.
Its a good time to pursue these indications, Love said, adding, As the field advances with various biomarkers, we will understand earlier in the disease process if drugs are working.
Another reason traditionally big indications like neurology and cardiology are getting more interest is the availability of genetic sequencing and the ability to slice those disease areas up into more manageable segments. It provides a regulatory path for companies working in those areas that previously did not exist, said Rahul Ballal, Ph.D., CEO of Imara, a company working on treatments for sickle cell disease and other blood disorders.
RELATED: JPM: Biogen bullish on Alzheimer's drug approval, sees Lilly data as positive despite AdComm rejection
For a long time, people have run away from those spaces for all the reasons you know: low probability of technical success, large, heterogeneous patient populations, Ballal said. And I think what biotech is doing thats really exciting within the neurodegenerative space and within cardiovascular disease is they are applying a rare disease approach to those diseases by finding patients within the very large swaths.
Whichever areas receive the most interest in 2021, the entire industry should make sure that treatments reach every patient who needs them, said Nessan Bermingham, CEO of Triplet Therapeutics.
We look at whats happening with the (COVID-19) vaccine and whats happening with the rollout of care for individuals who have gotten COVID-19, and the disparities are very clear, Bermingham said. In the U.S. and from a global standpoint, were only going to see those be further emphasized. This is something, as a biotech industry, we need to be very conscious of.
Biopharma companies should think about pricing, distribution and access not just of cutting-edge immuno-oncology meds and gene therapies but also of things like basic care, real-time feedback from doctors, diagnostics and imaging.
As we think about the disparities we face, weve not changed that, and arguably with new therapies coming out, weve actually made those disparities worse, Bermingham added. I think as an industry, we need to go back to the concept of healthcare democracy: that everyone has the right to healthcare.
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Instruction
COVID-19 in the last 90 days plus being treated with convalescent plasma or monoclonal antibodies, Hicks said. Other than that, its if we have limited doses. You can wait to give somebody else the courtesy of going in front of you, because you do have some level of protection with antibodies. Maybe wait your turn in line and let someone else go, because the thought is if you had COVID in the last 90 days, you have some level of antibodies protection. So give somebody else a shot before you.
Teachers and staff at an affluent South Bay school district can skip the line and get a COVID-19 vaccine by pretending to be health care workers at the behest of Good Samaritan Hospital, according to an email obtained by San Jos Spotlight.
Teachers cant get vaccines in Santa Clara County yet. The county is in the beginning part of Phase 1B, but its only vaccinating people 75 and older. Education and childcare workers come after health care workers and people 65 and older.
But teachers at the Los Gatos Union School District dont have to wait, their Superintendent Paul Johnson told them. They can get their vaccines now at the behest of the hospitals top leadership.
The reason the teachers get to skip the line, Johnson said in the email, is because they helped raise money in the spring for meals for health care workers at Good Samaritan Hospital.
The COO of the hospital says we can access the appointments through here and has cleared LGUSD staff to sign up under the healthcare buttons, Johnson wrote in the email to faculty and staff obtained by this news organization. This is a wonderful gesture by our Good Sam neighbors and I encourage you to take advantage of this within the next few hours.
Johnson said in the email that the plan was approved by Good Samaritans chief operating officer. He said the hospital would like to offer vaccines to the school district because they have not forgotten the kindness of the staff raising money for meals for health care workers.
In an interview with San Jos Spotlight, Johnson said its not a quid pro quo and that Good Samaritans offer is not connected to the money the district raised.
My understanding is Good Sam was cleared for the next tier, so teachers didnt jump in line, Johnson said. You would have to talk to Good Sam about offering to other districts outside of Los Gatos.
Sarah Sherwood, spokesperson for Good Samaritan Hospital, said that the hospital chose to offer vaccines to the Los Gatos teachers because the hospital had extra appointments one day.
We had some open time slots to fill and welcomed 65 Los Gatos teachers into the clinic to receive their vaccines, following county guidelines, Sherwood said. Now, with no additional open time slots, we need to continue to vaccinate the population of 75+.
Sherwood said the hospital is updating its website to make the vaccination schedule clearer.
It is our full intention to vaccinate as many people as possible, Sherwood said. It is our hope that we will be able to vaccinate many more in the near future.
According to the California Department of Public Health, counties can allocate vaccine doses on the assumption that immunization will be accepted by some but not all who are offered the vaccine, and then continue to offer vaccinations in progressive priority tiers.
For example, the department says, if a county has maximized use of the vaccine to administer individuals in Phase 1A, they should move to Tier 1 of Phase 1B while continuing to offer vaccines to those in higher priority groups.
We are very grateful that Good Sam reached out to our district and offered to help our LGUSD staff (teachers and support staff) get vaccinated, Johnson said. Teachers are essential workers, and as we transition back to in-person instruction, we are thankful that they are able to have access to vaccines to protect the students and community.
Los Gatos schools have not resumed in-person classes. The district has plans to open once cases in Santa Clara County fall below 25 cases per 100,000 residents. According to the states COVID-19 dashboard, the county averaged 67 cases per 100,000 this week.
Teachers wont be required to get vaccinated, Johnson added, and its a personal choice. He said the district only received guidance from Good Sam on how to navigate their sign-up system.
The state last week began vaccinating residents 65 and older, but health care providers in Santa Clara County, including Kaiser, are only vaccinating people 75 and up due to a vaccine shortage.
Due to the short supply of vaccines, Good Samaritan reported to the county that its only vaccinating eligible health care workers in the first phase of the states COVID-19 vaccine rollout plan.
Santa Clara County is receiving about 30,000 vaccines a week from the state and federal government. County supervisors have said its not enough and voted to send a letter to state health officials demanding more doses.
According to the Santa Clara County vaccine dashboard, Good Samaritan Hospital had received 6,585 first and second doses of the vaccine as of Jan. 22, and had administered 3,674 doses.
The Santa Clara County Board of Education did not respond to a request for comment.
Santa Clara County Public Health officials say they are looking into the matter after an inquiry from this news organization.
Contact Madelyn Reese at [emailprotected] and follow her @MadelynGReese on Twitter.
President Kristina M. Johnson sent the following email to The Ohio State University community today (Jan. 22).
Dear Students, Faculty and Staff:
I write to share an overview of the current available information about how the COVID-19 vaccine is being distributed under the guidelines from the Centers for Disease Control and Prevention and the state of Ohio.
Supplies of the vaccine remain low, and manufacturers are ramping up production. At this time, Ohio is scheduled to receive a total of 100,000 doses per week, which represents less than 1% of the states total population. We expect that additional vaccine manufacturers will be approved in the coming weeks, which will add to vaccine supply. Because of the limited availability, the early distribution is being phased in according to priority populations, which are detailed below.
Like the flu vaccine, we expect that eventually you will be able to receive a vaccine for COVID-19 through a variety of providers, including hospitals, retail pharmacies and health departments, depending on your health insurance, your medical provider, your location in the state and other factors. Including the Schottenstein Center, there are 60 COVID-19 vaccination locations in Franklin County alone and more are planned to be added.
We are working in close coordination with Governor Mike DeWine as well as state and local health experts. We will continue to share updates, and the latest information is also on the Safe and Healthy Buckeyes website. We will be holding a series of virtual town halls on COVID-19 the first Monday of each month through April. The first town hall is Monday, February 1, at 5:30 p.m. and will focus on information about the vaccine. We will share details of how to join the town halls soon through the Safe and Healthy Buckeyes website and onCampus.
Below is a summary of the current plans for vaccine distribution by the Wexner Medical Center in Columbus, along with general information and links for further vaccine information and guidelines from the state of Ohio. For those living outside Columbus, the state has created an online tool to help Ohioans identify vaccine distribution sites in their communities. Additional information about the states vaccine distribution plan is available on the Ohio Department of Health website.
The initial phase of distribution at the Wexner Medical Center is nearly complete and focused on health care personnel, support employees (e.g., environmental services, security, etc.) and health sciences students who provide patient care, consistent with state and federal guidance.
Vaccination scheduling opportunities will follow the states phased distribution plan. The time frames below are subject to change based on vaccine availability.
The state also has plans to begin vaccinating patients with certain severe congenital and developmental disorders that increase the risk of severe COVID-19 disease and student-facing employees of K-12 schools in the coming weeks.
As more information becomes available on when additional populations can receive a vaccine, we will communicate this information to you, and the state will share it publicly at coronavirus.ohio.gov/vaccine.
For those individuals currently eligible to receive a vaccine, an appointment is required, and the option to schedule an appointment is only available once the criteria are met.
Eligible Wexner Medical Center patients who have seen a provider in the last three years will receive an automated phone call, a MyChart email and/or regular mail with details on how and when to schedule. Eligible Wexner Medical Center patients are encouraged to schedule an appointment through their MyChart account. Individuals who are not patients of the Wexner Medical Center or those who do not have a MyChart account can call 614-688-VAXX (8299) for assistance. Vaccinations will take place at the Schottenstein Center. More information, including frequently asked questions, is available on the Wexner Medical Center website.
While this progress is promising, it remains critically important to keep following public health protocols even if you receive the vaccine. That means continuing to wear masks, practicing physical distancing, avoiding large gatherings and consistently cleaning your hands. Together As Buckeyes, we will continue to do our part to have a safe and healthy spring semester and beyond.
Sincerely yours,
Kristina M. Johnson, PhD
President
In the spring, while New York suffered untold devastation from the COVID-19 pandemic, California was so successful in keeping the virus at bay that at least one expert called it the California miracle.
So when the coronavirus began to proliferate with unprecedented fury in November, transforming California into the epicenter of the pandemic, health experts and residents struggled to understand what had gone wrong.
Now, with the crisis showing signs of easing, the main reason for the catastrophic surge is coming into focus: a false confidence that the pandemic could be kept in check. For the public, that complacency showed up in fatigue and frustration over safety restrictions. Officials, for their part, were caught off-guard by how rapidly, and how broadly, the virus spread once the numbers began to climb.
By Christmas, so many patients struggling to breathe needed to be hospitalized in California that emergency rooms in large swaths of the state closed to ambulances as doctors stuffed patients in hospital corridors. The holiday surge has so far killed more than 18,100 Californians, more than doubling the states total death toll from the pandemic in less than three months.
We never, never planned for something like this to happen, California Health and Human Services Secretary Dr. Mark Ghaly said in a recent interview. The states mask mandates, business closures and stay-at-home orders, he said, were all designed to try to avoid this.
There are many possible theories as to why California was hit so hard starting in the late fall, including the introduction of more contagious strains of the virus, dry weather that made transmission easier and a higher percentage of the population being vulnerable to the disease because relatively few Californians had been infected up to that point.
But most experts point to changes in behavior: people beginning to abandon staying home, social distancing while out and other precautions that experts say curb transmission of the coronavirus.
In the fall, masking dipped in California while social distancing fell to the lowest levels since the pandemic began, according to one analysis. Meanwhile, the numbers of Californians attending gatherings with 10 or more people reached the highest level since before March, according to a USC survey.
And when a coronavirus wave started building in late October, Californians didnt cut down on their risky activities as quickly as they had earlier in the pandemic. Instead, the state faced the alarming prospect of a series of amplifying events with Halloween, Thanksgiving, Hanukkah and Christmas, followed by New Years.
The complacency caught officials off-guard and in turn sealed the states fate, as the prevalence of the virus crossed a tipping point into explosive growth, experts say.
California Health and Human Services Secretary Dr. Mark Ghaly at a news conference in 2020 with Gov. Gavin Newsom.
(Randall Benton / Associated Press)
Had we had the same level of compliance that existed with the first wave, we could have avoided the magnitude, said UCLA epidemiologist Dr. Robert Kim-Farley. This wave has turned into a tsunami.
Though people let their guard down across the nation as the pandemic wore on, California requires a higher degree of compliance to stave off a New York-style disaster, given the states high rates of poverty and its relatively low number of hospital beds, experts say.
Some attribute the waning cooperation simply to fatigue. Others argue that a dizzying array of health orders exhausted and confused Californians and sparked backlash.
Though epidemiologists warned the nation of a deadly winter wave fueled by colder weather, they didnt predict that temperate California would become the prime example. For the six-day period that ended on New Years Day, California had the highest per capita COVID-19 death rate in the nation.
Did I expect to see December and January this bad? Yes. But I expected to see it throughout the United States, said UC Berkeley public health professor Dr. John Swartzberg. Thats what I think the shocker has been.
To be clear, even after the awful surge, California maintains a comparatively low per-capita COVID-19 death rate overall, ranking 37th out of the 50 states. And, following several weeks of horror, the state appears to have finally turned the corner as coronavirus cases and hospitalizations begin to drop, though new variants of the virus have raised fresh concerns.
In the eyes of Ghaly, who leads the states response to the pandemic, what went wrong in California comes down to COVID fatigue, or what he sometimes calls COVID resentment.With Halloween and the championships of the Lakers and Dodgers, lonely Californians exploited an opportunity to socialize, he said. Even his own mother, who lives in San Francisco, began pleading with him to let her visit him and his kids in Los Angeles.
She calls every day. And she says, But when is it ready? When can I come visit? Ghaly said. So I cant even imagine where you dont have the same level of information its not constantly in your face how hard it must be to not gather.
Officials, too, were feeling hopeful in the fall that they had figured out how to manage the pandemic. In L.A. County, nail salons and indoor malls reopened. Some local officials anticipated that indoor restaurant dining and indoor gyms would reopen later in the fall.
The public followed their lead. Californians perceived risk of catching the coronavirus fell to the lowest level since the pandemic began, while the percentage of Californians who had close contact with people they didnt live with peaked, according to the USC survey.
At the same time, Californians were moving around their communities at levels not seen since before the statewide stay-at-home order in March, according to cellphone mobility data analyzed by the Institute for Health Metrics and Evaluation.
The spread of the coronavirus began to quicken in the state, due to a false sense of security aided by low case numbers, said IHME epidemiologist Ali Mokdad.
You pay a price for your success, he said. The advice should be: This is here to stay. ... This virus is so stubborn. You make a tiny little mistake, it will go after that mistake.
Nurse Cristina Marco and chaplain Kevin Deegan with COVID-19 patient Domingo Benitez at Providence Holy Cross Medical Center.
(Francine Orr / Los Angeles Times)
When officials began warning in late October for people to limit their activities as coronavirus cases began to surge, the pleas increasingly fell on deaf ears.
Some Californians were distrustful of officials after Gov. Gavin Newsom ate at the French Laundry restaurant in defiance of his own health orders. Others were angry after months of unemployment with little economic help from the federal government or were simply fed up with living an isolated, walled-in version of their lives.
And after months of relative quiet in the hospitals, for many, the risk no longer seemed imminent.
On Nov. 16, a frustrated Dr. Wilma Wooten, the San Diego County health officer, said she had hoped a warning issued a month earlier about the resurgence of the pandemic would mark a change in the publics personal and collective behavior. It is quite obvious, however, that it did not.
Some of the inertia felt California-specific, said UC San Francisco epidemiologist Dr. Kirsten Bibbins-Domingo. Whereas other states reopened schools and many outdoor, low-risk activities when case numbers were low, Californias more restrictive orders created a feeling of being in lockdown for 10 months, she said.
I think Californians are more fatigued. Theyre fatigued in a way thats uniquely Californian, she said. We dont experience the fruits of all of the good work that weve done because were never quite open and so it feels hard to close down, even [when were] hearing what is a real message from our public health officials: that were in a crisis right now.
There is a relatively small window in which for officials to act to stop a devastating surge of the coronavirus, since each new infection makes it more likely that more people will become infected. California officials, seeing the writing on the wall, rushed to put in place policies in November and December to try to slow the spread.
But the orders engendered far wider criticism than had been seen up to that point. Of particular contention were a statewide curfew for most of the state banning many activities after 10 p.m., a ban on outdoor dining, closure of playgrounds which was eventually reversed amid backlash and the prohibition of most outdoor gatherings of any size. That malls remained open while going on a masked walk with a friend violated the health order became fodder for jokes, and frustration.
While many experts have backed these rules, others wonder if they ended up fueling a backlash. University of Florida epidemiologist Cindy Prins said she thinks California may have benefited from being more liberal with its rules for outdoor spaces.
Were all running a big experiment, because I dont think we know exactly what the right point is to have people be compliant, she said. I dont think all closed is the way to go. I dont think all open is the way to go. Im not sure where the happy medium is.
Some law enforcement officials in Sacramento, Orange, Fresno, Riverside and San Bernardino counties said they would not enforce Newsoms stay-at-home orders.
In L.A. County, some local politicians were incensed at the outdoor dining ban and began accusing county scientists of not following the science. County Supervisor Janice Hahn, who voted against the ban, said it became the final straw for residents: Up until that point, I felt like we had the publics trust, she said in an interview.
The loud debate around these orders dissolved the united front needed to gain adherence to public health measures, experts say.
By late December, 40,000 Californians were testing positive for the coronavirus each day and 20,000 were in the hospital. While the pushback to the regulations had been much more severe in the southern part of the state, the surge was too a sign of how important widespread cooperation with the rules can be, experts say.
Assemblyman Carlos Villapudua bumps elbows with Assemblywoman Blanca Rubio in the California state Capitol on Tuesday.
(Gina Ferazzi / Los Angeles Times)
The flood of new cases has exacted a horrific toll, with more than 500 Californians dying every day at the peak, and hospitals so crowded ill patients have had to wait as long as 17 hours to even just enter the emergency room.
Critics, including Florida Gov. Ron DeSantis, have said that the disaster in California is proof that mask mandates and stay-at-home orders dont work. Experts say they can be effective, but California simply requires a much higher rate of compliance with these measures than a state such as Florida due to its innate vulnerabilities.
California has the nations third-lowest ratio of hospital beds to residents, so the threshold for pushing ICUs to the brink is relatively low. The state is also home to several cities that are major travel hubs, reliant on public transportation, with a high percentage of residents living in poverty and in overcrowded homes, where the virus is more likely to spread due to the close quarters.
While 55% of Californias residents live in counties with high social vulnerability score a measure of how severely affected a region may be by a natural disaster or disease outbreak fewer than a quarter of Floridians do.
That California could somehow avoid a large COVID-19 surge without a China-style lockdown was naive, said UC Irvine public health professor Andrew Noymer. There is some randomness in when outbreaks hit Illinois worst surge came in November while Californias hit in December but there wont be safety from the pandemic until herd immunity via a vaccine is achieved, he said.
This virus will find a way, Noymer said. No place in the United States is just going to somehow evade this.
This week, however, hope arrived in the form of small percentages. The number of people in the hospital with COVID-19 in California has begun to decline, as have new case numbers.
The shifts are probably due to Californians decline in activity, which began to gradually decrease in November and hit a low the lowest since May in December, due to a combination of local and state rules, increased warnings and the publics natural tendency to become more cautious after witnessing the devastation around them, experts say.
As is usually the case with the pandemic, the consequences of peoples actions dont become evident for several weeks.
Ghaly said he thinks this progress shows that the state can control the pandemic, a spot of good news in a surge where the story has often been that things have only gone wrong.
Overall too, California has tallied 90 deaths for every 100,000 Californians since the pandemic began, compared with 212 per 100,000 people in New York, 158 out of 100,000 in Illinois and 119 out of 100,000 in Florida. In other words, if California had the same death rate as Florida, California would have a cumulative death toll of more than 47,000, instead of the 35,000 it does today.
Its hard to find successes in this, but ... improvements are successes, Ghaly said. What weve done in California has worked for us, and has done what Id hoped it had done, which is saved a lot of lives.
Times staff writers Sean Greene and Deborah Netburn contributed to this report.
The COVID-19 testing schedule for sites operated by the Louisiana Army National Guard (LANG) for the week of January 25 to January 30 is listed below. Sites are closed during state holidays and inclement weather.
The more contagious U.K. variant of COVID-19 has been identified in Louisiana, and all Louisianans need to take precautions to protect themselves and their loved ones. Avoid gatherings of individuals not part of your households, work from home remotely when possible, wear a mask, practice social distancing and good hand hygiene, and stay home if sick. If you have been exposed or have symptoms of COVID-19, get tested. And, when it is your turn, consider getting the COVID-19 vaccine.
Pre-registration for COVID-19 testing is encouraged by going toHealth.QuestDiagnostics.com/STLOU. Testing is for ages 3 and older. There is no cost, and no identification is needed. Test results are available by calling1-866-MYQUEST (1-866-697-8378), but note that wait times can be lengthy. Test results are also available through the Quest online portal or app.
If you are unable to make it to a LANG testing location, no-cost testing is available by appointment atselect Walgreens locationsthrough a partnership between Walgreens and the Department of Health. These locations offer testing 7 days a week to people ages 3 and older. Appointments are required; make yours atwalgreens.com/covid19testing.
Region 4:Acadiana
Symptoms of COVID-19 include:
Test site details
Save the number 877-766-2130 in your phone
Anyone who receives a call from 877-766-2130 is urged to answer, as the call is from a contact tracer who will keep an individual's information private. Personal information is used to quickly identify anyone a COVID-positive individual may have been in close contact with to help contain the spread of the coronavirus. Everyone called by a contact tracer is advised to monitor themselves for signs of illness for 14 days from when they first came in contact with the COVID-19 person.
If a resource need is identified through the contact tracing interview, the case is flagged for follow-up from a resource coordinator social worker who can connect individuals with resources including medication, masks, food assistance and even help locating alternative housing.
If someone calls from a number other than 877-766-2130, claims to be a contact tracer and asks for personal information, hang up immediately.If you have a positive lab result and have not yet heard from a contact tracer, you can call our team directly at 877-766-2130.
COLLIER COUNTY
There is a new push for widespread testing as Americans who are eligible wait on vaccinations.
One health care provider in Southwest Florida says its now offering free testing, and medical experts say this is key to keeping people out of the hospital.
It goes back to pre-symptomatic or asymptomatic spread. If you dont know youre infected, you cant isolate. Without that step, the virus can keep spreading.
Julie Pedretti is the COVID-19 community relations director for Healthcare Network. She says testing remains an important piece of stopping the spread, because its going to take time for the country to reach herd immunity.
Its going to take many, many months before we can get to that 80% vaccine rate, Pedretti said. Until then, we cannot let our guard down.
Some testing sites have shut down or scaled back because of vaccination programs. Thats where Pedrettis team comes in.
We know that the Department of Health is very busy with vaccines, so were ramping up our testing events, Pedretti said.
Help is on the way from the federal government as well. President Joe Bidens pandemic response plan calls for widespread testing.
How exactly they get rolled out is not fully understood at the moment, but I believe that there will probably be a focus on schools, said Dr. Michael Mina, an epidemiologist at Harvard. There will probably be a focus on essential businesses, and I hope that theres also a focus on getting these tests into homes.
Harry Owens got his first shot, but it was not without a lot of patience.
We waited in line, I guess about maybe 7:45, something like that, they started to come around and give out tickets, Owens said. I was 795 out of 800.
At 64, Owens wife cant get the vaccine yet, and neither can his children nor his grandchildren.
Thats why Owens applauds the renewed focus on testing.
Theres a lot of people out there who are younger than 65 that arent able to get that shot soon anyway, Owens said. I think from that standpoint, I think its very important.
Healthcare Network is offering free COVID-19 testing Saturday at the Nichols Community Center in Golden Gate from 9 to 11 a.m. You dont need an appointment, but you do need to bring a mask and your ID.
Isnt it just better to know whether you have COVID or not? Pedretti said. Whether you would test positive or not? So you can protect yourself and your loved ones and the rest of the community.
MORE: National Strategy for the COVID-19 Response and Pandemic Preparedness
