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What the Heck Happened to Los Angeles? (COVID Edition)

EASTSIDER-It is clear to everyone who lives here that Los Angeles (City and County) is the new national epicenter for COVID-19 and its variants. So how did we hunker down over the holidays? 

Two LA Times articles tell it all. First, on December 23, we were informed in a headline that COVID-19 surges at LA County shopping malls as holiday customers pack stores.” 

“Indeed, as COVID spreads faster than ever in LA County, it has reached malls, too. The vast majority of outbreaks reported at shopping malls during the pandemic were reported in the past four weeks, according to a Times analysis of data posted on the county’s website. An outbreak is defined as three or more cases among staff in a 14-day period.” 

This memorial to idiocy was then topped four days later on December 27, by another mind-boggling headline: Tens of thousands expected to travel, pass through LAX in coming week.” 

“The Transportation Security Administration screened 1.176 million passengers the Sunday after Thanksgiving, one of the busiest travel days of the year — and 1.191 million passengers the day before Christmas Eve, according to agency data. Many are expected to begin returning home to Southern California on Sunday.” 

And this week we find that we are now up to 10,000 deaths in LA County, with 1000 occurring since December 30. 

Health Services Stresses 

So, going into the Christmas/New Year’s Eve celebrations, here’s where the actual health care services personnel stood: 

ICU beds available? Zero. 

Available ICU staff like ER doctors, nurses, respiratory therapists, LVN’s? Maxed out.  

Traveling physicians, nurses, and the like (a few at healthy premiums for risking their lives)? They’re burning out and getting sick too. 

Dolts who travel between Christmas and New Year’s? Millions. 

And if all the so far accurate statistical information is in the ballpark, we will have another huge surge of COVID-19 hospitalizations in about two weeks. Thus, the thanks a bunch comment. 

So let’s see what this means to the health care professionals we rely on to keep us alive and able to recover from the COVID-19 virus. Like ICU physicians, ICU nurses, respiratory therapists, and all the other brave (yes, brave) health care professionals who try to keep us alive. 

To be an ICU physician, usually you must first become an internist. According to the American College of Physicians: 

To become an internist, a graduate of a four-year medical school must complete a residency in internal medicine, which usually lasts three years. Once general internal medicine residency training is complete, a physician may begin to practice internal medicine, or an internist may then choose to subspecialize in a particular area of internal medicine, for example, cardiology or infectious diseases. Subspecialty training, called fellowship, calls for two to three years of additional training.” 

And we have this additional set of requirements for full critical care

When combined with subspecialty training in pulmonary medicine (pulmonary and critical care medicine), a three-year fellowship is required after which the trainee is eligible for subspecialty certification in both pulmonary medicine and critical care medicine. 

For other internal medicine physicians, different routes of training in critical care medicine are available: 

  • A two-year accredited fellowship in critical care medicine after the internal medicine residency 
  • Two years of fellowship training in advanced general internal medicine (that include at least six months of critical care medicine) plus one year of accredited fellowship training in critical care medicine 
  • Two years of accredited fellowship training in a subspecialty of internal medicine (three years for cardiovascular disease or gastrointestinal disease) plus one year of accredited clinical fellowship training in critical care medicine 

Similarly, there are stringent requirements to become a Certified ICU Nurse: 

The most popular certification for ICU nurses is the certification for Adult Pediatric and Neonatal Critical Care Nurses (CCRN) awarded by the American Association of Critical Care Nurses. 

To be eligible to sit for the CCRN exam, nurses must meet the following criteria: 

  • Practice as an RN or APRN for 1,750 hours in direct care of acutely/critically ill pediatric patients during the previous two years, with 875 of those hours accrued in the most recent year preceding application 

OR 

  • Practice as an RN or APRN for at least five years with a minimum of 2,000 hours in direct care of acutely/critically ill patients, with 144 of those hours accrued in the most recent year preceding application 

According to the CCRN website, eligible clinical practice hours have to meet the following criteria: 

  • Must be completed in a U.S.-based or Canada-based facility or in a facility determined to be comparable to the U.S. standard of acute/critical care nursing practice. 
  • Are spent actively providing direct care to acutely/critically ill patients or spent supervising nurses or nursing students at the bedside of acutely/critically ill patients, if working as a manager, educator, preceptor or APRN. The majority of practice hours for exam eligibility must be focused on critically ill patients. 
  • Are verifiable by your clinical supervisor or professional colleague (RN or physician). Contact information must be provided for verification of eligibility related to clinical hours, to be used if you are selected for audit. 
  • CCRNs that work in areas such as intensive care units, cardiac care units, combined ICU/CCUs, medical/surgical ICUs, trauma units or critical care transport/flight. If you are unsure if your practice unit unit qualifies, discuss the requirements with your unit nurse educator or nurse manager.  

Visit www.aacn.org for more information about CCRN certification.  I take all this space to demonstrate two realities that none of us can change. First, it takes a long time and a lot of education to become an ICU Dr or Nurse. Second, we are running out of them as knowingly dangerous behavior aka bad choices by certain people are overflowing all the ICU beds in Los Angeles County. 

So every time one of these precious ICU staff burn out or get sick themselves as they try to save our lives, there are no replacements! 

Free Speech and Inalienable Right to be Stupid 

As an old 60s Berkeley type, I have a core belief in the First Amendment, and in the individual rights of each of us has to be as stupid, opinionated, and contrary as we want. 

So personally, if a bunch of Angelenos want to ignore the guidance, run around without masks, social distancing, and/or in large groups, I don’t care. Party hearty. I also don’t care if they get the virus, and wind up dying dirty in the back of an ambulance as they can’t stay alive for the 6-8 hour wait before they even get into a hospital. 

I do object, however, to their destroying or sidelining the already slim stock of ICU staff who the rest of us rely on to keep us alive in the event these people infect me or mine.  

Many of us have been playing by the rules, which translates into being hunkered down at home for the majority of 2020. I do understand the plight of those who are essential workers, or have to work or go totally broke. I think the majority of them have been as careful as they can to avoid being infected. They are in a terrible position and I hope all of them can escape this virus. 

But it’s hard to have sympathy for those who deliberately ignore the guidance put in place to keep us all safe -- those gathering in large groups, partying, traveling on airplanes, and pretty much ignoring the realities of COVID-19. 

The Takeaway 

The folks I really feel sorry for are the increasingly large numbers of Angelenos who live in substandard rental housing because they can’t afford anything better, and also often have a number of people in the household to stretch waning resources. That’s inherently dangerous, as is the fact that they may even be evicted at some point because there is no rent forgiveness or repayment breaks expected in the future. 

These are the good people who have to be out and about because there is no government support, and they have to do what they have to do to bring in money. Truth is, many of the temp/part time jobs they do get come with a high risk of getting the virus. That sucks. 

So give us all a break -- follow the guidelines designed to keep us safe, recognize that if you merely go out on the street, you are seriously at risk in LA. If nothing else, take note of the recent ambulance guidelines enacted: If the paramedics don’t think you are likely to make it, they should just wait for you to die and not bother the overwhelmed hospital system. 

Remember, as the LA Times reported on January 5: 

“About one in every five people getting tested for the coronavirus are positive — a quintupling since Nov. 1. 

And conditions are expected to worsen in the coming weeks as people who got infected during the winter holidays get sick. 

“Everyone should keep in mind that community transmission rates are so high that you run the risk of an exposure whenever you leave your home,” Los Angeles County Public Health Director Barbara Ferrer said. “Assume that this deadly invisible virus is everywhere, looking for a willing host.” 

So pray we get the vaccinations right and ramp up the delivery system so that we can all get vaccinated in the next month or so. Please.

 

(Tony Butka is an Eastside community activist, who has served on a neighborhood council, has a background in government and is a contributor to CityWatch.) Photo: ABC News. Edited for CityWatch by Linda Abrams.