How would you describe the current situation in Los Angeles relative to COVID 19?
· DPH report Wed 1/13: The Los Angeles County Department of Public Health (Public Health) confirmed 281 new deaths and 14,564 new cases of COVID-19. To date, Public Health identified 958,497 positive cases of COVID-19 across all areas of L.A. County and a total of 12,955 deaths. The county is experiencing horrific loss of life due to COVID-19. Over the last seven days, 1,606 people lost their lives, and this is an average of nearly 230 deaths per day.
· Total tested: Testing results are available for more than 5,077,000 individuals with 18% of people testing positive.
· Age statistic: >90% of patients who die of Covid in LAC are 50+ over. Of the 288 new deaths reported two days ago, 100 people that passed away were over the age of 80, 106 people who died were between the ages of 65 and 79, 61 people who died were between the ages of 50 and 64, 17 people who died were between the ages of 30 and 49, and two people who died were between the ages of 18 and 29. One death was reported by the City of Pasadena.
· Disproportionately affecting communities of color: As the COVID-19 pandemic worsens, certain groups are again bearing a greater burden of serious illness than others. Latino/Latinx residents are now experiencing a 7-day cumulative rate that has more than doubled, from 773 cases per 100,000 people on December 1, to 1,763 cases per 100,000 people on January 6. This is more than two times that of African American/Black residents, the group with the second highest case rate of about 790 cases per 100,000 individuals. White residents experienced 650 cases per 100,000 people and Asian residents are close behind with 555 cases per 100,000 individuals.
· The County is witnessing the tragedy from the surge in cases, and Latino/Latinx residents are faring the worst. In early-November, the death rate among Latino/Latinx residents increased more than 800%, from 3.5 deaths per 100,000 residents a day to 28 deaths per 100,000 residents a day. Over this same period, the death rate among African American/Black residents increased from less than 1 death per 100,000 people a day to more than 15 deaths per 100,000 people. Deaths also have increased dramatically among Asian residents, from 0.5 deaths per 100,000 people in early November to 12 deaths per 100,000 people and among White residents, there are now at 10 deaths per 100,000 people.
· Current inpatient counts: There are 7,949 people with COVID-19 currently hospitalized and 22% of these people are in the ICU. While the number of people hospitalized with COVID-19 each day has stabilized over the last few days at slightly under 8,000 patients, the demand on our healthcare system and hospitals remains overwhelming.
· Workplace outbreaks: The COVID-19 surge in Los Angeles County has contributed to a surge in outbreaks at workplaces across the county, including grocery stores, warehouses, manufacturing facilities, and many other workplaces where people come together on a daily basis. The largest increase is among general worksites, which includes warehouses, manufacturing facilities and logistics companies. In just over a month, outbreaks at these worksites increased from 9 per week on November 1, to 44 per week on December 6, nearly a fivefold increase.
· Schools: The County has also experienced an increase in outbreaks in schools and daycare settings. Starting in the middle of November, outbreaks increased from about 20 outbreaks to a total of 70 outbreaks by mid-December. And while almost all the outbreaks were small and well-contained, dozens of staff and a small number of students were affected.
· Vaccine: Public Health reports as of Tuesday, more than 194,000 first does of the COVID-19 vaccine have been administered to those in Phase 1A. In addition, more than 44,000 second doses have been administered. Public Health is ramping up capacity to complete vaccinations for the approximately 500,000 frontline healthcare workers. This currently includes adding dozens more pharmacies and healthcare clinics, as well as the addition of five new large-capacity vaccination sites (megaPODs) that the county is opening next Tuesday. These vaccination sites are only open to healthcare workers in Phase 1A. Healthcare workers can register for an appointment and must show job verification when showing up for their vaccine. The registration system for these five large-capacity vaccination centers for healthcare workers opened today. Please visit the healthcare worker signup http://publichealth.lacounty.gov/acd/ncorona2019/vaccine/hcwsignup/pods/.
· Vaccine goal: The current goal is to complete vaccinations of frontline healthcare workers and staff and residents at skilled nursing facilities by the end of January. As the County completes Phase 1A, we can look to starting vaccinations for groups within next phase – 1B, starting with those who are 65 and older as noted by the Governor today. We are working with the State to identify additional vaccine doses so that we can start to schedule appointments once the doses arrive.
Does LACMA Support A Shutdown of Businesses to Reduce Transmission?
· Businesses that are not adhering to safety protocols to protect workers and customers contribute to increased risk for COVID-19 spread. A list of non-compliant businesses that received citations can be found online. What is also concerning is that the largest increase in County covid infections has been among general worksites, which includes warehouses, manufacturing facilities and logistics companies. In just over a month, outbreaks at these worksites increased from 9 per week on November 1, to 44 per week on December 6, nearly a fivefold increase.
· Public Health encourages businesses to take advantage of the COVID-19 Safety Compliance Certification Program. The program provides business owners and employees the opportunity to take a free online training about COVID-19 infection control protocols and allows businesses to self-certify that they are fully implementing protocols in compliance with infection control and physical distancing requirements. To date, a total of 19,052 employees and employers have completed the training.
· We acknowledge that there continues to be far too many gatherings, parties, and celebrations post-holiday that has contributed to increased cases; the outcome of the holidays was projected to be disastrous and that has been confirmed with the latest numbers – though we are seeing a possible slight plateau.
What is the important message LACMA is sharing?
· We encourage Angelenos to follow the science, and therefore remain at home as much as possible during this ongoing and devastating surge. We support public policies aimed at decreasing the spread of the virus: when leaving home for essential services, wear a mask, practice social distancing at least 6 feet away from people you do not live with, continue frequent hand washing – and there should be no mingling, no crowding, especially with other households.
· We encourage people to isolate immediately from family and others if people have symptoms or test positive for COVID-19. Individuals with underlying health conditions and those that are older should remain in their home and not be around others unless seeking essential health and dental care. If you are having severe symptoms including difficulty breathing, persistent pain or pressure in the chest, inability to wake or stay awake and/or bluish lips or face, go to an emergency room or call 911.[DRS1]
Does LACMA Support The County’s Reopening Protocols?
· The Reopening Protocols, COVID-19 Surveillance Interactive Dashboard, Roadmap to Recovery, Recovery Dashboard protects the community.
Does LACMA Support Governor Gavin Newsom’s changes to COVID-19 vaccination eligibility guidelines ?
· Yes, since it translates to vaccinating key populations, specifically communities of color and allows counties to begin immediately vaccinating anyone over age 65.
· Additionally, the changes will ideally accelerate the rate of vaccinations across the County and State, as we want to get people vaccinated as quickly as possible, though this may pose a challenge with the sudden need for large numbers of personnel to administer the vaccines – when so many health care personnel are currently working in LA hospitals taking care of Covid patients.
Is the distribution of vaccines working?
· LACMA supports the new LA County system that lets people know if they are eligible to receive a vaccine, and if not yet eligible, to register for a notification via email or text when they are eligible.
· A second phase of that system will help counties, cities and others run mass vaccination events. It will include a way for eligible members of the public to schedule their vaccination appointments at those events.
· Individuals in Phase 1A – health care workers and long-term care residents – remain the highest priority to receive vaccines as demand for the vaccines continues to exceed supply. However, the new guidelines are intended to increase the pace of COVID-19 vaccine distribution to those at greatest risk. As of Monday, California had administered less than 1/3 of the 2.4 million doses of COVID-19 vaccine it has received.
What is LACMA Doing Specifically to Help?
We work side by side with LA DPH on physician communications, public education, and public health efforts. For example, we alert physicians with vaccine updates, which including current vaccination sites, supplies and more. We have also been very active in creating communications to support public health efforts, especially around social distancing, wearing a mask, and frequent handwashing.
We have also mobilized seven other medical society presidents to support the work of our public health officers in southern California, forming a new and historic partnership: The Southern California Medical Society Presidents Council. The Council has partnered with county officials on public education efforts, staffed county Covid-19 Committees and sharing clinical expertise, and promoted public health guidelines.
Would you say the Governor has mismanaged the vaccine roll out, the Tier process which seems punitive and is anti-business and missed the mark when it comes to doctors getting vaccinated?
The pandemic is the most devastating public health crisis the nation has ever faced in the past century as it has challenged all of us to cooperative, be vigilant, coordinate better, look at what is working, what not working - so I commend his leadership and that shared by Dr Ghaly (state DPH), Dr. Ferrer (LA DPH) and Dr. Muntu Davis, Health Officer and a member of our LACMA board of directors, for constantly reaching out to ask medical professionals and community stakeholders on what is needed, when and where.
We have heard that California has been slow to improve infections, hospitalizations, and deaths because of a combination of an apathetic public combined with a lack of mask mandate and not enough resources, PPEs, and state action. True?
I have not seen inaction on the part of the state or local public health officials. We must follow the guidance of our county, state and national health officials, including Dr. Fauci. There are glimmers of hope around the corner, as LA may be seeing the very early start of a plateau in cases. This is in stark contrast to the unspeakable - full ICUs, lack of inpatient beds, equipment, and health care staff.
So, do you think patient rationing is a needed move, as hard as that might be?
Physicians take an oath to first do no harm - so we need to focus on saving every life we can, stopping the spread of this disease, taking care of our healthcare teams - including physicians, nurses, and other essential healthcare workers because they are suffering. They are exhausted, physically and psychologically. And PTSD will be a reality for all of us to address once COVID 19 is behind us.
(Addendum: Crisis standards of care: most efficient use of limited resources for the greatest benefit of patients – and save the most lives. Without a formal crisis standards of care declaration, decisions regarding allocation of scare resources (eg. ventilator, bed) are made by doctors who are often not trained bioethicists in this sort of decision-making. Medical training teaches doctors to pursue the best for each patient, but this is often impossible during a crisis. Crisis protocols, which are enacted when declarations of crisis standards of care are made, maximize lives saved, and prioritize public health ethics.)
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