LA Sees Far Less Critical Illness Amid Omicron Wave

Despite an unprecedented spike in cases fueled by the Omicron variant, Los Angeles County hospitals are seeing far fewer critically ill coronavirus-positive patients than last winter.

Officials stress that the health care system still faces serious challenges with so many people infected, and it’s unclear how close the Omicron wave is to its peak. LA County ambulance services and hospitals are also struggling with staff shortages related to the coronavirus as more of their employees become infected.

But the early data seems to reflect the experience elsewhere – that Omicron, while much more transmissible than the previously dominant Delta variant, also tends to cause less severe symptoms, especially in those who have been vaccinated and boosted.

“This is very different from what we experienced a year ago,” said Dr. Brad Spellberg, Chief Medical Officer of the Los Angeles County-USC Medical Center, Friday. “Obviously, the number of positive tests is actually higher than it was a year ago — and I understand why that’s really scary, in terms of these rising numbers — but the average disease level is significantly lower.”

This week marked a year since the worst period of the pandemic hit locally, as the number of COVID-19 patients hospitalized in LA County rose to its all-time high of 8,098 on Jan. 5. three days later, intensive care units peaked at 1,731, at a time when hospital morgues were overcrowded.

On Thursday, there were 2,902 coronavirus-positive patients in LA County hospitals, 391 of whom were in intensive care. And while the number of coronavirus positive hospitalizations continues to rise, there are other signs that the Omicron wave will look different than before.

The total number of people admitted to hospitals in LA County for all reasons — COVID and otherwise — has actually been stable lately. During last winter’s wave, more than 16,000 people were hospitalized for a variety of reasons. This winter, that figure hovers around 13,000, according to data presented by Barbara Ferrer, director of the county’s Public Health.

“Now this could of course change. Hospital admissions are a lagging indicator. And as the cases increase, shortly thereafter, we start to see the increase in hospitalizations,” Ferrer said at a briefing on Thursday. “But I do want to point out that [this winter] we have not seen the same increase as at the start of the winter wave last year. ”

While the number of hospitalized patients testing positive for the coronavirus has risen rapidly recently, COVID-19 patients still occupy a relatively low percentage of the province’s intensive care beds.

Currently, approximately 7% of LA County’s total staffed ICU beds are occupied by COVID-19 patients. During the summer Delta wave, 15% of ICU beds were used by COVID patients, and last winter that share was over 50%.

In addition, many coronavirus-positive patients seek hospital care for non-COVID reasons, such as for hip replacement surgery, heart surgery or cancer treatment, Ferrer said, and their coronavirus diagnoses were confirmed only because hospitals require incoming patients to be tested.

In early November — before Omicron swept the world and Delta was still dominant — 75% of coronavirus-positive patients across the country were hospitalized for COVID-related medical problems, Ferrer said.

But in late December, Ferrer estimated that the same was true for only 45% of corona-positive hospital patients. That means a majority of coronavirus-positive patients are now hospitalized for reasons unrelated to COVID, “and would likely have been hospitalized regardless of their coronavirus infection,” Ferrer said.

“If you have a lot of community transmission, you’re going to have more people who test positive, who are asymptomatic for COVID disease, but in this case are hospitalized for something else,” she said.

During last winter’s COVID-19 peak, about 80% of COVID-positive patients in the emergency department were hospitalized, and nearly half of those went to the ICU, Spellberg said. Now only about a third of COVID-positive patients are admitted, and about 20 to 25% of those go to the ICU.

“That gives you an idea of ​​the size difference,” he said. “This is why last year was much more stressful in many ways. Last year we came within reach of triage patients.”

Still, it’s important to note that coronavirus-positive patients — regardless of why they were specifically admitted — are tricky to treat.

“People who test positive for COVID need resource-intensive, transmission-based precautions, including isolation rooms, cohort personnel and personal protective equipment, all of which place a particularly high burden,” Ferrer said.

The fact that there are now fewer critically ill COVID-19 patients than during previous waves is likely due to a number of factors, including the sheer number of residents who have been vaccinated or previously exposed to the virus.

In LA County, 75% of residents of all ages have received at least one dose of vaccine and 67% are fully vaccinated. About a quarter of the residents of the province have also received a booster dose.

Another likely explanation is that Omicron is less likely to infect the lungs. The variant is apparently more contagious in the upper respiratory tract, which is less of a concern for adults but can cause problems for very young children.

If many patients – especially those who have been vaccinated – are less sick, hospitals should be able to turn beds much more quickly.

While generally milder, Omicron is so contagious that the staff shortage, at least in some places, is now worse than during previous peaks.

“We’re cramped in the hospital not so much because of a flow of patients, but because we have patients coming in and some beds are closed,” Spellberg said.

This week, LA County assistant fire chief Brian Bennett said ambulance services were so hampered by infections — with perhaps half of their workforce unavailable for coronavirus-related reasons — that firefighters sometimes had to use fire trucks to transport patients.

“This is kind of unprecedented,” Bennett said in a briefing to the Carson City Council this week. For those with mild problems, firefighters “encourage residents to find a private vehicle or alternative methods of getting to the hospital so we can save those ambulances for the critical patients.”

The Los Angeles Fire Department is also seeing large numbers of firefighters who are unable to work because of the coronavirus, Chief Commissioner Ralph Terrazas said at a briefing. On Wednesday, 299 firefighters were unable to work due to the coronavirus, Terrazas said. A few weeks ago, that number was 24.

“It’s the highest we’ve ever seen,” Terrazas said of the fire department, which has nearly 3,800 employees. The department is canceling time off to maintain daily staffing levels, he added.

LA County officials also say 911 response times have deteriorated and ambulances are experiencing delays in dropping patients off at hospitals.

The Omicron variant, which now accounts for more than 85% of the cases analyzed in LA County, is easily the most contagious strain of the coronavirus to date — two to four times more transmissible than the Delta variant.

And that infects many more people at the same time.

LA County reported 43,712 new cases on Friday alone — the highest total ever in a single day. The previous reported record, 37,215, came on Thursday. At the peak of last winter’s wave, about 16,000 cases per day were reported weekly.

“If you have a ton of transmission like we have now, it affects everyone’s workforce. Everyone is understaffed…and certainly hospitals and healthcare providers are dealing with staffing issues,” Ferrer said.

“So that’s the real difference between what we have now and what we had, like when we had the Delta peak — where we actually had a lot of patients that needed hospital care, but we didn’t have that raging infection rate that made it real.” super hard to have enough staff to take care of people.”

While breakthrough infections among vaccinated and boosted people are becoming more common because of Omicron, unvaccinated people are still much more likely to get infected. In the week ending Christmas Day, it was confirmed that for every 100,000 unvaccinated people in LA County, 991 people had the coronavirus.

For every 100,000 people who were fully vaccinated, but not yet boosted, there were 588 new cases of coronavirus. And for every 100,000 that got their booster shot, there were 254 new cases of coronavirus that week.

That means unvaccinated county residents were four times more likely to report a coronavirus infection compared to vaccinated people who received their booster shot.

Unvaccinated LA County residents were also nine times more likely to be hospitalized than vaccinated but unvaccinated people. Compared to boosted people, they were 38 times more likely.

The number of coronavirus cases has risen dramatically among all racial and ethnic groups in LA County and is highest among black residents. For the 14-day period ending December 30, there were 1,558 new cases of coronavirus per 100,000 black residents. The comparable rates were 1,132 for white residents, 977 for Asian Americans and 947 for Latinos.

Holly Mitchell, the chairman of the LA County Board of Supervisors, said the high number of cases among black residents is a reflection of the community’s lower vaccination coverage.

“Hence my urging, my constant, vigilant encouragement to get people vaccinated,” Mitchell said. “If we get vaccinated, we will definitely be reduced in terms of hospitalization, disease severity and eventual death.”

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