Already overworked and strained Los Angeles County ICU doctors brace themselves for another anticipated surge in COVID-19 patients

• Doctors in Los Angeles County are bracing themselves for a likely rise in an already surging number of COVID-19 cases and hospitalizations.
• Physicians told Business Insider that their hospitals are running through multiple contingency plans to figure out how to best treat patients, maintain supplies, and keep healthcare workers safe.
• Los Angeles County has averaged over 14,000 daily new cases over the past week.
• Visit Business Insider’s homepage for more stories.

Doctors in Los Angeles County – the country’s most populous county home to more than 10 million residents – are planning multiple measures to handle an anticipated rise in the current surge of COVID-19 infections and hospitalizations. 

Los Angeles County has seen a sharp increase in novel coronavirus infections, hospitalizations, and death since November, with public health experts mainly attributing it to people ignoring social distancing measures during the holidays.

Healthcare workers in several hospitals across the county told Business Insider that they’re already overworked and at a high capacity of COVID-19 patients. Nonetheless, they’re tirelessly working on contingency plans ahead of an expected rise in cases following Christmas and the New Year holidays.

Los Angeles had an average of more than 14,000 daily new cases over the past week, according to data compiled by The New York Times. 

The Los Angeles Times reported the positivity rate of COVID-19 tests is now at 17% across the county, more than four times what it was on November 1.

Dr. Greg Kelman, Regional Medical Director of Operations at Southern California Kaiser Permanente Medical Group, told Business Insider that 80% of inpatients are being treated for COVID-19. 

So far, the group has worked to help train healthcare workers whose roles have been reduced, due to the postponement of elective surgeries, on roles relating to the treatment of COVID-19 patients. 

Kelman explained that the network has a series of plans to address a potential surge, however, he hopes it doesn't reach that far. 

He explained that, so far, to accommodate the current surge, the hospital has shifted to allow for more virtual visits to help keep space available for people who have to come in. They've also reduced some of their routine care and cut out things like elective procedures. 

If the surge continues Kelman said they may have to cut down even more routine care. Additional efforts include working with state regulators to get more people to help out in a healthcare setting even if it's just individuals who are simply bringing equipment or answering calls, or even getting nursing school students to help, or even calling on out of state Kaiser Permanente networks to help out if the surge gets too high. 

"After plan B, there's a plan C, and after plan C there's a plan D. We just hope not to go through all the alphabet," Kelman said. 

Some hospitals have been so strapped for physical space to host patients that they've had to treat some in their gift shop or chapel.

Kelman said his hospital has adapted to turn different departments, such as some areas in the emergency room, into spaces that accommodate ICU needs to see COVID-19 patients. 

Dr. Tamara Chambers, an ICU physician at Los Angeles County + USC Medical Center told Business Insider that compared to March, a lot more people of all ages are now coming in to be treated.

"In March, we were seeing much older patients - lots of nursing home patients. Now we're seeing all ages, all genders. We're seeing everyone, it has not discriminated. Many people have underlying conditions, but not all. So this virus has really evaded comprehension," she said. 

Chambers said that unless people take this more seriously it's going to become more difficult for hospitals and healthcare workers to provide adequate care for all patients. 

"We're really doing our best to try and hold the fort, but as long as people continue to fail public health measures and advice, then I think we're going to continue to see the surge," she said. 

She added that this isn't just an issue of providing care but said that healthcare workers are stressed. 

"Despite the number of beds that we have everybody's been fighting this fight since at least March, and people are tired. Workers are tired, workers are sick. It's taken a huge emotional and physical toll o everyone," Chambers said. "I worry about the continuity of the healthcare system and healthcare workers being able to provide care."

She added that staff members are also getting sick with COVID-19, which means there are sometimes fewer people who are able to treat patients, which in turn places more stress on other workers. 

Kelman highlighted that while it's likely to catch COVID-19 working with patients, he said more workers were catching the virus in their community rather than in controlled settings where they have protective equipment and know the people they are working with have the virus.

Despite that, both Kelman and Chambers worry that about the risk they take working closely with COVID-19 patients and if they may then spread the virus to their families. 

On top of that fear, the rising number of deaths, Chambers said, was taking an emotional toll on her and other workers.

"You're seeing a lot of deaths in ways that we don't normally see. Usually our patients, they get well and they move through their continuum of care and there are not these issues, but now you're seeing patients die on a regular basis every day," she said. 

Supply shortages are also a concern for the physicians. At least five hospitals in the county had to declare internal disasters and were forced to reroute ambulances to other facilities over concerns about their oxygen supply earlier this week.

Kelman explained that while they haven't really face pressing shortages yet, they've coordinated with other Kaiser Permanente hospitals in the region to help supply things like oxygen. So if one hospital is short another one will send over a supply. 

Both Kelman and Chambers said they're worried about having enough resources, like drugs, if cases continue to surge. 

While both physicians understand that people are facing pandemic fatigue and want to see their friends and family, they urge the public to make decisions that help stop the spread of the virus. 

"I think we're being referred to as the frontline, but really we're the last line. We rely on public health and safety measures," Chambers said. "We rely on people to stay home. We are trying to be the last line and provide the last level of care and support but there's only so much we can do."