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Essential California: 0% ICU availability in Southern California

A rack holds bags of personal protective equipment at Martin Luther King Community Hospital in Los Angeles.
A rack holds bags of personal protective equipment in the intensive care unit at Martin Luther King Jr. Community Hospital in Los Angeles.
(Francine Orr / Los Angeles Times)

Good morning, and welcome to the Essential California newsletter. It’s Friday, Dec. 18, and I’m writing from Los Angeles.

Addressing Angelenos from his mayoral residence instead of City Hall on Thursday night, L.A. Mayor Eric Garcetti warned that Los Angeles County may be required to “formally declare a systemwide crisis” in its hospitals in the coming days.

At a time when the virus has infiltrated Los Angeles like never before, the mayor was speaking from home because his 9-year-old daughter Maya had tested positive for COVID-19. The mayor and his wife have both tested negative thus far and will be quarantining from home.

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Earlier in the day, the availability of intensive care unit beds throughout Southern California hit 0%, and officials warned that conditions in hospitals are expected to erode further if COVID-19 continues to spread unchecked. The state defines the Southern California region as Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties.

[Read the story: “ICU availability in Southern California at 0%, and it’s going to get worse, officials warn” in the Los Angeles Times]

The number of hospitalized COVID-19 patients in Los Angeles County has increased at a staggering pace. For much of September and October, about 100 patients a day with COVID-19 were being newly admitted into hospitals in L.A. County daily. There are now about 600 new COVID-19 patients requiring hospitalization daily in the county, and officials expect that that number could rise to anywhere from 750 to 1,350 new COVID-19 patients a day by New Year’s Eve.

With ICUs filled, hospitals will step up measures to ensure the sickest patients still get the highest levels of care possible during the crisis, as my colleagues report. That often means moving some patients who would typically be in intensive care to other areas of the hospital, such as the emergency room.

Understanding what ICU availability actually means

ICU capacity is the number of staffed beds available at a point in time. ICUs are staffed by highly trained nurses and physicians who provide round-the-clock care to their patients, and the limiting factor is usually that staff, rather than the physical beds.

[See also: “ICU capacity explained: What to know about a key coronavirus metric in California” in the Los Angeles Times]

As my colleague Faith E. Pinho recently reported, the state determines a region’s ICU capacity with a weighted formula to ensure that some ICU beds remain open for non-COVID patients. So when the state says a region has reached 0%, it may actually still have some beds available. Capacity also fluctuates as patients exit the ICU and others enter.

Once those beds are full, a hospital goes into surge mode, which can accommodate up to 20% over its usual capacity. But when ICUs are stretched beyond capacity, the quality of care can decline and mortality rates can rise. Officials have also been training medical personnel who work elsewhere in hospitals to allow them to work in ICUs, and seeking nurses from outside the United States.

And now, here’s what’s happening across California:

Next in line for California’s COVID-19 vaccine? California’s first responders, farmworkers and educators would be among those next in line to be vaccinated against COVID-19 under recommendations that a state advisory committee discussed this week. Los Angeles Times

A government advisory panel endorsed a second COVID-19 vaccine Thursday, paving the way for the shot to be added to the U.S. vaccination campaign. FDA approval of the Moderna vaccine for emergency use is expected to quickly follow the advisory panel’s endorsement. Associated Press

What was your most indelible memory of 2020? Tell us about it, and we’ll share some of the responses in an end-of-the-year newsletter. Los Angeles Times

Note: Some of the sites we link to may limit the number of stories you can access without subscribing.

L.A. STORIES

The legal titan and the “Real Housewife”: Accused of stealing millions of dollars from vulnerable clients, lawyer Tom Girardi is facing the collapse of everything he holds dear: his law firm, marriage to a reality TV star, and reputation as a champion for the downtrodden. Los Angeles Times

Tom and Erika Girardi on "Real Housewives of Beverly Hills"
(Bravo)

“It’s probably been the worst year for our industry since Prohibition.” With COVID stimulus in sight, L.A.’s desperate nightclub owners hope it’s not too little, too late. Los Angeles Times

Mayor Garcetti won’t serve in the Biden administration. The mayor said Thursday that he had turned down overtures from the administration and told the president’s team he was needed in Los Angeles. He declined to name the positions that had been available to him. Los Angeles Times

After her COVID-19 ICU stay, a San Fernando Valley grandmother delivered hundreds of homemade tamales to Cedars-Sinai healthcare workers. It took her five days to make all of the tamales. KTLA

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POLITICS AND GOVERNMENT

Environmental justice groups block Mary Nichols’ path to lead the EPA: Nichols cultivated a national reputation as chair of the California Air Resources Board, but her support for California’s cap-and-trade program drew opposition — ultimately derailing her prospects of leading the the Environmental Protection Agency. Los Angeles Times

President-elect Joe Biden will nominate Rep. Deb Haaland to lead the Interior Department, making history by selecting the first Native American to oversee the agency. Los Angeles Times

CRIME AND COURTS

A former EDD worker allegedly used Sen. Dianne Feinstein’s name to scam jobless benefits. The ex-employee is accused of filing more than 100 false pandemic unemployment assistance claims using stolen personal information. Los Angeles Times

HEALTH AND THE ENVIRONMENT

As COVID-19 infections in their jails soar, an unmasked party attended by Northern California correctional deputies is under scrutiny: The Santa Clara County Sheriff’s Office said it was not aware of the off-duty party — which took place earlier this month — until a news organization asked about it this week, and that it was now reviewing the event. Mercury News

CALIFORNIA CULTURE

Despite shuttered campuses, some Silicon Valley tech firms are still paying cafeteria workers and janitors. “It’s not typical,” said UC Berkeley economics professor Enrico Moretti, adding that the move presumably reflects the colossal economic gains the tech sector has made during the pandemic. Cal Matters

Yosemite’s Ahwahnee hotel hosted a massive Thanksgiving feast. Unmasked guests had workers appalled. SF Gate

Until recently, it was almost impossible for California’s incarcerated firefighters to pursue a career after their release. A new state law changed that. The L.A. Times documentary short “Firefighting After Prison” takes you into the lives of two people hoping to become firefighters and give back to their communities. Los Angeles Times

A poem to start your Friday: “Spring and All” by William Carlos Williams. Library of America

Free online games

Get our free daily crossword puzzle, sudoku, word search and arcade games in our new game center at latimes.com/games.

CALIFORNIA ALMANAC

Los Angeles: sunny, 70. San Diego: sunny, 66. San Francisco: sunny, 57. San Jose: sunny, 61. Fresno: sunny, 55. Sacramento: sunny, 57. More weather is here.

AND FINALLY

Today’s California memory comes from Marie Davis:

Growing up on the family chicken ranch in the 1950s Valley, memories of beauty overwhelm me. The purple San Gabriels from every window; sweet tall grasses through which we kids would run for acres to the tangerine groves; perfume of citrus blossoms. When daddy died I hiked for solace through the hills, finding sheep and shepherds. Time brings tides of change, but I never lose touch with the beauty of the land which underlies all that human Los Angeles is. Beneath freeways and homes and busy lives, she is still there, holding us; there is peace in pausing to feel that.

If you have a memory or story about the Golden State, share it with us. (Please keep your story to 100 words.)

Please let us know what we can do to make this newsletter more useful to you. Send comments, complaints, ideas and unrelated book recommendations to Julia Wick. Follow her on Twitter @Sherlyholmes.


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