As COVID-19 Cases Soar, Overwhelmed California Hospitals Worry About Rationing Care

California hospitals are stretched to their limits as intensive care units fill up and COVID-19 cases continue to soar, leaving some facilities facing the prospect of not being able to provide critical care for everyone who needs it.

On Friday, the nation's most populous state recorded 43,608 new cases, while almost 17,400 people are currently hospitalized with confirmed or suspected COVID-19 cases, according to the California Department of Public Health. Over 3,500 of those cases are being treated in intensive care units, putting immense strain on hospitals.

Nearly all of California is under stay at home orders as ICU capacity statewide hovers around 2%. In Southern California and the 12-county San Joaquin Valley area, ICU capacity has been exhausted, leaving some facilities to go into "surge" mode, putting critical patients in other parts of the hospital like emergency rooms or operating recovery rooms.

Brad Spellberg, the chief medical officer of LA County USC Medical Center — one of the largest hospitals in the state — told NPR member station KPCC that means some patients are waiting hours for care as hospitals struggle to free up beds as quickly as possible.

"We are the safety net — that is the point," Spellberg said. "The safety net itself is being stretched to the limit."

Some hospitals are now preparing for the possibility of rationing care in the coming weeks, according a document obtained by the Los Angeles Times. The document, which was circulated among doctors at four hospitals run by Los Angeles County, outlined guidelines on how to allocate resources in a crisis situation, shifting from a goal of trying to save every patient to instead saving as many as possible. This would mean that those less likely to survive would not receive the same care that they would in a non-crisis situation.

"Some compromise of standard of care is unavoidable; it is not that an entity, system, or locale chooses to limit resources, it is that the resources are clearly not available to provide care in a regular manner," the document reads, according to the Times.

In an email, L.A. County Health Services Director Dr. Christina Ghaly told the Times that the guidelines were not in place as of Friday night.

"We have enough beds, supplies, and equipment for now, but we don't have enough trained staff for the number of patients who need care. We have brought in new staff, retrained and redeployed staff from other areas of the system, and have requested additional resources from the state," Ghaly wrote. "But these measures are not anticipated to be enough to meet the continuously escalating number of patients that are presenting across the county for care."

Last week, California was forced to activate its "mass fatality" program, which coordinates mutual aid across several government agencies. According to the California Office of Emergency Services, a mass fatality is an incident in which more deaths take place in a period of time than can be handled by local coroner or medical emergency personnel.

The worsening crisis comes as residents across the state are preparing for a holiday season unlike any other. Under the state's stay-at-home order, residents are prohibited from gathering with anyone outside their immediate household.

The order has also meant strict new guidelines for businesses amid the holiday shopping season. While retail stores are allowed to remain open, they're limited to a 20% indoor capacity. Apple Inc. announced on Saturday that it would temporarily close all 53 of its stores in California in an effort to help curb the spread of the virus and encourage people to stay at home.

Still, it seems many are flocking to stores for last-minute gifts. On Saturday, NBC's Los Angeles affiliate tweeted and aerial video of overflowing parking lots at the Citadel Outlets shopping mall.

The state's COVID-19 restrictions have also forced major sporting events to change plans last minute. The Rose Bowl in Pasadena will no longer host this year's College Football Playoff semifinals after the state said it would not make an exception for player guests at the game. The game will instead be held in Arlington, Texas. Meanwhile, the San Francisco 49ers recently announced that they will be spending the remainder of their season in Arizona.

The restrictions and spike in cases come as the first shipment of the COVID-19 vaccine developed by Pfizer and BioNTech began arriving this past week. Gov. Gavin Newsom said some 721,500 total doses are expected in the state by the end of this week — and while the vaccine does provide hope, he urged residents to continue to be careful and stay at home.

"This is a deadly disease, a deadly pandemic, and we're in the middle of it right now," Newsom said. "We're near the end, but we're in the middle of the most acute peak."