L.A. seeing far less critical illness amid Omicron surge

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 they did last winter.

Officials emphasize that the healthcare system still faces serious challenges because so many people are being infected, and it’s unclear how close the Omicron wave is to peaking. L.A. County ambulance services and hospitals also are contending with coronavirus-related staffing shortages as more of their workers become infected.

But the early data seem to reflect the experience elsewhere — that Omicron, while far 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 week marked the one-year anniversary of the most difficult period of the pandemic locally, when the number of COVID-19 patients hospitalized in L.A. County soared to its all-time high: 8,098, on Jan. 5. The number of people in intensive care peaked at 1,731 three days later, at a time when hospital morgues were overflowing.

As of Wednesday, there were 2,661 coronavirus-positive patients in L.A. County hospitals, including 352 in intensive care. And while coronavirus-positive hospital admissions are still trending upward, there are other signs that the Omicron wave will look different from those that came before.

The overall number of people admitted into hospitals in L.A. County for all reasons — COVID and otherwise — has actually remained stable recently. During last winter’s surge, more than 16,000 people were hospitalized for all reasons. This winter, that figure has been hovering around 13,000, according to data presented by county Public Health Director Barbara Ferrer.

“Now, this can change, obviously. Hospitalizations are a lagging indicator. And as cases go up, shortly afterwards, we start seeing the increases in hospitalizations,” Ferrer said during a briefing Thursday. “But I do want to note that [this winter] we haven’t seen the same rise we saw at the beginning of the winter surge last year.”

And, even though the number of hospitalized patients testing positive for the coronavirus has risen quickly recently, COVID-19 patients are still occupying a relatively low percentage of the county’s intensive care beds.

Currently, about 7% of L.A. County’s total staffed ICU beds are taken up by COVID-19 patients. During the summer Delta wave, 15% of ICU beds were used by COVID patients, and last winter, that share was more than 50%.

In addition, many coronavirus-positive patients are seeking hospital care for non-COVID reasons, such as for a hip replacement, 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 around the world and Delta was still dominant — 75% of coronavirus-positive patients countywide were in the hospital for COVID-related medical issues, Ferrer said.

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

“When you’ve got a lot of community transmission, you’re going to have more people testing positive, who are asymptomatic for COVID illness, but in this case getting hospitalized for something else,” she said.

Still, it’s important to note that coronavirus-positive patients are tricky to treat, even if they’re in the hospital for other reasons.

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

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

In L.A. County, 75% of residents of all ages have received at least one dose of vaccine, and 67% are fully vaccinated. About one-quarter of the county’s residents have also received a booster dose.

Another likely explanation is that Omicron appears to be less likely to infect the lungs. The variant is seemingly more contagious in the upper airways, which is of less concern for adults but can pose problems for very young children.

While it is milder on the whole, Omicron is so contagious that staffing shortages are, at least in some places, worse now than in previous surges.

This week, L.A. County Assistant Fire Chief Brian Bennett said ambulance companies were so hobbled by infections — with maybe half of their workforce unavailable for coronavirus-related reasons — that firefighters at times 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 people with mild issues, firefighters are “encouraging the residents to either find a private vehicle or alternative methods to get to the hospital so that we can save those ambulances for the critical patients.”

The Los Angeles Fire Department is also seeing high numbers of firefighters unable to work due to the coronavirus, Chief Ralph Terrazas said at a briefing. As of Wednesday, 299 firefighters were unable to work due to the coronavirus, Terrazas said. Just a few weeks ago, that number was 24.

“It’s the highest we’ve seen at any one time,” Terrazas said of the Fire Department, which has nearly 3,800 workers. The department is canceling time off to maintain daily staffing, he added.

L.A. County officials also say 911 response times have worsened, and ambulances are facing delays in dropping off patients at hospitals.

The Omicron variant, which now comprises more than 85% of analyzed cases in L.A. County, is easily the coronavirus’ most contagious strain yet — two to four times as transmissible as the Delta variant.

And that’s infecting far more people simultaneously.

On Thursday, L.A. County set yet another record for daily reported coronavirus cases, with more than 37,000. During the peak of last winter’s surge, about 16,000 cases were being reported a day over a weekly period.

“If you have a ton of transmission like we have now, it affects everybody’s workforce. Everybody’s short-staffed … and certainly, hospitals and healthcare providers are facing staffing issues,” Ferrer said.

“So that’s the real difference between what we have now and what we had, for example, when we had the Delta surge — where we actually had lots of patients who needed hospital care, but we didn’t have this raging rate of infection that was really making it super hard for there to be enough staff to care for people.”

While breakthrough infections among vaccinated and boosted people are becoming more common because of Omicron, unvaccinated people are still far more likely to be infected. For the week that ended on Christmas Day, for every 100,000 unvaccinated people in L.A. County, 991 people were confirmed to have the coronavirus.

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

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

Unvaccinated L.A. County residents were also nine times as likely as vaccinated-but-unboosted people to need hospitalization. Compared with boosted people, they were 38 times more likely.

Coronavirus case rates have risen dramatically among all racial and ethnic groups in L.A. County and are highest among Black residents. For the 14-day period that ended Dec. 30, there were 1,558 new coronavirus cases 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 chair of the L.A. County Board of Supervisors, said the high case rates among Black residents are reflective of the community’s lower vaccination rate.

“Hence, my insistence, my constant, vigilant encouragement for people to be vaccinated,” Mitchell said. “Getting vaccinated certainly will bring our numbers down in terms of hospitalization, severity of illness and, ultimately, death.”

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