“It’s a tragedy,” Dr. Nida Qadir, co-director of the medical intensive care unit at Ronald Reagan Medical Center UCLA, said of MLK statistics. Her hospital had death rates “much lower than that,” she said, although the hospital has not released the figure. A new study of patients in 168 hospitals found that about half of the patients on Covid had died and that survival varied considerably among hospitals.
Dr Theodore J. Iwashyna, an intensive care physician at the University of Michigan, said the differences in hospital outcomes reflected a “system choice.” He and others have studied patients with complex lung disease and found that those treated in smaller hospitals with fewer resources and less experience in their management tend to have lower survival rates. “The big hospitals should have taken these patients and removed them” from the MLK, he said.
During the Los Angeles outbreak, hospital mortality also increased because fewer mildly ill patients were hospitalized, said Dr. Roger J. Lewis, professor of emergency medicine at Harbor-UCLA Medical Center who helps analyze Covid data for the county. This was probably even more the case in small hospitals like MLK in areas with high rates of chronic disease, he said.
The medical team invited Mr Flores’ wife to the hospital, which is generally closed to visitors during the pandemic. She found her husband scared and shaking. He was not getting enough oxygen, a doctor said, and without a ventilator he could die in two days. Mr. Flores told him he wanted to go home, then changed his mind. He was exhausted and had chest pain, he said. He would try the ventilator because he wanted to live longer for his family.
Yet his oxygen levels remained low. Doctors gave him steroids and blood clot medication. They turned him over on his stomach and even paralyzed him for periods of time to help the ventilator run more efficiently. But nothing seemed to make a difference. Mr Flores had “cut and dried Covid lung failure,” said Dr Prasso.
Some Covid patients have a final option: treatment using a machine that gives the lungs a chance to rest and, hopefully, repair itself. The procedure, extracorporeal membrane oxygenation, or ECMO, is typically only offered in large hospitals to patients who meet strict criteria.
According to Dr Christopher Ortiz, an intensive care specialist from UCLA, a leading hospital, who participated in MLK But Dr Prasso said he had stopped considering treatment. Earlier in the pandemic, he had pushed to transfer some MLK patients to hospitals providing ECMO, but ultimately gave up.
“We never succeeded,” he said. “Nobody wants his insurance.”