While the tally of positive COVID-19 tests grows larger, the average age of patients has been inching lower in recent weeks as the initial wave of the pandemic has surged back with fury.
When the pandemic grew in March and April, hospitals found themselves overwhelmed and low on key supplies to mitigate the spread of the coronavirus, and elderly men and women with pre-existing health conditions represented a large percentage of cases. A significant number of such patients came from skilled nursing facilities, whose residents sometimes made up a super-majority of deaths in a given community.
Now, in the weeks after Los Angeles County and state officials briefly relaxed public restrictions, it’s a different picture.
“We’re finding, particularly during this post-Fourth of July time period but really after June, many of our cases are now younger,” said Patricia Sung, an epidemiologist and manager of infection prevention at USC Verdugo Hills Hospital. “In the first emergence of COVID, many if not most of our patients were from nursing homes. Senior adults with co-morbidities made up a lot of our patients.”
Sung said many recent patients are in their 40s and 50s, who in the early days of the pandemic would have been considered anomalies — that is, unless they had compromised immune systems or served on the front lines of the pandemic. That said, more patients are presenting as “definitely not well” while also not being sick enough to be admitted as in-patients, Sung said.
“The interesting part to me has been more so the linkages,” Sung added. “Previously, [younger] people were sick because they worked as an essential worker or worked with [nursing facility] residents, and now we’re seeing that someone was exposed to someone else in the community with COVID.”
As of The News-Press’ deadline this week, there has been a total of 2,322 confirmed cases of COVID-19 among Glendale residents, of whom 134 have succumbed to the disease — the second-highest toll for an L.A. County city outside of Los Angeles itself. The case count is not meant to be current; in other words, the number does not get smaller when patients recover or die from the disease.
Meanwhile, the black and Latino communities have been overrepresented in Los Angeles County’s total of cases and deaths. According to the county Department of Public Health, Latinos have the highest death rate — 58 per 100,000 residents — and blacks’ death rate of 49 per 100,000 residents is double that of whites.
Although health officials throughout L.A. County are sounding the alarm again with regard to hospital beds, supplies and tests, Glendale hospitals appear for now to have avoided that resurgence.
“Glendale is fortunate in that it is not a significant hot spot — yet — and the increase in cases has been gradual,” Dr. Armand Dorian, chief medical officer of USC-VHH, said in a statement. “It almost seems like for every new patient admission, we are also discharging patients, and the flow is manageable. However, there are hot spots in surrounding neighborhoods that we are monitoring.”
Other area hospitals are agreeing.
“We’ve had a small surge again, but nothing like we were in April or May,” said Alice Issai, president of Adventist Health Glendale. “We’re not surging like the hospitals in the L.A. market. We’re still operating under our normal bed capacity and we have plenty of [intensive care unit] capacity.”
Issai noted that Adventist has not returned to its expanded ICU plan that it employed in the initial wave of patients. Additionally, the hospital’s COVID-19 patients are relegated to one of the campus’ towers while other patients occupy the second, and the emergency room has deployed outdoor tents to handle patients exhibiting COVID-19 symptoms.
Dr. Steven Brass, chief medical officer for Adventist, agreed that the demographics were changing among patients, but added that the general outlook also appears different that it was.
“We’re seeing younger patients coming in, and they’re not requiring ICU levels of care,” Brass said. “We’re treating the COVID aggressively early on, and that allows us to avoid ICU or intubations. There are more medications available to us, our knowledge has improved and our operations have streamlined so that our patients are getting top care.”
In a statement, Dr. William Wang, chief medical officer for Glendale Memorial Hospital and Health Center, concurred that his hospital has observed the same demographic shifts others are reporting.
“Our ICU admissions have remained stable, yet our admissions to the medical floors are skewing to a younger population of those under 50 years of age,” Wang wrote. “Additionally, we have seen an increase in the number of asymptomatic pregnant patients who are testing positive for COVID.”
Wang added that Glendale Memorial, which is managed by Dignity Health, is prepared to use its network to implement a surge plan, acquire additional resources and transfer patients as necessary.
Brass said Adventist keeps a daily track of the city’s large number of skilled nursing facilities, an effort that he believes contributes to the better handle that health-care workers have on that situation.
“We established a really close relationship with them early on,” Issai added. “Our fire department here got very much involved trying to help them out. We’ve provided a lot of help and education to them so they don’t panic and send a patient to the hospital prematurely. We’re continuing to keep a pulse on that.”
Face masks and other coverings remain at the forefront of prevention for medical professionals, with Adventist recently adopting an advertising campaign — #IMaskFor — which asks staffers to say whom they’re personally protecting by masking up.
“The one thing you can do that has the highest impact is the masking. It is the single most effective thing we can do,” Issai emphasized. “The important thing is wearing it and wearing it appropriately: covering our nose and mouth.”
Dorian, at USC-VHH, added he would pick a mask if he “had to battle this virus with one weapon.”
“Even though it does not provide full protection against the coronavirus, a mask is a filter that may lessen viral load,” he added. “In recent weeks, we have seen COVID-19 patients presenting with less severe symptoms, and fewer patients requiring intensive care. This may be partially attributed to other factors, like warmer weather. But there is no question that masks are a key component of fighting the pandemic.”
Health officials also generally endorsed local plans to begin school years with remote learning, with some districts pledging to explore hybrid options when appropriate.
“When there’s an ability to reopen schools safely, I think that’s a serious conversation to have,” said Sung, who noted she has a child in grade school. “I’d guess some schools would be able to do it easier than other schools. Wanting to address the community transmission is really important before we can even have that conversation.”
Brass, citing Centers for Disease Control guidelines, said reopening schools should depend on the status of the community.
“It depends on what the prevalence is in the community,” he said, adding he, too, has a young child. “That should drive the decisions on whether to open schools. It should be data driven. I don’t think it’s a black and white answer.
“If we’re in the middle of very high infectivity rate” as we are now, he added, “that could contribute to the problem.”
