latimes--2020-12-19--Against all odds, one man's spirit shines through on the streets of downtown L.A. in time of COVID

I ’ ve been on the hunt for joy lately .
I ’ ll take any I can find right now .
With so many in our city and nation sick and suffering and struggling and sad , joy has seemed in far too short supply , even in what ’ s supposed to be the season for it .
So I was grateful for the chance this week to soak up the spirit of Steven Traylor , who , against all odds , finds his own joy and spreads it .
Each day , three times a day , @ @ @ @ @ @ @ grabs a tambourine and sets off from his apartment .
Always eclectically dressed , maybe wearing a powder blue linen suit and a big beaded necklace and a long yellow scarf that flutters in the wind , he pulls a cart that holds a giant speaker with lights that flash red , green and blue .
And as he blasts gospel and love songs and rap , this tall , skinny man prances and dances , skips and hops , twirls and struts in improbable moves that often seem entirely his own .
@ @ @ @ @ @ @ he vogues , and a fair share of people tune him out .
But at bus stops and street corners and in busy intersections , in front of Grand Central Market , in the squalor of skid row , weary eyes — sometimes above masks — take him in and watch him spin and visibly brighten at the sight .
Sometimes feet start to tap .
Sometimes hands start to clap .
Sometimes hips start to move in time with his .
“ Never once have I seen him upset , ” said @ @ @ @ @ @ @ a Rite-Aid on Broadway , who sees him dancing every day and says she feels cheered every time .
All of which I find especially moving given Traylor ’ s life and his circumstances , which he told me about when I went to meet him Tuesday outside his home on Main Street .
I ’ d come with photographer Mel Melcon , who first spotted and tagged along with Traylor on the street last week and then suggested that I talk to him .
Traylor , whose birthday was Sunday , spent @ @ @ @ @ @ @ shelters and sleeping on the streets of this city , without a tent or a friend to lend him a hand .
He got lucky .
He got help .
A dedicated caseworker secured him permanent supportive housing .
For half a dozen years now , he has had an apartment in a complex that offers him on-site support for his drug addiction and for the mental illness that he told me has dogged him since he was badly stabbed in one of many rough living situations years ago and left traumatized and @ @ @ @ @ @ @ lost , with nowhere to lay his head but the pavement .
When I met him in the courtyard of the New Genesis Apartments two days after his birthday , he bounced down the stairs from his fourth-floor apartment beaming , carrying a still-boxed sheet cake that he ’ d held off cutting into in order to show it to us in all its perfection .
“ Dec 13 , 1960 , Happy Birthday to Steven !
” read the red icing on white .
He told me he ’ d ordered it @ @ @ @ @ @ @ also bought a birthday card with the number 60 in silver glitter because “ if I don ’ t do it myself , it would never get done.
” “ I ’ m just thankful , ” he said .
“ For being alive , still standing tall .
I still have my limbs .
Just to see 60 , it ’ s a blessing.
” Traylor has rarely been able to depend on others for long , he said .
His apartment at New Genesis — with its own kitchen and bathroom @ @ @ @ @ @ @ s ever called his own .
He pays rent with the Supplemental Security Income he receives .
“ I ’ m just so proud of myself , ” he told me .
“ I feel like a man should have his own castle.
” He grew up in L.A. living with his mother and sometimes her mother .
His grandmother cleaned houses .
His mother worked two jobs , at a hotel and at the post office .
He was the eldest of 13 children — three sharing both of his parents .
@ @ @ @ @ @ @ who he said was “ a playboy ” and did little if anything to raise him .
When he was with his mother , he said , they moved often , from one bad spot to the next .
He cooked and cared for her younger kids .
His mother came home worn and spent .
He adored her , but she had little left over for him at the end of her long days .
He loved basketball and played on the B team at Fairfax High in the late 1970s , @ @ @ @ @ @ @ it to a game , he told me .
“ You look out at the crowds .
You don ’ t see nobody , ” he said , his voice still cracking at the hurt of that four decades after the fact .
He stuck through high school but didn ’ t graduate , he said .
There was no one to help him keep on course .
Sometimes , Traylor gets caught in a scratched record , skipping back again and again to replay the things that went wrong in his life @ @ @ @ @ @ @ , the wrong turns he made that bumped him off finishing school or working at warehouse jobs or having a big family that supports him .
He has a son , long ago lost to him , who wound up in foster care .
He has siblings spread all over , most of whom he hasn ’ t seen in years .
His pain runs deep .
But he ’ s made so much progress , said Maurice Gray , the licensed substance abuse counselor and case manager from Exodus Recovery who helped @ @ @ @ @ @ @ saw something special in Traylor from the start .
Traylor ’ s made big strides in taming his addictions , Gray said .
He ’ s gotten therapy .
He ’ s gotten help with money management .
“ From there , he ’ s been a happy-go-lucky guy , ” he said .
When I asked Gray about Traylor ’ s dancing , I could hear the smile in his voice as he laughed .
“ I ’ ve watched him bust a move so many times , ” he told me @ @ @ @ @ @ @ tell his peers , That ’ s what I love about him .
He ’ s free as a bird , he just do what he want to do , he don ’ t bother nobody , just dance down the street.
” For his part , Traylor told me he likes to show a little style , coax a smile , bring a little brightness , for himself and for others .
“ I see myself as a mellow , debonair sort of fellow , ” he said .
“ I dance @ @ @ @ @ @ @ I let my feelings out .
And it ’ s good exercise .
But I think I touch a lot of people in different ways.
” On Thursday , when he and I hit the streets for another spin , he handed me a matching Santa hat to wear as I followed in his wake .
I saw him make people laugh outside a boarded-up store on Broadway .
I saw a woman join him dancing past a cart grilling onions and hot dogs on Los Angeles Street .
On 6th Street , @ @ @ @ @ @ @ at a street stall , a young boy wearing a handmade RIP T-shirt featuring a photo of a man with a mask hanging below his chin quietly took Traylor in and moved his sneakers to his music .
I saw a couple of people hand Traylor $ 1 bills though he didn ’ t go asking for them .
“ They feel the spirit .
They come and bless me , ” he said .
“ I ’ m doing this for my own enjoyment .
But I ’ m also changing other @ @ @ @ @ @ @ had to agree .
I was having a rough week .
I ’ d just lost a neighbor I loved quickly to cancer .
I ’ d come to Traylor feeling tired and sad .
And in my Santa hat , watching him dance , I ’ d let go and for a moment found just what I needed .

Steven Traylor enjoys dancing through DTLA to lift people’s spirit. “A smile means a lot to me, keeps me going and makes me strong,” said Traylor.
I’ve been on the hunt for joy lately. I’ll take any I can find right now.
With so many in our city and nation sick and suffering and struggling and sad, joy has seemed in far too short supply, even in what’s supposed to be the season for it.
So I was grateful for the chance this week to soak up the spirit of Steven Traylor, who, against all odds, finds his own joy and spreads it.
Advertisement
Each day, three times a day, Traylor puts on a Santa hat, grabs a tambourine and sets off from his apartment. Always eclectically dressed, maybe wearing a powder blue linen suit and a big beaded necklace and a long yellow scarf that flutters in the wind, he pulls a cart that holds a giant speaker with lights that flash red, green and blue. And as he blasts gospel and love songs and rap, this tall, skinny man prances and dances, skips and hops, twirls and struts in improbable moves that often seem entirely his own.
Down the sidewalks of downtown L.A., he vogues, and a fair share of people tune him out. But at bus stops and street corners and in busy intersections, in front of Grand Central Market, in the squalor of skid row, weary eyes — sometimes above masks — take him in and watch him spin and visibly brighten at the sight.
Steven Traylor dances on the sidewalk along Broadway in downtown Los Angeles. (Mel Melcon / Los Angeles Times)
Sometimes feet start to tap. Sometimes hands start to clap. Sometimes hips start to move in time with his.
“Never once have I seen him upset,” said Markaisja Stance, a security guard outside a Rite-Aid on Broadway, who sees him dancing every day and says she feels cheered every time.
All of which I find especially moving given Traylor’s life and his circumstances, which he told me about when I went to meet him Tuesday outside his home on Main Street.
California What Hollywood Boulevard looks like when COVID-19 drives the tourists away Hollywood Boulevard is normally Los Angeles’ tourist strip. But during the COVID-19 pandemic, it is eerily empty
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I’d come with photographer Mel Melcon, who first spotted and tagged along with Traylor on the street last week and then suggested that I talk to him.
Traylor, whose birthday was Sunday, spent a long time in and out of shelters and sleeping on the streets of this city, without a tent or a friend to lend him a hand. He got lucky. He got help.
A dedicated caseworker secured him permanent supportive housing. For half a dozen years now, he has had an apartment in a complex that offers him on-site support for his drug addiction and for the mental illness that he told me has dogged him since he was badly stabbed in one of many rough living situations years ago and left traumatized and hearing scary voices in his head and lost, with nowhere to lay his head but the pavement.
When I met him in the courtyard of the New Genesis Apartments two days after his birthday, he bounced down the stairs from his fourth-floor apartment beaming, carrying a still-boxed sheet cake that he’d held off cutting into in order to show it to us in all its perfection.
Steven Traylor holds a birthday card that he got for himself and the cake that he ordered a week in advance from Ralphs. (Mel Melcon / Los Angeles Times)
“Dec 13, 1960, Happy Birthday to Steven!” read the red icing on white. He told me he’d ordered it from Ralphs a week in advance and also bought a birthday card with the number 60 in silver glitter because “if I don’t do it myself, it would never get done.”
“I’m just thankful,” he said. “For being alive, still standing tall. I still have my limbs. Just to see 60, it’s a blessing.”
Traylor has rarely been able to depend on others for long, he said. His apartment at New Genesis — with its own kitchen and bathroom — is the first place he’s ever called his own. He pays rent with the Supplemental Security Income he receives.
“I’m just so proud of myself,” he told me. “I feel like a man should have his own castle.”
He grew up in L.A. living with his mother and sometimes her mother. His grandmother cleaned houses. His mother worked two jobs, at a hotel and at the post office. He was the eldest of 13 children — three sharing both of his parents. Most were step-siblings sharing a father, who he said was “a playboy” and did little if anything to raise him.
When he was with his mother, he said, they moved often, from one bad spot to the next. He cooked and cared for her younger kids. His mother came home worn and spent. He adored her, but she had little left over for him at the end of her long days.
He loved basketball and played on the B team at Fairfax High in the late 1970s, but his mother only once could make it to a game, he told me.
“You look out at the crowds. You don’t see nobody,” he said, his voice still cracking at the hurt of that four decades after the fact. He stuck through high school but didn’t graduate, he said. There was no one to help him keep on course.
Sometimes, Traylor gets caught in a scratched record, skipping back again and again to replay the things that went wrong in his life, the people who let him down, the wrong turns he made that bumped him off finishing school or working at warehouse jobs or having a big family that supports him.
He has a son, long ago lost to him, who wound up in foster care. He has siblings spread all over, most of whom he hasn’t seen in years. His pain runs deep.
But he’s made so much progress, said Maurice Gray, the licensed substance abuse counselor and case manager from Exodus Recovery who helped him off the streets and said he saw something special in Traylor from the start.
Traylor’s made big strides in taming his addictions, Gray said. He’s gotten therapy. He’s gotten help with money management.
Steven Traylor makes his way home to the New Genesis Apartments, a place in downtown Los Angeles that provides permanent supportive housing to homeless people. (Mel Melcon / Los Angeles Times)
“From there, he’s been a happy-go-lucky guy,” he said.
When I asked Gray about Traylor’s dancing, I could hear the smile in his voice as he laughed.
“I’ve watched him bust a move so many times,” he told me. “That’s what I tell his peers, That’s what I love about him. He’s free as a bird, he just do what he want to do, he don’t bother nobody, just dance down the street.”
For his part, Traylor told me he likes to show a little style, coax a smile, bring a little brightness, for himself and for others.
“I see myself as a mellow, debonair sort of fellow,” he said. “I dance for me. It’s how I let my feelings out. And it’s good exercise. But I think I touch a lot of people in different ways.”
On Thursday, when he and I hit the streets for another spin, he handed me a matching Santa hat to wear as I followed in his wake.
I saw him make people laugh outside a boarded-up store on Broadway. I saw a woman join him dancing past a cart grilling onions and hot dogs on Los Angeles Street. On 6th Street, as his family was shopping for sweatshirts at a street stall, a young boy wearing a handmade RIP T-shirt featuring a photo of a man with a mask hanging below his chin quietly took Traylor in and moved his sneakers to his music.
I saw a couple of people hand Traylor $1 bills though he didn’t go asking for them.
“They feel the spirit. They come and bless me,” he said. “I’m doing this for my own enjoyment. But I’m also changing other people’s moods.”
And I had to agree.
I was having a rough week. I’d just lost a neighbor I loved quickly to cancer. I’d come to Traylor feeling tired and sad.
And in my Santa hat, watching him dance, I’d let go and for a moment found just what I needed.


latimes--2020-12-19--L.A. County outlines wrenching moves to ration health care if COVID-19 hospital crisis worsens

With intensive care units full and projections showing big increases in hospitalizations through New Year ’ s Day , Southern California ’ s medical system is faced with the prospect of not being able to provide critical medical care to everyone who needs it , which would significantly increase the chances of patients dying as they wait for help .
Already , hospitals are juggling resources to keep up , placing the overflow of ICU patients in other parts of hospitals not designed for them , clearing out critical care wards of patients who can survive elsewhere and in some @ @ @ @ @ @ @ long as eight hours until space is available .
But much more wrenching choices could be ahead as the COVID-19 surge shows no signs of slowing down , and there is little hope for the arrival of an army of additional medical professionals who can greatly expand intensive care unit availability through the end of the year .
Many hospitals are preparing for the possibility of rationing care in the coming weeks as the number of patients exceeds their staffs ’ abilities to care for them .
A document obtained by The Times @ @ @ @ @ @ @ crisis situation was recently circulated among doctors at the four hospitals run by Los Angeles County .
The guidelines call for a shift in mindset that is unfamiliar to many medical providers .
Instead of trying everything to save a patient , their goal during a crisis is to save as many patients as possible , meaning those less likely to survive will not receive the same level of care they would have otherwise .
Doctors will no longer be pulling out all the stops to save a life but instead strategizing about @ @ @ @ @ @ @ possible from perishing .
“ 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 .
L.A. County Health Services Director Dr. Christina Ghaly said in an email that the guidelines were not in place as of Friday night but that they were essential to develop given the surge has arrived and “ the worst is yet @ @ @ @ @ @ @ 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.
” Across the nation , it has already become @ @ @ @ @ @ @ with COVID-19 symptoms today than it was a couple of months ago , said Dr. Kirsten Bibbins-Domingo , UC San Francisco chair of the department of epidemiology and biostatistics .
This sets up the potential for a deadly Catch-22 already seen in hard-hit places in China , Italy and New York earlier in the pandemic — hospitals so crowded that people have to be extremely sick before they ’ re admitted , by which time , it may be too late to save them .
Earlier in the pandemic , some less critically @ @ @ @ @ @ @ to return home instead of being admitted to an overcrowded hospital .
Some people deteriorated at home and later died .
Had they been admitted earlier , as would have been the case if the hospital were less crowded , they ’ d have a much higher chance of surviving .
In Wuhan , China , a steelworker this year recounted to The Times about how , by the time his father got a hospital bed , it was outside the ICU , and no nurses were available .
His father died a @ @ @ @ @ @ @ April , an emergency room physician in New York City told The Times that patients were advised to stay away from the hospital until the last minute , but then it would take three to four hours for an ambulance to arrive .
A patient ’ s condition can decline precipitously in that time .
“ When hospitals start to to get full … we subtly change our thresholds for admitting someone to the hospital , ” Bibbins-Domingo said .
“ So maybe last month , we might say , ‘ Wow , @ @ @ @ @ @ @ .
Let ’ s admit you to the hospital because we want to be more cautious.
’ And when a hospital is full , that is a time when we might … say , ‘ Well , why don ’ t we wait another day and see how you do ?
’ ” Symptoms can worsen so quickly that it may be too late to seek help by the time a person realizes something is seriously wrong , or , having been turned away once , some sick patients may second-guess whether they @ @ @ @ @ @ @ should .
“ We want to have a system functioning such that anyone who is sick enough that should be in the hospital is able to find a place in the hospital , and if they are severely ill , to have a bed available in the ICU , ” said Dr. Robert Kim-Farley , medical epidemiologist and infectious-diseases expert at the UCLA Fielding School of Public Health .
A study published in the summer in the journal JAMA Internal Medicine found that patients admitted to hospitals with fewer ICU beds had a @ @ @ @ @ @ @ memo said the shortages are unlikely to be of tools like ventilators but instead of highly trained staff , specifically respiratory therapists , ICU nurses and critical care physicians .
Decisions would be made by an appointed triage officer .
For patients who receive a scarce resource , they will be given up to two days to see if it is helping , at which point they should be reassessed to determine whether the treatment should continue .
If the patient has not shown improvement or has gotten worse , the resource may @ @ @ @ @ @ @ The ethical justification … is that in a public health emergency when there are not enough critical care resources for all , the goal of maximizing population outcomes would be jeopardized if patients who were determined to be unlikely to survive were allowed indefinite use of scarce resources , ” the document states .
Meanwhile , patients waiting for these resources may move up in the queue if their condition deteriorates and they are determined to be more in need , according to the guidelines .
The decisions will be made by the @ @ @ @ @ @ @ executive if there is a dispute .
The chief medical officer of L.A. County ’ s flagship public hospital warned that although the county has not yet suffered catastrophic consequences , it “ is now moving towards becoming the epicenter of the pandemic … and if we don ’ t stop the spread , our hospitals will be overwhelmed.
” “ If you have a heart attack , if you get into a car accident , if you fall off a ladder , or have a stroke , we may not have a @ @ @ @ @ @ @ Brad Spellberg , chief medical officer of L.A. County-USC Medical Center .
He added : “ I ’ m not going to sugarcoat this : We are getting crushed.
” The spring surge in New York overwhelmed the medical infrastructure and caused a huge increase in deaths because some people simply could not get the care they needed .
Treatment of COVID-19 has advanced considerably since then , with new procedures that have reduced mortality rates and new drugs that are helpful for the sickest patients .
Hospitals have more supplies and have @ @ @ @ @ @ @ oxygen in patients .
The autumn surge , however , has been much worse than anyone imagined in California , caused in part by many Californians deciding they were done with social distancing and mask-wearing guidelines , and ignoring pleas by officials to cancel large Thanksgiving gatherings .
If Californians did stop meeting with other people around the time the new state stay-at-home order went into effect for most of the state just before midnight Dec. 7 , the state still could avoid the fate of New York , according to some experts @ @ @ @ @ @ @ and infectious-diseases expert at UC San Francisco , said if Californians are heeding that order , the earliest signs of a leveling off in new daily cases could be seen by Monday and in the days thereafter .
“ I ’ d say we have three more weeks of pressure on the hospitals , ” Rutherford said .
“ Hopefully , some of the vaccines can take some of the pressure off from nursing homes.
” Rutherford said he suspects “ people are going to do the right thing.
” But anything is @ @ @ @ @ @ @ na happen with Christmas ?
You saw how convincing we were with Thanksgiving.
” Los Angeles County ’ s chief medical officer , Dr. Jeffrey Gunzenhauser , said he is closely watching the number of people hospitalized with COVID-19 , distraught at the rapid rise .
He said he is waiting for the inflection point , the moment when the rate of growth begins to flatten out .
“ We have not hit it .
It is still picking up faster .
The number of people going into the hospitals is pretty much @ @ @ @ @ @ @ It ’ s not just getting bigger — it ’ s getting bigger faster , ” he said .
Gunzenhauser said that once the county does hit the inflection point , it will still be awhile before it hits the peak .
And once it hits the peak , there will still be thousands of more people who continue to be hospitalized as the numbers begin to reduce .
L.A. County has continued to report single-day coronavirus case numbers at or near daily records .
On Friday , an independent Times tally found @ @ @ @ @ @ @ , the second highest single-day tally on record ; on Wednesday , 22,469 cases were recorded .
L.A. County is now averaging about 13,600 coronavirus cases a day over the last week , more than triple the comparable figure on Thanksgiving .
On Friday , 87 deaths were reported in L.A. County , which is now averaging 79 deaths a day over the past week , a record and more than double the figure from Thanksgiving .
As of Friday at 9 a.m. , fewer than 70 ICU beds were available across L.A. @ @ @ @ @ @ @ that actually fluctuates from hour to hour , a significant drop from the midmorning tally of about 100 earlier in the week .
Pleas for further reinforcements of additional medical staff desperately needed have so far largely gone unanswered because , as state officials have warned , there is virtually no more extra medical staff available nationwide to help treat the tsunami of COVID-19 hospitalized patients .
California on Friday broke a record for most coronavirus cases in a single day with 53,326 , topping the high last set Wednesday , when 52,330 @ @ @ @ @ @ @ Times ’ county-by-county survey .
The state is now averaging more than 40,000 new coronavirus cases a day over the last week , a new record and 10 times the figure from Halloween .
The record for the number of Californians hospitalized for COVID-19 has been broken for 20 days in a row , rising to 16,019 by Thursday , including 3,447 people in intensive care units .
COVID-19 hospitalizations have multiplied sevenfold since late October .
The state recorded 265 COVID-19 deaths Friday , its fourth-largest single-day tally .
California is now @ @ @ @ @ @ @ a new record , and five times the comparable figure from early November .
A doctor at an L.A. County public hospital said this week that there were zero ICU beds left for patients , forcing the hospital to move into surge mode .
The hospital was also asking staff to postpone any vacations in the next six weeks , the physician said .
The doctor anticipates that deaths will double by January and that the hospital will be treating patients in the hallways with one staff member caring for too many patients @ @ @ @ @ @ @ cases and the steep slope of the trajectory that shows no sign in bending , we ’ re essentially screwed , ” the doctor said .
“ We ’ re afraid that California is heading towards New York spring status at this rate.
” A nurse at a Kaiser Permanente hospital in L.A. County said his facility is rapidly running out of beds , as he and other staff work six days a week to keep up .
Patients without COVID-19 are being put wherever possible to make room for the crush of @ @ @ @ @ @ @ to be getting the vaccine soon , but no word exactly when , ” he said .
“ It is insanely busy and stressful with constant changes day by day.
” Times staff writers Meredith Blake , Luke Money and Alice Y. Su contributed to this report .

Rong-Gong Lin II, Soumya Karlamangla, Adam Elmahrek

With intensive care units full and projections showing big increases in hospitalizations through New Year’s Day, Southern California’s medical system is faced with the prospect of not being able to provide critical medical care to everyone who needs it, which would significantly increase the chances of patients dying as they wait for help.
Already, hospitals are juggling resources to keep up, placing the overflow of ICU patients in other parts of hospitals not designed for them, clearing out critical care wards of patients who can survive elsewhere and in some cases keeping patients on ambulances for as long as eight hours until space is available.
But much more wrenching choices could be ahead as the COVID-19 surge shows no signs of slowing down, and there is little hope for the arrival of an army of additional medical professionals who can greatly expand intensive care unit availability through the end of the year.
Many hospitals are preparing for the possibility of rationing care in the coming weeks as the number of patients exceeds their staffs’ abilities to care for them. A document obtained by The Times outlining how to allocate resources in a crisis situation was recently circulated among doctors at the four hospitals run by Los Angeles County.
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The guidelines call for a shift in mindset that is unfamiliar to many medical providers.
Instead of trying everything to save a patient, their goal during a crisis is to save as many patients as possible, meaning those less likely to survive will not receive the same level of care they would have otherwise. Doctors will no longer be pulling out all the stops to save a life but instead strategizing about how to keep as many people as possible from perishing.
“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.
L.A. County Health Services Director Dr. Christina Ghaly said in an email that the guidelines were not in place as of Friday night but that they were essential to develop given the surge has arrived and “the worst is yet to come.”
“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.”
Across the nation, it has already become harder to get admitted to the hospital with COVID-19 symptoms today than it was a couple of months ago, said Dr. Kirsten Bibbins-Domingo, UC San Francisco chair of the department of epidemiology and biostatistics.
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This sets up the potential for a deadly Catch-22 already seen in hard-hit places in China, Italy and New York earlier in the pandemic — hospitals so crowded that people have to be extremely sick before they’re admitted, by which time, it may be too late to save them.
Earlier in the pandemic, some less critically ill patients in hot zones were asked to return home instead of being admitted to an overcrowded hospital. Some people deteriorated at home and later died. Had they been admitted earlier, as would have been the case if the hospital were less crowded, they’d have a much higher chance of surviving.
In Wuhan, China, a steelworker this year recounted to The Times about how, by the time his father got a hospital bed, it was outside the ICU, and no nurses were available. His father died a week after he was admitted. In April, an emergency room physician in New York City told The Times that patients were advised to stay away from the hospital until the last minute, but then it would take three to four hours for an ambulance to arrive. A patient’s condition can decline precipitously in that time.
“When hospitals start to to get full … we subtly change our thresholds for admitting someone to the hospital,” Bibbins-Domingo said. “So maybe last month, we might say, ‘Wow, you’re not getting enough oxygen. Let’s admit you to the hospital because we want to be more cautious.’ And when a hospital is full, that is a time when we might … say, ‘Well, why don’t we wait another day and see how you do?’”
Symptoms can worsen so quickly that it may be too late to seek help by the time a person realizes something is seriously wrong, or, having been turned away once, some sick patients may second-guess whether they should return to the hospital when they should.
“We want to have a system functioning such that anyone who is sick enough that should be in the hospital is able to find a place in the hospital, and if they are severely ill, to have a bed available in the ICU,” said Dr. Robert Kim-Farley, medical epidemiologist and infectious-diseases expert at the UCLA Fielding School of Public Health.
A study published in the summer in the journal JAMA Internal Medicine found that patients admitted to hospitals with fewer ICU beds had a higher risk of death.
The county memo said the shortages are unlikely to be of tools like ventilators but instead of highly trained staff, specifically respiratory therapists, ICU nurses and critical care physicians. Decisions would be made by an appointed triage officer. For patients who receive a scarce resource, they will be given up to two days to see if it is helping, at which point they should be reassessed to determine whether the treatment should continue.
If the patient has not shown improvement or has gotten worse, the resource may be reallocated to someone else.
“The ethical justification … is that in a public health emergency when there are not enough critical care resources for all, the goal of maximizing population outcomes would be jeopardized if patients who were determined to be unlikely to survive were allowed indefinite use of scarce resources,” the document states.
Meanwhile, patients waiting for these resources may move up in the queue if their condition deteriorates and they are determined to be more in need, according to the guidelines. The decisions will be made by the triage officer and potentially the facility chief executive if there is a dispute.
The chief medical officer of L.A. County’s flagship public hospital warned that although the county has not yet suffered catastrophic consequences, it “is now moving towards becoming the epicenter of the pandemic … and if we don’t stop the spread, our hospitals will be overwhelmed.”
“If you have a heart attack, if you get into a car accident, if you fall off a ladder, or have a stroke, we may not have a bed for you,” said Dr. Brad Spellberg, chief medical officer of L.A. County-USC Medical Center.
He added: “I’m not going to sugarcoat this: We are getting crushed.”
The spring surge in New York overwhelmed the medical infrastructure and caused a huge increase in deaths because some people simply could not get the care they needed. Treatment of COVID-19 has advanced considerably since then, with new procedures that have reduced mortality rates and new drugs that are helpful for the sickest patients. Hospitals have more supplies and have better techniques for increasing the level of oxygen in patients.
The autumn surge, however, has been much worse than anyone imagined in California, caused in part by many Californians deciding they were done with social distancing and mask-wearing guidelines, and ignoring pleas by officials to cancel large Thanksgiving gatherings.
If Californians did stop meeting with other people around the time the new state stay-at-home order went into effect for most of the state just before midnight Dec. 7, the state still could avoid the fate of New York, according to some experts.
Dr. George Rutherford, an epidemiologist and infectious-diseases expert at UC San Francisco, said if Californians are heeding that order, the earliest signs of a leveling off in new daily cases could be seen by Monday and in the days thereafter. “I’d say we have three more weeks of pressure on the hospitals,” Rutherford said. “Hopefully, some of the vaccines can take some of the pressure off from nursing homes.”
Rutherford said he suspects “people are going to do the right thing.” But anything is possible. “What’s gonna happen with Christmas? You saw how convincing we were with Thanksgiving.”
Los Angeles County’s chief medical officer, Dr. Jeffrey Gunzenhauser, said he is closely watching the number of people hospitalized with COVID-19, distraught at the rapid rise. He said he is waiting for the inflection point, the moment when the rate of growth begins to flatten out.
“We have not hit it. It is still picking up faster. The number of people going into the hospitals is pretty much growing more and more every day. It’s not just getting bigger — it’s getting bigger faster,” he said.
Gunzenhauser said that once the county does hit the inflection point, it will still be awhile before it hits the peak. And once it hits the peak, there will still be thousands of more people who continue to be hospitalized as the numbers begin to reduce.
L.A. County has continued to report single-day coronavirus case numbers at or near daily records. On Friday, an independent Times tally found that L.A. County reported 15,749 coronavirus cases, the second highest single-day tally on record; on Wednesday, 22,469 cases were recorded. L.A. County is now averaging about 13,600 coronavirus cases a day over the last week, more than triple the comparable figure on Thanksgiving.
On Friday, 87 deaths were reported in L.A. County, which is now averaging 79 deaths a day over the past week, a record and more than double the figure from Thanksgiving.
As of Friday at 9 a.m., fewer than 70 ICU beds were available across L.A. County, a point-in-time daily tally recorded that actually fluctuates from hour to hour, a significant drop from the midmorning tally of about 100 earlier in the week.
Pleas for further reinforcements of additional medical staff desperately needed have so far largely gone unanswered because, as state officials have warned, there is virtually no more extra medical staff available nationwide to help treat the tsunami of COVID-19 hospitalized patients.
California on Friday broke a record for most coronavirus cases in a single day with 53,326, topping the high last set Wednesday, when 52,330 cases were reported, according to The Times’ county-by-county survey. The state is now averaging more than 40,000 new coronavirus cases a day over the last week, a new record and 10 times the figure from Halloween.
The record for the number of Californians hospitalized for COVID-19 has been broken for 20 days in a row, rising to 16,019 by Thursday, including 3,447 people in intensive care units. COVID-19 hospitalizations have multiplied sevenfold since late October.
The state recorded 265 COVID-19 deaths Friday, its fourth-largest single-day tally. California is now averaging 226 deaths a day, also a new record, and five times the comparable figure from early November.
A doctor at an L.A. County public hospital said this week that there were zero ICU beds left for patients, forcing the hospital to move into surge mode. The hospital was also asking staff to postpone any vacations in the next six weeks, the physician said. The doctor anticipates that deaths will double by January and that the hospital will be treating patients in the hallways with one staff member caring for too many patients.
“With the continued rise in cases and the steep slope of the trajectory that shows no sign in bending, we’re essentially screwed,” the doctor said. “We’re afraid that California is heading towards New York spring status at this rate.”
A nurse at a Kaiser Permanente hospital in L.A. County said his facility is rapidly running out of beds, as he and other staff work six days a week to keep up. Patients without COVID-19 are being put wherever possible to make room for the crush of coronavirus patients.
“We are supposed to be getting the vaccine soon, but no word exactly when,” he said. “It is insanely busy and stressful with constant changes day by day.”
Times staff writers Meredith Blake, Luke Money and Alice Y. Su contributed to this report.


latimes--2020-12-20--News Analysis: The pandemic helps fuel a long-shot effort to remove Gov. Gavin Newsom

Among the many catchphrases coined by Gov .
Gavin Newsom during his livestreamed briefings about California ’ s COVID-19 emergency is his promise to point out “ trend lines before they become headlines ” — a reminder that warning signs often appear long before things reach a crisis point .
It ’ s an observation that could also apply to Newsom ’ s political fortunes .
As he slogs through an unparalleled crisis , the 53-year-old Democrat finds himself staring at the most unexpected of trend lines : the very real chance of a special statewide election in 2021 in @ @ @ @ @ @ @ .
Only once has a California governor faced a recall : the 2003 election that cut short the tenure of Gov .
Gray Davis .
By most measures , the current circumstances make for an ill-fitting comparison — whereas Davis had narrowly won reelection the year before and was widely unpopular , Newsom won the governorship in 2018 by the largest margin in modern history and has maintained a strong job approval rating .
But public reaction to recent events has caught Democrats by surprise .
As Californians reel from a sharp rise @ @ @ @ @ @ @ , some have taken aim at Newsom over his administration ’ s restrictions that have closed businesses , implemented overnight curfews and limited family and faith traditions .
The timing has proved lucky for the angry activists who launched a recall petition against the governor in the early spring , an effort recently joined by a cadre of professional Republican political consultants and fundraisers and boosted last month by a largely unnoticed court ruling .
Not unlike the effort in 2003 , the campaign has tapped into a vein of discontent , a @ @ @ @ @ @ @ to Davis becoming the first and only governor recalled in California history .
Newsom hasn ’ t publicly commented on the recall effort , deflecting a reporter ’ s question Monday by commenting on the state ’ s work in distributing the COVID-19 vaccine .
Nor have most Democrats , seemingly worried about boosting what they see as an unjustified effort .
Others say the situation could become more worrisome if the governor doesn ’ t fight back .
“ Don ’ t just ignore it or engage in wishful thinking that it @ @ @ @ @ @ @ , ” said Garry South , who served as Davis ’ chief political strategist and consulted for Newsom when he briefly ran for governor a decade ago .
Davis tried to ignore the unprecedented campaign launched against him until the special election was called — by which time it had gained enough momentum to attract the candidacy of the celebrity who rode it to victory , Arnold Schwarzenegger , a Republican .
South argues that Newsom should fight back much earlier .
“ He needs to really start constructing a war council that @ @ @ @ @ @ @ ” he said .
“ With social media , this thing ’ s already caught fire on the right.
” Voters who seek to remove an elected official don ’ t have to prove malfeasance , under rules dating back to the inception of California ’ s recall process more than a century ago .
Any reason will suffice , and , as the California Constitution explicitly states , the justification “ is not reviewable ” by any state officer .
The loose requirements of the process probably explain why so many recall @ @ @ @ @ @ @ — but also why most of them have failed to catch on .
Of 165 attempts against a statewide officer or member of the Legislature , only 10 have qualified for the ballot .
Six of those elections — all of them , other than the Davis recall , involving legislators — were successful .
The most recent resulted in the removal in 2018 of an Orange County state senator , who won his seat back last month .
Half a dozen recalls have been filed against Newsom since 2018 , the first @ @ @ @ @ @ @ The recall petition now under consideration lists an assortment of grievances : broad swipes at his stance on issues such as illegal immigration , taxes and homelessness , and specific criticism of his moratorium on the death penalty .
But the pandemic upped the ante for Newsom ’ s foes .
State public health rules dictating which businesses can remain open and which activities are allowed have been assailed as arbitrary .
Legislators have bristled at the governor ’ s use of executive power and the many foibles of California ’ s unemployment @ @ @ @ @ @ @ A rising chorus of parents and educators have demanded a statewide policy covering when to reopen school campuses ; so far , those decisions have been left largely to local school districts , a matter particularly galling to those who note that Newsom ’ s four children returned this fall for limited in-person teaching at a private school in Sacramento .
The most flammable moment came last month , when Newsom attended a dinner at a pricey Napa Valley restaurant .
Photos leaked to a Los Angeles TV station showed the governor and @ @ @ @ @ @ @ others , none of whom were wearing masks .
Some conservative critics saw his apology as insincere .
“ That smugness was the straw that broke the camel ’ s back , ” Ray Appleton , who hosts a talk show on KMJ-AM in Fresno , told listeners last week .
“ It ’ s like someone just threw the switch and said , ‘ There it is , we ’ re going to get this guy.
’ ” Doing so will require more than just motivation .
A recall election hinges on @ @ @ @ @ @ @ of the total ballots cast in the most recent gubernatorial election — in this case , the endorsement of some 1.5 million voters .
Because even the best petition drives end up with a portion of signatures deemed invalid , the assumption is that the Newsom recall effort needs the endorsement of at least 1.6 million voters , perhaps closer to 2 million .
Under the normal election calendar , which allows 160 days to gather signatures , the effort would already be over .
But in the same way the public health @ @ @ @ @ @ @ life , it has prompted an exception to the rules of a recall .
Last month , a Sacramento judge gave recall proponents an additional 120 days — through the middle of March — to gather signatures , pointing to recent rulings that provided extra time for backers of two proposed ballot measures who cited the challenges of circulating voter petitions under California ’ s coronavirus restrictions .
“ I think it was a mistake for Democrats not to appeal that decision , ” South said .
Dave Gilliard , a veteran Republican @ @ @ @ @ @ @ the successful Davis recall petition drive , recently joined the nascent effort .
His group dusted off the name and logo of the 2003 campaign — “ Rescue California ” — and is raising money for signature gathering .
“ I think the timing is right , ” Gilliard said .
“ This frustration with the pandemic — he ’ s the guy in charge.
” Even so , the political odds favor Newsom .
Gilliard acknowledges that there ’ s a narrow window in which to raise enough cash .
His group @ @ @ @ @ @ @ Newt Gingrich and former Arkansas Gov .
Mike Huckabee .
But for every Republican who excites would-be donors , the Newsom political team will see opportunities to paint the recall as a partisan effort to do what GOP candidates haven ’ t been able to do in California since 2006 : win a statewide election .
Dan Newman , a political advisor to Newsom , said the governor is focused on “ getting us through the home stretch of this COVID crisis ” and criticized the recall as “ a dangerous and toxic @ @ @ @ @ @ @ , anti-mask , anti-vaccine extremists.
” In the parlance of Newsom , the “ trend line ” of the recall movement is not firmly set .
Though organizers of the campaign say they have collected close to 800,000 signatures , slightly more than half that number have been turned in to elections officials .
And if it does make it to the ballot , some suggest looking not at California ’ s 2003 recall election for a preview but instead at the one that sought to remove Wisconsin Gov .
Scott Walker in @ @ @ @ @ @ @ the recall but won reelection two years later .
Newsom , already a national political figure with $ 15 million in campaign cash in the bank , could easily come out of the experience stronger than ever .

Some have taken aim at the restrictions put in place by California Gov. Gavin Newsom amid the COVID-19 pandemic.
Among the many catchphrases coined by Gov. Gavin Newsom during his livestreamed briefings about California’s COVID-19 emergency is his promise to point out “trend lines before they become headlines” — a reminder that warning signs often appear long before things reach a crisis point.
It’s an observation that could also apply to Newsom’s political fortunes. As he slogs through an unparalleled crisis, the 53-year-old Democrat finds himself staring at the most unexpected of trend lines: the very real chance of a special statewide election in 2021 in which voters could remove him from office.
Only once has a California governor faced a recall: the 2003 election that cut short the tenure of Gov. Gray Davis. By most measures, the current circumstances make for an ill-fitting comparison — whereas Davis had narrowly won reelection the year before and was widely unpopular, Newsom won the governorship in 2018 by the largest margin in modern history and has maintained a strong job approval rating.
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But public reaction to recent events has caught Democrats by surprise. As Californians reel from a sharp rise in COVID-19 cases and a gloomy economy, some have taken aim at Newsom over his administration’s restrictions that have closed businesses, implemented overnight curfews and limited family and faith traditions.
Maggie Assaele of Westlake Village protests against state stay-at-home orders outside Cronies sports bar in Agoura Hills this month. (Mel Melcon / Los Angeles Times)
The timing has proved lucky for the angry activists who launched a recall petition against the governor in the early spring, an effort recently joined by a cadre of professional Republican political consultants and fundraisers and boosted last month by a largely unnoticed court ruling. Not unlike the effort in 2003, the campaign has tapped into a vein of discontent, a combination of fear and malaise that led to Davis becoming the first and only governor recalled in California history.
Newsom hasn’t publicly commented on the recall effort, deflecting a reporter’s question Monday by commenting on the state’s work in distributing the COVID-19 vaccine. Nor have most Democrats, seemingly worried about boosting what they see as an unjustified effort.
Others say the situation could become more worrisome if the governor doesn’t fight back.
“Don’t just ignore it or engage in wishful thinking that it won’t qualify for the ballot,” said Garry South, who served as Davis’ chief political strategist and consulted for Newsom when he briefly ran for governor a decade ago.
Davis tried to ignore the unprecedented campaign launched against him until the special election was called — by which time it had gained enough momentum to attract the candidacy of the celebrity who rode it to victory, Arnold Schwarzenegger, a Republican.
South argues that Newsom should fight back much earlier.
“He needs to really start constructing a war council that can help him navigate the process,” he said. “With social media, this thing’s already caught fire on the right.”
Voters who seek to remove an elected official don’t have to prove malfeasance, under rules dating back to the inception of California’s recall process more than a century ago. Any reason will suffice, and, as the California Constitution explicitly states, the justification “is not reviewable” by any state officer.
The loose requirements of the process probably explain why so many recall petitions have been filed over the years — but also why most of them have failed to catch on. Of 165 attempts against a statewide officer or member of the Legislature, only 10 have qualified for the ballot. Six of those elections — all of them, other than the Davis recall, involving legislators — were successful. The most recent resulted in the removal in 2018 of an Orange County state senator, who won his seat back last month.
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Half a dozen recalls have been filed against Newsom since 2018, the first only two months after his inauguration. The recall petition now under consideration lists an assortment of grievances: broad swipes at his stance on issues such as illegal immigration, taxes and homelessness, and specific criticism of his moratorium on the death penalty.
But the pandemic upped the ante for Newsom’s foes.
State public health rules dictating which businesses can remain open and which activities are allowed have been assailed as arbitrary. Legislators have bristled at the governor’s use of executive power and the many foibles of California’s unemployment agency, led by his appointees. A rising chorus of parents and educators have demanded a statewide policy covering when to reopen school campuses; so far, those decisions have been left largely to local school districts, a matter particularly galling to those who note that Newsom’s four children returned this fall for limited in-person teaching at a private school in Sacramento.
The most flammable moment came last month, when Newsom attended a dinner at a pricey Napa Valley restaurant. Photos leaked to a Los Angeles TV station showed the governor and his wife sitting in tight quarters with others, none of whom were wearing masks.
Some conservative critics saw his apology as insincere.
“That smugness was the straw that broke the camel’s back,” Ray Appleton, who hosts a talk show on KMJ-AM in Fresno, told listeners last week. “It’s like someone just threw the switch and said, ‘There it is, we’re going to get this guy.’”
Doing so will require more than just motivation. A recall election hinges on collecting voter signatures equal to 12% of the total ballots cast in the most recent gubernatorial election — in this case, the endorsement of some 1.5 million voters. Because even the best petition drives end up with a portion of signatures deemed invalid, the assumption is that the Newsom recall effort needs the endorsement of at least 1.6 million voters, perhaps closer to 2 million.
Under the normal election calendar, which allows 160 days to gather signatures, the effort would already be over. But in the same way the public health crisis has upended the norms of everyday life, it has prompted an exception to the rules of a recall.
Last month, a Sacramento judge gave recall proponents an additional 120 days — through the middle of March — to gather signatures, pointing to recent rulings that provided extra time for backers of two proposed ballot measures who cited the challenges of circulating voter petitions under California’s coronavirus restrictions.
“I think it was a mistake for Democrats not to appeal that decision,” South said.
Dave Gilliard, a veteran Republican strategist and one of the architects of the successful Davis recall petition drive, recently joined the nascent effort. His group dusted off the name and logo of the 2003 campaign — “Rescue California” — and is raising money for signature gathering.
“I think the timing is right,” Gilliard said. “This frustration with the pandemic — he’s the guy in charge.”
Even so, the political odds favor Newsom.
Gilliard acknowledges that there’s a narrow window in which to raise enough cash. His group recently touted endorsements from former House Speaker Newt Gingrich and former Arkansas Gov. Mike Huckabee. But for every Republican who excites would-be donors, the Newsom political team will see opportunities to paint the recall as a partisan effort to do what GOP candidates haven’t been able to do in California since 2006: win a statewide election.
Dan Newman, a political advisor to Newsom, said the governor is focused on “getting us through the home stretch of this COVID crisis” and criticized the recall as “a dangerous and toxic brew of ambitious Republican politicians and pro-Trump, anti-mask, anti-vaccine extremists.”
In the parlance of Newsom, the “trend line” of the recall movement is not firmly set. Though organizers of the campaign say they have collected close to 800,000 signatures, slightly more than half that number have been turned in to elections officials.
And if it does make it to the ballot, some suggest looking not at California’s 2003 recall election for a preview but instead at the one that sought to remove Wisconsin Gov. Scott Walker in 2012. Walker not only beat back the recall but won reelection two years later. Newsom, already a national political figure with $15 million in campaign cash in the bank, could easily come out of the experience stronger than ever.


latimes--2020-12-19--Suspect opens fire at mall in Milpitas, shooting one man

A suspect opened fire inside the Great Mall in Milpitas on Saturday evening , shooting one man and sending crowds of frantic shoppers running for cover , police said .
Authorities responded to the scene at 5:16 p.m. following reports of a shooting outside Old Navy , said Lt. Tyler Jamison of the Milpitas Police Department .
Jamison would not comment on the condition of the victim or the whereabouts of the suspect .
“ Right now , we ’ re not releasing any more information , ” he said .
“ We ’ re having everyone shelter in place @ @ @ @ @ @ @ search.
” Shortly before 9 p.m. Milpitas police said they had safely cleared the mall .
“ ALL CLEAR , teams have concluded their searches of the mall interior , ” police tweeted .
“ Everyone who was sheltering-in-place has been escorted out safely .
There were no additional victims associated to this shooting .
“ There were two unrelated medical emergencies during evacuations , which required medical transportation to a local hospital .
Detectives and Field Evidence Technicians remain on scene and are actively investigating this incident .
There are currently no @ @ @ @ @ @ @ time .
”

Authorities said one man was shot when a suspect opened fire at the Great Mall in Milpitas on Saturday.
A suspect opened fire inside the Great Mall in Milpitas on Saturday evening, shooting one man and sending crowds of frantic shoppers running for cover, police said.
Authorities responded to the scene at 5:16 p.m. following reports of a shooting outside Old Navy, said Lt. Tyler Jamison of the Milpitas Police Department. Jamison would not comment on the condition of the victim or the whereabouts of the suspect.
“Right now, we’re not releasing any more information,” he said. “We’re having everyone shelter in place until officers finish their investigation and their search.”
Shortly before 9 p.m. Milpitas police said they had safely cleared the mall.
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“ALL CLEAR, teams have concluded their searches of the mall interior,” police tweeted. “Everyone who was sheltering-in-place has been escorted out safely. There were no additional victims associated to this shooting.
“There were two unrelated medical emergencies during evacuations, which required medical transportation to a local hospital. Detectives and Field Evidence Technicians remain on scene and are actively investigating this incident. There are currently no on-going threats to the community at this time.”


latimes--2020-12-19--L.A. County outlines wrenching moves to ration healthcare if COVID-19 hospital crisis worsens


latimes--2020-12-20--Group greenlights Moderna COVID-19 vaccine for use in California as hospitals struggle

A working group of scientists and experts Sunday endorsed the COVID-19 vaccine developed by Moderna and the National Institutes of Health , clearing the way for it to be distributed throughout California and much of the West .
The group , initially formed by California and later joined by Nevada , Oregon and Washington , reviewed the vaccine separately from the U.S. Food and Drug Administration , which on Friday issued emergency use authorization .
The group made its recommendation to the governors of the four states Sunday morning , officials said in a news release .
Shipments of the @ @ @ @ @ @ @ early this week , officials said .
“ While California is in some of the darkest days of our COVID-19 surge , with too many families grieving lost loved ones , there is light as more vaccines are approved for distribution , ” Gov .
Gavin Newsom said in a statement .
California has already received shipments of the vaccine developed by Pfizer and BioNTech , which were earmarked for workers at acute-care hospitals and residents of long-term care facilities .
The vaccine isn ’ t expected to be available to members of @ @ @ @ @ @ @ .
Experts say that ’ s not soon enough to avert catastrophe at the region ’ s hospitals , which have been struggling as they fill up with COVID-19 patients .
There were 16,843 COVID-19 patients in California hospitals Saturday , with 3,614 of them in intensive care , according to data released by the state Sunday .
That was a huge increase from two months before , when there were 2,291 such patients , 657 of them in intensive care .
The availability of intensive care unit beds in Southern California and @ @ @ @ @ @ @ Sunday , according to the state .
Los Angeles County hospitals were treating the largest share of patients : 5,709 , with 1,175 of them in intensive care .
Patient volume is expected only to increase , as new cases of the coronavirus are growing more quickly than at any other point during the pandemic and often take two to three weeks to result in hospitalization .
L.A. County public health officials announced Saturday that the county had surpassed 600,000 total cases of the virus , a troubling development given that it was @ @ @ @ @ @ @ reached 500,000 cases .
By comparison , L.A. County surpassed 200,000 reported cases of the virus Aug. 6 .
It was 80 days later that the county recorded its 300,000th case Oct. 25 .
As the transmission rate began to climb , L.A. County reported its 400,000th case 36 days later , on Nov. 30 .
Just 11 days later , the county topped 500,000 cases .
On Sunday , the county recorded 12,763 new cases of the virus and 53 related deaths , bringing its total to 623,670 cases and 8,875 deaths @ @ @ @ @ @ @ The Times .
New case numbers are often lower on the weekends because some laboratories don ’ t report results .
The share of tests coming back positive for the virus each day has also risen sharply , topping 16 % over the last seven days , officials said Sunday .
That rate , which helps analysts determine whether more new cases are being identified because of increased transmission or because more people are being tested , had reached 10 % during the height of the last surge in mid-July but then fell @ @ @ @ @ @ @ UCLA infectious disease epidemiologist Dr. Tim Brewer said the exponential increase means that L.A. County is on a dangerous path .
“ I have yet to see any clear signals that things are slowing down , and I ’ m very concerned about the next two months , ” he said .
He worries that any precautions people are taking now will loosen in late December as people long to be around people for Christmas and New Year ’ s , adding another surge to the current one .
Already , UCLA Health @ @ @ @ @ @ @ be on call at any given time , due to the unprecedented numbers of COVID-19 patients needing hospitalization , he said .
The biggest issue is that hospitals may quickly run out of providers who can administer ICU-level care and will be forced to draft doctors from other specialties .
“ I haven ’ t done ICU medicine since I was a resident — you don ’ t want me adjusting your ventilator , ” he said .
“ That ’ s the challenge , actually — it isn ’ t so much @ @ @ @ @ @ @ It ’ s the physicians , the nurses , the respiratory therapists , all of the trained people to do that highly specific work that you can ’ t just pull out of a hat.
” New cases , hospitalizations and deaths are all surging more ferociously than they were in the summer , which was previously the high-water mark for the pandemic in Southern California .
The increases mirror a trend seen nationwide , which poses an added challenge when it comes to calling in staffing assistance , said Dr. Brad Spellberg @ @ @ @ @ @ @ County-USC Medical Center .
“ During the first phase of the ramp-up of cases in the L.A. County area , the virus was not simultaneously out of control everywhere and so people could be summoned from other counties or out of state , ” Spellberg said .
“ When the entire United States is in crisis , where are you going to find people ?
” Healthcare professionals are bracing for the likelihood that things will get worse before they get better .
A doctor at an L.A. County public hospital said that @ @ @ @ @ @ @ increasing exponentially without an end in sight.
” Many parts of the hospital are being converted to COVID-19 wards , and ICU teams are being staffed up with workers from other departments that are temporarily halting their services .
The doctor said it seems as though they will be stretched so thin that by early January they will have to begin rationing care .
“ We ’ re going to be New York with bodies piling up .
Wouldn ’ t be surprised if L.A. rings in the new year as the COVID @ @ @ @ @ @ @ the physician , who requested anonymity because the person was not authorized to speak to the media .
“ I don ’ t know how many ways to explain to people to isolate and stay home short of bringing a camera to the ICU and ED [ Emergency Department ] to show them the mess of what we ’ re experiencing.
” In a welcome bright spot , hundreds of healthcare workers at L.A. County hospitals have received a vaccine dose so far , and that number was expected to hit roughly 6,000 @ @ @ @ @ @ @ week .
L.A. County will reserve the initial allotment of the Moderna vaccine for staff and residents at skilled nursing facilities , frontline EMTs and paramedics , and those who administer vaccines , public health officials said .

A working group of scientists and experts Sunday endorsed the COVID-19 vaccine developed by Moderna and the National Institutes of Health, clearing the way for it to be distributed throughout California and much of the West.
The group, initially formed by California and later joined by Nevada, Oregon and Washington, reviewed the vaccine separately from the U.S. Food and Drug Administration, which on Friday issued emergency use authorization. The group made its recommendation to the governors of the four states Sunday morning, officials said in a news release.
Shipments of the vaccine are expected to arrive in California early this week, officials said.
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“While California is in some of the darkest days of our COVID-19 surge, with too many families grieving lost loved ones, there is light as more vaccines are approved for distribution,” Gov. Gavin Newsom said in a statement.
California has already received shipments of the vaccine developed by Pfizer and BioNTech, which were earmarked for workers at acute-care hospitals and residents of long-term care facilities.
The vaccine isn’t expected to be available to members of the general public until spring or summer.
Experts say that’s not soon enough to avert catastrophe at the region’s hospitals, which have been struggling as they fill up with COVID-19 patients. There were 16,843 COVID-19 patients in California hospitals Saturday, with 3,614 of them in intensive care, according to data released by the state Sunday. That was a huge increase from two months before, when there were 2,291 such patients, 657 of them in intensive care.
The availability of intensive care unit beds in Southern California and the San Joaquin Valley remained at zero Sunday, according to the state.
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Los Angeles County hospitals were treating the largest share of patients: 5,709, with 1,175 of them in intensive care.
Patient volume is expected only to increase, as new cases of the coronavirus are growing more quickly than at any other point during the pandemic and often take two to three weeks to result in hospitalization.
L.A. County public health officials announced Saturday that the county had surpassed 600,000 total cases of the virus, a troubling development given that it was only eight days after the county had reached 500,000 cases.
By comparison, L.A. County surpassed 200,000 reported cases of the virus Aug. 6. It was 80 days later that the county recorded its 300,000th case Oct. 25.
As the transmission rate began to climb, L.A. County reported its 400,000th case 36 days later, on Nov. 30. Just 11 days later, the county topped 500,000 cases.
On Sunday, the county recorded 12,763 new cases of the virus and 53 related deaths, bringing its total to 623,670 cases and 8,875 deaths, according to an independent tally by The Times. New case numbers are often lower on the weekends because some laboratories don’t report results.
The share of tests coming back positive for the virus each day has also risen sharply, topping 16% over the last seven days, officials said Sunday.
That rate, which helps analysts determine whether more new cases are being identified because of increased transmission or because more people are being tested, had reached 10% during the height of the last surge in mid-July but then fell to around 3% in October.
UCLA infectious disease epidemiologist Dr. Tim Brewer said the exponential increase means that L.A. County is on a dangerous path.
“I have yet to see any clear signals that things are slowing down, and I’m very concerned about the next two months,” he said.
He worries that any precautions people are taking now will loosen in late December as people long to be around people for Christmas and New Year’s, adding another surge to the current one.
Already, UCLA Health is scheduling multiple infectious disease doctors to be on call at any given time, due to the unprecedented numbers of COVID-19 patients needing hospitalization, he said. The biggest issue is that hospitals may quickly run out of providers who can administer ICU-level care and will be forced to draft doctors from other specialties.
“I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff. It’s the physicians, the nurses, the respiratory therapists, all of the trained people to do that highly specific work that you can’t just pull out of a hat.”
New cases, hospitalizations and deaths are all surging more ferociously than they were in the summer, which was previously the high-water mark for the pandemic in Southern California.
The increases mirror a trend seen nationwide, which poses an added challenge when it comes to calling in staffing assistance, said Dr. Brad Spellberg, chief medical officer at Los Angeles County-USC Medical Center.
“During the first phase of the ramp-up of cases in the L.A. County area, the virus was not simultaneously out of control everywhere and so people could be summoned from other counties or out of state,” Spellberg said. “When the entire United States is in crisis, where are you going to find people?”
Healthcare professionals are bracing for the likelihood that things will get worse before they get better.
A doctor at an L.A. County public hospital said that the number of COVID-19 patients is “increasing exponentially without an end in sight.”
Many parts of the hospital are being converted to COVID-19 wards, and ICU teams are being staffed up with workers from other departments that are temporarily halting their services. The doctor said it seems as though they will be stretched so thin that by early January they will have to begin rationing care.
“We’re going to be New York with bodies piling up. Wouldn’t be surprised if L.A. rings in the new year as the COVID capital of the world,” said the physician, who requested anonymity because the person was not authorized to speak to the media.
“I don’t know how many ways to explain to people to isolate and stay home short of bringing a camera to the ICU and ED [Emergency Department] to show them the mess of what we’re experiencing.”
In a welcome bright spot, hundreds of healthcare workers at L.A. County hospitals have received a vaccine dose so far, and that number was expected to hit roughly 6,000 by Christmas, officials said earlier this week.
L.A. County will reserve the initial allotment of the Moderna vaccine for staff and residents at skilled nursing facilities, frontline EMTs and paramedics, and those who administer vaccines, public health officials said.


latimes--2020-12-20--Shooting at Northern California mall was suicide attempt, police say

The shooting that emptied the Great Mall in Milpitas on Saturday evening was a suicide attempt , according to police .
A 22-year-old man , initially thought to be a victim of a shooting at the mall , had turned a gun on himself , the Milpitas Police Department said in a news release .
The man , a San Francisco resident , suffered a non-life-threatening gunshot wound and was taken to the hospital by paramedics .
The sound of gunfire disrupted holiday shopping for mall customers and employees who either fled the scene or sheltered in place at the @ @ @ @ @ @ @ the mall at 5:16 p.m. after reports of a shooting outside Old Navy .
They instructed people inside stores to stay put as they searched for possible suspects and victims .
Other law enforcement agencies and fire departments assisted , and people were escorted to the parking lot as their locations were deemed safe .
At 9:26 p.m. — more than four hours after they arrived — police announced on Twitter that they had concluded their search and that everyone in the mall had been escorted out .
They did not find any @ @ @ @ @ @ @ the evacuations , two people had unrelated medical emergencies and were taken to the hospital .
By Sunday morning , detectives from the Milpitas Police Department ’ s Special Investigations Unit had determined that the man ’ s gunshot wound was self-inflicted .

The shooting that emptied the Great Mall in Milpitas on Saturday evening involved a man who accidentally shot himself, police said.
The 22-year-old man was initially thought to be a victim of a shooting at the mall, the Milpitas Police Department said.
For the record: An earlier version of this article stated that the shooting was a suicide attempt. Police said it was an accidental shooting.
A news release issued by the police described the incident as involving “a self-inflicted gunshot wound.” Capt. John Torrez said the man was not trying to harm himself and fired the gun accidentally.
The man, a San Francisco resident, suffered a non-life-threatening gunshot wound and was taken to the hospital by paramedics.
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The sound of gunfire disrupted holiday shopping for mall customers and employees who either fled the scene or sheltered in place at the Bay Area mall.
Police arrived at the mall at 5:16 p.m. after reports of a shooting outside Old Navy.
They instructed people inside stores to stay put as they searched for possible suspects and victims. Other law enforcement agencies and fire departments assisted, and people were escorted to the parking lot as their locations were deemed safe.
At 9:26 p.m. — more than four hours after they arrived — police announced on Twitter that they had concluded their search and that everyone in the mall had been escorted out. They did not find any additional victims, they said.
During the evacuations, two people had unrelated medical emergencies and were taken to the hospital.
By Sunday morning, detectives from the Milpitas Police Department’s Special Investigations Unit had determined that the man’s gunshot wound was self-inflicted.


latimes--2020-12-20--With coronavirus spreading in L.A. County supermarkets, here are some tips for shopping safely

With COVID-19 spreading with relentless speed across Los Angeles County , supermarkets and grocery stores are being hard hit .
The Times chronicled the rising infection levels at markets .
Dr. Jeffrey Gunzenhauser , Los Angeles County chief medical officer , recommended consolidating trips to businesses , perhaps visiting the grocery store every other week instead of weekly , if possible .
People should also be prepared to leave and return another time if the store is too crowded , lines are long or shoppers aren ’ t wearing masks .
“ You should have a Plan A and a @ @ @ @ @ @ @ “ If things are operating as they should , I ’ m comfortable with that — people shouldn ’ t have an irrational fear that just walking in the building is a problem.
” He pointed out that customers are more likely to be in close contact with other shoppers than with employees , so community prevalence may be a better indicator of risk than whether a store recently suffered an outbreak among staff .
Currently , 1 in 80 people in L.A. County are thought to be infectious with the coronavirus .
@ @ @ @ @ @ @ people entering stores should wear masks , keep six feet from others , plan to go when stores might be less crowded and spend as little time inside as possible .
The longer a person spends in close contact with an infected person , the more likely they are to catch the virus — even if both are wearing masks .
“ There is no safe activity that involves being within six feet of another person that you do not live with , ” she said .
“ I know this is the @ @ @ @ @ @ @ want to linger and browse and be out shopping , particularly when it comes to Christmas gifts , but we really want people to be as expedient and efficient as possible.
” The Centers for Disease Control and Prevention has issued guidelines for shopping as safely as possible .
The agency recommends online shopping when possible .
But here are some other CDC tips : • Wear a in public settings and when around people who don ’ t live in your household , especially when social distancing is difficult .
• When @ @ @ @ @ @ @ , go during hours when fewer people will be there ( for example , early morning or late night ) .
• If you are at severe illness , find out if the store has special hours for people at higher risk .
If they do , try to shop during those hours .
• If you normally bring your own reusable shopping bags , ensure they are cleaned before each use .
Some locations have temporarily banned the use of reusable shopping bags during the COVID-19 pandemic , so check your state @ @ @ @ @ @ @ before bringing reusable bags .
• Disinfect the shopping cart , using disinfecting wipes if available .
• Do not touch your eyes , nose or mouth with unwashed hands .
• Stay at least six feet away from others while shopping and in lines .
• Use marked entry or exit points and follow any directional signs or floor markings designed to keep people at least six feet apart .
• Touch only products that you plan to purchase , if possible .
• Consider not consuming any sample or purchase food @ @ @ @ @ @ @ • If possible , use touchless payment ( pay without touching money , a card or a keypad ) .
If you must handle money , a card , or use a keypad , use hand sanitizer right after paying .
• Before entering and after exiting the grocery store or market , use a hand sanitizer that contains at least 60 % alcohol .
• When you get home , and before preparing or eating food , wash your hands with soap and water for at least 20 seconds .
• Currently @ @ @ @ @ @ @ , the virus that causes COVID-19 , from is thought to be low .
However , it is always important to follow good .
• When unpacking groceries , meat , poultry , eggs , seafood , and other perishables within two hours of purchasing .
• Do not use disinfectants designed for hard surfaces , such as bleach or ammonia , on food packaged in cardboard or plastic wrap .
• After unpacking groceries , wash your hands with soap and water for at least 20 seconds .
If soap and water @ @ @ @ @ @ @ sanitizer that contains at least 60 % alcohol .
• Regularly using a commercially available or a DIY disinfecting solution .
The California Department of Public Health has also issued guidance to grocery stores about how to prevent COVID-19 spread .
This is the L.A. County Public Health order related to grocery store operations .

Stephanie Nguyen goes food shopping ahead of the Thanksgiving holiday at Baron’s Market on Nov. 19 in San Diego.
With COVID-19 spreading with relentless speed across Los Angeles County, supermarkets and grocery stores are being hard hit.
The Times chronicled the rising infection levels at markets.
California Supermarkets in L.A. County see unprecedented coronavirus infection rates Grocery stores and other essential businesses have been hit hard by the coronavirus surge, further straining services that must stay open despite the stay-at-home order.
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Dr. Jeffrey Gunzenhauser, Los Angeles County chief medical officer, recommended consolidating trips to businesses, perhaps visiting the grocery store every other week instead of weekly, if possible. People should also be prepared to leave and return another time if the store is too crowded, lines are long or shoppers aren’t wearing masks.
“You should have a Plan A and a Plan B,” he said. “If things are operating as they should, I’m comfortable with that — people shouldn’t have an irrational fear that just walking in the building is a problem.”
He pointed out that customers are more likely to be in close contact with other shoppers than with employees, so community prevalence may be a better indicator of risk than whether a store recently suffered an outbreak among staff. Currently, 1 in 80 people in L.A. County are thought to be infectious with the coronavirus.
UCLA epidemiology professor Shira Shafir reiterated that people entering stores should wear masks, keep six feet from others, plan to go when stores might be less crowded and spend as little time inside as possible. The longer a person spends in close contact with an infected person, the more likely they are to catch the virus — even if both are wearing masks.
“There is no safe activity that involves being within six feet of another person that you do not live with,” she said. “I know this is the time when a lot of people might want to linger and browse and be out shopping, particularly when it comes to Christmas gifts, but we really want people to be as expedient and efficient as possible.”
The Centers for Disease Control and Prevention has issued guidelines for shopping as safely as possible. The agency recommends online shopping when possible. But here are some other CDC tips:
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General
Wear a mask in public settings and when around people who don’t live in your household, especially when social distancing is difficult.
in public settings and when around people who don’t live in your household, especially when social distancing is difficult. When you do have to visit in person, go during hours when fewer people will be there (for example, early morning or late night).
If you are at higher risk for severe illness, find out if the store has special hours for people at higher risk. If they do, try to shop during those hours.
severe illness, find out if the store has special hours for people at higher risk. If they do, try to shop during those hours. If you normally bring your own reusable shopping bags, ensure they are cleaned before each use. Some locations have temporarily banned the use of reusable shopping bags during the COVID-19 pandemic, so check your state, local, store or market policies before bringing reusable bags.
Disinfect the shopping cart, using disinfecting wipes if available.
Do not touch your eyes, nose or mouth with unwashed hands.
Stay at least six feet away from others while shopping and in lines.
Use marked entry or exit points and follow any directional signs or floor markings designed to keep people at least six feet apart.
Touch only products that you plan to purchase, if possible.
Consider not consuming any sample or purchase food or drink items from self-service stations.
If possible, use touchless payment (pay without touching money, a card or a keypad). If you must handle money, a card, or use a keypad, use hand sanitizer right after paying.
Practice hand hygiene
Before entering and after exiting the grocery store or market, use a hand sanitizer that contains at least 60% alcohol.
When you get home, and before preparing or eating food, wash your hands with soap and water for at least 20 seconds.
Unpack safely at home
Currently, the risk of infection from SARS-CoV-2, the virus that causes COVID-19, from food products, food packaging or bags is thought to be low. However, it is always important to follow good food safety practices .
is thought to be low. However, it is always important to follow good . When unpacking groceries, refrigerate or freeze meat, poultry, eggs, seafood, and other perishables within two hours of purchasing.
meat, poultry, eggs, seafood, and other perishables within two hours of purchasing. Do not use disinfectants designed for hard surfaces, such as bleach or ammonia, on food packaged in cardboard or plastic wrap.
After unpacking groceries, wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
Regularly clean and disinfect kitchen counters using a commercially available disinfectant product or a DIY disinfecting solution.
More resources
The California Department of Public Health has also issued guidance to grocery stores about how to prevent COVID-19 spread.
This is the L.A. County Public Health order related to grocery store operations.


latimes--2020-12-20--Deputies fatally shoot man; victim of another shooting is found nearby

Los Angeles County sheriff ’ s deputies shot and killed a man in Lennox on Saturday night and found a man who had been fatally wounded in another shooting nearby , authorities said .
Deputies from the South Los Angeles Sheriff ’ s Station responded to the 4400 block of West 104th Street shortly before 7 p.m. to a report of a gunshot victim , the L.A. County Sheriff ’ s Department said in a news release .
They saw a man standing at the end of a driveway holding a gun , and one or more deputies opened fire @ @ @ @ @ @ @ .
The man refused to comply with deputies ’ orders and tried to raise his gun again , and deputies fired a second time , the Sheriff ’ s Department said .
The man died at the scene .
Two handguns were recovered , the Sheriff ’ s Department said .
Deputies who responded to the call found another gunshot victim lying in the street about a block away in the 10300 block of Burin Avenue in Inglewood , the Sheriff ’ s Department said .
The man was taken to a local @ @ @ @ @ @ @ man is not believed to have been struck by deputies ’ bullets , but it was not yet clear whether the shooting was linked to the man who was killed by deputies , the Sheriff ’ s Department said .
Two more handguns were recovered from the second scene , authorities said .
Authorities did not release either man ’ s identity .

Two men were killed in shootings in Lennox on Saturday, authorities said.
Los Angeles County sheriff’s deputies shot and killed a man in Lennox on Saturday night and found a man who had been fatally wounded in another shooting nearby, authorities said.
Deputies from the South Los Angeles Sheriff’s Station responded to the 4400 block of West 104th Street shortly before 7 p.m. to a report of a gunshot victim, the L.A. County Sheriff’s Department said in a news release.
They saw a man standing at the end of a driveway holding a gun, and one or more deputies opened fire, the Sheriff’s Department said.
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The man refused to comply with deputies’ orders and tried to raise his gun again, and deputies fired a second time, the Sheriff’s Department said.
The man died at the scene. Two handguns were recovered, the Sheriff’s Department said.
Deputies who responded to the call found another gunshot victim lying in the street about a block away in the 10300 block of Burin Avenue in Inglewood, the Sheriff’s Department said. The man was taken to a local hospital, where he died.
The man is not believed to have been struck by deputies’ bullets, but it was not yet clear whether the shooting was linked to the man who was killed by deputies, the Sheriff’s Department said. Two more handguns were recovered from the second scene, authorities said.
Authorities did not release either man’s identity.


latimes--2020-12-20--San Francisco public schools won't reopen for in-person learning in January

San Francisco public schools won ’ t reopen for in-person learning in January because of a breakdown in negotiations between the school district and teachers unions over coronavirus safety , the San Francisco Unified School District said .
“ The district can not meet all of the new requirements SFUSD ’ s labor unions have proposed , and there is not sufficient time to complete bargaining in order to reopen any school sites on Jan. 25 , ” the district said in an online statement .
The biggest barrier , the district said , is a demand by labor groups @ @ @ @ @ @ @ in-person learning until the state puts San Francisco in the orange tier , reserved for places with moderate transmission of the coronavirus .
The state ’ s color-coded reopening system ties reductions in new coronavirus cases and the rate of positive coronavirus tests to eased restrictions .
San Francisco is now in the purple tier , indicating widespread transmission .
Elementary school students and pupils with disabilities had been expected to return to classrooms in late January .
“ I can ’ t imagine how hard this is for our families and for @ @ @ @ @ @ @ been in the classroom since March and are falling further behind every single day , ” she said in a written statement .
“ We should not be creating a false choice between education and a safe return to classrooms.
” When San Francisco recovers from the current surge , Breed said , “ we need to be ready to get our students in the classroom.
” Breed said San Francisco health officials had been among the most conservative in the nation in reopening sectors .
“ When they say our schools can @ @ @ @ @ @ @ , “ our kids should be in the classroom the next day.
” There have been no outbreaks in the city ’ s 78 community education hubs or the 91 private schools that have been open for indoor learning , Breed said .

The Golden Gate Bridge and San Francisco skyline are seen from the Golden Gate National Recreation Area.
San Francisco public schools won’t reopen for in-person learning in January because of a breakdown in negotiations between the school district and teachers unions over coronavirus safety, the San Francisco Unified School District said.
“The district cannot meet all of the new requirements SFUSD’s labor unions have proposed, and there is not sufficient time to complete bargaining in order to reopen any school sites on Jan. 25,” the district said in an online statement.
The biggest barrier, the district said, is a demand by labor groups that no staff or students return for in-person learning until the state puts San Francisco in the orange tier, reserved for places with moderate transmission of the coronavirus. The state’s color-coded reopening system ties reductions in new coronavirus cases and the rate of positive coronavirus tests to eased restrictions.
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San Francisco is now in the purple tier, indicating widespread transmission. Elementary school students and pupils with disabilities had been expected to return to classrooms in late January.
Mayor London Breed called the announcement “infuriating.”
“I can’t imagine how hard this is for our families and for our young people who haven’t been in the classroom since March and are falling further behind every single day,” she said in a written statement. “We should not be creating a false choice between education and a safe return to classrooms.”
When San Francisco recovers from the current surge, Breed said, “we need to be ready to get our students in the classroom.”
Breed said San Francisco health officials had been among the most conservative in the nation in reopening sectors.
“When they say our schools can start reopening,” the mayor said, “our kids should be in the classroom the next day.”
There have been no outbreaks in the city’s 78 community education hubs or the 91 private schools that have been open for indoor learning, Breed said.