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Lessons From Los Angeles’s Deadly Winter

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Good morning.

In the Golden State, the average number of new Covid-19 cases per day over the past week dipped to 6,641 — not the lowest they’ve been, but the trajectory is remarkable for the speed with which positivity rates have plummeted, especially compared with the slower flattening of cases after the state’s summer surge.

As The Los Angeles Times reported, California’s declining case numbers can most likely be attributed to a combination of factors including widespread behavioral precautions, vaccinations and, ironically, the huge number of people who have already had the virus.

[Read more about the factors affecting when the United States could reach herd immunity.]

At the same time, the nation is confronting yet another unfathomable milestone: half a million deaths from the coronavirus, a mere month after the United States passed 400,000.

Leaders continue to urge caution, as dangerous coronavirus variants gain footholds.

And as the vaccine rollout continues, experts have said that losing sight of the inequities that helped propel California’s winter crisis could shape our recovery; already, early data suggests white Californians are getting vaccinated more quickly than groups that have been hit harder by the virus.

Those inequities were on full display at Martin Luther King Jr. Community Hospital, as my colleague Sheri Fink recently reported in this harrowing look at the heart of Los Angeles’s surge, when hospitals were overwhelmed and hundreds died.

I asked her about what Californians should learn from the hospital’s plight. Here’s our conversation:

Early in the pandemic, you sent some of the earliest, most harrowing dispatches out of New York hospitals, and you also reported from Houston during the summer. What was different about reporting from L.A. during this surge? How did it compare?

Sadly, it was all too familiar. The disparities were similar, with a disproportionate impact of the disease among Latinx and Black communities and in less wealthy areas. Hospitals yet again had to care for far more critically ill patients than they were designed and staffed to manage, scrambling to create space and recruit reinforcements.

The distress among medical providers was if anything more acute. They had been running a marathon and they were exhausted and often in disbelief over the denial they see in the larger community. Even though there is more knowledge now about how to manage patients with severe Covid, the level of deaths at the hospital where I spent more than a week reporting was horrifying.

One difference now is that if you are at higher risk for progressing to severe Covid-19 — if you are 65 or older or have certain chronic medical conditions — a type of treatment exists that has been shown to reduce hospitalizations and deaths.

But the catch is that you need to get the infusion of monoclonal antibodies early, before having to be hospitalized. It blocks the entry of the virus into cells, and several types have received emergency authorization from the F.D.A. However, in South L.A. where I was reporting, relatively few patients who could benefit seemed to be accessing them.

There were also some positive differences: Health providers had the protective equipment they needed to help keep themselves safe. And many of them have been vaccinated against the virus that causes Covid-19.

In the story, you talked to Dr. Elaine Batchlor, M.L.K.’s chief executive, who expressed frustration that her hospital was overwhelmed, while other larger hospitals had fewer patients. But state officials said over and over during the surge that they were working closely with hospital groups and providers to even out the burden.

Can you explain a little more about whether or why the hospital wasn’t able to transfer significant enough numbers of patients to bigger institutions with better resources?

Even as the surge subsided, M.L.K. remained at or near the top in the area for the ratio of Covid patients per licensed hospital bed. For this particular hospital, there was little evidence of any leveling of the burden, aside from government officials making National Guard personnel and contract nurses available.

Dr. Batchlor told stories of having personally phoned other hospitals trying to get patients transferred. I was present when government officials let hospital leaders know that two local hospitals had been staffed up to receive some surge patients, but that was after the curve was already bending. Doctors at M.L.K. said that when they would try to transfer patients whom they thought needed specialized care in other facilities, they were denied.

In their minds, this had to do with the payer mix of their patients, only 4 percent of whom have commercial insurance. They said it was a longstanding problem that the pandemic has only highlighted.

What are you watching most closely now, as vaccinations ramp up? (I’m thinking of nationwide trends in treatment, troubling hot spots or equity in the vaccine rollout.)

Having reported overseas, I have been looking at the vaccine rollout not only within our communities and our country, but also in other countries that did not have the means to support advance manufacturing or buy up large portions of the global supply.

The lowest income countries have had as of yet almost no access to authorized vaccines. If equity weren’t an important enough value on its own, the virus itself is reminding us about humanity’s shared fate.

New strains may emerge anywhere it continues to circulate, and some experts say that global economic recovery depends on the virus being controlled around the world, not only in wealthier countries.

[Read the full story here.]

California Today goes live at 6:30 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com. Were you forwarded this email? Sign up for California Today here and read every edition online here.

Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles — but she always wants to see more. Follow along here or on Twitter.

California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.

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