By Dan Whitcomb and Steve Gorman

LOS ANGELES (Reuters) – Los Angeles health officials have told first responders to stop bringing adult patients who cannot be resuscitated to hospitals for treatment, citing a shortage of beds and medical staff, as the latest COVID-19 surge threatened to overwhelm the city’s healthcare systems.

The orders, issued late on Monday and effective immediately, marked a further escalation of measures being taken nationwide by state and local officials due to alarming increases in COVID-19 infections, hospitalizations and deaths.

“Patients in traumatic full arrest who meet current Ref 814 criteria for determination of death shall not be resuscitated and shall be determined dead on scene and not transported,” Marianne Gausche-Hill, medical director of the Los Angeles County Emergency Medical Services Agency, said in the directive.

Ref 814 refers to the county’s policy on determining and pronouncing death in a patient who has not been transported to a hospital.

California, the most populous U.S. state, has been hit particularly hard by the latest coronavirus surge that some public health officials attribute to Thanksgiving holiday gatherings in November. Los Angeles is one of two counties reporting a shortage of intensive care unit beds.

The state of some 40 million residents reported 72,911 COVID-19 cases on Monday, a single-day record since the pandemic began.

Los Angeles County EMS Director Cathy Chidester has called the situation a “hidden disaster,” not plainly visible to the public in a county where COVID-19 patients were dying last week at the rate of one very 10 minutes.

    Ambulances have in some cases been forced to wait several hours to unload patients, causing delays throughout the county’s emergency response system.

The United States has reported a total of 20.8 million cases and 355,00 COVID-19 deaths. A record 129,000 COVID-19 patients were in hospitals as of Tuesday.

The worsening situation has put increasing pressure on state and local officials to speed up distribution of the two vaccines approved for emergency use to protect against the coronavirus.

Federal health officials said on Monday that more than two-thirds of the 15 million coronavirus vaccines manufactured by Pfizer Inc (NYSE:) and Moderna (NASDAQ:) Inc and shipped within the United States have yet to be administered.

But some healthcare workers began getting their second shots of the Pfizer vaccine this week. Both vaccines require two doses three or four weeks apart.

The governors of New York and Florida have said they would penalize hospitals that fail to dispense shots quickly.

“It’s a matter of life and death,” New York Governor Andrew Cuomo said at a news conference on Tuesday. “If a hospital has done all their healthcare workers, fine, we will take that supply back and go to essential workers.”

The U.S. government is considering halving the doses of Moderna’s vaccine to free up supply for more vaccinations.

But scientists at the National Institutes of Health and Moderna said on Tuesday it could take two months to study whether the halved doses would be effective.

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