RESTRICTIONS TO TIGHTEN: ICU capacity by region the benchmark for latest orders
San Diego County will be tied to all of Southern California in a new “regional” stay-at-home order that mandates closure of many businesses when intensive care capacity drops below 15 percent.
Under the order, all personal care service businesses, including salons and barber shops, plus wineries, bars, breweries and distilleries, family entertainment centers, museums, zoos and aquariums would have to cease operations and restaurants would have to stop outdoor dining.
Indoor retail establishments would be able to remain open during the busy holiday season, but at no more than 20 percent capacity. Hotels and other lodging establishments would be allowed to remain open only “for critical infrastructure support.”
While the restrictions are
similar to the state’s stay-athome order in March, there is a significant difference: Outdoor recreation facilities can remain open “to promote and protect the physical and mental well-being ” of residents. That includes beaches and outside gyms though none may “sell food or drink for on-site consumption,” and no overnight stays will be allowed at campgrounds.
While it appeared that ski resorts would be allowed to remain open during the shutdown orders, indoor and outdoor playgrounds would have to close.
Schools will continue to operate in their current modes. Those that have previously reopened for in-person instruction can remain open and schools can continue to bring kids back for in-person education under the state’s Elementary School Waiver process.
None of these restrictions are currently in effect, and nobody knows exactly when they will be.
Late Thursday afternoon, the California Department of Public Health published the consolidated intensive care unit capacities for each of the five regions that will hang together. Southern California, which includes 11 counties including San Diego, Los Angeles, Imperial, Riverside, San Bernardino, Santa Barbara, Ventura and San Luis Obispo, is listed at 20.6 percent, a bit more than the San Joaquin region at 19.7 percent but less than the “Greater Sacramento” region at 22.2.
The state will release a fresh set of percentages daily, and those regions that hit 15 percent will have 24 hours to go into the latest level of government-mandated COVID-19 restrictions.
Newsom said the move is necessary to slow the spread of the novel coronavirus, which has picked up significantly during the holiday season. Making sacrifices now, he said, is a critical piece of coping with a coming surge in cases and hospitalizations associated with the Thanksgiving holiday that is expected to arrive in the next few weeks.
“This is the most challenging moment since the beginning of this pandemic. This is the time to put aside your doubt. Lives are in the balance,” Newsom said.
How long will it take for regions to shed enough ICU capacity to sink to 15 percent or less?
The governor said he did not have much confidence it would be too long at all in most places.
“We anticipate as early as the next day or two, as long as next week ... the Bay Area may have a few extra days,” Newsom said.
But the latest numbers, shared in San Diego County’s daily COVID-19 update Wednesday, show that the region is likely to be put into a more restrictive lockdown even though its intensive care remains more favorable than Southern California’s.
It is unclear exactly how the state is using total licensed capacity or available bed capacity to calculate its percentages; however, San Diego appears to exceed the Southern California number no matter which denominator is used.
Thursday’s daily COVID-19 report from the county health department indicates that 77 percent of “current” ICU capacity was in use Wednesday, meaning that about 23 percent remains available. Local hospitals are collectively licensed to operate 853 ICU beds. If that number is the state’s statistical measuring stick, then the local ICU occupancy rate would be about 63 percent.
Why lump so many different counties together?
Dr. Mark Ghaly, California’s secretary of health and human services, said the regional strategy is intended to make sure that there is somewhere to transfer overf low patients in counties where ICU beds fill up or staffing levels are not adequate to meet demand.
“When capacity can’t be met within a specific county, we lean on neighboring counties and their hospital delivery systems,” Ghaly said.
No one will escape the system for at least three weeks after hitting 15 percent collective ICU capacity. After three weeks, Ghaly said, the state will begin looking to ease restrictions for regions that have climbed above that mark.
But returning to previous levels of operation, the physician said, will not happen unless his departments’ internal projections find that the situation is not likely to worsen in the coming four weeks. Looking at the recent number of new positive cases, he said, allows epide
miologists to predict what’s likely to arrive at hospitals in the future.
“We know that cases today will end up in the hospital two weeks from the time that we register those cases,” Ghaly said. “Within about a week, a week and a half, we start to see individuals that are hospitalized going to the intensive care units.”
Local leaders were clearly not excited about having the pace of San Diego’s reopening tied to so many other counties, many that have had higher percapita infection rates than have occurred locally. But they did not appear ready to revolt.
County Supervisor Greg Cox said in an email that it is “frustrating to be thrown into the mix with other counties.”
“Nevertheless, we will continue to do our part to keep people safe,” Cox said.
Supervisor Jim Desmond, who has most vocally opposed the state’s tiered reopening system, said it does not makes sense to target local businesses when the virus is now widespread in the community.
While he was pleased, he added, that the state is starting to use bed capacity as a metric for which locations should remain open, Desmond said he didn’t think fighting the latest order was an option.
“Unfortunately, the governor has taken a hard stance on whatever he comes out with,” Desmond said.
San Diego’s level of local coronavirus activity continued to generate significantly more positive tests than it did just a few weeks ago with 1,504 additional cases and five deaths announced Thursday. The total number of concurrent hospitalizations increased from 739 Tuesday to 753 Wednesday.