FEWER COVID-19 PATIENTS IN LOCAL HOSPITALS
Unvaccinated — some by choice — keeping case rate stable, officials say
One year ago, Dr. Jess Mandel marveled at an empty Interstate 5 as he biked across the freeway on his way to the full intensive care unit at Jacobs Medical Center in La Jolla.
Though the route is the same today, the numbers have flipped for the UC San Diego pulmonologist and division chief.
“The roads are more full, but occasionally I see empty beds in the ICU or the emergency department, which we went months and months and months without seeing,” he said. “It’s still a little shocking when you walk by a room and there is not a patient in it.”
The change shows dramatically in the numbers. According to county records, the pandemic hit its peak in local hospitals on Jan. 12, with 1,804 confirmed and suspected COVID-19 cases simultaneously occupying beds at more than 20 facilities. For more than two weeks now, coronavirus has taken up only about one-tenth as much space, with a collective total of 158 COVID-19 patients in beds on Sunday, the most recent day for which data was available.
And yet, while the numbers have been consistently much lower than they were just a few months ago, they have settled into a steady pattern, generally just under 200 per day.
The situation begs a simple question: Who’s still getting hospitalized after coronavirus infection?
Anecdotally, Mandel said, it’s abundantly clear that nursing home residents are not ending up hospitalized nearly as frequently as they were.
“My impression is the county has done a fantastic job getting those folks vaccinated, because we are not seeing them in the way that we once did,” Mandel said.
Some age 65 and older, he added, are still getting infected and sick enough to be admitted, though they tend to be unvaccinated and living at home with or without other family members present in their households. Those in their 50s, who only just became broadly eligible for vaccination on April 1, also are in the mix, he said.
Among those eligible for the vaccine, he said, there remains an undercurrent of reluctance and distrust that has not gone away
despite 2,794 death reports among 167 million doses delivered in the United States. Those deaths, which have not been proven to have been caused by the vaccine, are 0.00167 percent of all doses delivered.
“I encounter more patients than I wish I did who are not interested in getting the vaccine,” Mandel said. “What I hear people say is they feel like it was too rushed, it was too fast, that they worry that, in the rush to get a vaccine to market, that corners were cut or that safety precautions were not observed.”
Having read the evidence for himself, Mandel said he does what he can to explain that the number of people tested with the current crop of vaccines is at least as large, probably larger, than those used to approve other vaccines.
“I feel very strongly that that’s not the case, that it has been a very transparent process,” Mandel said. “All of the safety data has been looked at by many, many neutral parties.
“There is no question that these are really terrific vaccines.”
Beyond the daily number of COVID-19 patients in beds, it’s difficult to find the whole picture of how hospitalizations have changed in San Diego County. The Hospital Association of San Diego and Imperial Counties said the average amount of time patients spend in beds when they do get admitted has not changed much compared to the winter peak, but could provide no broader measures of comparative admission rates.
Sharp HealthCare, though, did have some hard numbers to share. The median age of the 3,654 COVID-19 patients that Sharp’s four main hospitals admitted in December and January was 64 while the median age for the 358 COVID-19 admissions in March was 55, clearly showing the significant effect of a vaccination program that focused first on seniors.
In December and January, 60 percent of hospitalized patients were age 60 or older compared with 41 percent in March.
Though the age of COVID-19 hospital patients has fallen by about a decade, Brett McClain, Sharp’s chief operating officer, said that hospitalization remains more common among those with certain chronic health problems, including obesity, diabetes and congestive heart failure.
“Even though it is trending younger, the severity of illness is relatively consistent,” McClain said.
And there are early signs, the executive added, that coronavirus activity may again be on the uptick.
In December and January, 27.7 percent of patients who visited Sharp’s hospitals tested positive compared with 4.4 percent in March.
But McClain said that last week that number started to tick up again after three weeks of stability, suggesting that a surge connected to the Easter holiday, spring break or the prevalence of more-infectious coronavirus variants may be getting going.
“If we see any more rise, I’m going to get more concerned,” McClain said. “It drives home the point that we’re not done.
“We are enjoying some leveling off, and we are certainly enjoying good numbers in terms of our vaccination rates, but we still need to do the other things, the masking up and keeping distance, to keep ourselves safe.”
Mandel agreed, noting that it is particularly unpleasant, in this era of increasing vaccination, to see patients getting infected who could already or soon get a shot.
“It makes you sad, because whenever you admit a patient like that, you just feel like this was presumably preventable if they had just been vaccinated,” he said.
His message at the moment is simple: “We’re almost there, let’s not blow it.”
“I encounter more patients than I wish I did who are not interested in getting the vaccine.” Dr. Jess Mandel UC San Diego pulmonologist and division chief