Stay-home orders likely to be extended
For first time on Monday, state surpasses 60,000 new cases in one day
With the recent surge in coronavirus cases, hospitalizations and deaths showing few signs of abating, Gov. Gavin Newsom said Monday it’s “very likely” California will extend into 2021 the stay-home orders affecting most residents of the Golden State.
The restrictions were set to begin expiring at the end of December for some regions, but the state plans to evaluate capacity in hospital intensive care units and other factors in the coming days that likely will mean more time at home.
California for the first time on Monday topped more than 60,000 new cases in a day, according to reporting by this news organization, and was closing in on an average 250 deaths a day over the past week.
“We are anticipating a substantial increase in the hospital surge,” Newsom said at a Monday coronavirus news conference.
Some projections forecast more than 75,000 hospitalizations in the coming weeks, more than four times current levels, with families planning to gather over the Christmas holiday despite pleas from public health officials to stay home. That could overwhelm hospitals and ICUs already straining to care for existing patients.
Hospitalizations in California already have increased 63% in the last two weeks, with more than 17,000 coronavirus patients now in the hospital. ICU numbers also have increased 51%,
with more than 3,640 patients needing critical care. The testing positivity rate also has crept up from less than 9% two weeks ago to 12%, highest since the earliest days of the pandemic.
The state has just 2.5% capacity available at intensive care units, including 0% in Southern California and the San Joaquin Valley. In the Bay Area, ICU availability stands at 13.7%, just below Greater Sacramento’s 16.2%.
The only area in the state not under a stay-home order remains Northern California, where the ICU threshold sits at 28.7%. The state has pegged its current stay-home rules — which shut down most indoor activities, sharply limited social gatherings and imposed quarantines on travelers — to 15% ICU availability.
When a region has 0% available space in its ICUs, it doesn’t necessarily mean it doesn’t have any ICU space available but rather that hospitals must activate surge beds and staff they don’t ordinarily use. It also raises the prospect those extra beds will be understaffed or use staff with less-than- optimum training.
“We are worried that certain regions do exceed their existing capacity and even may go beyond the existing surge capacity they currently have planned,” warned Health and Human Services Secretary Dr. Mark Ghaly, noting that about 12% of today’s cases will require hospitalization and 12% of those likely will require ICU admission.
Stephen Parodi, an executive vice president with Kaiser Permanente, said the health care giant has tapped cardiologists to help out with intensive care and postponed even outpatient elective procedures to devote staff to those spending the night in the hospital.
In Kaiser’s Northern California region, Parodi said, coronavirus patients account for 40% of hospitalizations, half of all ICU patients and a quarter of ventilator use.
A third of ICUs are close to full, and at a couple of hospitals, entire ICUs are occupied by those with COVID-19. Unlike some smaller hospitals, Kaiser still has the ability to meet demand by transferring patients within its own network, but that’s getting more complicated as hospitalizations rise.
“Those are really significant numbers that we’ve never seen in the course of the pandemic so far,” Parodi said.
“I’m extremely concerned that with the coming Christmas and New Year’s holidays,” he added, “that if we repeat the same kind of behavior that occurred with Thanksgiving Day, we’re going to look at a much worse situation.”
Kaiser is not alone. San Mateo County on Monday announced it would spend $4.5 million to add 10 ICU beds at Dignity Health’s Sequoia Hospital in Redwood City that will serve the entire Bay Area region.
“It does appear as if we are heading for a surge upon a surge,” said Louise Rogers, chief of San Mateo County Health.
The county is also using more than 80 hotel beds to house people who don’t need the level of care a hospital provides but who don’t have a safe, uncrowded space to recover.
To the south, Santa Clara County reopened DePaul Health Center in Morgan Hill on Dec. 15 to care for “step down” patients who no longer need hospital-level care. There are currently 12 patients at DePaul, a spokeswoman said Monday.
Already, the state has opened four “alternative care” sites, including at the Sleep Train Arena in Sacramento, and could open at least that many more. The sites are currently caring for 62 patients, but that number is likely to rise. One of the sites is in hardhit Imperial County, where Newsom has requested an extension of federal help through January.
In the past, places such as Imperial County transferred patients elsewhere. But as COVID-19 surges across the state, that becomes less of a possibility.
Yet, the largest challenge at many hospitals is not bed space or personal protective equipment like masks and gloves but staffing, with the traveling nurses that have typically offered some relief in high demand across the country.
The state has already dispatched 607 medical workers to help at 75 facilities across 24 counties, Newsom said, and is requesting more federal help from the Department of Defense.
California is also considering implementing a new quarantine protocol for visitors from the United Kingdom, where a new strain of the coronavirus that appears to be more transmissible is raising alarm. So far, it has not been found in California.
There is one bright spot, Newsom said: More than 70,000 people in the state have received the first dose of Pfizer’s coronavirus vaccine, and hundreds of thousands more front-line workers are expected to be inoculated this week.
Some 560,625 doses of the Pfizer vaccine should arrive this week, Newsom said, along with more than 670,000 doses of the newly approved Moderna vaccine.
The governor acknowledged the Pfizer shipments are about 40% below what the state had anticipated because of an error at the federal level, but Newsom complimented the Trump administration on its work to distribute the vaccine.
“This is an extraordinary accomplishment,” Newsom said.