Bay Area begins to feel Thanksgiving fallout
Alarming spike in cases is first sign of postholiday surge
Coronavirus cases have shot up over the past several days in San Francisco and other parts of the Bay Area, the first sign of a dreaded post-Thanksgiving surge that public health officials fear will put more strain on hospitals already on pace to run out of beds.
The troubling local reports came as the state passed 20,000 deaths due to COVID-19, another sad marker in the pandemic. California
recorded 117 deaths on Monday to bring the total to 20,054.
Both the state and the Bay Area reported recordsmashing cases on Monday: 34,491 for California and 3,913 for the ninecounty region. Monday was the first day the Bay Area has reported over 3,000 cases. The death toll also has started to rise. Nearly 800 deaths were reported in the state last week and 65 deaths in the Bay Area, both increases of about 80% over the previous week.
Over the past four days, San Francisco reported 1,067 new cas
es — a shockingly high number that accounts for 6% of the city’s 17,000 total cases since the pandemic began. San Francisco reported a recordhigh 316 cases on Monday.
Five other Bay Area counties reported recordbreaking case totals over the past day or two, including Santa Clara County, which recorded 1,431 cases on Monday — double its singleday peak from the summer. The county reported nearly 4,000 cases over the past four days, or about a tenth of its total for the pandemic.
More than 33 million Californians were under shelterinplace orders once again as of Monday, in a desperate attempt to protect hospitals while the pandemic swells across the state. Public health officials say the Thanksgiving spike in cases will almost certainly lead to jumps in patients requiring hospitalization and intensive care in the next week or two.
It’s obvious from the spiking case numbers that many people ignored public health pleas to avoid Thanksgiving gatherings, infectious disease experts said. But with the rest of the holiday season approaching — starting with Hanukkah, which begins on Thursday — public health officials are doubling down on the familiar messages.
“We know people did not heed advice,” said Dr. Jim Marks, director of advance planning for the San Francisco Department of Public Health. “We as a city did not. We as a region, we as a state, we as a country did not. We can’t recover from the trajectory we’re on and continue to behave the same way. We have to behave very differently or we’re not going to be able to provide hospitallevel care to a large number of citizens.”
The main concern is for intensive care capacity, which already is stretched precariously thin in much of the state, including Southern California and the San Joaquin Valley. Statewide, hospital intensive care availability has dropped to 14%, Gov. Gavin Newsom said during a Monday briefing.
More than 10,000 people are hospitalized with COVID19, including 2,360 patients in intensive care, as of Sunday. Those numbers have increased roughly 70% over the past two weeks.
The San Joaquin Valley dropped to 6.3% ICU availability as of Monday, and Southern California fell to 10.9%. The low ICU bed count in both regions forced them under the state’s new stayathome order, which is triggered when availability falls below 15%.
Intensive care capacity in the Bay Area region — which the state defines as the usual nine counties plus Monterey and Santa Cruz — has improved slightly, with 25.7% of beds available as of Sunday night. But five counties nonetheless ordered a preemptive stayathome edict. As of Monday, San Francisco, Santa Clara, Alameda and Contra Costa counties mostly were shut down again. Marin County’s preemptive stayathome order takes effect Tuesday.
California reported more than 100,000 coronavirus cases last week and averaged more than 20,000 cases a day — the first time the state has crossed both those distressing benchmarks. The Bay Area is averaging about 2,300 cases a day, also a record. The positive test rate is about 10% for the state, according to a Chronicle analysis.
But the most recent numbers are even more unsettling and likely tied directly to Thanksgiving, public health experts said. They expect the numbers to worsen over the next week or two as those holiday cases continue to climb — and as people return home from travel and possibly pass the virus to others, creating secondary outbreaks.
“We know that those cases that occurred around people’s dinner tables or travels are going to show up right about now. Maybe the last couple of days we’re seeing that, but we know we’ll be seeing it for many days to come,” said Dr. Mark Ghaly, secretary of California Health and Human Services, during a Monday briefing.
Roughly 12% of those who test positive will end up in the hospital, infectious disease experts say. The number of COVID19 patients hospitalized and in intensive care already are at peak levels both in the state and the Bay Area.
Marks said the latest forecasts in San Francisco have the city running out of ICU beds on Dec. 27, but the models don’t yet take into account Thanksgiving cases. With the city averaging more than 30 cases per 100,000 residents a day, “you are looking at rampant spread in the community,” he said.
He noted that the reproduction value for San Francisco is around 1.5, which means every person infected is spreading the virus to 1.5 other individuals and the current outbreak is growing rapidly. The reproduction value needs to be below 1 for community transmission to slow down and stop. San Francisco was comfortably below 1 for most of the fall, and even during the summer surge never reached 1.5.
“We already have more COVID patients in the hospital than we hit in the peak of the second ( summer) surge. The rate of rise is steeper. And there is no evidence that it is slowing down,” Marks said.
The preemptive shelterinplace order was necessary, he added, because once the region has just 15% availability in its ICUs, “we run out of beds in a week. There is just very little runway.”
Still, there has been notably less widespread support for this stayathome directive compared to the first one in March, even among public health experts who were behind the original order. On Monday, the San Mateo County health officer said in a terse statement that he had no intention of joining his peers in a regional stayathome order ahead of a state mandate.
“I look at surrounding counties who have been much more restrictive than I have been, and wonder what it’s bought them. Now, some of them are in a worse spot than we are,” said Dr. Scott Morrow in the statement, which he published online. “Surely a hard, enforced, ( shelterathome) order will certainly drive down transmission rates. But what we have before us is a symbolic gesture, it appears to be style over substance, without any hint of enforcement, and I simply don’t believe it will do much good.”
Morrow said he believes that hospitals in his county are wellequipped to handle the winter surge. He noted that the region has not yet activated contingency plans to maximize intensive care capacity, such as opening special surge units or canceling elective procedures throughout the Bay Area.
But other local public health officials said they’re concerned about the pace of hospitalizations in their own counties as well as the widespread capacity crunch across the state.
Santa Clara County currently has only 50 intensive care beds available, said Dr. Ahmad Kamal, director of health care preparedness. Sixtytwo patients were admitted to hospitals in the county on Sunday alone, and he expects that number to climb to 100 soon.
“We are very concerned about our health care system’s capacity, in particular when it comes to ICU beds,” Kamal said. “Many of our hospitals continue to have five or fewer vacant ICU beds.”
Marks said San Francisco currently has five COVID19 patients who were transferred from other counties that were running low on ICU space. He worries about the city’s ability to keep taking those patients as more San Franciscans need hospital care.
“As bad as it could get here it’s likely to get significantly worse everywhere else. Those large regions that have already shut down, they’re going to run out of beds,” he said. “We will do everything we can to accommodate requests for help. But we’ll have to make some hard decisions as we approach our bed capacity in terms of our ability to continue to honor mutual aid requests.”