Coronavirus updates: ICU space shrinks across California; weekend cases smash records
It was a brutal weekend for California, as the coronavirus pandemic continues to worsen in effectively every possible way.
Saturday and Sunday marked the two grimmest days of the health crisis in terms of reported COVID-19 infections and hospitalizations, at a time when the state is already grappling with strained intensive care unit capacity and a month-long deluge of new lab-confirmed cases that now appears to be intensifying in the wake of Thanksgiving.
California on Saturday added 25,000 new COVID-19 cases, a daily record immediately topped by the 30,000 reported Sunday, according to the California Department of Public Health. The state added 24,735 more on Monday, pushing the all-time total for lab-confirmed infections to about 1.37 million.
The state has surpassed 10,000 concurrently hospitalized COVID-19 patients for the first time, Gov. Gavin Newsom said in a Monday morning news conference, including a record-high 2,360 in intensive care units. The total number of available ICU beds dropped below 1,600 for the first time during the pandemic on Sunday, but rebounded above 1,700 on Monday.
State health officials reported 209 virus fatalities Saturday, the second-highest daily death toll to date, pushing California’s cumulative total close to 20,000.
Tighter state-imposed restrictions on businesses and gatherings are likely just days away, for places not already subject to them.
At-home oxygen tanks, rapid RN training
Newsom announced Monday that the state is launching a “Home O2” program that will support coronavirus patients “at home with oxygen and paramedic support.”
The program will be rolled out soon in three Southern California counties, with initial capacity for 200 patients: 100 later this week for Imperial, and 100 in “coming weeks” for Riverside and San Bernardino counties.
The governor also said the state is currently in the process of implementing two-day training courses “to get (registered nurses) up to speed in caring for ICU patients.”
On Monday, the state also started rolling out “formal tele-ICU consults” allowing critically ill virus patients to contact physicians virtually.
Newsom said the state is bringing in 815 contracted medical workers to help with the surge. The state requested federal aid in the form of 160 hospital staff to join ICU strike teams, and 80 EMS providers to help at skilled nursing facilities, hospitals and other sites.
Newsom unveils CA Notify smartphone app
A Bluetooth-enabled app called CA Notify will go live this week, allowing people to receive smartphone notifications telling them if they have been near someone who tested positive for COVID-19.
The app exchanges random codes between users’ phones. If a person tests positive, they enter a verification code into their app, and it notifies any other app user who was within six feet for 15 minutes or more of possible exposure.
Newsom stressed in his news conference that the program is “exposure notification” technology, not contact tracing, because it does not require users to divulge personal information or identify their close contacts.
Where do California’s regions stand in terms of ICU capacity?
The strict protocols introduced by Newsom on Thursday, calling for non-essential businesses to close down and gatherings to cease like in his initial stay-at-home order from March, have already taken effect in two of five regions combining for a majority of the state’s population.
Last week’s addendum to the health order grouped California’s 58 counties based on existing mutual aid health system infrastructures, with counties subject to the new restrictions for at least three weeks starting the day after their region’s overall ICU capacity drops below 15%.
The five regions are: Bay Area, Greater Sacramento, Northern California, San Joaquin Valley and Southern California.
The latter two fell beneath 15% Saturday, triggering regional shutdowns. As of Monday, the San Joaquin Valley had only 6.3% of ICU beds available, and Southern California had 10.9%, Newsom announced in his news conference.
Five Bay Area counties — Alameda, Contra Costa, Marin, San Francisco and Santa Clara — proactively ordered tighter restrictions ahead of the regional order. The 11-county Bay Area as of Monday still had 25.7% of its ICU beds available.
Yolo County in the Sacramento area also tightened its own order in response to its local hospital emergency, but included an exception that will allow outdoor restaurant dining to continue at least a few more days. The Yuba-Sutter bi-county region urged residents to stay at home, but framed its message as an advisory rather than a mandatory order.
Greater Sacramento had its total ICU capacity reported at 20.3% on Monday, up from 18.2% on Sunday.
Still, the state’s stay-at-home order could trigger in the capital region any day now. Capacity dropped by 3.2% from Saturday to Sunday and will likely continue to fluctuate on a daily basis, as ICU admissions for COVID-19 spike due to the recent record-setting case totals while hospitals work to counter that growth by expanding surge capacities.
Northern California — made up mostly of all the counties north of Greater Sacramento — had 28.2% ICU capacity available, the highest of the five regions through Monday.
However, Northern California has by far the lowest volume of licensed ICU beds among the regions, at about one-quarter Greater Sacramento’s total, state hospital data show. This means the capacity percentage is much more sensitive to raw changes in patient total, in either direction.
San Joaquin Valley, Southern California and the five Bay Area counties that bolstered their orders combine for more than three-quarters of the state’s 40 million residents.
ICUs in Greater Sacramento are filling, but no shutdown yet
Monday’s ICU capacity staying above 15% means the Sacramento region won’t have to impose new stay-at-home restrictions on Tuesday.
There are 13 counties in the Greater Sacramento region — Alpine, Amador, Butte, Colusa, El Dorado, Nevada, Placer, Plumas, Sacramento, Sierra, Sutter, Yolo and Yuba.
Four of those have no hospitals with licensed ICU beds within their county lines: Alpine, Plumas, Sierra and Sutter.
Across the remaining nine counties, capacity is running low amid COVID-19 patient counts that fluctuate day-to-day, but on the whole have risen dramatically in recent weeks in the entire region. Hospitals’ available, staffed ICU bed capacity can increase or hold stable despite rising COVID-19 patient numbers because of boosts in staffing, as well as a drop in the number of patients in the ICU being treated for different ailments.
Sacramento and Placer have the biggest ICUs of the group and the highest numbers of beds still available, but both are seeing that capacity wither.
Sacramento County in Sunday’s data update reported available beds falling from 73 to 65, before rising up to 76 on Monday. Placer County’s three hospitals reached an all-time high of 27 coronavirus patients in intensive care, but available beds held at 21.
Butte’s ICU capacity dipped from 15 beds Saturday to nine on Sunday, then went back up to 15 on Monday, state data showed.
Adventist-Rideout in Marysville, the only general acute care hospital serving Yuba and Sutter counties, had just one staffed ICU bed to spare last Tuesday through Thursday; it rose back to three as of Sunday’s update from CDPH and then tripled to nine as of Monday.
Yolo County’s two hospitals, both smaller than Rideout, had their combined ICU capacity drop to four beds Monday, down from seven on Sunday, as the intensive care total for COVID-19 reached a record-high 12.
El Dorado maintained six ICU beds reported available, even as its coronavirus patients in intensive care also hit a new high of eight. Overall hospitalizations for the virus, though — not just ICU cases — dropped from 22 to 18 between Sunday and Monday.
The smallest intensive care units in the region — Amador and Colusa counties, which have six licensed ICU beds, and Nevada County, which has eight — dropped to two available beds on Sunday: one in Amador and one in Nevada. That increased to seven with Monday’s update, as one more Amador bed and four more Nevada County beds became available.
California COVID-19 cases are skyrocketing after Thanksgiving
The nightmarish scenario health experts warned might emerge after Thanksgiving may be materializing, and right on schedule, given the typical incubation period for the virus.
Federal security screening data show Nov. 20-22 was the busiest three-day stretch for air travel in the U.S. during the pandemic, with some significant portion of those travelers most likely heading for Thanksgiving gatherings despite officials’ pleas not to do so.
Two weeks later, this past Friday through Monday brought California’s four highest reported case totals of the pandemic, combining for more than 101,000 positives. The state averaged nearly 22,000 daily new cases in the past week.
The recent figures drove the rolling two-week average for positivity up to 8.4%, the highest yet during the pandemic. During the summer surge, the positive rate maxed out at 7.6%.
The recent case numbers have horrific implications for what may happen to hospitals as December progresses.
State Health and Human Services Secretary Dr. Mark Ghaly said last week that approximately 12% of COVID-19 patients end up hospitalized within two weeks after onset of symptoms.
That would work out to an additional 12,000 hospitalizations linked to those who tested positive in the past four days alone — 2,000 more than the 10,070 who were already hospitalized as of Monday’s update.
Ghaly further said the state estimates 30% of hospitalized COVID-19 patients end up requiring intensive care.
That’d be over 3,600 new ICU cases linked to the recent four-day case load — more than double the state’s current count for available beds.
Already, with the bulk of Thanksgiving-linked virus activity not yet showing up in hospitalization data, California has recorded triple-digit net gains to its concurrent patient total for 24 consecutive days. This means that not only are hospital admissions for COVID-19 up, but that they have substantially outpaced releases — and deaths — of virus patients for more than three weeks, amplifying the crisis.
Deaths are already on the rise. The state as of Monday was averaging 86 daily virus fatalities over the past two weeks and 108 over the past seven days, according to CDPH. Less than a month ago, as California continued its long rebound from summer, deaths bottomed out on Nov. 11 at a two-week average of 41 per day.
Coronavirus deaths are emerging in areas that had been essentially spared in the earlier months of the pandemic. El Dorado County reported four last week, compared to four in the eight months prior to that. Nevada County, which had nine deaths from March through November, added seven fatalities in the first four days of December.
Over 800 dead in six-county capital area
The six counties that make up the bulk of the Greater Sacramento region by population — Sacramento, El Dorado, Placer, Sutter, Yolo and Yuba — have combined for close to 65,000 confirmed cases and at least 817 COVID-19 deaths.
Sacramento County has reported a total of 43,426 infections and 620 COVID-19 deaths since the onset of the pandemic. The county on Monday reported 2,330 new infections since Friday — an average of about 777 a day.
As in the rest of the state, the infection rate has been rapidly rising as winter approaches. County health officials shattered a single-day infection record last week when more than 1,100 infections were reported Tuesday.
In terms of episode date, which is the earliest of either onset of symptoms or the positive test specimen being collected, Nov. 30, last Tuesday and last Wednesday marked the county’s three largest case loads of the pandemic by far, at 971, 974 and 858, respectively. The previous high had been 662 infections one week earlier on Nov. 23, county data show.
Local health officials have now confirmed at least 89 virus deaths in Sacramento County residents for November. That makes it the third-deadliest month of the pandemic, edging past July but below the tallies for August and September.
Countywide, 374 people were hospitalized with COVID-19 on Monday, including 76 in ICUs, state data show.
Yolo County has reported a total of 5,492 infections and 84 deaths, with three fatalities coming Saturday. The county reported 125 new cases Monday, following 60 infections Sunday and 145 Saturday.
The county’s most recent weekly test positivity rate is a whopping 17.12%, which has risen from less than 4% at the start of October, according to the local health dashboard.
Yolo had 20 hospitalized with the virus, including 12 in intensive care, a new all-time high.
Placer County health officials have reported a total of 6,910 infections and 74 deaths, last updated Friday.
Recent data indicates a weekly positivity rate of 8.9%. Since late September, the average per capita infection rate has soared.
State data as of Monday showed 154 people were in Placer hospitals with COVID-19, including 27 in ICUs, both records for the county.
El Dorado County has a low cumulative numbers compared to its neighbors, with 2,822 positive test results and eight deaths, but its most recent test positivity rate is higher than either Sacramento’s or Placer’s at 11.2%.
Health officials say 18 people are hospitalized in El Dorado with the virus, down from 22 on Sunday, but with the ICU total jumping from five to a record-high eight.
In Sutter County, at least 3,915 people have been infected and 22 have died. Local health officials confirmed 106 cases Friday and reported one death.
Neighboring Yuba County has reported 2,403 infections and 11 dead, with 46 new infections added Friday. Its daily infection record was set last Wednesday, when 87 people were confirmed to have coronavirus.
The test positivity rate in Sutter County is 20.1%, the highest in the state. Yuba County’s most recent rate according to CDPH was 16.2%, third-highest among the 58 counties.
The bi-county health office dashboard showed 39 Sutter residents and 16 Yuba residents hospitalized as of last Friday, though not all of them at Adventist-Rideout in Yuba County, which as of Monday’s state data update had 46 coronavirus patients including eight in intensive care.
This story was originally published December 7, 2020 at 9:20 AM.
