Intensive care availability declined in the bay area again on Tuesday and there were virtually no vacant ICU beds in much of the state for the 19th consecutive day, as California tried to find a way to escape the long winter wave.
The statewide intensive care situation has become so dire that on Tuesday night the state issued a new health order that requires counties with reasonable ICU availability, which would include several in the bay area, to accept the transfer. of hospital patients who are in crisis and can no longer provide adequate care.
Hospitals in Southern California and the San Joaquin Valley have been inundated with COVID-19 patients for weeks and may be forced to ration care soon. The new health order also requires that most counties in these regions cancel almost all elective surgeries. The order takes effect immediately.
“This request helps to ensure that patients continue to receive adequate medical services, better allocating available resources across the state to avoid overburdening specific hospitals, counties and regions,” said Dr. Tomás Aragón, director of the Department of Public Health at California and the state health official in a statement. The order was Aragon’s first since taking office this month; he was previously the San Francisco health officer.
“When hospitals are overloaded and crowded, they are no longer able to provide the traditional standards of care we expect,” he said, “but if health resources are available elsewhere, we must ensure that Californians can receive care. appropriate ”.
The state has been struggling with its current increase for more than two months, and although there are signs that it may stabilize, the next few weeks still look terrible, public health officials said.
At the same time, vaccines were launched much more slowly than expected or expected. Further exacerbating the situation, a new, more infectious strain of coronavirus is circulating – 28 more cases were announced in San Diego County on Tuesday, for a total of 34 across the state – which could complicate attempts to delay the spread of the disease.
“December was very difficult and January will not be easier,” said the mayor of San Francisco, London Breed, during a news conference on Tuesday.
It is too early to say how much more pressure will be put on hospitals with an expected increase in cases due to the holiday season. Several counties in the Bay Area are reporting the first signs of a post-Christmas peak. But public health officials say they still cannot say whether they are facing a small bump or the start of a new “wave on another wave”.
On Monday, the state reported 74,135 cases, a record of one day by a significant margin, although it did include an accumulation of extended holiday cases for some counties.
Intensive care availability dropped to 5.9% in the bay area on Tuesday, but that number varied dramatically between counties. San Francisco reported that 35% of its ICU beds were available and four patients were transferred to municipal hospitals in other municipalities.
ICU availability has been at 0% in Southern California and the San Joaquin Valley, the two most affected regions, since mid-December.
San Francisco public health officials were unable to say immediately on Tuesday what impact the new health order would have on local hospitals. But at a news conference earlier in the day, Dr. Grant Colfax, director of the San Francisco Department of Public Health, noted that the enormous stress in the ICU in other parts of the state could affect the Bay Area as well.
“Although we have care available and people need care, it is moral, ethical and correct to provide this care when requested,” said Colfax, referring to transferred patients currently hospitalized in the city. “We are watching our capacity very carefully, because as the central and southern parts of the state continue to experience a catastrophic situation and as the region has fewer ICU beds, we expect that the capacity of beds in our local ICU will also start to decrease. “
Cases and deaths
The seven-day average in daily cases has risen in some counties in the Bay Area and remains stable for the region as a whole. Some counties are reporting declines in cases, although it is difficult to say whether this is due to delays in testing and reporting or a real decrease in the spread of the disease.
“I would hesitate to make any radical policy changes based on holiday data so far, so soon. A lot of things in COVID happen over weeks, and there are still 10 days until Christmas, ”said Dr. Nicholas Moss, Alameda County health officer.
He said there would certainly be an increase in cases after Christmas and the New Year. “The question is: is it the worst case scenario in which we will resume daily increases?” Moss said. “Or is it a speck? Things go up, but they go down again, and the momentum is simply not there to drive a wave. “
The state recorded 503 deaths on Tuesday, higher than the daily average of the previous week. The bay area recorded 73 deaths, also a marked increase in recent days. Both counts were the second highest for the state and region since the pandemic began.
Hospitals and intensive care
Cases have increased in Contra Costa County since Christmas, but officials said they still do not know how big the post-holiday increase will be and are concerned about the extra pressure on hospitals. The availability of intensive care has been in the single digits in the county for the past few days.
“So, we are already at the highest point we have ever been, and seeing these cases decrease is worrying,” said Dr. Ori Tzvieli, deputy health officer. “We are kind of holding our breath and hoping that our peak will not be as big as Southern California, because they are really fighting over there.”
On Monday, 269 patients with COVID-19 were hospitalized in Contra Costa County, including 69 in intensive care – both peaks of the pandemic. For the Bay Area, the intensive care count dropped slightly from a high over the weekend, with 495 people in the ICU on Monday; 2,134 patients with COVID-19 were hospitalized in the region.
Across the state, 21,597 people were hospitalized with COVID-19 and 4,623 were in the ICU – both new peaks for the pandemic.
Typically, counties will support each other if a hospital is crowded with patients, as can happen during a season of severe flu. But Tzvieli said that is not such a viable option now, with overburdened hospitals across California. The state has opened six “alternative care facilities” to help deal with overflows.
Tzvieli said that hospitals in his county are dealing with his current patient load, but he fears that a major outbreak – in a nursing home or in an overcrowded event, for example – could be disastrous.
“At the moment, they are close to the limit,” said Tzvieli.
Virus variant
San Diego County officials said on Tuesday that they had identified 28 more cases of people likely infected with the new variant of the coronavirus, which has been alerting the world. The county reported a total of 32 confirmed or probable cases, and two other cases were identified in San Bernardino County over the weekend.
The San Diego County cases include 28 that were confirmed with genomic sequencing and four cases that were directly linked to one of the confirmed infections. The samples were collected from December 27 to 31. One of the 32 patients was temporarily hospitalized, but the others remained at home.
None of the patients traveled recently, so they did not get the strain in the UK, where the variant was first identified, or anywhere else outside California. The patients are from 19 different families in four cities.
“The fact that these cases have been identified in various parts of the region shows that this strain of the virus may be spreading rapidly,” said Dr. Wilma Wooten, a San Diego County health officer, in a statement. “People must be extremely cautious to avoid obtaining and spreading COVID-19, especially this variant, which the research has shown to be more contagious.”
The variant has been identified in at least four other states. Public health officials in the bay area said they suspected it was also circulating in this region, although they have yet to identify any cases.
Erin Allday is a writer for the San Francisco Chronicle. Email: [email protected] Twitter: @erinallday