The latest and deadliest coronavirus outbreak has hit the whole of California, leaving no county untouched in the huge and diverse state, from dense and busy subways to extensive suburbs and vast rural and agricultural areas.
Still, different parts of the state felt the impact in very different ways.
The main stress factor of the last wave is the availability of intensive care units. State officials, fearing a post-Thanksgiving increase in cases would overburden hospitals, have set an ICU availability limit of 15% to trigger requests for regional blockade. The restrictions are in place for four of the five regions, covering more than 98% of the state’s residents.
In northern California, the only region that does not obey requests to stay at home, almost a third of the ICU beds are still available. Greater Sacramento is at 17.4%, and the Bay Area region was last reported at 7.5%.
Both the San Joaquin Valley and Southern California regions are at 0%.
These and other data comparisons highlight the differences between the most populous counties and metropolitan areas in the state, especially between the northern and southern parts of the state.
THE BAY AREA
The Bay Area as a whole is performing better than some of the more populated areas in and around Los Angeles. The Bay Area’s rate of new daily cases per 100,000 inhabitants has varied from 40 to 50 years in recent weeks.
“This may reflect the mask’s high conformity, high ventilation in our area due to its location and general adherence to distance in the Bay Area compared to other regions,” said Monica Gandhi, an infectious disease specialist at UCSF.
She added that “general trust by public health officials in the bay area, leading to greater compliance with stay-at-home measures” may also explain why the increase is not so bad here compared to Southern California.
Case rates differ slightly in each Bay Area county. San Francisco and Marin counties have lower daily case rates, while Solano, Santa Clara and Napa report cases about twice as high. But they are still below the state’s daily case rate, which was in the high 90s and down 100 last week.
Solano County continues to lead the bay area with the highest daily case rates. The county health officer attributed the increase to Thanksgiving Day and other weekend meetings and activities, and individuals still meet with others or go to work, even if they know the risk or are symptomatic.
Santa Clara County has also recorded high rates of daily cases recently – mainly in the mid-1960s per 100,000 people. Dr. Ahmad Kamal, the county’s health care preparation director, said Santa Clara had 28 ICU beds, or 8.5% availability, on Wednesday. He said that pandemic fatigue is the main factor, and communities of color in the southern and eastern parts of the county are withstanding the impact.
Kamal said that five days after Christmas, the county has yet to see an increase comparable to what occurred after Thanksgiving Day, and he expects residents to cancel plans and take extra precautions during the holiday.
“We have great concerns coming with New Year’s Eve, which has traditionally been a common time for meetings, especially among young people who feel at low risk or are not so susceptible to the virus,” he said.
Any further increase, Kamal said, will “take us to the extreme” of Southern California, where patients are being treated in gift shops and hospital corridors.
“We are staggering on the threshold and holding our breath waiting for what will happen on New Year’s Eve,” he said. “We are not there yet, but we are very close to that.”
GREATER REGION SACRAMENTO
The Sacramento County case rate has recently been close to the average for the bay area, dropping slightly from the low 1960s to the mid 1950s per 100,000 inhabitants. At a meeting of the Board of Supervisors on Wednesday, Public Health Officer Dr. Olivia Kasirye said that before Christmas, the county had an average of 800 cases and 10 additional deaths per day, and after the holiday there were 664 cases and six deaths a day.
“It looks like we’re going in the right direction, but it’s still too early to say,” she said. “We haven’t seen the impact of Christmas and the trips our residents made at that time, so we are still very cautious about the direction the numbers are taking.”
Although the availability of ICUs in Sacramento County is currently above the state’s 15% blocking limit, the health official said the shelter order at the site may not be lifted soon if there is a holiday peak, and patients in other overburdened areas they may need to be moved to hospitals in the Sacramento area. Earlier this month, the county began treating some COVID-19 patients in an alternative treatment facility installed at the Sleep Train Arena.
SOUTH CALIFORNIA
Southern California was dominated by the latest increase, with cases so violent that they pushed the state’s rate to the top spot in the country.
Robert Kim-Farley, professor at the School of Public Health UCLA Fielding, attributes the increase to pandemic fatigue. Southern California counties were also starting with a higher baseline, and many never reached the very low levels that Bay Area counties observed in October.
“With such high levels of the disease, the chance of going to the store and contacting the virus is much greater,” he said. “It becomes a snowball effect.”
The composition of the Southern California workforce has also made the region vulnerable. San Bernardino and Los Angeles counties, in particular, have large numbers of people working in key manufacturing jobs. Many are Latinos and live in densely populated and low-income areas, where the virus can spread more easily.
According to state data, San Bernardino County has the highest average seven-day case rate in the state at 165.5 per 100,000, the highest positive test rate at 23% and the highest positivity rate among communities disadvantaged by 26.8%.
Los Angeles County also has one of the highest case rates, 132.7 per 100,000, according to state metrics, with a positive test rate of 16.5% and a positive health equity test rate of 23 , 4%. Los Angeles County hospitals are completely overloaded, with some diverting ambulances and placing patients in gift shops and conference rooms. Authorities fear that if things get much worse, hospitals will need to start rationing care.
Los Angeles County has by far the largest population in California, with more than 10 million residents, and is racially and economically diverse. Experts say the city was vulnerable from the start to a pandemic. According to the CDC, the county has a high social vulnerability score, which indicates how a natural disaster or disease outbreak can affect a community’s health. Neighboring counties of San Bernardino and Riverside have even higher scores.
Kim-Farley said that occasional confused messages from county leaders have created confusion for residents, including the divided Council of Supervisors, some of whom want the economy to reopen, and others who want strong measures from the public health department to continue.
“People are not united around a common vision and message, and it confuses people,” said Kim-Farley. “This has been a problem at many levels of government.”
In neighboring Orange County, the case rate averaged 104 per 100,000 people last week. Hospitalizations increased 225% over the previous month. While the home stay request in the Southern California region has been extended, meaning that restaurants are closed for in-person dining, some restaurant owners in Orange County have challenged the restrictions using the hashtag #OpenSafe.
On Tuesday, Riverside County recorded 73 deaths, a historic record for the county.
The California National Guard sent medical staff members to support a city hospital that was understaffed, and overcrowded patients waiting for beds to be opened were placed in the facility’s cafeteria.
Kim-Farley said southern California counties are having their “New York moment”. At the start of the pandemic, New York City’s case rates skyrocketed and hospitals were overwhelmed.
“I think we will see another increase in the coming weeks because of the amplification that occurs during the holidays,” he said. “There is a light at the end of the tunnel with vaccines, but the tunnel is getting ugly and increasingly ugly to cross.”
Todd Trumbull designed the graphics in this article.
Kellie Hwang is a writer for the San Francisco Chronicle. Email: [email protected]