With intensive care capacity buckling under an unprecedented surge in coronavirus cases, California has opened four field hospitals where dozens of patients are being treated and the state is bringing in hundreds of additional health care providers.
The majority of the state — all of Southern California and the San Joaquin Valley — continued to be at, or far past, intensive care capacity as of Monday as COVID-19 hospitalizations hit new peaks. Statewide, intensive care availability was 2.5%.
And the pressure on hospitals won’t be abating soon. California reported a record-smashing 62,529 new cases on Monday, a grim reminder that the surge is still swelling and a harbinger of further increases in patients needing intensive care in the coming weeks.
Several counties and hospitals are reviewing crisis care guidelines that determine how to ration patient care if facilities run out of staff or other resources and are no longer able to provide appropriate treatment to everyone, said Dr. Mark Ghaly, secretary of California Health and Human Services, at a news briefing Monday. No hospital or county is yet enacting those guidelines, he said.
“We continue to build up our capacity so that even though hospital systems may be preparing along those lines, that we do everything we can to make sure Californians receive the care that they need,” Ghaly said. “Our goal is to make sure those plans are in place, but work hard to make sure no one has to put them in place anywhere in California.”
Gov. Gavin Newsom said at the same briefing that he likely will extend the state stay-at-home order for the Southern California and San Joaquin Valley regions, which is to expire Dec. 28. Almost the entire state is currently under the order, including all of the Bay Area. The Bay Area order expires Jan. 8, though it’s likely to be extended as well, public health officials have said.
Cases and deaths
After weeks of trailing the national surge in cases, California is driving the U.S. numbers. Statewide, case rates are nearly double the national average — about 114 cases per 100,000 residents in California, compared to about 65 per 100,000 residents in the U.S.
Despite Monday’s record cases, there are hints that the California surge may be slowing. The state averaged about 42,000 cases a day last week, about 32% higher than the week before. But that was a slower rate of increase than the previous week.
The Bay Area reported on average about 4,300 cases a day last week, a 31% increase over the week before. That was also a slightly slower rate of increase.
Nationally, cases appear to be plateauing, though public health officials warn that travel and gatherings for the upcoming holidays could bring on another surge in a week or two. The United States passed 18 million cumulative cases on Monday.
COVID-19 deaths continue to rise at alarming rates. The state reported 1,632 deaths last week, a nearly 50% increase from the previous week. In the Bay Area, deaths more than doubled, with 166 fatalities last week.
“Today’s the shortest day of the year, which means it’s the darkest day of the year, and we are at the darkest point in the pandemic so far,” said Dr. Nicholas Moss, the Alameda County health officer, in reference to the winter solstice on Monday.
At a virtual town hall, he said that though hospitals in his county are faring better than many other parts of the state, he’s concerned about the coming weeks. He acknowledged how badly people want to see friends and family over the holidays but advised them to stay home and not gather, to protect those most vulnerable of serious illness and death.
“It might be the darkest day of the year,” he said, “but that also means every day after will get lighter.”
Hospitals and intensive care
Statewide hospitalizations passed 17,000 on Sunday, a 70% increase from 14 days ago and more than twice the peak of the summer surge. Hospitalizations climbed about 64% in the Bay Area, to more than 1,700 as of Sunday.
Intensive care availability in the Bay Area region — which includes Santa Cruz and Monterey counties — climbed Monday, to 13.7%. But several counties are struggling more than others, including Santa Clara County, which was at 11% availability as of Monday.
One dire forecast suggests that 90,000 people with COVID-19 could need hospitalization in California by the end of January, Ghaly said at Monday’s briefing. That’s a worst-case scenario, based on models predicting how many people who are already infected, or may be in the next few weeks, will need hospital care.
Several Bay Area counties have said that they are no longer taking transfer patients from other parts of the state because their intensive care units are precariously close to capacity. That removes an important tactic for alleviating stress on hospitals in hard-hit parts of the state. In the summer surge, for example, Imperial County on the southern border transferred dozens of COVID-19 patients to other counties, but there’s less opportunity for that now.
Newsom said at Monday’s briefing that with hospitalizations blowing up all over California, counties are trying to build capacity in their own communities by opening alternative medical sites and bringing in health care providers from other areas.
Many hospitals have expanded their intensive care and COVID wards but are unable to keep up with demand. Some have opened tents in parking lots and other outdoor spaces for overflow patients who don’t need intensive care. But in several parts of the state the problem isn’t a lack of beds but a lack of doctors and nurses.
The state has activated field hospitals in Imperial, Sacramento, Orange and Tulare counties, and 62 patients were being treated at those sites as of Monday. More than 600 health care workers have been deployed by the state to help expand care, and Newsom said he’s requested another 200 providers from the U.S. Department of Defense.
State public health officials are considering opening two field hospitals in the Bay Area, in San Francisco and Richmond.
Vaccines
The state received its first 110,000 doses of the newly authorized Moderna vaccine on Monday, Newsom said. The Moderna vaccine is being prioritized for rural parts of the state because it doesn’t require the ultra-cold storage that’s needed for the Pfizer vaccine, which many remote parts of California don’t have the equipment to store safely.
Newsom said the state is expecting another 233,000 doses of the Pfizer vaccine this week.
In all, 70,258 Californians received their first dose of vaccine during the first week of immunizations, Newsom said.