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California now the COVID epicenter of the US; ICU space at 0%

At Sharp Memorial Hospital in San Diego, nurses treat a patient diagnosed with COVID-19 in an isolation room on March 26, 2020. (Nelvin C. Cepeda/San Diego Union-Tribune/TNS)

California enters the final week of 2020 as the U.S. epicenter of the coronavirus crisis.

The state of 40 million people has seen more than 2.1 million test positive and at least 24,220 die of COVID-19 since the start of the pandemic, according to the California Department of Public Health.

More than 570,000 of those cases and 3,250 of the deaths have come in the past two weeks — averages of about 41,000 cases and 232 deaths per day, both record highs for the state. California has reported the highest number of new cases per capita in the past week of any state, according to data from Johns Hopkins University.

As of Sunday, more than 19,200 patients were hospitalized with confirmed cases of the virus in California, including 4,123 treated in intensive care units. Both totals are now officially more than double the peak observed during the summer surge, when about 7,200 were hospitalized with 2,050 in intensive care.

ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve, according to CDPH.

This does not mean there are zero ICU beds vacant across California; rather, it means the two regions with 0% capacity — Southern California and the San Joaquin Valley — have reached extremely deep into surge protocols to continue treating severe patients, COVID-19 or otherwise.

Those two regions were placed under the state’s strict stay-at-home order, unveiled by Gov. Gavin Newsom in early December, three weeks ago. The order directs restaurants to cease both indoor and outdoor dining and mandates closures for personal care services like salons and barbershops, on top of the restrictions already in place for purple-tier counties.

State health officials reassess the projected ICU situation in each region after three weeks within the order to determine whether the tight restrictions must continue. Extensions for Southern California and San Joaquin Valley are essentially guaranteed, with an announcement likely coming today from the state as they hit the three-week mark.

For the 13-county Greater Sacramento area, it’s less clear. The region’s three-week window will end this Thursday, on New Year’s Eve. Greater Sacramento has fluctuated around but mostly above the 15% benchmark used as the initial trigger for the stay-at-home order since mid-December. As of Sunday, it had 17.8% ICU availability.

The Bay Area had 11.1% of its ICU beds available through Sunday and must stay under the order through at least Jan. 8. Only the 11-county Northern California region, north of Greater Sacramento, has not entered the shutdown; it still had 28% availability as of Sunday.

The impact on hospitals goes beyond just COVID-19 patients and overwhelmed intensive care units. Kaiser Permanente confirmed over the weekend that it will postpone “elective and non-urgent surgeries” at its Northern California hospitals for one week, from now through Jan. 4, the San Jose Mercury News reported Saturday.

Glimpses of slowing growth, but holiday impact looms

Health experts are supremely concerned about holiday gatherings last week for Christmas, as well as any New Year’s revelry later this week, and their strong potential to deepen the current crisis.

Officials in ravaged Los Angeles County, as well as Newsom, have referred to the prospect of a “surge on top of a surge on top of a surge.” The initial surge started around early November and grew worse after Thanksgiving, with officials fearing Christmas will present an even bigger jolt to infections, hospitalizations and deaths in the weeks to come.

Ahead of Christmas, many in California and across the U.S. pleaded for people to either cancel or scale back their holiday gathering and travel plans. Many Americans appear not to have done so: federal data shows nearly 1.2 million passengers passed through security checkpoints last Wednesday and almost 1.3 million on Sunday, making those the two busiest air travel days since the start of the pandemic in mid-March.

It remains a bit too early to draw many conclusions, but there have been some modest signs of potential slowdown in California’s current surge in data from the past week.

The graph for test positivity, as a two-week average, has increased from 12% to 12.3% in the past week. That increase of 0.3% is much lower than the 1.6% growth the previous week (10.4% to 12%) and the 2.1% jump during the week of Dec. 7 to Dec. 13 (8.1% to 10.2%).

And the statewide total for hospitalized virus patients, while at a record-high 19,237, increased by only 62 in Friday’s data update and by just six on Saturday, snapping a 41-day streak of triple-digit net growth. The total then grew by 294 in Sunday’s update — significantly higher, but still low relative to daily increases of more than 500 patients that have been routine for California throughout December.

The holiday shouldn’t have substantially impacted either the test positivity rate or hospital data. The state tracks positivity as a two-week average so that a single day does not skew the data, and the CDPH dashboard showed more than 98% of all licensed hospital beds being accounted for in Friday and Saturday reporting.

The metrics are all still on upward trajectories — especially deaths, which lag weeks behind the other indicators — but the first step toward plateau or decline is a slower acceleration of increases. But, as health officials warn, it’ll take a couple of weeks to see whether Christmas and/or New Year’s celebrations undo this apparent progress, and if so, to what extent.

Given the holiday impact, Newsom said in a recent video message that the state projects its hospital number will double in the next month, up to more than 36,000 hospitalized patients.

“I fear that, but we’re not victims to that if we change our behaviors,” he said.

Trump signs stimulus bill, without revisions on direct payments

President Donald Trump on Sunday night signed a $900 billion stimulus package, days after he criticized the relief bill and said the included $600 direct payments were too small.

Trump had called for the checks to be increased to $2,000 for individuals and $4,000 for couples.

But in the bill as written and passed, the funds currently guaranteed include $600 for eligible adults earning up to $75,000 in adjusted gross income plus $600 per child dependent.

Treasury Secretary Steven Mnuchin has indicated that payments should start appearing for direct deposit users within about two weeks, while physical checks will take longer to deliver.

Vaccines arrive this week at California nursing facilities

With distribution and administration of the Pfizer and Moderna coronavirus vaccines both underway, today will mark the start of a massive inoculation campaign at skilled nursing facilities across California.

It’ll take at least about a month to finish administering shots at the state’s 1,200 licensed nursing facilities, which house some of the most vulnerable populations and have been hotspots for deadly outbreaks.

In the four-county capital region of Sacramento, El Dorado, Placer and Yolo, nursing home residents account for well under 1% of the population, but about 25% of all COVID-19 deaths, state data show.

CVS and Walgreens will assist in vaccination efforts at long-term care facilities in California.

Skilled nursing facilities are in Phase “1a” of California’s virus vaccination plan. The other group in Phase 1a, front-line health care workers who deal directly with COVID-19 patients, began receiving shots in mid-December.

Local numbers: 98,000 infected, 1,100 dead in six-county area

Across the six-county area of Sacramento, El Dorado, Placer, Sutter, Yolo and Yuba counties, nearly 98,000 residents have tested positive for COVID-19 and at least 1,132 have died.

Sacramento County has reported a total of 63,131 infections since the onset of the pandemic, and 827 residents have died of COVID-19. County health officials on Monday added 3,361 additional cases Monday for a four-day reporting period including Christmas and the weekend, along with 18 newly reported virus deaths.

By date of death occurrence, the county now reports 152 deaths for Dec. 1 through Dec. 22, including 148 in just the first 18 days of the month. December has surpassed the 144 from November to become the second-deadliest month of the pandemic for Sacramento County residents. The current month remains on track to surpass 200, well exceeding the 181 deaths from August.

Virus hospitalizations in Sacramento County have declined in the past few days while the ICU patient total remains elevated. The overall total in hospital beds fell from a record-high 518 reported Wednesday to 452 in Sunday’s update.

State data showed 99 ICU patients countywide as of Sunday, but the number of available ICU beds has increased from 63 to 84 in the past eight days as hospitals work to expand surge capacity.

Placer County health officials have reported a total of 12,262 infections and 120 deaths. Last week week, more than 1,700 new infections and nearly two dozen deaths were confirmed.

As of Sunday’s state data update, 192 people were in Placer County hospitals with COVID-19 including 25 in ICUs. The county has 23 ICU beds available.

Yolo County has reported a total of 7,501 infections, 160 of which were reported on Thursday, and 109 deaths. One death was reported Thursday.

State data showed Yolo with a record-tying 29 confirmed COVID-19 patients in hospital beds, but only four in intensive care units.

El Dorado County has reported 5,095 positive test results and 13 deaths. In the last week, more than 683 new cases have been confirmed.

Health officials say 25 people are hospitalized with the virus. Ten are in ICUs, up from five reported on Christmas Eve. State data shows only two ICU beds available in El Dorado County, down from 11 early last week.

In Sutter County, 6,037 people have been infected and 46 have died. Of those, 109 were confirmed infected Thursday. Sutter reported 51 residents hospitalized as of Thursday, including seven in intensive care.

Neighboring Yuba County has reported 3,628 infections and 17 dead, with 74 new infections reported Thursday. Twenty-seven Yuba residents were reportedly hospitalized as of Thursday. Twenty-seven people are currently hospitalized.

Not all of those patients are necessarily hospitalized in-county, but the only hospital serving the bi-county region — Adventist-Rideout in Marysville — had a record-high 65 virus patients as of Sunday’s update from the state, including 13 in the ICU. Only two ICU beds remained available as of that update.

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(c) 2020 The Sacramento Bee

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