Category Archives: Intensive Care Units (ICUs)

DAILY UPDATE link for California ICU bed availability BY REGION

By Roger Straw, December 5, 2020, updated Dec 7, 2020

The State of California is now posting a readily available DAILY UPDATE on California’s REGIONAL ICU hospital bed availability.  This is super important as a 15% level is the trigger for the state’s Dec. 3 Stay At Home Order.  Save this link for future use: https://covid19.ca.gov/stay-home-except-for-essential-needs/(You will need to scroll down to “Regional Stay Home Order”).

Below is the most current data from covid19.ca.gov:

EARLIER VERSION FOR COMPARISON:  Below you will find the map and the listing from December 5:

SAHO ICU bed % available as of December 5, 2020 for the 5 regions:

Northern California 24.1%
Bay Area 21.7%
Greater Sacramento 21.4%
San Joaquin Valley 8.6%
Southern California 12.5%


BenIndy NOTES

SAHO is short for Stay At Home Order.

I will try to find out and post here the usual time of day when the numbers are updated.  Stay tuned.

 

Latest California County-by-county ICU capacity numbers

[Editor: I am not finding a source for daily updating of California REGIONAL ICU bed capacity, which will be the trigger for the upcoming stay-at-home orders.  Below are the current COUNTY numbers.  I will continue to watch for a regional report.  No doubt the State will post something soon….  – R.S.]

Newsom implements regional stay-at-home order tied to ICU capacity

CalMatters, by Ana B. Ibarra and Lauren Hepler, December 3, 2020
EMT Giselle Dorgalli, second from right, looks at a monitor while performing chest compression on a patient who tested positive for coronavirus in the emergency room at Providence Holy Cross Medical Center in the Mission Hills section of Los Angeles on Nov. 19, 2020. Photo by Jae C. Hong, AP Photo
EMT Giselle Dorgalli, second from right, looks at a monitor while performing chest compression on a patient who tested positive for coronavirus in the emergency room at Providence Holy Cross Medical Center in the Mission Hills section of Los Angeles on Nov. 19, 2020. Photo by Jae C. Hong, AP Photo

IN SUMMARY
Imposing the strictest restrictions in months, Gov. Gavin Newsom announces a regional stay-at-home order tied to an alarmingly low number of hospital beds amid a statewide coronavirus surge.

In the face of a “surge on top of a surge,” Gov. Gavin Newsom announced today the strictest measure in months for a regional stay-at-home order tied to the number of intensive care beds as hospitals near their capacity in the face of a statewide coronavirus surge.

The governor’s order calls for tougher restrictions when ICU bed capacity drops below 15% in any of five regions. The state reported Northern California was at 18.6%, Bay Area 25.4%, Greater Sacramento 22%, San Joaquin Valley 19.7% and Southern California 20.6%. With those numbers, Newsom said the order could be triggered in the next day or two for most regions. Once initiated, the order would last three weeks. The governor urged people to stay within their households as much as possible to help stem the spread.

“If we don’t act now, our hospital system will be overwhelmed, if we don’t act now, we’ll continue to see a death rate climb; more lives lost,” Newsom said during a press conference.

This map is interactive on CalMatters website. Click here or on the image to go there, then hover over any county for ICU capacity on Dec. 3.

Under the order, people will have to stay home as much as possible as playgrounds, museums, movie theaters, salons and barbershops shut back down. Restaurants could only offer take-out and people can still go out for essential things like groceries, exercise and doctor appointments. K-12 schools that have reopened can remain open, and retail stores can operate indoors at 20% capacity.

California is kicking off what could be the worst month of the pandemic yet. Hospital admissions have surpassed the previous peak from the summer. At least one county, Imperial, is again transferring ICU patients to hospitals outside county lines, according to the California Hospital Association. In the spring, Imperial County sent more than 500 patients to hospitals as far as Sacramento and the Bay Area.

By Christmas Eve, 112% of the state’s ICU beds could be occupied if current trends continue, Newsom said earlier this week. On Wednesday, the state recorded more than 18,500 new cases, Newsom said — the most in a single day since the pandemic began. With the new restrictions, he said the state hoped to head off “too much concentrated retail activity” during what is normally the busy holiday shopping season.

Hospitals struggling with their current coronavirus caseloads are bracing for a delayed onslaught. In Imperial County, the number of hospitalized coronavirus patients at El Centro Regional Medical Center — one of two hospitals in the county — is already nearing peaks seen during previous surges. Of the 128 of patients occupying the facility’s 161 licensed beds, 60 are coronavirus patients, according to Adolphe Edward, the hospital’s chief executive officer.

“At the highest highest of what I would call COVID 1.0 — first wave — we had 65 patients,” Edward said. “We have not seen yet the effects of Thanksgiving. And that’s coming.”

For businesses and their workers, the big test will be whether keeping their operations going at limited capacity will be “productive enough” to prevent mass closures and job losses, said Julien Lafortune, a research fellow who has studied unemployment during the pandemic for the Public Policy Institute of California. The state’s jobless rate dipped back into single digits in October at 9.3%, down from a high of over 16% in April, but many businesses are confronting months of accumulated losses just as the virus explodes.

“We can keep businesses open right now,” Lafortune said, “but a lot of people wouldn’t go out.”


The new stay-at-home order is softer than what Newsom announced in the spring. On March 19, California came to a standstill after Newsom declared the country’s first statewide shelter-in-place order. All schools closed their doors and resorted to Zoom lectures; restaurants and bars ceased operations, leaving many workers in limbo; and those who could, began their working-from-home odyssey.

On Thursday, businesses and officials across the state raced to understand what the new rules would entail — including some of those charged with enforcing them.

“I don’t know what the rules are,” said Monterey County Chief Deputy Sheriff John Thornburg. “I’ve literally been sitting here for the last half-hour trying to figure out what they are, so I don’t know.”

Health experts and officials do know more about the virus and how it is transmitted than they did in the spring, so restrictions can be better customized, said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco.

Rutherford is optimistic that the majority of Californians will adhere to the new rules. That, combined with the first tranche of vaccines, could give California a much-needed break, he said.

“We’ve turned the curve before,” Rutherford said. “It wasn’t magic, it was people paying attention.”

The new shutdown procedures come at a precarious moment for the California economy. Home prices and Wall Street have surged to record highs, but stubbornly high unemployment has fueled what economists at UCLA call “an unequal economic recovery.” Though vaccine optimism has boosted financial markets in recent weeks, those gains could recede this winter as the virus surges, UCLA Senior Economist Leo Feler cautioned in a forecast released this week. Small businesses are in a particularly vulnerable position.

“Today is the slowest day we’ve had since June,” Sheree Hardy, owner of the Trencher sandwich shop in L.A.’s Echo Park neighborhood, said on Thursday. “The vibe out there right now, it’s an uneasy vibe.”

This chart is interactive on CalMatters website. Click here or on the image to go there, then hover over the chart for details.

For many caught up in job cuts — which have disproportionately hit Black and Latino Californians, as well as women pushed out of the workforce to care for children — the next few weeks were already going to be stressful. Some 750,000 state residents will lose federal unemployment benefits on Dec. 26 if current deadlines hold, and 2.1 million Californians could lose their rental homes when eviction moratoriums lift weeks later.

“The pandemic has been an inequality bomb,” said Micah Weinberg, CEO and president of progressive advocacy group California Forward. “What people want to see is a plan for an equitable economic recovery that is as serious, as well thought out and as well-funded as the plan to shut everything down.”

Another stay-at-home order could help alleviate pressure on the frontlines, said Stephanie Roberson, government relations director with the California Nurses Association.

“I think now is the time,” Roberson said. “We can try to piecemeal this out, but it’s so widespread we need to take a statewide approach.”

Even before Newsom’s announcement, experts were betting a lockdown order in December would look different than what the state saw in March.

Exactly how the new regulations play out for businesses will likely come down to legal battles already underway. Earlier this week, a judge ordered Los Angeles County officials to provide more health evidence for shutting down outdoor dining in addition to indoor restaurants and retail. The lawsuit was backed by the California Restaurant Association, one of several business groups demanding more specifics about how regulators are evaluating public safety and calibrating restrictions.

At the same time, the state has attempted to respond to ongoing concerns about a lack of enforcement for worker safety protocols by issuing new emergency rules for employers. The standards by the Department of Industrial Relations, which went into effect earlier this week, call for site-specific health plans, reporting instances of multiple infections to public health officials and providing masks to all workers. Santa Clara County has also added new quarantine requirements for businesses that ask workers to travel long distances.

Some business owners in service industries hit hardest by the pandemic expressed frustration with shifting rules while trying to adapt to an unpredictable situation. Mike Duvall, founder and president of The Spirit Guild, which makes vodka and gin from California clementines in downtown L.A, said shuttering his sector entirely would be “a betrayal” of the work distilleries have done to produce hand sanitizer during the pandemic.

“If they were to shut us down, you know, I would like to see them try,” Duvall said. “What are they going to do, come bolt up our place while we’re making sanitizer?”

In the meantime, the stalemate drags on over whether Californians will see another major round of individual stimulus checks or business loans. The state announced new tax extensions and $500 million in small business grants this week, and Newsom said Thursday that, “We are just getting started in terms of the business relief and business support.” Congress remains divided over offering more federal aid before the end of the year, setting the stage for a battle over how to redirect limited funds to struggling businesses, workers and others.

Newsom, meanwhile, said the state is focused on stemming the tide of the virus with mass vaccinations just on the horizon. “There is light at the end of the tunnel,” he said.

Reporters Rachel Becker, Jackie Botts, Nigel Duara and Byrhonda Lyons contributed to this story.

Virus surges: ICU beds filling up in hard-hit spots; Bay Area shutdown likely mid-December

Newsom to impose new stay-at-home orders in California’s hardest-hit areas

[see map below]
A masked Los Gatos woman who declined to share her name waits to see a doctor after being admitted to the Emergency Department at Good Samaritan Hospital in San Jose, Calif. Friday, July 31, 2020 where doctors are currently treating twelve COVID-19 patients in various states of severity. Photo: Jessica Christian / The Chronicle
San Francisco Chronicle, Alexei Koseff, Peter Fimrite, Dec. 3, 2020

SACRAMENTO — Vast swaths of California will fall under new shutdown orders in the coming weeks after Gov. Gavin Newsom announced additional restrictions Thursday to try to slow the coronavirus surge in areas where intensive care unit capacity is dwindling.

Newsom said he was “pulling the emergency brake” to help California through a third surge of the pandemic, one he hoped would be a final ordeal before a coronavirus vaccine becomes widely available after the winter months.

“The bottom line is if we don’t act now, our hospital system will be overwhelmed. If we don’t act now, we’ll continue to see a death rate climb, more lives lost,” Newsom said during a news briefing. But, he added, “There is light at the end of this tunnel. We are not in a permanent state.”

The orders, which do not immediately impact the Bay Area, will close personal care services such as hair and nail salons, playgrounds, bars and wineries, movie theaters, museums and zoos in places where fewer than 15% of intensive care unit beds are available across an entire region. ICU capacity will be tracked in five regions: Bay Area, rural Northern California, Greater Sacramento, San Joaquin Valley and Southern California, stretching from San Luis Obispo to the Mexican border.

Retailers, grocery stores and other businesses in those regions that are allowed to remain open will have to operate at 20% capacity, and restaurants will be able to offer only takeout or delivery. No outdoor or indoor dining will be allowed. Schools that have received a waiver to reopen can continue to offer in-person classes.

The orders will remain in effect for at least three weeks after the state imposes them and can be lifted only if the available ICU capacity in the region is projected to rise above 15% again within four weeks after that. At that point, counties in the region will return to one of the state’s current color tiers, with associated restrictions, based on their individual case rates.

Dr. Grant Colfax, director of the San Francisco Department of Public Health, said Thursday that the city is considering issuing orders similar to the new state edict even before the city hits the 15% ICU mark. Alameda County public health officials Thursday indicated they may follow that same path, issuing stronger restrictions before the state takes action.

“Everything is on the table at this point,” Colfax said. “It is likely that we will take additional steps consistent with the governor’s orders soon.”

As of Thursday, the Bay Area region had 25.3% of its ICU beds available, the state said.

Whether San Francisco or other Bay Area counties move faster than the state prescribes depends on the trajectory of hospitalizations and case rates across the region, Colfax said. At the current rate, the city will run out of ICU beds on Dec. 26, Colfax said.

“And that’s without accounting for what we expect from Thanksgiving,” he said. “We are doing relatively well compared to the rest of the state, but the virus is spreading like wildfire across the state, and if we run out of beds, whether it’s San Francisco or Santa Clara (County), there is not going to be capacity to put people in beds outside the region.”

The state is also reinstating a ban on all nonessential travel statewide, a move intended to reduce mixing between households and discourage family gatherings ahead of the holidays. It includes an exemption for outdoor exercise.

“Today’s message is not about how do we mix safely,” said Mark Ghaly, secretary of California’s Health and Human Services Agency. “It’s about how we reduce our mixing altogether — staying at home unless it is absolutely essential.”

Newsom said the Bay Area will probably fall below the ICU threshold for new shutdowns by mid-December. The state defined Bay Area in this matter as San Francisco, Alameda, Contra Costa, San Mateo, Santa Clara, Sonoma, Marin, Napa, Solano, Santa Cruz and Monterey counties.

Other parts of the state are expected to come under the stay-at-home order even sooner.

The moves come as California struggles with a dramatic rise in COVID-19 cases and hospitalizations, which has already forced Bay Area counties to crack down on community activities. Much of the state and every Bay Area county except Marin have instituted curfews prohibiting nonessential activity between 10 p.m. and 5 a.m.

As of Thursday afternoon, the nine-county Bay Area had recorded 158,554 cases and 1,996 deaths since the pandemic began. The numbers have exploded over the past month.

The region averaged nearly 1,600 new cases per day for the week that ended Nov. 29, an increase of more than 33% over the previous week, according to a Chronicle data analysis. The Bay Area set an ignominious record in November, averaging 1,158 new cases a day, an average that increased to 1,500 a day over the last two weeks of the month. That’s compared to 480 new cases a day in October. The previous high for a month was 1,061 per day in August.

On Monday, following the Thanksgiving holiday, the Bay Area reported 2,500 cases, by far the most in a single day since the start of the health crisis.

Peter Chin-Hong, a professor of medicine and infectious diseases at UCSF, said Newsom’s order was not as drastic as it could have been. He said the governor could issue blanket restrictions but suspects he limited the order to preserve the economy.

Still, he said, the fact that there are hospitals in California with less than 15% capacity in their intensive care units is disturbing.

“For me it illustrates very loudly that this third surge in California is very different than the other two,” Chin-Hong said. “There is no room for complacency. I’m scared. Now everybody is hurting, so there is no give in the system.”

The surge is happening in every Bay Area county, but Chin-Hong said Santa Clara County is likely to be the hardest hit by the regulations, at least right away.

With nearly 2,000 COVID-19 patients in hospitals, only 44 ICU beds are available countywide, officials said. Dr. Sara Cody, the county health officer, said the county is in danger of running out of beds if the current trend continues.

One indication of Santa Clara County’s trouble is the fast-spreading outbreaks at long-term care facilities.

Dr. George Han, the county’s deputy public health officer, said Thursday that 151 people recently tested positive at the Amberwood Gardens skilled nursing center. Sixty have tested positive since Nov. 23, including four staffers, at San Jose’s Boccardo Reception Center. Fourteen tested positive there Wednesday.

Han said the infected residents and those with exposure were put up in hotels. It was the county’s first large-scale outbreak at a homeless shelter, but it wasn’t the only one. Seven people have tested positive since Nov. 18 at South Hall, a shelter in San Jose.

“We have seen an increase recently in all these settings,” said Han, who attributed the increase to a rise in cases throughout the community. “It is more dangerous right now in our community than at any other point in the pandemic.”

In an attempt to quell the spread, Santa Clara County issued a travel directive Monday requiring a 14-day quarantine for people who travel into the county from a distance greater than 150 miles.

The disease is rampant in San Francisco, which reported 209 new infections on Thursday, a count not seen since the summer surge in July. It brought the total cases in the city to 16,001 since the start of the pandemic. The number of people hospitalized with COVID-19 in San Francisco has increased 45% in the past week, and cases have more than quadrupled over a month.

The daily average of new cases in California climbed above 15,000 in the past week, Newsom said, and the number of deaths is rising again, as well. The state saw back-to-back days of more than 100 deaths this week, including 113 on Wednesday, the governor said. A month ago, the daily total was 14 deaths.

Newsom said that without further public health interventions, the state could run out of capacity in intensive care units by Christmas Eve if the surge continues at its current rate. About three-quarters of ICU beds are full, nearly 25% with COVID-19 patients.

Restaurant owners were relieved that Newsom did not shut down outdoor dining statewide at once, an option the governor could have considered.

“I was prepared for the worst, but I’m relieved that the governor made some concessions for restaurants to allow us to try to stay afloat,” said Rocco Biale, the owner of Rocco’s Ristorante Pizzeria in Walnut Creek. “It’s a break for the restaurant industry. Let’s see how long it can last.”

Los Angeles County and the city of Los Angeles adopted their own modified stay-at-home orders this week, largely prohibiting people from gathering outside their immediate households but allowing retail businesses, parks, beaches, golf courses and tennis courts to remain open.

Republican leaders immediately slammed the new order as excessively harsh and questioned the scientific rationale behind the move.

“Gov. Newsom continues to disrupt life as we know it without releasing the full data behind his decisions or showing the impact his actions are having on our lives,” state Senate Republican Leader Shannon Grove of Bakersfield said in a statement. “The governor owes the state leadership that is committed to transparency and accountability.”

Recognizing that frustration has mounted across the state with his quickly changing restrictions, Newsom practically begged Californians to take the latest order seriously.

“This is the time, if there was any doubt, to put aside your doubt,” he said, “to put aside your skepticism, to put aside your cynicism, to put aside your ideology, to put aside any consideration except this: Lives are in the balance. Lives will be lost, unless we do more than we’ve ever done.”

San Francisco Chronicle staff writers Erin Allday and Michael Williams contributed to this report.