Category Archives: ICU

Dr. Richard Fleming: Letter to Benicia City Council on Benicia’s Mask Mandate

February 11, 2022
By Benicia’s Dr. Richard Fleming
(posted here with permission)

Dear Council members and Mr. Upson – Should Benicia lift its current indoor mask mandate?

My recommendation is: Not yet, but hopefully soon.
Richard Fleming, M.D., Benicia, CA

Our state is lifting the statewide mask mandate February 15. Most Bay Area counties will be lifting their indoor mask mandates the week of February 14, 2022, though the specific approach varies. Some counties will require that unvaccinated people continue to wear masks in indoor public spaces, and that masks are still required by all in some indoor spaces.

There is clearly a strong desire to return to normal life and social interactions after two years of this pandemic. There are objective signs the pandemic may be on the cusp of turning into an endemic situation, given increasing vaccination rates and increasing natural immunity. But it is apparent that different geographic areas are in different stages of moving towards endemicity. And it is also clear from our collective experience over the past two years that it is not unusual to see viral spread increase after public health restrictions are lifted in defined geographic areas.

Given these two realities, I feel our city should proceed in a measured way – relying on objective data which gives the most accurate available picture of the current state of the pandemic in our city – in deciding when to lift the indoor mask mandate. This mandate, it should be noted, has been supported and complied with by the vast majority of city residents and visitors to our city. It would be tempting to yield to feelings of exhaustion with the pandemic, but doing so may lead to policy changes we come to regret.

*    *    *

When our city council put in place the current mask mandate on August 25, 2021, it decided to use an objective metric to decide when this mandate could be lifted. When case rates in Benicia stayed in the CDC-defined moderate transmission level for 30 consecutive days, masking would no longer be required. Subsequent discussions in the council have considered using more than one metric to make a mandate-lifting decision, but no decision was made and goal numbers were not established.

Using several metrics would provide greater assurance about when it would be safe to lift the mask mandate. Any single metric has some intrinsic flaws, so a combination of several would provide a more accurate picture of the state of the pandemic in our city.

Under our current metric – case rate – we have too many cases per week to stop the mask policy. According to Resolution 21-88, we need to reach 27 or fewer cases weekly and maintain that for 30 days. We are currently at 100 new cases per week. Though this number is very high, it is trending downwards. For much of January, we were averaging 200-400 cases per week. Progress is being made, and there is reason to hope that in the weeks ahead, we will achieve a moderate level of transmission. (It is important to keep in mind the caveat that case numbers are increasingly inaccurate and reflect an undercount due to the growing use of home antigen tests. This is why adopting several metrics would provide greater accuracy.)

*    *    *

Other metrics that could be used include the following. I feel that in assessing this data, we look not just at current numbers, but at trend lines, since those can provide dynamic information on the trajectory of the virus.

  • Hospitalizations. We do not have Benicia-specific data, so Solano County data can be used as a proxy. The county is currently seeing 35 covid-19 hospitalizations per 100K residents, which is close to the highest level of the pandemic. More concerning is that our hospitalization rate is trending upwards. It has risen 48% compared to two weeks ago. Our hospitalizations are rising more rapidly than any Bay Area county other than Marin, whose hospitalization rate is only 21 per 100K. So, even though the official case-rate numbers are trending in a good direction, hospitalizations paint a more concerning picture of where our county stands.
  • Vaccination rate. Currently, 78.6% of city residents have gotten 2 shots of Moderna or Pfizer, or 1 shot of J&J. Of this number, 55% are boosted. So the proportion of city residents who are truly fully-vaccinated is 43.2%. (Boosters are proven to be crucial for optimal protection.) 35.4% of city residents received full initial vaccine doses but are not yet boosted. They do have greater immunity than unvaccinated people, or those who did not complete their initial vaccine series. There are many city residents who have some degree of natural immunity, but their level of protection is not clear. A significant proportion of people who report having recovered from covid have no detectable antibodies, and it is not clear how long antibodies persist in those with natural immunity. Bottom line, while our community’s immunity is increasing, a significant proportion of our residents remain highly susceptible to serious covid infection.

Comparing our city’s vaccination rate to nearby counties, 6 of the other 8 Bay Area counties have a higher percentage of their entire county vaccinated than does the city of Benicia. We are still lagging behind in what should be achievable vaccination levels.

  • Test positivity rate. No city data is available. Solano County’s positive test rate is 19%, compared to a statewide rate of 7%.
  • Hospital capacity, ICU bed availability, and ventilator availability. In these metrics, our county is doing fairly well, though it is also true our hospital staff and health care workers are under significant stress and are looking forward to the period when covid-19 becomes truly endemic, rather than aspirationally endemic.

*    *    *

Bottom line, I encourage you to maintain your commitment to using objective data to decide on when to lift the mask mandate. I recommend you adopt 3 metrics – cases, hospitalizations, and vaccination rates – as the data to look to. Choosing a goal for each metric, and requiring 2 of the 3 goals to be met over some period of time, would help maintain a safe environment for our city. I feel making the decision based on such measures would be widely-supported in our city. And, at whatever point you decide to lift the mandate, I recommend you also clearly advise our residents that indoor mask-wearing in public spaces is still appropriate and encouraged until the metrics improve even more, and that you also allow individual businesses to continue requiring masks of their own customers.

Sources for above data available upon request.

Thank you.

Richard Fleming, M.D.

Surge: Some ambulances forced to wait hours as Bay Area ICU availability plunges

California, Bay Area hospitals strain amid crush of ICU patients

San Francisco Chronicle, By Jill Tucker, January 2, 2021
A COVID-19 patient who has had a stroke is prepared to be flown from one hospital to another on Dec. 22. Hospitals across California are straining to keep up with the surge.
A COVID-19 patient who has had a stroke is prepared to be flown from one hospital to another on Dec. 22. Hospitals across California are straining to keep up with the surge. Photo: Francine Orr / Los Angeles Times

The Bay Area’s intensive care unit availability dipped to 5.1% — its lowest figure yet — on the second day of the new year, even as the state braces for a further surge from Christmas and New Year’s celebrations.

The situation has gotten so difficult in Santa Clara County that some ambulances are sitting outside emergency rooms for up to seven hours waiting for a bed to open up for the patients they are carrying, county health officials said.

The delays — which mean the waiting ambulances cannot respond to other calls — have caused the San Jose Fire Department to transport people to emergency rooms at least a half-dozen times in the past week, the county officials said.

It’s a problem that’s already well known to the hard-hit Los Angeles area, where ambulances have waited for up to eight hours outside a hospital before patients could be moved inside, according to the Associated Press. In some cases, doctors started treating cases inside the vehicles.

Across the state, the outlook remained bleak, with a record 4,531 coronavirus patients in California intensive care units on Friday and the number of cases continuing to rise. The state recorded 53,341 new coronavirus cases on Friday, the second highest single-day figure, and another 386 deaths.

Available intensive care unit capacity in the Greater Sacramento region dropped sharply on Saturday, from 11.5% on Friday to 6.9%. The region, which includes the California side of Lake Tahoe, remains under a stay-home order, as do the Bay Area, the San Joaquin Valley and Southern California. The latter two regions are drawing heavily on hospital surge capacity, since their regular ICUs have zero availability.

Experts fear it’s unlikely to get better anytime soon, because it’s still too early for hospitals to see the effects from a Christmas surge.

“Admission to the ICU is often 10 to 12 days after exposure,” said Dr. Robert Siegel, a Stanford virologist. “The number of deaths may continue to increase for another week or more.”

Siegel also expects spikes from Christmas gatherings “will merge with, and contribute to surges” from New Year’s gatherings.

The ambulance wait times in Santa Clara County could be an alarming sign of things to come. The county saw a record number of COVID-19 deaths Friday — 38.

Santa Clara County Supervisor Joe Simitian, who co-chairs the Health and Hospital Committee at the Board of Supervisors, said wait times for ambulances are not uncommon during busy times of the week or during holidays. But they typically last no more than an hour — not seven.

“Whatever the period of time is, it’s always a concern because by definition you have folks you want to have admitted as soon as possible, and you want to have an ambulance crew on the road as quickly as possible,” Simitian said.

The combination of New Year’s Eve and COVID may have added stress on the county’s emergency system, he said.

“When you put together New Year’s Eve compounded by the COVID crisis, there are going to be some outliers that are troubling,” he said. “My understanding is they were relatively few in number — but obviously that’s cold comfort if you’re the one waiting for an ambulance.”

James Williams, the Santa Clara County counsel, said the county’s hospital system has been “teetering on the edge,” since a post-Thanksgiving surge in virus hospitalizations. He fears that another, similar surge, would greatly exacerbate what is already a problem with wait times at hospitals.

“If we have another surge now, anything like what we had after Thanksgiving — it’s going to cause collapse,” Williams said. Unlike March, the county cannot just make room by transporting patients to other facilities in California or another state. Santa Clara County has contingency plans for how to provide “some level of support” to those who may need it during a potential surge. But, Williams warned, those contingency plans would not be “providing everyone with the level of medical care that we take for granted in the United States.”

The virus continued its indiscriminate path through the population, infecting the young, old, famous and infamous. Talk show host Larry King, 87, was hospitalized with the virus, according to reports Saturday, while Dawn Wells, who played Mary Ann on “Gilligan’s Island,” died Wednesday. And at least one person was hospitalized after a New York Republican club’s Christmas party featuring an unmasked conga line.

Between pandemic fatigue and the holidays, the current surge will probably continue well into January, with hospitals, funeral homes and nursing homes continuing to see the fallout. State prisons also continued to see a surge, with 6,510 reported cases in the last two weeks — a sizable portion of the 40,985 incarcerated people who have had COVID-19 at some point.

Across Southern California, where the virus has hit the hardest, mortuaries have had to turn away families due to lack of space for all the bodies — and with funeral homes filling up, there’s a backup of bodies at hospitals, Los Angeles County Director of Health and Human Services Dr. Christina Ghaly told the Associated Press. The county medical examiner is looking for alternatives to store the bodies, she said.

Although thousands of California front-line workers have received vaccines, there is no impact yet on case counts. But the idea of a vaccine may be having something of behavioral impact, for good or for bad, according to Stanford’s Siegel.

“Some people have increased their precautions with the realization that it would be tragic to be infected when their turn to be vaccinated may be just around the corner,” he said. “Other people have increased their risk behavior knowing they will soon be protected or knowing that other people around them are vaccinated.”

Chronicle staff writer Michael Williams contributed to this report.  Jill Tucker is a San Francisco Chronicle staff writer.

Solano County: down to 9 ICU beds available as of Wednesday December 16

Latest numbers from COVID19.CA.GOV

COVID19.CA.GOV is the only WEEKEND source of information on the coronavirus in Solano County.  The hospitalization details ON THE MAP below are current as of now, and are automatically updated here on the Benicia Independent with each new day’s report from CA.GOV.

For the record, COVID-19 Hospital Data as of Wednesday Dec. 16:

Positive Patients 105
Suspected Patients 16
ICU Positive Patients 32
ICU Suspected Patients 1
ICU Available Beds 9

Hover your mouse over items below to see detailed data, including numbers on a given date.

Solano County: only 11 ICU beds available as of Tuesday December 15

Latest numbers from COVID19.CA.GOV

COVID19.CA.GOV is the only WEEKEND source of information on the coronavirus in Solano County.  The hospitalization details ON THE MAP below are current as of now, and are automatically updated here on the Benicia Independent with each new day’s report from CA.GOV.

For the record, COVID-19 Hospital Data as of Tuesday Dec. 15:

Positive Patients 121
Suspected Patients 11
ICU Positive Patients 32
ICU Suspected Patients 1
ICU Available Beds 11

Hover your mouse over items below to see detailed data, including numbers on a given date.