Category Archives: ICU

ICU Hospital Bed Capacity in Vacaville and Vallejo Among Most Impacted in Bay Area

How Bay Area ICU capacity compares to the most impacted areas in California, nation

San Francisco Chronicle, by Kellie Hwang, Dec. 11, 2020 
Nurse Waymond Jones (left) Respiratory Therapist Laura Sandoval (center) and nurse Larry Ngiraswei (right) prepare to prone a COVID-19 patient in the ICU at Regional Medical Center of San Jose, an acute-care hospital, on Tuesday, Dec. 8, 2020 in San Jose, California. Following Thanksgiving there has been an uptick in COVID-19 cases all over California and the Bay Area. Photo: Gabrielle Lurie / The Chronicle

Hospitals in the Bay Area, California and across the nation are running short of intensive care unit beds as the latest coronavirus surge sets new records for cases, hospitalizations and deaths.

On Thursday, California reported a record 2,710 ICU hospitalizations, and four of five state regions, including part of the Bay Area, were under the regional stay-at-home order issued last week by Gov. Gavin Newsom. The order is triggered when available ICU hospital capacity dips below 15%.

The five regions, based on California’s mutual aid system and emergency response networks, are the Bay Area, Southern California, the San Joaquin Valley, Greater Sacramento and Northern California.

The Southern California region, with 7.7% ICU availability as of Thursday, and the San Joaquin Valley, with just 1.9% availability, fell under the stay-at-home order last weekend. Restrictions went into effect overnight Thursday for the Greater Sacramento area, with 13.3% availability.

The Bay Area region was at 17.8% available ICU capacity Thursday, though five of its 11 counties — San Francisco, Alameda, Contra Costa, Santa Clara and Marin — have voluntarily tightened restrictions in line with the state order. Sonoma County announced Thursday it will join them this weekend. Northern California had the highest ICU availability in the state, at 30.3%.

Critical shortages are occurring across the nation. On Monday, the U.S. Department of Health and Human Services began releasing COVID-19 hospital capacity data at the facility level, aggregating daily hospital reports and sharing them on a weekly basis. The New York Times has created an interactive map detailing the ICU capacity throughout the U.S.  [BenIndy editor: The NYTimes map shows Fairfield (22 of 30 ICU beds occupied, 75% on Dec. 9) as well as Vallejo (20 of 24, 81%) and Vacaville (10 of 11, 91%).  It’s a little hard to navigate the map, but worth it for the numbers.  – R.S.] 

Here are the ICU occupancy rates for both the most-impacted and the largest high-population locations in the Bay Area, compared with California and the U.S., according to the data released Monday. The figures are based on seven-day average patient count by hospital service area.

Daly City: 100% of ICU beds occupied

Santa Rosa: 95% of ICU beds occupied

 Vacaville: 91% of ICU beds occupied 

South San Francisco: 90% of ICU beds occupied

San Leandro: 90% of ICU beds occupied

Petaluma: 88% of ICU beds occupied

Martinez: 83% of ICU beds occupied

Fremont: 83% of ICU beds occupied

 Vallejo: 81% of ICU beds occupied 

Castro Valley: 80% of ICU beds occupied

Sonoma County

In Santa Rosa, the largest city in Sonoma County, ICUs are 95% full. Sonoma County did not initially join the five Bay Area counties in adopting the stay-at-home measure, but officials announced Thursday that the county would adopt it starting Saturday at 12:01 a.m.

“Although Sonoma County has fared better until now than other parts of the state in terms of demand on our hospitals, we have been seeing an alarming increase in cases and hospitalizations in recent days, and this is putting increased strain on our medical resources,” county health officer Dr. Sundari Mase said in a news release. “We feel we have no choice but to join the other Bay Area counties in preemptively adopting the governor’s Stay-Home order.”

Mase noted that hospitalizations in Sonoma are near the county’s highest ever, and that coronavirus case rates are at their highest since the pandemic began. “We also are seeing a wider geographic spread of infection,” Mase said. She tied the increases to the surge in cases across the nation as well as large gatherings in the county, including over Halloween and Thanksgiving.

At a community briefing on Wednesday, the most recent ICU available capacity was reported at 11.6% in Sonoma County. ICU beds occupied in Sonoma are at 57%, Healdsburg is at 20% and Petaluma stands at 88%. The county removed hospital capacity data from its website, and the Press Democrat reported that officials are working with the state to fix discrepancies between the county and state websites.

MOST IMPACTED CALIFORNIA

Daly City: 100% of ICU beds occupied

Huntington Beach (Orange County): 100% of ICU beds occupied

Ventura: 99% of ICU beds occupied

Upland (San Bernardino County): 97% of ICU beds occupied

Chula Vista (San Diego County): 97% of ICU beds occupied

Oxnard (Ventura County): 96% of ICU beds occupied

Victorville (San Bernardino County): 95% of ICU beds occupied

Thousand Oaks (Ventura County): 95% of ICU beds occupied

Santa Rosa: 95% of ICU beds occupied

Fresno: 95% of ICU beds occupied

Lynwood (Los Angeles County): 95% of ICU beds occupied

Northridge (Los Angeles County): 95% of ICU beds occupied

Arcadia (Los Angeles County): 94% of ICU beds occupied

Redlands (San Bernardino County): 94% of ICU beds occupied

Fontana (San Bernardino County): 93% of ICU beds occupied

Redding: 91% of ICU beds occupied

Huntington Beach

In California, all of Huntington Beach’s 11 ICU beds are occupied. The Orange County city of fewer than 200,000 has made headlines as a gathering place for locals to demonstrate their resistance to mask orders and other pandemic restriction-enforcement measures.

Ventura County

In Ventura County, the cities of Ventura, Oxnard, Thousand Oaks and Camarillo are all at more than 95% ICU capacity. The county is grouped in the Southern California region, which is under the regional stay-at-home order. County supervisors have unanimously voted to propose a new region that would include Santa Barbara and San Luis Obispo counties, which have much higher available ICU capacity and therefore likely could remove restrictions on businesses sooner.

MOST IMPACTED U.S.

Albuquerque, N.M.: 116% of ICU beds occupied

Baton Rouge, La.: 109% of ICU beds occupied

Ogden, Utah: 107% of ICU beds occupied

Upland, Pa.: 106% of ICU beds occupied

Easton, Pa.: 104% of ICU beds occupied

Abington, Pa.: 102% of ICU beds occupied)

Pompano Beach, Fla.: 100% of ICU beds occupied

Port St. Lucie, Fla.: 100% of ICU beds occupied

Dothan, Ala.: 100% of ICU beds occupied

Douglasville, Ga.: 100% of ICU beds occupied

Wailuku, Hawaii: 100% of ICU beds occupied

Chicago Heights, Ill.: 100% of ICU beds occupied

Leonardtown, Md.: 100% of ICU beds occupied

St. Joseph, Mo.: 100% of ICU beds occupied

St. Cloud, Minn.: 100% of ICU beds occupied

Albuquerque

The hospital service area that includes Albuquerque shows the highest ICU occupancy in the nation at 116%. In mid-November, New Mexico Gov. Michelle Lujan Grisham tightened restrictions statewide in hopes of reducing the virus spread, but that wasn’t enough. On Nov. 20, a backup hospital in Albuquerque was opened to relieve the strain. Now hospitals are reaching surge capacity at nearly 1,000 hospitalizations daily. Officials are preparing to ration care to coronavirus patients, with the only criterion being whether a person is likely to survive.

TOP LARGEST LOCATIONS IN THE BAY AREA GROUP

San Francisco: 72% of ICU beds occupied

Oakland: 62% of ICU beds occupied

Santa Rosa: 95% of ICU beds occupied

San Jose: 68% of ICU beds occupied

Greenbrae: 59% of ICU beds occupied

Napa: 45% of ICU beds occupied

Vallejo: 81% of ICU beds occupied

Daly City: 100% of ICU beds occupied

Concord: 78% of ICU beds occupied

Salinas: 61% of ICU beds occupied

Santa Cruz: 76% of ICU beds occupied

TOP LARGEST CALIFORNIA CITIES

Los Angeles: 80% of ICU beds occupied

San Diego: 65% of ICU beds occupied

San Jose: 68% of ICU beds occupied

San Francisco: 72% of ICU beds occupied

Fresno: 95% of ICU beds occupied

Sacramento: 83% of ICU beds occupied

Long Beach: 51% of ICU beds occupied

Oakland: 62% of ICU beds occupied

Bakersfield: 75% of ICU beds occupied

Anaheim: 87% of ICU beds occupied

Santa Ana: 37% of ICU beds occupied

Riverside: 88% of ICU beds occupied

Stockton: 90% of ICU beds occupied

Irvine: No ICU data reported from local hospitals

Chula Vista: 97% of ICU beds occupied

Chula VIsta

Chula Vista, in San Diego County, has the highest percentage of ICU beds occupied at 97%. San Diego County’s hospitals have seen a crush of coronavirus admissions since late November, and some facilities have reported that they are already utilizing surge beds, concerned about an increase of cases due to the Thanksgiving holiday.

TOP LARGEST U.S. CITIES

New York City: 78% of ICU beds occupied

Los Angeles: 80% of ICU beds occupied

Chicago: 65% of ICU beds occupied

Houston: 91% of ICU beds occupied

Phoenix: 64% of ICU beds occupied

Philadelphia: 84% of ICU beds occupied

San Antonio: 91% of ICU beds occupied

San Diego: 65% of ICU beds occupied

Dallas: 93% of ICU beds occupied

San Jose: 68% of ICU beds occupied

Austin, Texas: 85% of ICU beds occupied

Jacksonville, Fla.: 79% of ICU beds occupied

Fort Worth, Texas: 92% of ICU beds occupied

Columbus, Ohio: 83% of ICU beds occupied

Charlotte, N.C.: 81% of ICU beds occupied

Texas

Dallas has the lowest ICU capacity on this list, with just 7% of ICU beds available. Dallas County recently reported the second-highest daily death toll in the pandemic, and the county had to lower business capacity from 75% to 50% on Dec. 3 after going over the 15% ICU capacity threshold.

Fort Worth, in Texas’ Tarrant County, follows closely behind with 92% of ICU beds occupied. The Tarrant County Medical Examiner’s office is near storage capacity for bodies, so two refrigerated trucks have been brought in and are expected to be used soon.

Over 300 NEW cases in Solano County over the weekend, more than 1,000 ACTIVE cases, positive test rate at 12.8%


It’s coming, why wait?  Solano County COVID numbers show need for shutdown now…

By Roger Straw, December 7, 2020

Unlike his colleagues in neighboring counties, Solano County Public Health Officer Dr. Bela Matyas prefers to wait for Governor Newsom’s regional stay-at-home order.  I have studied the numbers on a daily basis since April, and I think Matyas’ decision is incredibly unwise.  This post-Thanksgiving outbreak is different from our earlier surges.  We are in for a dramatic rise in COVID infections and hospitalizations now through mid-January.

So we need to take extra precautions, NOW.  Your best advice is to stay home as much as you can, and make plans now for a different kind of Christmas, Hanukah and New Year celebration.  Wear a mask if you must go out, order groceries for pick-up or delivery, don’t stay long anywhere but home, and keep your distance more carefully than ever before.

Here are the Monday numbers – take note!

[Source: Solano County Coronavirus Dashboard.  For a complete archive of County updates, see my Excel ARCHIVEALSO see important daily updates from another source, COVID19.CA.GOV: here on the BenIndy at Cases and Deaths AND Hospitalizations AND ICU Beds by REGION.]

Monday, December 7: 334 (!) new cases over the weekend, no new deaths.  Since Feb: 11,747 cases, more than 600 hospitalized, 85 deaths.Compare previous report, Friday, Dec. 4:Summary

  • Solano County reported 334 (!) new cases over the weekend.  As of today, Solano has seen an average of 142 new cases per day over the last 14 days! (source: covid19.ca.gov Total of 11,747 cases since the outbreak started.
  • Deaths – no new deaths reported today, total of 85 Solano deaths since the pandemic began.
  • Active cases – Solano reported 116 fewer active cases today.  New total of 1,080 active cases Active cases have increased alarmingly lately – COMPARE: average number of Active Cases during October was 284 – today we are at 1,080!  Is the County equipped to contact trace so many infected persons?  Who knows?  To my knowledge, Solano has offered no reports on contact tracing.
  • Hospitalizations – (For best info, see BenIndy page, COVID-19 Hospitalizations Daily Update for Solano County.)  CAUTION ON COUNTY REPORTING: According to Solano Health Officer Dr. Bela Matyas, the County occasionally updates Age Group hospitalizations retroactively, adding substantial numbers.  Thus, many hospitalizations are never reported as CURRENTLY hospitalized.  Today, Solano County reported the number of CURRENTLY hospitalized persons increased by 2, total of 68, but TOTAL hospitalized since the outbreak began supposedly remained unchanged todaya total of 603 of all ages hospitalized since the outbreak began.  The County will likely update this figure at a later date.  [For my manual calculation of total hospitalizations, see age group stats below.]
  • ICU Beds(For detailed info see BenIndy page, COVID-19 Hospitalizations Daily Update for Solano County, and for REGIONAL data see COVID-19 ICU Bed Availability by REGION.)  The County reported a decrease in ICU beds available today, down from 35% to 33%.
  • Testing – The County reports today that 4,680 residents were tested over the weekend, a total of 135,052 unduplicated residents tested for COVID-19 since the outbreak began.  30.1% of Solano County’s 447,643 residents (2019) have been tested.

Positive Test Rate – Extremely high at 12.8%

Solano County reported another high 7-day average positive test rate today of 12.8%, down from Friday’s 16.8%, but far and away over the State’s purple tier threshold of 8%Average percent positive test rates are among the best metrics for measuring community spread of the virus.  The much lower and more stable California 7-day average test rate has also been on the rise lately, and rose substantially today from Friday’s 8.5% to 10.5%(Note that Solano County displays past weeks and months in a 7-day test positivity line graph which also shows daily results.  However, the chart does not display an accurate number of cases for the most recent days, as there is a lag time in receiving test results.  The 7-day curve therefore also lags behind due to unknown recent test results.) 

By Age Group
  • Youth 17 and under – 29 (!) new cases today, total of 1,328 cases, representing 11.3% of the 11,747 total cases.  No new hospitalizations reported today among this age group.  Thankfully, no deaths have ever been reported in Solano County in this age groupBut cases among Solano youth rose steadily over the summer, from 5.6% of total cases on June 8 to 11% on August 31 and has plateaued at over 11% since September 30.  Youth are 22% of Solano’s general population, so this 11.x% may seem low.  The significance is this: youth are SERIOUSLY NOT IMMUNE (!) – in fact at least 14 of our youth have been hospitalized since the outbreak began.
  • Persons 18-49 years of age – 208 (!) new cases today, total of 6,891 cases. This age group is 41% of the population in Solano, but represents just under 60% of the total cases, by far the highest percentage of all age groups.  The County reported no new hospitalizations among persons in this age group today.  A total of 194 have been hospitalized since the outbreak began.  No new deaths in this young group today, total of 6 deaths.  Some in this group are surely at high risk, as many are providing essential services among us, and some may be ignoring public health orders.  I expect this group is a major factor in the spread of the virus.
  • Persons 50-64 years of age – 72 (!) new cases today, total of 2,299 cases.  This age group represents nearly 20% of the 11,747 total cases.  The County reported no new hospitalizations among persons in this age group today.  A total of 162 have been hospitalized since the outbreak began.  No new deaths in this age group today, a total of 16 deaths.
  • Persons 65 years or older – 24 new cases today, total of 1,222, representing 10.4% of Solano’s 11,747 total cases.  The County reported no new hospitalizations among persons in this age group today.  A total of 233 have been hospitalized since the outbreak began.  No new deaths in this age group today, total of 63 of our elders who died of COVID, accounting for 74% of Solano’s 85 total deaths.
City Data
  • Benicia added 12 (!) new cases today, total of 312 cases since the outbreak began. 
  • Dixon added 26 (!) new cases today, total of 840 cases.
  • Fairfield added 72 new cases today, total of 3,502 cases.
  • Rio Vista remained steady today, total of 97 cases.
  • Suisun City added 29 (!) new cases today, total of 818 cases.
  • Vacaville added 98 (!) new cases today, total of 2,461 cases.
  • Vallejo added 96 (!) new cases today, total of 3,676 cases.
  • Unincorporated areas added 1 new case today, total of 41 cases.
Race / Ethnicity

The County report on race / ethnicity includes case numbers, hospitalizations, deaths and Solano population statistics.  This information is discouragingly similar to national reports that indicate significantly worse outcomes among black and brown Americans.  Note that all of this data surely undercounts Latinx Americans, as there is a large group of “Multirace / Others” which likely is composed mostly of Latinx members of our communities.

  • Asian Americans are 14% of Solano’s population, and account for 10% of cases, 12% of hospitalizations, and 18% of deaths.
  • Black Americans are 14% of Solano’s population, and account for 12% of cases, but 16% of hospitalizations, and 23% of deaths.
  • Latinx Americans are 26% of Solano’s population, but account for 22% of cases, 26% of hospitalizations, and 18% of deaths.
  • White Americans are 39% of the population in Solano County, but only account for 26% of cases, 28% of hospitalizations and 32% of deaths.
More…

The County’s Coronavirus Dashboard is full of much more information, too extensive to cover here on a daily basis.  The Benicia Independent will continue to summarize daily and highlight significant portions.  For more, check out the Dashboard at https://doitgis.maps.arcgis.com/apps/MapSeries/index.html?appid=055f81e9fe154da5860257e3f2489d67.

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.