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.