Marco della Cava
| USA TODAY
California sets stay home order amid virus surge
California Gov. Gavin Newsom said Thursday most of the state will likely be under a new stay-at-home order within a day or two. Newsom said the new rules will trigger when a region’s intensive care unit capacity falls below 15%. (Dec. 3)
SAN FRANCISCO — These are scenes from a battlefield. Full intensive care units. Doctors and nurses working for hours without sleep. Waves of patients dying.
Across California, a post-Thanksgiving COVID-19 spike is ravaging cities and counties that once had been models for how to keep coronavirus cases low. To date, the state has logged 1.9 million cases and 22,000 deaths, with new records seemingly set daily.
“I feel like someone at war, it’s chaotic all the time,” said Erin McIntosh, 38, a mother of four who works as a rapid response nurse at Riverside Community Hospital southeast of Los Angeles. She said the National Guard is scheduled to help with care soon.
“Nurses do this because it’s their life’s work,” she said. “But many are reaching their breaking point.”
McIntosh’s voice is subdued these days. Six of her COVID-19 patients recently died, including a 25-year-old who they felt sure would make it. She said she can’t give the kind of care people deserve due to the overwhelming crush of cases.
“People’s lives are on the line,” she said. “We’re taking more patients, we’re working more shifts, sometimes 24 hours at a time. But we can’t give 100% to everyone.”
These waning weeks of 2020 have fast become “some of the darkest days of our COVID-19 surge,” California Gov. Gavin Newsom said Sunday as he urged residents to heed public health warnings about traveling or gathering in groups over the holidays. A day later, Newsom said Monday night that the state’s state-at-home orders, due to expire at the end of the month, would likely be extended.
Chaos seems to be the order of the day. Newsom himself is back in quarantine for a second time after someone on his staff tested positive. Los Angeles Unified School District, the state’s largest, announced campuses would stay closed after the Christmas break. Pasadena’s storied Rose Bowl collegiate football showdown is moving to Texas after officials declined to let players’ families come.
Some California health care workers have received doses of the coronavirus vaccine developed by Pfizer, and shipments of another highly efficient variant made by Moderna is expected to start soon.
But for the vast majority of the state’s 40 million residents, those inoculations remain months away. In the meantime, hospitals are paying the price — as are patients, some of whom aren’t visiting for COVID-19 reasons.
“Hospitals never want to stop semi-elective surgeries, but with this colossal mess that we have now that’s something they’ll have to start considering,” said George Rutherford, professor of epidemiology and statistics at the University of California, San Francisco.
Rutherford, whose daughter is an emergency room nurse whose hospital has started moving COVID-19 patients into the emergency room area, said the state’s hospital system is built “with a surge system mindset.” That means if an earthquake or fire hits one part of the state, hospitals in another region or county stand ready to ease the burden.
“But right now, it’s just bad everywhere,” he said, adding that he is hopeful case numbers drop soon. “This surge is the ‘son of Thanksgiving.’ Now that we are more than a few weeks out from that, it means we should start to turn a corner soon.”
Christmas, however, could well tax the state’s medical network to a breaking point. Airports around the country report growing crowds as pandemic-weary Americans take their chances with the virus to rendezvous with loved ones.
“That’s why we all have to hammer home the message about social distancing,” said Rutherford. “I try not to make outlandish promises to my six kids, but I said don’t come see me now and I promise, we’ll celebrate Christmas in July in Hawaii.”
In Los Angeles, doctors at Lakewood Regional Medical Center are seeing non-coronavirus patients who are delaying going to the hospital when they experience symptoms related to strokes and heart attacks, said Jennifer Bayer, the hospital’s spokesperson.
Bayer said Lakewood staffers are “very tired and stretched thin,” but continue to meet the needs of a steady influx of COVID-19 patients by converting beds as needed into intensive care areas. If there was one recent bright spot, it was the arrival last week of COVID-19 vaccine doses which the hospital dispensed to personnel.
“These days,” said Bayer, “it’s the little things that go a long way.”
California only behind Tennessee in new cases
Just how California’s COVID-19 caseload went from manageable to overloaded is a matter of much speculation.
But some experts say that a number of factors are to blame: lax social distancing early in the fall coming out of a summer that found many people getting back to normal routines; an abundance of Thanksgiving travel despite health official pleas against moving around; and the general misperception that socializing indoors with pods of friends can keep you safe.
“That’s where most people feel like they’re OK, but the truth is even if you feel your friends are being safe, too, you don’t know where they got their groceries or gas that day,” said Tim Brewer, professor of medicine and epidemiology at the University of California, Los Angeles. “All you’re doing is increasing your pool of exposure.”
Brewer says if you must meet with trusted friends, stay socially distanced, wash your hands often and, above all, gather outdoors.
“Viruses either transmit or they don’t, so we either put conditions in to interrupt that spread or we don’t,” said Brewer. “We just need to really commit to rededicating ourselves to the measures that we know can protect us.”
Some parts of California need to heed that message more than others.
California’s Lassen County, a rural area in the northeastern corner of the state with around 35,000 residents, ranks fifth in the nation with 343 COVID-19 cases per 100,000 residents. The hardest-hit county is Oklahoma’s Alfalfa, where more than a third of some 5,000 residents have tested positive for the virus.
Nationally, California ranks second in daily new cases per 100,000 residents, with 108. Tops is Tennessee, at 132, according to the non-profit tracking site Covid Act Now.
More bad news may be on the way. A model the state uses to forecast trends says that the number of COVID-19 cases admitted to state hospitals could swell to 75,000 by mid-January. Medical facilities, already overwhelmed, are reaching breaking points.
Hospitals tell the most poignant and painful COVID-19 tale. As of this past weekend, more than 16,840 Californians were admitted with confirmed cases, more than double the state’s July peak. More than 150 new deaths are being tallied daily, bringing the total to 22,590, according to the state’s health department.
Nearly 80% of intensive care units are being used statewide, according to Covid Act Now. Of nearly 8,000 ICU beds available in the state, half are taken by non-COVID-19 patients. Of what remains, more than 3,500 beds are being used by virus sufferers, with more arriving daily.
While some counties still have an ICU cushion, such as Santa Barbara down south (50% of beds available) and Sonoma up north (32%), many are already at 100% capacity, including counties such as Imperial and Fresno, that are home to the state’s agricultural industry.
The poor and people of color continue to be disproportionately impacted by COVID-19, both in terms of health and finances. The current spike seems to be claiming more such victims.
In many rural California counties, healthcare is administered by small clinics. What regional hospitals do exist are small. In San Bernardino County, where white people make up only 33% of the heavily Latino population, St. Mary Medical Center has 213 beds and only 20 ICU spaces, causing patients to be treated in hallways.
But even big cities with sophisticated hospital systems are feeling the brunt of the pandemic’s surge.
San Francisco is a case in point. Mayor London Breed locked down the city early in the pandemic, and its new daily case rates were in the single digits per 100,000 residents through the fall. That number has shot up to 36 per 100,000 in the past week.
Suffering the most by far is Los Angeles County, home to a quarter of the state’s population. While case rates there virtually paralleled those of San Francisco in September, today the county has 131 new cases per 100,000 residents. The county’s ICU headroom rate is 88%.
Facing a crush of patients, doctors and nurses find themselves stretched thin. In Riverside, McIntosh said many of her colleagues are gone. Some have taken more lucrative nursing posts in other states, while others “are just done,” overwhelmed both by the growing drumbeat of death as well as what she sees as a dismissive attitude toward health community recommendations ranging from masks to vaccines.
“I hear people saying, ‘I won’t get a COVID-19 shot,’ just like some people have said they won’t wear masks,” said McIntosh. “But believe me, the result of that attitude is a huge amount of suffering that we see every day.”
She describes making a now all too common call to relatives of COVID-19 patients, some of whom she has met only hours before in a FaceTime call with the patient, letting them know their relative has passed.
“You tell them, and you get that deep, haunting cry from them that haunts me every day,” she said.
If there is a light at the end of this dark COVID-19 tunnel, it is the vaccine, McIntosh said. The other day, she got her first of two shots. She said it brought her one step closer to sanity.
“I care so much about all my patients, but I also care about my family and not getting them sick from my job,” said McIntosh. “Now, maybe I can feel better about not putting them at risk while I continue to help others.”
Follow USA TODAY National Correspondent Marco della Cava: @marcodellacava
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