California’s ICUs have fewer available beds than when winter stay-at-home orders were issued

Shortly after Thanksgiving last year, with California caught up in a record-breaking surge of coronavirus cases and still waiting on a vaccine, hospitals were treating more than 2,100 COVID-19 patients in intensive-care units and had fewer than 1,700 ICU beds available.

Desperate to keep hospitals from becoming overwhelmed, Gov. Gavin Newsom announced a drastic step Dec. 3: Regions of the state where ICU capacity dropped below 15% would be subject to severe new stay-at-home orders to help combat spread of the virus. Southern California was shut down a few days later — most gatherings were banned, many businesses had to close and residents reacted with emotions ranging from resignation to rage.

This past week, California surpassed 2,000 COVID-19 patients in ICUs statewide, and the number of available ICU beds dropped below 1,600, according to the state Department of Public Health. Almost half of those beds are in the state’s three largest counties; some smaller counties have zero ICU beds available.

But this time, although some hospital workers say the COVID-19 surge is again affecting their ability to properly care for all patients, there are no shutdowns, no capacity limits on businesses or events, no social distancing requirements, no statewide mask mandates, except in K-12 schools. State vaccine requirements apply only to health care and congregate-setting workers, school staffers, state employees and attendees of mega-events. For the most part, restrictions and mandates are being left up to local health officials and the private sector.

So what’s different?

Recall, vaccines

For one thing, voting is underway in an election to determine whether Newsom will be recalled from office. The odds of his administration taking strong action that might anger voters before the election ends Sept. 14 are exceedingly small, many experts say.

But the political situation isn’t the only difference. A primary goal of last winter’s stay-at-home orders was to keep the surge from inundating hospitals until vaccinations could get rolling. Newsom said at the time — too optimistically, in hindsight — “This is the final surge. We have a light at the end of the tunnel with these vaccines.”

Vaccines are now widely available to everyone age 12 and older, and they’re exceedingly good at preventing severe disease and death. Almost everyone hospitalized for COVID-19 these days, doctors say, are people who have chosen not to get vaccinated.

Additionally, while early December was only the midpoint of the terrible winter surge, hospitalization data show signs that the current surge is starting to level off. But there’s no guarantee that will continue, especially with students, many of whom aren’t old enough to be vaccinated, going back to school, and Labor Day around the corner. Holidays during the pandemic often have been followed by spikes in COVID-19 cases.

“There are much greater protections available than last year, but Newsom is going to be under tremendous pressure to take stronger measures if these trends continue,” said Dan Schnur, professor at the UC Berkeley’s Institute of Governmental Studies, Pepperdine University’s Graduate School of Public Policy and USC’s Annenberg School of Communications.

“It’s impossible to imagine him doing much on this front before the election,” Schnur said, “but if he survives and is free of the political considerations of the recall, it could be a very different story.”

To Richard Carpiano, a professor of public policy at UC Riverside, “Now would be the time to do things.

“Public Health 101 is about getting ahead of the curve, taking preventative measures, not waiting until it’s already here,” Carpiano said. “But the well of public discourse has been so poisoned. People think, ‘I’m vaccinated now so I’m bulletproof.’ That’s just not the case. We need to be thinking about masks, ventilation systems, vaccine verification systems.”

Northern counties hardest hit

Last winter, Southern California was the hardest-hit region of the state. For more than a month, the state said its ICU capacity was at 0%.

Department of Public Health officials declined to make anyone available for an interview about the current situation, and didn’t respond to questions they asked for in writing about what ICU capacity is now in the state’s five regions or whether officials were considering any new restrictions or mandates.

But hospitalization data show that Southern California is now faring relatively better than other parts of the state — it’s the only region with fewer COVID-19 patients in the ICU now than in early December, although a few counties, including Riverside, Santa Barbara and San Luis Obispo, are an exception.

It’s far Northern California and the greater Sacramento area that are suffering most now.

“Currently, we’re seeing an overwhelming number of COVID patients, all younger and sicker than the last surge. It’s sort of daunting,” said Casey Bell, an emergency room nurse at Sutter Roseville Medical Center northeast of Sacramento in Placer County, where the public health department issued a health warning Wednesday as coronavirus hospitalizations reached record numbers.

Bell said more than 20 of her hospital ICU 36 beds are occupied by COVID-19 patients on ventilators. The hospital is so full that people who should be admitted are having to stay in the ER, so the lobby fills up and wait times have stretched up to seven hours.

She described handling emergencies in triage rooms and having to bunk two ventilated COVID patients in the same ER room because there wasn’t room in the ICU  — situations she called unsafe and scary but unavoidable.

‘In survival mode’

Across the region, 438 ICU beds are available in Los Angeles County, 99 in San Bernardino County and 52 in Riverside County, according to the state.

Orange County still has about 140 ICU beds available, but the delta variant outbreak is straining the health care system across the county, said Dr. Jim Keany, co-director of the emergency department at Providence Mission Hospital in Mission Viejo. Keany said his hospital is operating “beyond capacity … beyond what the state identifies as crisis operation.”

Bell, Keany and others say they are exhausted, and not just physically from the long hours. Bell, for instance, was on her eighth straight day of working 12- to 16-hour shifts.

The mental toll of the pandemic dragging on, and knowing that most of the patients they’re caring for could have avoided what Keany called the “living hell” of a severe COVID-19 infection if they’d just gotten vaccinated, is straining health care workers across the state and nation.

“We’re literally in survival mode as providers,” Keany said.

Communication and unity

Dr. Angelique Campen, an emergency physician at Providence Saint Joseph Medical Center in Burbank and a clinical professor of emergency medicine at UCLA, said that while last year’s restrictions did make a difference in bringing down COVID-19 case rates, cracking down again may not be the answer now.

The people who understand the gravity of the situation are the ones getting vaccinated, while others who don’t understand or are misinformed are resistant, she said. “So it’s just trying to get the right information out there to help us get over this,” Campen said.

Tiffany Dodson is an ER nurse at Sutter Coast Hospital in Crescent City, about 20 miles south of the Oregon border. The only hospital within two hours, it serves a rural area of about 30,000 people, and has been hit recently by a wave of COVID-19 patients. At times, Dodson said, they’ve been forced to triage virus patients in their cars because the 11-bed ER has turned into a surge COVID unit.

While she’s been exhausted, distressed and frustrated at times, “There are definitely words of encouragement I would like to spread to the community: We’re seeing that vaccines are helping, reducing symptoms, reducing rates.”

Dodson said instead of vaccine mandates, “We have to focus on unity, unifying with our communities, working together and showing that taking individual steps to help this process will make this better.”

What’s next?

Fred Smoller, an associate professor of political science at Chapman University, expects things to change after the recall election, one way or the other.

“If Newsom keeps his job, I think he will ‘follow the science’ and do what needs to be done to contain the virus, which may include lockdowns,” Smoller said.

“However, if he is recalled, and front-runner (Larry) Elder wins, then I think we’ll see COVID policy much more like the laissez-faire policies of GOP governors (Ron DeSantis of Florida and Greg Abbott of Texas). That is, government overreach is the problem, not the virus. Depriving people of their liberty — freedom to choose to get vaccinated — is worse than them dying,” he said. “Either way, the candidates will view the vote as a mandate.”

Source: Orange County Register