Intensive care availability sank in the Bay Area again on Tuesday and there were virtually no vacant ICU beds across much of the state for the 19th straight day, as California groped for a way out of the long winter surge.
The intensive care situation statewide has become so dire that the state Tuesday night issued a new health order that requires counties with reasonable ICU availability, which would include several in the Bay Area, to accept transfer patients from hospitals that are in crisis and can no longer provide adequate care.
Hospitals in Southern California and the San Joaquin Valley have been inundated with COVID-19 patients for weeks and may be forced to ration care soon. The new health order also requires most counties in those regions to cancel almost all elective surgeries. The order is effective immediately.
“This order helps ensure that patients continue to receive appropriate medical services by better distributing available resources across the state to prevent overwhelming specific hospitals, counties and regions,” said Dr. Tomás Aragón, director of the California Department of Public Health and the state health officer, in a statement. The order was Aragón’s first since he assumed the state post this month; he was previously the San Francisco health officer.
“When hospitals are overwhelmed and overflowing, they are no longer able to provide the traditional standards of care we expect,” he said, “but if health care resources are available elsewhere, we should ensure Californians can receive appropriate care.”
The state has struggled with its current surge for more than two months, and though there are signs it may level off, the next few weeks are still looking grim, public health officials said.
At the same time, vaccines have rolled out much slower than hoped for or expected. Further exacerbating a bad situation, a new, more infectious strain of the coronavirus is circulating — 28 more cases were announced in San Diego County on Tuesday, for a total of 34 statewide — which could complicate attempts to slow the spread of disease.
“December was really hard, and January is not going to be any easier,” said San Francisco Mayor London Breed during a Tuesday news conference.
It’s too soon to say how much more pressure will be placed on hospitals from an anticipated increase in cases due to the end-of-year holidays. Several Bay Area counties are reporting the first hints of a post-Christmas spike. But public health officials say they can’t yet tell if they are facing a small bump or the start of a new “surge on top of a surge.”
On Monday, the state reported 74,135 cases, a one-day record by a significant margin, though it included a backlog of cases from the long holiday weekend for some counties.
Intensive care availability dropped to 5.9% for the Bay Area on Tuesday, but that number ranged dramatically across counties. San Francisco reported that 35% of its ICU beds were available and four patients had been transferred to city hospitals from other counties.
ICU availability has been at 0% in Southern California and the San Joaquin Valley, the two hardest-hit regions, since mid-December.
San Francisco public health officials could not immediately say Tuesday what impact the new health order would have on local hospitals. But in a news briefing earlier in the day, Dr. Grant Colfax, director of the San Francisco Department of Public Health, noted that the enormous ICU stress in other parts of the state could affect the Bay Area, too.
“While we have care available and people need care, it’s the moral and ethical and right thing to do to provide that care when asked,” Colfax said, referring to the transfer patients currently hospitalized in the city. “We are watching our capacity very carefully, because as the central and southern part of the state continue to experience a catastrophic situation, and as the region has fewer ICU beds, we would expect our local ICU bed capacity to start going down as well.”
Cases and deaths
The seven-day average in daily cases has ticked up in some Bay Area counties and remains flat for the region as a whole. A few counties are reporting drops in cases, though it’s hard to say if that’s due to holiday lags in testing and reporting or an actual decrease in disease spread.
“I would hesitate to make any radical policy changes based on holiday data so far, this early on. A lot of things in COVID play out over weeks, and we’re still only 10 days out from Christmas,” said Dr. Nicholas Moss, the Alameda County health officer.
He said an increase in cases after Christmas and New Year’s will surely arrive. “The question is: Will it be the worst-case scenario where we’ll have a resumption in day-over-day increases?” Moss said. “Or is it a blip? Things go up but they go down again, and the dynamics just aren’t there to drive a surge.”
The state reported 443 deaths on Tuesday, higher than the previous week’s daily average. The death toll has been notably low in the Bay Area over the past few days, with between zero and 19 COVID-19 fatalities reported daily. The region reported 93 deaths on Dec. 31, the deadliest day of the pandemic, so far.
Hospitals and intensive care
Cases have picked up in Contra Costa County since Christmas, but officials said they don’t yet know how big the post-holiday surge will be, and they’re concerned about the extra strain on hospitals. Intensive care availability has been in the single digits in the county in recent days.
“So, we’re already at the highest we’ve ever been, and having those cases down the pike is worrisome,” said Dr. Ori Tzvieli, the deputy health officer. “We’re sort of holding our breath and hoping our peak will not be as big as Southern California’s, because they’re really, really struggling down there.”
As of Monday, 269 COVID-19 patients were hospitalized in Contra Costa County, including 69 in intensive care — both peaks for the pandemic. For the Bay Area, intensive care counts dropped slightly from a weekend high, with 495 people in the ICU as of Monday; 2,134 COVID-19 patients were hospitalized in the region.
Statewide, 21,597 people were hospitalized with COVID-19 and 4,623 were in the ICU — both new peaks for the pandemic.
Ordinarily, counties will provide backup to one another if a hospital is overwhelmed with patients, as can happen during a bad flu season. But Tzvieli said that’s not as viable an option now, with hospitals strained all over California. The state has opened six “alternative care sites” to help handle the overflows.
Tzvieli said hospitals in his county are handling their current patient load, but he worries that one large outbreak — at a nursing home or from a superspreading event, for example — could be disastrous.
“Right now they’re close to the edge,” Tzvieli said.
Virus variant
San Diego County officials said Tuesday that they have identified 28 more cases of people likely infected with the new coronavirus variant that’s been raising alarm around the world. The county has reported a total of 32 confirmed or probable cases, and two other cases were identified in San Bernardino County over the weekend.
The San Diego County cases include 28 that have been confirmed with genomic sequencing, and four cases that were linked directly to one of the confirmed infections. The specimens were collected Dec. 27 to Dec. 31. One of the 32 patients was temporarily hospitalized but the others have remained at home.
None of the patients had traveled recently so they did not pick up the strain in the United Kingdom, where the variant was first identified, or any other place outside California. The patients are from 19 different households in four cities.
“The fact that these cases have been identified in multiple parts of the region shows that this strain of the virus could be rapidly spreading,” said Dr. Wilma Wooten, the San Diego County health officer, in a statement. “People should be extra cautious to prevent getting and spreading COVID-19, especially this variant, which research has shown is more contagious.”
The variant has been identified in at least four other states. Bay Area public health officials said they suspect it is circulating in this region too, though they have not identified any cases yet.
Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday
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