Officials projecting ICUs to hit max capacity in just weeks

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It’s all about the math for state officials projecting what’s coming in the COVID-19 pandemic.

Roughly 12 percent of all COVID-19 cases result in hospitalizations, they say, and 10 to 30 percent of those patients ultimately require critical care in an intensive care unit.

So with cases surging to unprecedented levels in recent weeks, projections that have ICU beds statewide filled to capacity by mid-December have prompted warnings of a new stay-at-home order aimed at limiting further spread of the virus.

“Bottom line is we are looking at intensive care unit capacity as the primary trigger for deeper, more restrictive actions because when that capacity goes away, or even when it gets stretched so far that staffing is stretched, we know that the quality of care… sometimes takes a dip and we see outcomes we don’t want to see,” said Dr. Mark Ghaly, California’s secretary of health and human services.

“We want to act sooner than that so that we can get transmission down and we can handle those potential high ICU surges,” Ghaly said during a press briefing with Gov. Gavin Newsom on Monday.

Data the pair presented projected that hospital beds statewide will be at 78 percent of capacity by Christmas Eve and 80 percent of capacity in the greater Sacramento region while ICU beds will be at 112 percent of capacity statewide and 103 percent in the Sacramento region.

Yolo County may already be seeing the warning signs in increased hospitalizations.

“Our hospitals have capacity, but limited,” county spokeswoman Jenny Tan said Monday. County residents hospitalized with COVID-19 increased from 12 last week to 22 as of Monday.

Tan said last week Woodland Memorial Hospital, one of two hospitals in the county, “had to increase capacity for a short duration so they opened their surge unit.”

“That situation has since stabilized,” Tan said, “and we’ve been lucky enough that an additional unit hasn’t needed to stay open for longer periods of time, but that could very much change due to the pandemic and this current surge that we’re in.”

Woodland Memorial and Sutter Davis — the county’s two hospitals — are relatively small with limited numbers of ICU beds, so critical-care patients are often transferred elsewhere.

“Hospitals work within their healthcare systems first to increase capacity and will then transfer patients as needed,” Tan noted. “Once our hospitals and hospital systems are full, then they will reach out to other facilities for additional capacity.”

Additionally, county residents who belong to healthcare systems such as Kaiser Permanente or UC Davis generally go to hospitals outside of the county, in Sacramento or Vacaville, for example.

That reliance on a regional healthcare system is common throughout the state, particularly for smaller counties.

“So we are looking at this from a regional perspective,” said Ghaly, “because … if a patient needs care and they can’t get it in a hospital in their community, in their county, then we need to make sure that surrounding counties’ hospitals are able to serve those individuals.”

And while the state has increased hospital-bed capacity, including making Arco Arena available if needed in the Sacramento region, hospital beds are not the same as ICU beds, Ghaly noted.

“Much of the surge capacity that we have built up is able to take care of what we say are medical/surgical beds,” he said. “They are not ICU-equivalent beds. What we worry about at this time is specifically the ICUs … usually specialized space, specialized equipment and specialized staff.”

And with cases of COVID-19 spiking the way they have — well before the outcome of Thanksgiving gatherings is seen — drastic action may be needed, Newsom said Monday.

“If these trends continue, we’re going to have to take much more dramatic, arguably drastic action, including taking a look at those purple-tier counties,” Newsom said. “If we see these trends continue, (there is) the potential for a stay-at-home order for those regions in purple because of hospitalizations and ICUs.”

“We are now not just looking at positivity rates,” added Newsom. “We’re now not just looking at case rates. We are now looking in real time at hospitalization numbers and ICU capacity in those regions.”

What that stay-at-home order would entail remains to be seen, but indoor activities remain the riskiest, and riskier than they’ve ever been, Ghaly said, given how widespread virus transmission has become.

“(T)he minute you walk in the door of any entity indoors, the chance of encountering someone with COVID who can actually transmit it is higher than it’s ever been,” said Ghaly. “And we know indoors is the kind of scenario where COVID does transmit and pretty easily. When you take down your mask, when you close that distance between you and others who aren’t in your household, all of those things that we’ve been talking about for months, are only amplified today because of the level of transmission.

“So although people want us to identify the sector or sectors where we see transmission the most, the truth is right now it’s just all around our communities and everyone is somewhat vulnerable to having an encounter with someone who’s infected.

“And that means that activities that people thought a month ago were safe and lower risk today are higher risk,” said Ghaly. “So part of this is we need to recalibrate for a short period of time what we do to keep this transmission down, protect people who could become sick and hospitalized and need that care and, frankly, to keep the death toll in California as low as we can.

“But we are really in a different situation with transmission than we’ve ever faced before. Every activity a month ago lower risk, this month higher risk than ever before.”

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