Orange County health officials say the overall trend of COVID-19 cases appears to be heading in the right direction, as they continue to monitor data on test results and hospitalizations.
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Indeed, based on recent data reviewed by Voice of OC from local hospitals, it is clear that hospitalizations from coronavirus went up markedly in the last few weeks while appearing to stabilize in recent days.
At the same time, officials acknowledge inconsistencies with data collection, including changes day-to-day in the number of hospitals reporting how many of their patients had COVID-19. The hospitals missing from one day to the next could be big or could be small, according to the county.
Despite the data collection issues, hospital officials said they were seeing a stabilizing of COVID cases last week.
As of a week ago, county health officials were looking at projections showing that when the peak hits in the coming weeks, OC hospitals would need hundreds to thousands more intensive care beds than currently are available for COVID patients.
On Thursday, the county’s health officer, Dr. Nicole Quick, said hospitals currently have capacity and she’s seeing encouraging signs that the spread is slowing, based on the daily numbers of positive test results.
However, Quick also indicated the testing rates are low in Orange County and across the state. The total number of tests reported – including both positive and negative – also varies from one day to the next, at over 1,000 total tests on some days and closer to 450 or 500 on others.
“What we are most concerned about is the trend. Overall, we believe our trend is headed in the right direction, and that’s related to the number of new cases we’ve seen over a period of time,” Quick said at a Thursday news conference when Voice of OC asked how many hospital beds, intensive care beds, and ventilators she believes are needed when the surge hits.
“We are working actively with the state, as well as our region, to ensure that we have enough hospital beds [and] ICU beds, to meet this,” Quick said, adding she did not have the specific numbers of needed beds in front of her.
Quick also cautioned against reading too much into the positive test numbers, saying only a small portion of the population has been tested so far amid nationwide shortages of testing supplies.
“We still are only testing a very small portion of the population right now,” Quick said at Thursday’s news conference. “In all of the state of California, as well as in the counties, less than 1 percent of the population has been tested.”
In Orange County, about 0.4 percent of the population had been tested as of Thursday, according to official data. In neighboring San Diego County, which has a similar population size, about 0.7 percent of the population had been tested.
“We definitely all know that there is a shortage in capacity of testing across the U.S., state of California, Orange County as well,” Quick said Thursday.
“One of the things we look at is a measure of the number of positive tests we get each day, versus how many tests we’ve done. we have seen that number remain relatively consistent. So that kind of gives us some measure of whether or not we’re picking up more positives or not.”
Many times more people likely have COVID than have been able to get tested, according to health officials in Orange County and across the nation.
Hospital Data Collection Changes Day to Day
Getting accurate real-time data on hospitalizations is crucial to bringing an infectious disease under control, according to the national pandemic strategy.
“In order to manage an outbreak most effectively, it is necessary to establish mechanisms for ‘real-time’ clinical surveillance in domestic acute care settings such as emergency departments, intensive care units, and laboratories to provide local, State, and Federal public health officials with continuous awareness of the profile of illness in communities,” the plan states.
“State, local, and tribal public health departments should develop relationships with hospitals and health care systems within their jurisdictions to facilitate collection of real-time or near real-time clinical surveillance data from domestic acute care settings such as emergency departments, intensive care units, and laboratories.”
Orange County Health Care Agency officials started collecting hospitalization data on COVID after being pressed by Voice of OC, though there continue to be inconsistencies with how it’s collected.
The number of hospitals that provide data in OC is inconsistent from one day to the next, depending on how many hospitals miss the cutoff time to report their daily numbers.
On some days, 19 or 20 hospitals reported their COVID hospitalizations, while on other days it’s 24 hospitals, without an indication of whether the missing hospitals on some days are large or small.
“The hospitals are asked to complete the survey daily. Not all hospitals are complying with the request each day,” OC Health Care Agency spokeswoman Jessica Good said in an emailed response to Voice of OC’s questions.
“The number of hospitals reporting each day contributes to the volatility; likewise, which hospitals report can contribute as well (i.e. large hospital vs. small hospital).”
County officials say they are not asking hospitals to report numbers for the past days they didn’t provide data, which would provide a complete picture of past days and a more accurate comparison of day-to-day changes.
“In the beginning, there was confusion as how the hospitals would report,” said Tammi McConnell, the county’s emergency medical services administrator, in an emailed response provided through a county spokesperson.
“We do not request prior days data, but we do send the list of ‘non-responders’ to the hospital association, who follows-up with the executives in order to encourage compliance. Notably, over the last few days, 23 or 24 of the hospitals reported.”
The total number of test results reported day to day also varies, with more than 800 total results per day – including both positives and negatives for COVID – reported earlier in the week, while 448 were reported Thursday.
Hospitals Report Lots of Capacity, Along with Concerns that Some Patients Are Holding off on Going to the Hospital
Executives at local hospitals say they’re continuing to watch the trends, and whether a recent flattening of hospitalizations will continue to hold or rise.
“The last four days has kind of been flat…obviously it’s going to take more days of that to really appreciate if that’s just a moment or if there’s a trend there,” said Robert Braithwaite, CEO of Hoag Memorial Hospital Presbyterian – one of OC’s largest hospital networks – in an interview Thursday.
“We’ve got plenty of capacity as of right now. And we’ve never really even come close to filling up, which is fortunate,” he added.
Braithwaite cautioned against seeing a flattening of new hospitalizations as a sign that people can stop social distancing and sheltering at home, which health experts widely believe are preventing the virus from spreading faster.
Another concern, he said, is that people have been delaying going to the hospital – or avoiding hospitals altogether – for heart attacks, strokes and other medical emergencies, out of fear of getting COVID-19. It’s a trend seen elsewhere in the country as well.
“We are starting to see a few individuals that are delaying their [emergency] care needs because of concerns around contracting COVID, where we’ve had some individuals actually have more serious conditions like a stroke or heart attacks, and they just delay,” Braithwaite said.
“And those delays can close on treatment windows that are otherwise available to them if they go ahead and access emergency services. And I think that’s going to be one of those emerging stories as we go farther in” during the pandemic, he added.
Braithwaite also said he was encouraged to see in-house COVID testing become up and running at Hoag and other hospitals in Orange County. The new tests shortens the turnaround time for testing patients to a couple of hours, down from the previous wait time of as many as four or five days at outside private labs, he said
If a patient has COVID symptoms, the hospital can test them and in 2 hours can have the result, he said, calling it “a game changer, on many levels.”
Braithwaite said it gives patients peace of mind if it turns out they don’t have COVID, and helps medical providers know they can shift from wearing protective gear to a more standard way of treating patients.
In the prior 24 hours, Braithwaite said about 10 patients were tested for COVID, all had test results back in about 2 hours, and all of the tests came back negative.
To prepare for the potential surge in COVID patients, state and county officials are aiming to set up hundreds of hospital beds at the OC Fairgrounds and Fairview Developmental Center as overflow beds if existing hospitals end up nearing their capacity.
The idea is for the new hospitals to free up beds for existing hospitals to focus on COVID patients whose lives are most at risk.
State officials are taking the lead in planning both hospital facilities, and have asked that nurses, doctors and other medical professionals interested in helping with the statewide surge sign up at healthcarevolunteers.ca.gov
Health officials continue to emphasize that social distancing will help reduce the virus’ spread and lessen the chances of hospitals getting overwhelmed with patients.
“We have reason to be hopeful that [social distancing] is working,” said Quick, the county health officer, at Thursday’s news conference.
“I want to remind everybody that this doesn’t mean we can lessen up on any of this, we still need people to stay home and only come out for essential activities.”
Nick Gerda covers county government for Voice of OC. You can contact him at firstname.lastname@example.org.