By 
Nick Gerda |
Orange County coronavirus hospitalizations are now rising faster than at any other point in the pandemic, with patient counts jumping closer to levels where hospitals could go further into “crisis care” surge measures like converting waiting areas and tents into treatment rooms, according to county health officials.
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As of Sunday, OC hospitals reported having 634 current patients with coronavirus, more than double the 292 people hospitalized as of June 1.
Since mid-June, patient counts have been rising by about 130 patients per week.
If hospitalization counts keep rising at the current rate, by early next week there would be over 750 coronavirus patients in local hospitals, which is one of several key sets of numbers county officials and hospitals are monitoring for activating hospital surge plans called “crisis care strategies.”
Those strategies include steps like converting normal hospital rooms into intensive care units; expanding beds by adding them to surge tents, conference rooms and waiting areas that would be converted to treatment areas; adding staffing by switching to longer shifts; canceling elective procedures; and further rationing of personal protective equipment.
The 750-patient guideline “is one of several important factors to monitor, and it is a consideration that numbers are getting to a point that stresses the system,” said Dr. Gagandeep Grewal, associate medical director of emergency medical services at the OC Health Care Agency, in an emailed response to Voice of OC’s questions last week. He emphasized the number is not an “absolute trigger,” but rather a guide that’s looked at in the context of other key measures.
“For example, if in two weeks our hospitalized cases go up by a factor of 1.8, to a level of 740, we will still consider that to be very concerning and would not wait until the doubling time worsens or the [daily number of coronavirus patients] tops 750,” Grewal said in a July 2 written answer to questions.
“It’s very worrisome,” said Dr. Paul Yost, chairman of CalOptima, Orange County’s public health insurance plan for people with low or no incomes, regarding patient counts rising now more quickly.
“In our own hospitals, we’re contemplating cutting back on elective surgeries,” to keep beds available, with surgeries potentially limited to the types of procedures where patients can safely go home on the same day, said Yost, who works as a doctor at St. Joseph Hospital.
“Each COVID patient is an isolation patient, and it requires full [personal protective equipment] every time going in and out of the room,” so a coronavirus patient “requires more resources than other types of patients, in order to keep all the health care providers as safe as possible.”
Yost said he’s been seeing people in the community going to parties and bars without masks on during the pandemic. “That’s just going to spread this disease further and faster,” he said.
Hospital leaders are urging the public to wear face coverings, stay away from large gatherings, and to keep physical distancing as much as possible.
“California is experiencing a new surge in COVID-19 cases in many parts of the state, including Orange County. Fortunately, we did not undo all the preparation work we undertook in February, March and April, to treat the pandemic as it began and brace for the worst,” said Dr. Todd Newton, medical director for Kaiser Permanente Orange County, which runs one of the largest hospital networks in the county, in a statement Monday to Voice of OC.
“We never shut down our national command center, we did not dismantle the changes we put in place that allow us to double our capacity to care for hospitalized patients across our organization. As a result of this preparation, we are now in a better position to identify and predict potential hot spots and surges of patients seeking high-level care for COVID-19,” he added.
“The best way residents can help us fight future spikes and alleviate capacity issues at our hospitals is to follow the state mandate of wearing a mask, avoiding large gatherings, continuing to physically distance and staying at home except for permitted work and essential needs,” Newton said. “We must work together to combat this virus.”
Earlier in the pandemic, Orange County was doing better than its surrounding counties, but has since seen its hospitalization and death rates rise higher than San Diego County and nearly as high as Los Angeles County.
County officials previously said they expected to see hospitalizations and cases rise as the economy re-opened and more people from different households interact in close proximity. They’re now stressing the importance of the public wearing face coverings and keeping 6-foot distance from people who aren’t in the same household, to help slow the virus’ spread so the economy can stay open and hospitals don’t get inundated.
“The vaccine isn’t here yet. The tools that we have really include social distancing, wearing of face coverings, hand washing,” county CEO Frank Kim told Voice of OC on Monday.
“We need everyone to lean in and comply, because we all have a responsibility to ensure that we’re not allowing the disease to progress through our community in a way that would harm not only our family members and friends and our community, but affect our ability to operate our economy and our hospitals.”
Most experts would attribute much of the increasing hospitalizations to the re-opening of the economy and a lack of adherence by many to wearing face coverings and social distancing, though the exact effect of these factors is not scientifically known, Orange County Health Care Agency officials said Monday in an emailed response to Voice of OC’s questions.
Health Care Agency officials said several factors are likely at play, with some causing more of an increase than others:
- “Re-opening of the economy—especially areas in which there is a higher risk of exposure such as inside dining or work places;”
- “Lack of compliance to face covering and social distancing directives, including indoor gatherings;”
- “COVID fatigue—overall complacency even in those who are trying to comply;”
- “More people movement—as summer has come, there may be a higher tendency for people to move about resulting in more contact among people. Even though they may be compliant, none of the standard preventative methods is completely foolproof;”
- “Recent protests and rallies—people in close quarters even though they are outside;”
- “Outbreaks in congregate living facilities—nursing homes, assisted living facilities, prisons, etc.;”
- “The natural exponential curve of the pandemic—more infected people will spread the virus more in an exponential fashion. The curve was flat but now we are seeing the ‘bell’ part of the bell curve.”
Residents of lower-income Latino communities in Santa Ana and West Anaheim are getting hit harder by coronavirus than other parts of the county, according to city-by-city infection rates.
The two cities are home to 20 percent of the county population but about 40 percent of county residents who have tested positive for coronavirus.
“These areas hardest hit by COVID-19 tend to be lower income, higher density, and are often employed in essential jobs that involve interfacing with the public,” said Curtis Condon, research manager with the county Health Care Agency, in a statement last month.
Three of Orange County’s top public health executives have resigned with little explanation since the pandemic took hold locally in March, including last month’s resignation of the county health officer, Dr. Nichole Quick, who had faced public threats from anti-mask activists at county supervisors meetings.
And for weeks, Orange County’s top elected official, supervisors’ Chairwoman Michelle Steel, started the county’s weekly coronavirus news conferences by painting a rosy picture of OC’s coronavirus data, falsely saying it’s better than all of the surrounding counties.
In fact, the county’s own data showed hospitalization and death rates in Orange County were worsening and outpacing neighboring counties in recent weeks.
The day after Voice of OC published an article last Wednesday about her misrepresentations of the rates, Steel acknowledged the higher coronavirus rates in her weekly update last Thursday, noting a recent meeting she had with hospital executives.
And on Monday, Steel called on the public to wear face coverings and practice physical distancing.
“With cases of COVID-19 in California increasing over the last six weeks, I ask the residents and visitors of Orange County to please wear a face covering when you are in a public place and unable to properly social distance, as well as following hygiene and social distancing guidance,” Steel was quoted as saying in the statement from her office.
“This is of the utmost importance to protect your health and the health of others, so that we can return back to normal as quickly as possible.”
Steel and county Supervisor Don Wagner have publicly questioned whether the hospitalization jump could be partly due to the transfer of patients to OC hospitals from Imperial County, which is grappling with a sharp jump in patients that have overwhelmed local hospitals there.
But less than 1 percent of current coronavirus patients in OC hospitals were transferred from Imperial County, according to data reported by hospitals to the Orange County Health Care Agency.
As of Monday, OC hospitals reported a total of 6 current patients who had been transferred from Imperial County, out of the more than 600 coronavirus patients in OC hospitals.
All hospitals in Orange County are being impacted by the pandemic, according to county health officials.
“We initially saw the highest degree of hospital burden in the hotspots of the county (Anaheim and Santa Ana), but as COVID-19 has become more widespread we are seeing the burden shift to hospitals based on their size, not just location,” Grewal said.
County officials have declined to release data showing which hospitals are most impacted by coronavirus.
Nick Gerda covers county government for Voice of OC. You can contact him at ngerda@voiceofoc.org.