Orange County’s coronavirus hospitalization numbers continue to be dogged by uncertainty, with the numbers of reported patients dropping over the past week at the same time questions about the accuracy of reporting are heightening.
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This week, County Supervisors Chairwoman Michelle Steel questioned how many of the reported hospitalized virus patients are there solely for coronavirus complications, or came in for another procedure like a knee replacement and ended up testing positive for the virus.
Steel, at Thursday’s news conference, said she “further questioned if the [county Health Care Agency] has been separating individuals that had come to hospitals solely for COVID-19 or had been added to the positive totals after coming in for different medical reason we want to work closely with the hospitals on this issue.”
CalOptima board chairman Dr. Paul Yost, who’s an anesthesiologist at St. Joseph’s Hospital, said that is unlikely noting his hospital — along with others — have largely cancelled elective surgeries and are doing outpatient procedures instead.
“People are hospitalized only enough if they’re sick enough to be hospitalized,” said Yost in a Friday phone interview.
“This makes absolutely no sense to a physician at all. We don’t want people who are COVID positive anywhere near the hospital — patients, visitors or anyone else. Unless the only time they’re in the hospital is if they’re sick enough to be there,” said Yost, who’s a former president of both the Orange County Medical Association and the California Society of Anesthesiologists.
Interim county health officer Dr. Clayton Chau said most hospitals test for the virus and he didn’t have an estimate of how many people who are hospitalized weren’t initially there for severe virus symptoms.
“I know from talking to most of my colleagues in the hospital system, if you go in for a procedure … most hospitals will test you for COVID because they wanna make sure they place you in the appropriate section of the hospital just for people who have COVID,” Chau said. “To the extent — how many of those people, we don’t know.”
But Yost said hospitals are increasingly doing outpatient procedures, meaning a patient can go home that same day.
“We’re only doing things where we can get that patient out of the hospital as quickly as humanly possible,” Yost said. “We’re even doing some total joint replacements in the same day.”
Dr. Saahir Khan, who treats virus patients at UC Irvine Medical Center in Orange, said an overwhelming number of hospitalized patients are there because of the virus and not for other issues.
“In my experience, it’s a very small number that are COVID positive that are primarily hospitalized for reasons other than COVID. And that’s partly because we’re not doing as many of those elective surgeries and those patients, most of the time aren’t hospitalized for significant periods of time,” said Khan, who’s also an infectious disease expert.
He also said most hospitalized patients are there because of the virus.
“So our experience is that the vast majority of COVID patients that are hospitalized are there for active symptoms, and for other complications of COVID-19, such as blood clots,” Khan said in a Friday phone interview.
Meanwhile, the virus has now killed 618 people out of 36,196 confirmed cases, according to the county Health Care Agency.
Hospitalizations look to be plateauing, with 593 hospitalized, including 191 in intensive care units.
“Our number of patients in the hospital is down a little bit, but our number of intubations is the same or higher,” Yost said. “But they kind of fluctuate a little bit.”
“I think that the COVID patients have plateaued somewhat,” Khan said.
There’s been 409,264 tests conducted throughout OC, which is home to roughly 3.2 million people.
The county office of Emergency Medical Services noted the disease is still spreading, although there’s signs the situation is improving.
“Hospitalizations have leveled some in recent days, however are still elevated and are up increased 30% in the past month,” stated Friday’s situation report. “Some of the recent trends are encouraging showing some reduction in disease transmission and leveling of hospitalizations, however, we still need further reduction in disease transmission to protect the hospitals and healthcare systems.”
And there’s a delay in hospitalization reporting because of new federal reporting requirements.
“There’s a change in the hospital reporting system. The hospitals used to report directly to CDC and on the 21st of this month, that has changed to reporting to [U.S. Department of Health and Human Services]. And with that, there’s a change in the form that the hospitals fill out and it is actually quite extensive now, and that’s the reason for a delay,” Chau said at Thursday’s news conference.
County health officials also said hospitals are transferring some virus patients to long term care and skilled nursing facilities, while not keeping an exact count on the facilities or their capacities.
“Yes, hospitalized COVID-19 positive patients are being discharged to long term care facilities. The OC Health Care Agency (HCA) does not track individual transfers. However, when a hospitalized COVID-19 positive patient is transferred to a Skilled Nursing Facility (SNF), that patient would be subtracted from the hospitalized count (by the sending hospital) and added to the SNF count via the state daily reporting,” county health officials said in an email last week.
Four months of the pandemic has taken a toll on hospital staff, with many people having to often work 12 hour shifts, Yost said.
“People are working very hard and they’re getting tired. Days off are very few in between.”
Here’s the latest on the virus numbers across Orange County from county data: