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Public health experts and frontline doctors are expecting Orange County’s coronavirus situation will worsen this month, with a potential wave of new cases stemming from holiday celebrations.
Hospitalizations are already high.
The trends aren’t expected to start reversing any time soon.
“If you look at where we’re projected to be based on what we’re seeing now, in two weeks, the graphs go straight up — they’re not even curved. They go straight up to the sky,” said Dr. Todd Newton, an emergency care physician and OC medical director for Kaiser Permanente. “More and more people are going to get sick and more people are going to die.”
Newton said the hospital has been doing everything they can to free up staff and beds to treat virus patients, like quickly discharge stabilized patients for home care, utilize telehealth visits and encourage nonvirus patients to keep up regular care to avoid hospitalizations.
“We’ve pulled those levers, we have other levers we can still pull,” Newton said in a phone interview last Tuesday. “We are now into having to plan for surges on top of our surge plans and I’m very concerned if we get another one after New Year’s, the hospital system is going to be in very bad shape.”
UC Irvine epidemiologist and public health professor Daniel Parker said the spikes could stretch into February.
“It’s already looking really bad. My best guess is we’re going to be well into January, maybe February before it kind of drops off,” Parker said in a phone interview last Wednesday.
The second wave is battering Orange County worse than the first wave over Summer.
During the peak of the first wave, 722 people were hospitalized at one point in July.
But the daily case rates were beginning to decrease during that time.
Now, OC is roughly averaging 3,000 new daily cases for the past week.
The highest daily average during the first wave was just over 1,000 new cases a day.
State public health officials estimate roughly 12% of all newly infected people will end up in hospitals within three weeks.
Despite seeing some slight decreases in hospitalizations over the New Year holiday weekend, 2,136 people were are hospitalized, including 487 in intensive care units as of Saturday, according to state public health data.
It’s the latest available data due to maintenance on the state’s servers.
Numerous social media postings and digital flyers indicate there were New Year’s Eve parties throughout OC.
Voice of OC readers continue to send in descriptions of restaurants and bars all over Orange County plainly ignoring state guidelines.
And screening data from the Transportation Security Administration indicates millions of people flew during Christmas week.
“When I look at what’s happening in a large part of society, many people are taking this seriously. But what I see with people having sports tournaments, parties, restaurants still having indoor dining — it doesn’t comport with what we’re seeing on the inside, which is a health disaster,” said Newton, who spends a lot of time in emergency care facilities as a physician and OC medical director for Kaiser Permanente. “It’s not an emergency, it’s not a crisis … I would call it a full-fledged disaster.”
Meanwhile, the California Department of Public Health officials are requiring all hospitals file a “crisis” plan with state officials for the possibility of rationing care.
“You are in situations where you occasionally have to ration supplies, care,” said Secretary of the state Health and Human Services Agency Dr. Mark Ghaly at a news conference last Tuesday. “Not every patient gets the same level of attention as we hoped they would.”
While Ghaly said he’s not aware of any hospitals in crisis mode at the time, he said staff and state officials need to prepare for the possibility.
“We need to be prepared for the possibility that some hospitals have to resort to crisis care,” Ghaly said. “Medical professionals will have to make hard choices.”
OC’s emergency rooms are seeing increasing average waiting times to offload ambulance patients, according to a Dec. 31 situation report from the OC Emergency Medical Services.
As of last Thursday, the latest available report, 14 emergency rooms had a wait of more than 30 minutes and eight had more than an hour wait.
And mobile field hospitals — tents with beds — are being rolled out to hospitals around OC to help handle spiking virus hospitalizations.
UC Irvine Medical Center, St Jude’s Medical Center, Fountain Valley Regional Medical Center and Los Alamitos Medical Center either have or are slated to get tents.
“We knew that we would be here. We are in a place where we have a lot of people needing hospitalization and they’re taking a longer time to get discharged, so that is occupying a lot of space in the hospital,” said Dr. Shruti Gohil, a critical care and infectious disease physician at UCI Medical Center.
As of last week, the UCI was awaiting final certification to open its field hospital.
“We have had to open up our mobile hospital unit, which was set up and mobilized over the last week and a half,” Gohil said. “We’re going to be using that to offload some of the congestion in the hospital.”
UC Irvine epidemiologist Sanghyuk Shin said he expects the next few weeks to look similar to the weeks following Thanksgiving, with increasing daily cases and hospitalizations.
“I think something close to what we saw with Thanksgiving and even before that what we saw around Halloween time as well, there was a surge two, three, up to four weeks after these events. I think we can expect something similar. So we’re not turning the corner in terms of decreasing the rates until the end of January, at best,” Shin said in a phone interview last Monday.
Shin said he’s also worried about some of the smaller hospitals in Orange County.
“I’m worried about the smaller health care facilities and smaller hospitals that don’t have quite the resources that we have at UCI. So they tend to be the ones that get overloaded and are not able to handle the surge as well as some of the more better resourced facilities,” he said.
As of Saturday, the latest available data due to server maintenance, the virus has killed 1,901 people out of 161,589 cases, according to the county Health Care Agency.
That number includes 26 new deaths reported, which could stretch back up to two or three weeks due to reporting delays.
The virus has already killed more than three times as many people as the flu does on a yearly average.
For context, Orange County has averaged around 20,000 deaths a year since 2016, including 543 annual flu deaths, according to state health data.
According to those state death statistics, cancer kills over 4,600 people, heart disease kills over 2,800, more than 1,400 die from Alzheimer’s disease and strokes kill over 1,300 people.
Orange County has already surpassed its yearly average 20,000 deaths, with 21,110 people dead as of November, according to the latest available state data.
It’s a difficult virus for the medical community to tackle because some people don’t show any symptoms, yet can still spread it. Others feel slight symptoms, like fatigue and a mild fever.
Others end up in ICUs for days and weeks before making it out, while other people eventually die from the virus.
Newton said it’s hitting North OC harder than South OC, although the virus is more widespread in the south than during the first wave.
“It’s always hit the north harder than the south. Definitely both have widespread COVID activity and definitely people are getting sick north and south. But, yes, there’s a disproportionate impact to the north community,” Newton said.
Numerous public health experts interviewed by Voice of OC last year attribute the disproportionate impacts in many working class North and Central OC neighborhoods to overcrowded housing, lack of access to health care and because many people don’t have the option to work from home.
“It’s hitting them hard, there’s no doubt about it. We see it. It’s not uncommon, unfortunately we’re used to it. It’s not uncommon to have entire households infected. We’ve had tragic situations where two people of the household die,” Newton said.
Epidemiologists are having a tough time pinpointing what exactly is driving the new spikes, although state and local public health officials have largely blamed it on private house parties and dinners.
“I know that people are kind of pointing to family gatherings and things of that nature. I’m a little bit skeptical about that because those types of data being presented are only being based on the 10%, 20% of COVID-19 cases that are investigated. The vast majority of COVID19 cases, we don’t know where people got it,” Shin said.
Parker echoed Shin’s concerns.
“When you’re doing the contact tracing, the easiest contacts to identify are the ones in your own house. So we have pretty good data on what’s happening inside households,” Parker said. “The strangers that you were around somewhere or the people you maybe forgot you were around at work — the data is just a little bit different there … I wouldn’t feel real confident in saying where transmission is going on at the most at this point.”
Both epidemiologists said there’s so many new daily cases, it’s impossible to investigate each new case and keep up with the spikes.
Spencer Custodio is a Voice of OC staff reporter. You can reach him at scustodio@voiceofoc.org. Follow him on Twitter @SpencerCustodio