Coronavirus updates: California surpasses 20,000 cases in hospitals as ICUs stay full

Dec. 29—The final few days of 2020 will be a critical moment in the coronavirus pandemic for California, where COVID-19 infections, hospitalizations and deaths have been skyrocketing for nearly two full months.

This week is sandwiched between two major holidays — Christmas last week and New Year's Day at the end of this one — that health officials have warned for weeks have high probabilities of increasing virus spread, as many are likely to gather in group settings despite pleas to avoid doing so.

The holidays' impact likely won't be visible in the data until about a week into January.

But California has not yet even escaped the tidal wave of infections that started in November and has since launched the state, which once fared very well considering its vast size, into its dreadful position as the United States' current epicenter.

About 570,000 of the state's 2.18 million all-time cases for the 10-month health crisis have been reported in the past two weeks, according to the California Department of Public Health. The statewide total for confirmed patients in hospital beds cracked 20,000 on Tuesday with a one-day increase by more than 600 patients. Over 4,300 are now in intensive care units.

As the state's death toll heads toward 25,000, officials have recorded an average of nearly 240 deaths a day over the past two weeks, including 242 new deaths reported Tuesday — about 100 higher than the peak moving average during the summer surge.

In glimpses of better news, Gov. Gavin Newsom said in a news conference Monday the most recent statewide data do reflect a "moderate" plateau in COVID-19 hospital admissions; they've actually trended slightly downward outside of Southern California, he said.

CDPH data also show test positivity rate is growing at a much slower pace than it was earlier in December, and may also be on something of a plateau. The 14-day average, now 12.6%, has increased 0.8% over the past 10 days, after it had jumped 3% in the previous 10-day stretch.

But concern remains high that a post-Christmas surge will cancel out that progress, plunging California into a steeper surge and a deeper hospital crisis next month.

Hospitals are already heavily impacted.

In Northern California, Kaiser Permanente put at least a one-week pause on elective and non-urgent surgeries, postponing those through Jan. 4.

A spokesperson for Adventist-Rideout hospital in Marysville, the only hospital serving the Yuba-Sutter bicounty region, confirmed to The Sacramento Bee on Tuesday the California National Guard has been assisting in its emergency department "for several weeks" and may continue to assist through next week.

"We continue to request our community to wear a mask when out and avoid gatherings," Adventist-Rideout spokeswoman Monica Arrowsmith added in her emailed response.

In the hardest-hit parts of the state, overwhelmed hospital systems have begun conversations about the possibility of rationing hospital care. The Los Angeles Times reported Monday some Los Angeles County hospitals are so flooded they are putting patients in conference rooms or gift shops.

Where does California's ICU capacity stand?

State Health and Human Services Secretary Dr. Mark Ghaly on Tuesday shared updated data projections for ICU capacity in the Southern California and San Joaquin Valley regions, which combine for about 27 million of the state's 40 million residents and have each had aggregate ICU availability of 0% for well over a week.

As expected, Ghaly confirmed those two regions will remain under the state's regional stay-at-home order, leaving restaurants' dining rooms and personal care services like salons shut down "for the time being."

The situation has become so severe in those regions that, since Christmas Eve last Thursday, statewide aggregate ICU space has been reported at 0% — even as two of the remaining three geographic regions, Greater Sacramento (19.1%) and Northern California (27.9%), maintain more than 15% availability.

Ghaly says the state will release a region from the stay-at-home order once that region has both completed the initial three-week window and when the state projects its ICU capacity being at or above 15% four weeks into the future. The projections involve calculations based on current ICU capacities, but also COVID-19 case and transmission rates.

Projections will be reassessed daily, but the state is not currently predicting either Southern California or the San Joaquin Valley will return to adequate capacity within the next four weeks.

The outlook is less clear for Greater Sacramento, which has fluctuated near but mostly slightly above the 15% cutoff trigger and will reach three weeks within the order on Thursday; and for the Bay Area, which recently fell under 10% availability but rebounded to 10.4% on Tuesday and won't have its ICU situation reassessed until Jan. 8.

Ghaly did not share four-week ICU projection data for either Greater Sacramento or the Bay Area during Tuesday's briefing.

The sparsely populated Northern California region is the only one not to have entered the order, having stayed between about 25% and 30% ICU capacity since the new system was introduced.

Contingency care vs. crisis care

Ghaly in Tuesday's briefing shared a chart explaining California's "crisis care continuum" which involves three gradual phases: conventional, contingency and crisis care.

The conventional phase describes the ideal conditions and level of care usually provided by health systems in normal times.

At the contingency stage, hospital beds start having to be converted, staff work longer shifts and supplies must be carefully conserved.

"Frankly, most hospitals in California are operating today in contingency care," Ghaly said. "This is where you start to see space in a hospital that is (normally) used for other types of care ... now being used to serve COVID patients."

Finally, at the crisis level, there are "significant changes" in nurse-to-patient and doctor-to-patient ratios, "major changes in clinical responsibilities" and potentially the rationing of critical supplies and/or triage of medical care and ventilators.

Ghaly said it is not the state's authority to determine whether individual hospital facilities must convert to crisis care. Rather, the state's role is to help hospitals plan for crisis care in advance, support those that do enter it and help hospitals remain in crisis mode "for as brief a period as possible."

Ghaly acknowledged that some Southern California hospitals are likely instituting crisis mode protocols, particularly in terms of staff-to-patient ratios, though none have specifically notified the state health department regarding this point.

What's the latest on vaccine planning, distribution?

The state is slated to receive its second round of Moderna vaccines and third round of Pfizer doses by the end of this week. The state is now expected to end 2020 having received about 1.8 million COVID-19 vaccines, after initially projecting it would receive 2.1 million.

Newsom said more than 260,000 vaccine doses have been administered in California as of Saturday. The early "Phase 1A" doses are dedicated to front-line health care workers who deal directly with COVID-19 patients, as well as skilled nursing facilities.

California is entering a vaccine partnership with Walgreens and CVS, whose pharmacy staffs will administer doses of the Pfizer vaccine to "all residents and staff in over 800 nursing homes, assisted living, residential care, and other long-term care facilities," according to the state's COVID-19 website.

"We didn't want to use staff or key supplies and pull it away from our other efforts," Newsom said Monday.

Plans for Phase 1B could be finalized as early as Wednesday, Newsom said, with those shots likely starting to be administered in the next few weeks.

California's vaccine advisory panel met last week to discuss the phases. The committee says Phase 1B should include people who are at high risk of exposure due to working in "selected" critical infrastructure jobs; people ages 75 and older; and people aged 65 through 74 who have medical conditions that place them at higher risk of severe COVID-19.

In that same proposal, Phase 1C — which is farther away from being finalized — would see doses go to more essential workers not included in 1B, those ages 65 through 74 who do not having existing medical conditions and people ages 16 through 64 who do have such a condition.

Newsom also Monday issued a stern warning to medical providers about what will happen if they let a friend or relative cut in line to receive the vaccine.

"I just want to make this crystal clear: If you skip the line or you intend to skip the line, you will be sanctioned, you will lose your license. You will not only lose your license, we will be very aggressive in terms of highlighting the reputational impacts as well."

Gig workers overpaid by federal aid program can file waiver

The new COVID-19 stimulus package passed by Congress and signed by President Donald Trump on Sunday includes a provision meaning many California gig workers and independent contractors won't have to repay portions of overpaid unemployment aid.

The previous relief bill passed in March established a program called Pandemic Unemployment Assistance for self-employed workers and gig workers.

But due to a lack of clear communication regarding whether workers were supposed to report gross or net income, many PUA recipients were overpaid, some of them by thousands of dollars.

The clause in the latest relief bill means many workers won't have to repay California the overpaid aid if they can show they filed their PUA application in good faith — or, as the bill phrases it, if a repayment "would be contrary to equity and good conscience."

Six-county Sacramento area surpasses 100,000 total cases

The six-county area of Sacramento, El Dorado, Placer, Sutter, Yolo and Yuba counties on Tuesday surpassed 100,000 confirmed, cumulative COVID-19 cases over the course of the pandemic. At least 1,155 have died.

Sacramento County has reported a total of 63,898 infections since the onset of the pandemic, and 833 residents have died of COVID-19. County health officials on Monday added 3,361 additional cases for a four-day reporting period including Christmas and the weekend, along with 18 newly reported virus deaths, followed by 767 cases and six fatalities Tuesday.

By date of death occurrence, the county now reports 158 deaths for Dec. 1 through Dec. 22, including 149 in just the first 18 days of the month. December has surpassed the 144 from November to become the second-deadliest month of the pandemic for Sacramento County residents. The current month remains on track to surpass 200, well exceeding the 181 deaths from August.

Virus hospitalizations in Sacramento County appeared showed some recent signs of decline but have since rebounded some. The overall total in hospital beds fell from a record-high 518 reported last Wednesday to 452 in Sunday's update, then increased back to 484 by Tuesday.

State data showed 93 ICU patients countywide as of Tuesday, down from 99 on Sunday, with 101 ICU beds now available. That's the most free ICU beds for the county since Nov. 11.

The county reports that 461 of its deaths and just under 35,000 of its confirmed cases have been residents of the city of Sacramento.

Placer County health officials have reported a total of 13,055 infections and 125 deaths. The county reported 793 new cases and five new deaths for the four-day period of Christmas through Monday.

State data showed Placer on Monday surpassing 200 hospitalizations for the first time, then reaching 206 with 28 in ICU beds on Tuesday. ICU availability fell from 20 to 19. Placer on its local dashboard Monday reported higher totals, of 208 hospitalized and a record-setting 32 in ICUs, but also reported 20 ICU beds still remaining available.

Yolo County has reported a total of 7,955 cases and 109 deaths. Yolo reported 147 new cases Tuesday after just 18 on Monday, according to the county's dashboard. The county's last death was reported Thursday.

State data showed Yolo with a record-tying 29 confirmed COVID-19 patients in hospital beds including 13 in ICUs as of Monday. Both dropped significantly Tuesday, down to 24 hospitalized and seven in ICUs, with 22 ICU beds available.

El Dorado County has reported 5,613 positive test results and 21 deaths. The county reported 104 new cases and three deaths Tuesday, a day after 414 new cases and five additional deaths were added for the four-day reporting window that included Christmas.

After suffering just four deaths through the first eight months of the pandemic, El Dorado has had at least 17 residents die of the virus in a little over three weeks.

Health officials say 26 people are hospitalized with the virus as of Tuesday, down two compared to Monday, with nine still in ICUs. State data showed three ICU beds available, down one from Monday.

In Sutter County, at least 6,290 people have been infected and 49 have died. The county added 253 cases and three deaths in a four-day update. Sutter reported 53 residents hospitalized Monday including 11 in intensive care, up from 51 and seven last Thursday.

Neighboring Yuba County has reported 3,805 infections and 17 dead, with 177 new infections and one fatality reported over the holiday weekend. Twenty-seven Yuba residents were reportedly hospitalized as of Monday, the same count as last Thursday, with five in intensive care.

Not all of those patients are necessarily hospitalized in-county, but the only hospital serving the bi-county region — Adventist-Rideout in Marysville — hit a record-high 68 virus patients in Monday's state update, followed by 67 on Tuesday. The county had 14 virus patients in ICU beds and just one ICU bed available in both day's updates.

The Bee's Kim Bojórquez, Jeong Park and Andrew Sheeler contributed to this story.

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