Concern grows over virus surge, impact on ICUs
EDITOR’S NOTE: The following story was written a day before today’s (Dec. 3) announcement by Gov. Newsom concerning new stricter stay-at-home measures (except for essential needs) for regions in California, including the Merced area.
With the total number of COVID-19 cases in the county at 12,281 as of Dec. 1 and the number of active COVID-19 cases at 1,619 — a significant increase since October — local health officials are becoming increasingly concerned about the impact on local hospitals.
“The active cases are increasing pretty dramatically,” said Dr. Kristynn Sullivan, Merced County’s supervising epidemiologist, during an interview with the Times earlier this week. “We had over 1,600 probable active cases as of Nov. 30. At the end of October, we started to see these cases go back up. Before that, they were down to 300. In a little over a month, we’ve seen five times the number of probable active cases.
“For comparison, from Oct. 1 to Oct. 30, there was an increase of 655 cases. From Nov. 1 to Nov. 30, there was an increase of 2,431 cases. And this does not take into consideration the number of Thanksgiving Day gatherings, so we may be looking even worse if there is a spike two weeks after Thanksgiving, which would be Dec. 10.
“As of Nov. 30, 32 were hospitalized with COVID in the county, and 61 total.
“The biggest concern is the hospitalization rate. We’re now seeing the hospitals are starting to get impacted — not only here but statewide — and that’s a concern.
“The biggest thing we’re concerned about in terms of hospital capacity is ICU capacity because we only have 24 ICU beds in the whole county, and at least 20 of those are filled currently so we’re nearing ICU capacity as a county.
“Between Nov. 6 and Dec. 1, at Mercy Merced, their total census of COVID positive patients was 10, and now [Nov. 30], there are 10 positive patients in the ICU, so we’re seeing a pretty significant rise. Mercy has 20 ICU beds, so 50 percent of the ICU is filled with COVID positive patients.
“The reason this is a concern is there are a lot of other things that people need ICU for, so all those people who need an ICU bed for something that’s not COVID are impacted. Heart attack, surgery recovery, bacterial pneumonia or influenza-related pneumonia, cancer complications or a stroke are the usual reasons people need ICU. There’s no other disease like this where half of our ICU beds are needed by COVID patients, and that’s when COVID becomes the most dangerous.
“We have gotten better at treating this, but that assumes that people have availability of the treatment. When the hospitals are overwhelmed, that can lead to poor outcomes, not only for the COVID patients but also for the other people who need the beds.
“The case surge is what we expected at this point, and the way we get more beds is through a surge plan.
“A surge plan is used when a hospital is at ICU capacity. They have plans to increase their capacity on site and also they may have plans to be able to divert patients to other regions in the State or to other hospitals within their system if they’re part of a hospital system.
“Of course, if the rest of the state is also seeing an increase in hospitalizations, it makes it much more difficult.”
Dr. Sullivan said, “We should be getting our first handful of doses as early as this month. They will go to high touch health care workers, and skilled nursing — both health care workers and residents — and then they’ll expand beyond that. It’s still being determined who will be next, but it may be essential workers — those who work in agriculture, law enforcement and packing plants and things of that nature.”
Why are there more outbreaks at high schools than middle school or elementary?
Merced County high schools have had outbreaks recently, including Buhach Colony High, Merced High, El Capitan High and Golden Valley High.
When asked why more high schools are having outbreaks, Dr. Sullivan said, “High schools are the highest risk because of the nature of high school. People are moving a lot more in the classes.
“In terms of age also, there is a cut off age where the virus doesn’t affect kids as much, and it looks like kids do not spread COVID as easily as adults do, and that age at which a kid stops being a kid in COVID terms is right around 10-years-old.
“Older kids can transmit the virus among themselves and to adults about as effectively as adults. With younger kids, they’re typically going to school and home, but the older age group may have more extracurricular activities and also there’s more mingling.”
Outbreak comings and goings
There were 30 outbreaks as of Dec. 1.
Dr. Sullivan told the Times, “Some of those coming off the outbreak list today are In-Shape Health Club, Yosemite Avenue, Yamato Colony MCOE Assets Program, and Central Valley Cardiovascular Medical Group.
“Some of the newest outbreaks are at Anberry Transitional Care, Central Star Crisis Stabilization Unit, Grace Homes, a skilled nursing facility, and Merced Behavioral Health Center.”
Dr. Sullivan said, “Last Wednesday [Nov. 25], the positivity rate was at 8 percent, and the state put out today that we are at 10.3 percent with a four-day lag. That indicates that our test positivity rate is going to keep increasing beyond what we’ve seen. [The positivity rate has to be less than 8 percent to move to Red Tier.]
“As to the number of cases per 100,000 residents per day on Nov. 30, we’re getting a credit right now from testing so much, but even with the credit, we’re at 33.8. Two weeks ago, the number of cases per 100,000 residents per day was 16.9. This case rate has doubled, essentially. [It has to be less than 7 cases per 100,000 residents per day to move to Red Tier.]
“The health equity quartile positivity rate is also increasing as of Dec. 1. Currently, it’s a little above our countywide positivity rate. It is 10.1 percent. (It has to be less than 8 percent to move to Red Tier.)
Has the curfew been effective?
Starting Nov. 21, there has been a curfew in effect from 10 p.m. to 5 a.m.
Dr. Sullivan told the Times, “It doesn’t seem the curfew affected people’s behavior and it does not appear to have been an effective intervention.”
Why are we seeing a surge in cases? What is the path for Merced County to get back to Red Tier and what can we do?
Dr. Sullivan said, “A lot of the reason for the surge is people gathering. People are spending more time inside in the colder weather.
“People are not being as careful as they were, and that’s due to COVID fatigue.
“We’re a long way from Red Tier at this point. What we start doing now takes two weeks to kick in. The only way to kick this is if people stay home unless they really have to go out.
“The best measures for people to help decrease the number of cases are masking, social distancing, hand hygiene, keeping holiday celebrations virtual or less than 12 people and less than three households and outdoors, or if indoors, with the windows open, and only several hours instead of all day.
“Masks need to fit properly, snugly over the nose and cheeks and below the chin.”