State extends stay-at-home order in Southern California

A homeless person sleeps on the ground as an ambulance passes by outside a shuttered nail salon.

Restrictions will remain in place indefinitely

San Diego Union-Tribune

Dec. 30, 2020 9 AM PT

Southern California will remain under the state’s stay-at-home order as yet another holiday-induced surge is expected to further tax the region’s health care systems in early January.

The extension of the order means all businesses aside from critical infrastructure and retail will remain closed and restaurants are only permitted to serve food for pick-up or delivery. No timeline was given for when it might be lifted; that depends on whether the region can rebound from an intensive-care bed crisis.

In his weekly California Health & Human Services Agency update of hospital capacity and COVID-19 status throughout the state’s counties, Secretary Dr. Mark Ghaly urged the community to avoid gathering together in unsafe ways to celebrate New Year’s Eve.

“This concept of a surge upon a surge — or exposure upon exposure — is real,” Ghaly said. “Christmas gathering and infection becomes amplified a bit more exponential over the New Year’s celebrations, and we could see the worst of it in early January, and frankly, many of the hospital leaders that I’ve talked to in Southern California are bracing for exactly that.”

His plea comes in light of concerns regarding the heightened community spread, as well as increased holiday travel risk where some may have contracted the virus at a Christmas gathering before unknowingly passing it along to others this coming weekend.

Right now, most of the state’s hospitals are currently operating under contingency standards instead of the conventional or usual level of care.

This means post- and pre-operation beds are being used to serve coronavirus patients; single rooms may be converted to doubles; staff are working longer shifts, often under new configurations or supervision; and supplies are being conserved or re-used when they would normally only be used once. Care may also be delayed, as in the case of the ambulance diversions that have occurred in San Diego County this month.

Like a rubber band, hospital care can only be stretched so thin before reaching a breaking point, Ghaly said, and medical care could devolve into a crisis zone. If that happens, patients may be cared for in cots in lieu of beds, supplies and therapies may be rationed, and doctors will need to make difficult decisions.

“There might be situations where staff is stretched pretty thin, and not every patient gets the level of attention that we would hope they would in either conventional or contingency care situations,” Ghaly said. “For the levels of care in crisis, you may have to triage medical care, decide how you’re going to use other scarce resources.”

The state is trying to do everything possible to avoid hospitals falling into a crisis care mode, but it is still possible that it will happen before the pandemic ends.

California Department of Aging Director Kim McCoy Wade said medical decisions can’t be based on anything aside from the likelihood of surviving in the near term. That means care decisions cannot be based on a myriad of issues such as race, gender, age, immigration status, chronic medical decisions or insurance status, among other things.

The decision to keep Southern California under the state’s stay-at-home order comes in large part due to an expected holiday surge and as hospitals continue to see increased hospitalizations and need for intensive care unit beds. The state decision is made based on its four-week projection, which looks at the current ICU bed capacity, 7-day average case rate, transmission rate and rate of ICU admissions.

The ICU capacities for both the Southern California region that includes San Diego County and the San Joaquin region are at zero percent. While not all beds within those regions are taken, when ICU capacity for COVID-19 patients exceeds 30 percent, the facility is deemed ill-prepared to serve those needing urgent and emergency care for trauma issues like heart attacks and strokes.

“We must continue to work to make sure hospitals have a chance to provide that care to all Californians who need it,” Ghaly said.

Regions will not be released from the state’s stay-at-home order restrictions until ICU bed capacity meets or exceeds 15 percent.

The state also announced Tuesday, Dec. 29, that Humboldt County is being moved from the purple or most-restrictive tier to the red or second most-restrictive tier. There are still 54 in the state’s purple tier, three in red, and one in orange.

San Diego County reported 2,534 new cases of the virus on Tuesday, which is a 44.7 percent increase compared to Monday’s report of 1,751 new cases. The report also shows there were 44 new hospital admissions and 11 new ICU admissions Monday. This brings the total number of coronavirus hospitalizations up to 1,562 with 388 patients in the county’s ICU beds.

Thus far, 1,435 people have died from the novel coronavirus in San Diego County, including the 31 new cases reported Monday.

In the past seven days, there have been 57 community outbreaks confirmed in the county.

— Lauren J. Mapp is a reporter for The San Diego Union-Tribune