COVID-19 cases in California reach 500,000; ICU availability at 2% statewide

Amid a flurry of related developments — from Congress agreeing on a second stimulus deal, to a second vaccine earning approval, to Gov. Gavin Newsom quarantining for the second time — California finds itself in an increasingly untenable coronavirus situation.

Winter officially arrived Monday, and it figures to be the darkest season in living memory for many, many Californians.

Nearly one-quarter of all licensed hospital beds across the state are occupied by patients positive for COVID-19. Intensive care units, which handle the most critically ill, had 2.1% availability statewide, according to the California Department of Public Health.

And tens of thousands more Californians are testing positive for the coronavirus every day, meaning there's no relief in sight for a few more weeks at the absolute minimum.

It's already by far the worst surge of the 10-month pandemic. But new infections, hospitalizations, ICU patients and the rate of death are still growing at unrelenting paces, promising to deepen both the health crisis and the economic hit taken as businesses endure another round of widespread closures. Things will almost certainly get worse before they get better.

California's COVID numbers: 500,000 cases in past 2 weeks

The state for the first several months of the pandemic fared among the best in the U.S. as far as COVID-19 metrics, a feat that had been especially impressive considering its vast size and population of roughly 40 million.

Not anymore. Entering Monday, California has reported the second-most new cases per 100,000 residents over the past week among all 50 states, behind only Tennessee, according to data compiled by Johns Hopkins University.

California has, remarkably, recorded more than 512,000 lab-confirmed COVID-19 cases in the past two weeks, including more than 90,000 this past weekend, according to CDPH. Daily increases of more than 40,000 cases have suddenly become the norm, after the state had been averaging about one-tenth that number as recently as early November.

The 512,000 infection figure represents nearly 30% of the cumulative total for the entire health crisis, which is now over 1.8 million. It also nearly quadruples the worst 14-day stretch from summer, while testing capacity has only increased a bit more than double since then.

For the past two weeks, 12% of diagnostic tests for the virus have returned positive; for the past seven days, the statewide rate is 13.3%. The percentage is up from a record low of 2.5% in mid-October, climbing quickly and steadily over the past two months.

Nearly 17,000 are hospitalized across California with confirmed cases of COVID-19, including more than 3,600 in ICU beds, according to state data updated Sunday. Between virus patients and others requiring high-level care, fewer than 1,400 ICU beds were vacant. (The ICU percentage doesn't just reflect unoccupied beds but also other considerations including staffing availability.)

The hospitalized total has essentially doubled since the start of December, when it was reported at about 8,500. The ICU patient load has increased 80% this month, up from just over 2,000.

Statewide, new fatalities from the coronavirus are coming faster than ever, and the COVID-19 death toll is also accelerating extremely quickly.

The two-week rolling average on Sunday reached 194 deaths per day, 52 more than the summer's peak of 142. California entered December averaging fewer than 70 daily deaths over the prior two weeks. In early November, the rate had been as low as 40.

COVID-19 metrics correlate along a chain beginning with infections and ending in deaths: Elevated new cases lead to increased concurrent hospital totals, which lead to crowded ICUs, which result in higher fatality rates.

To date, more than 1.85 million Californians have tested positive and at least 22,593 have died of COVID-19, according to CDPH.

Where does regional ICU capacity stand?

The state in Sunday's update said Southern California, home to 20 million, and San Joaquin Valley, where 7 million reside, each remain at 0% ICU availability, as they have for most of the past week.

The 13-county Greater Sacramento region and the 11-county Bay Area each had about 12% capacity remaining.

Those four regions, home to over 98% of California's population, are all subject to the regional stay-at-home order, which prohibits both indoor and outdoor restaurant dining among other restrictions. The order is activated across the entirety of a region once that region crosses below 15% ICU availability. The state will assess the ICU situation in each region after three weeks to determine whether those tighter protocols can be lifted.

Only the 11-county North State region, home to about 685,000, has not yet fallen below that mark and entered the tighter restrictions; it was at 24% Sunday.

What does 0% ICU availability mean?

With Southern California and the San Joaquin Valley recently running out of available ICU beds, there are early reports of what that actually looks like in the state.

Hospitals are still accepting patients. But some critically ill ones who would normally be given an ICU bed are now being treated in parts of hospitals that are being transitioned for intensive care, such as emergency rooms or postoperative surgical beds, according to numerous media reports from across the state.

Nurses are having to treat a higher number of patients at the same time, necessarily reducing the quality of care received.

In Fresno and nearby Central California counties, ambulances may soon deny rides for less-sick patients if they're determined not to urgently require emergency care, The Fresno Bee reported.

One of California's largest hospitals, Los Angeles County USC Medical Center, is under such intense strain that some patients must wait hours to receive care, NPR and the Los Angeles Times each reported in recent days.

The latter publication also reported that if the crisis worsens, Los Angeles County — home to 10 million people — may have to ration hospital care. That's a dire, last-resort strategy: It would mean establishing a triage system, compromising availability of care in an effort to keep as many people alive as possible.

Late last week, the Washington Post published a haunting seven-minute video showing the situation at St. Mary Medical Center in the San Bernardino County town of Apple Valley, giving a relatively rare glimpse inside an overwhelmed hospital.

"COVID patients are treated in parking lots, hallways and lobbies of a California hospital that, like the nation, is struggling to keep pace with the pandemic," the Post's description for that video reads.

The governor's office earlier this month announced a pilot "Home O2" program, instituted in the Southern California counties of Riverside, Imperial and San Bernardino, that'd see as many as 200 patients sent home with "oxygen and paramedic support," another move intended to free up hospital space.

What about California's 11 overflow hospital sites?

Overflow sites are being activated across the state, with patients now being treated in five of 11 established surge centers.

The 11 sites have 1,544 beds in "warm" status, with 105 patients in beds at the five sites in use.

That includes the Sleep Train Arena practice gym, where the state said 16 patients were being treated as of Sunday's update. During the spring, the Sleep Train alternate care facility never treated more than 10 patients in any one day.

The surge sites contain "low-acuity" beds, not ICU, Office of Emergency Services officials have confirmed for weeks. But treating patients at these locations frees up space and staffing at regular hospitals that can be used for ICU patients.

___

The Bee's Sophia Bollag and Vincent Moleski; The Fresno Bee's Tim Sheehan; and McClatchyDC reporter David Lightman contributed to this story.