More COVID patients landing in Sonoma County ICU beds as virus spreads among unvaccinated people

With a modest but stubborn surge of COVID-19 cases adding to the usual summer spate of recreational misadventures and heat-related illness, Sonoma County’s intensive care units are filling at an uncomfortable if not alarming rate.

As of Tuesday, 72% of the county’s staffed ICU beds were occupied — or 81.5% discounting surge capacity — according to county data. There were 44 patients with COVID-19 being treated in the area’s six hospitals that day, and 13 of those patients were in intensive care, numbers last seen here in mid-February, Sonoma County Health Officer Dr. Sundari Mase said.

All of the current ICU cases involve unvaccinated people, county officials said. Across the local hospital network, 92% of admitted COVID patients are unvaccinated.

And the worst of the summer spike may still lay ahead, officials said.

“This surge is representing what happened pre-reopening. This is from relaxation and behavior from before the governor relaxed” health restrictions on June 15, said Dr. Panna Lossy, a clinical faculty member at Santa Rosa Family Medicine Residency and at UCSF. “Then he relaxed it, then we had Fourth of July. That’s one thing that worries me.”

The new transmission and hospitalization rates don’t compare to the deadly surge of December and January, when as many as 23 Sonoma County residents were dying in a week. Lossy compares the current situation to the August surge of 2020 — the pandemic’s worst phase here until the darkness of December.

Others agree we have reached a stage that warrants serious concern, with about 25% of the eligible population having yet to receive a single dose of a vaccine. That slice of the public, about 110,000 people is now being hammered by the virus, county epidemiologists say.

Dr. Chad Krilich, medical director for Providence Health’s two Sonoma County hospitals, Santa Rosa Memorial and Petaluma Valley, cited the region’s rate of positive COVID-19 test results.

“Our positivity rate at the end of December was 8% for the county, and we’re 3% now,” he said. “But we were at 1% not long ago. So it’s increasing.”

Over the three-day July 4 weekend, Krilich said, the COVID inpatient census at Santa Rosa Memorial went from 8 to 11 to 13. By Wednesday it was up to 15, including four patients in the ICU.

“What I don’t know is what the impact is of having a population within our county that’s unvaccinated, and knowing that we are open, and knowing I don’t see as many people wearing masks as I used to,” Krilich said.

He’s hoping the end result isn’t a new cluster of deaths.

“The natural history of COVID is that we see the number of new cases increase in the county. And then we see the number of hospitalizations increasing. And then we see the number of mortalities increasing,” Krilich said. “So we want to try to avoid that trajectory again.”

If a spate of COVID deaths doesn’t follow the uptick in cases and hospitalizations this time, it may well be due to the shifting age demographic of coronavirus patients. The county’s most recent 60-day history of new cases shows most have fallen in the 20-29 age range, for men and women. The next highest category for females is 30-39; for males, it’s 10-19.

It’s a younger cohort falling prey to the virus these day, a group that tends to have better overall health and fewer disadvantageous health conditions.

That, too, is a frustration to health professionals, because that younger demographic has gotten vaccinated at a lower rate than their elders. The vaccination rate for 25- to 34-year-olds in Sonoma County is 64.3%, which includes those have been partially immunized with one dose. In the 16-24 range, it’s 61.9%. The number is 93% for those 65 and older.

Every one of the Sonoma County’s current COVID-related ICU cases, and 92% of those hospitalized for the virus, are unvaccinated, said Kate Pack, the county’s lead epidemiologist. Of the few who had been immunized, Pack said, all were over 65 with significant underlying conditions.

“We are now seeing the likely consequence of the choices of patients who are choosing not to get vaccinated,” Krilich said. “And that is people acquiring COVID and being hospitalized.”

Lossy worries particularly about Sonoma County’s Latino population. Fewer than 52% of those residents are fully vaccinated, compared to 66% of white residents. And because of the increasing dominance of the more transmissible delta variant, Lossy said, one shot probably isn’t enough to protect someone.

“The original variant, they thought the first shot got your immunity level into (percentages in) the 70s, and the next put it into the 90s,” Lossy said. “So people thought, ‘Oh, I’ll just get one shot.’ That’s not true with the delta variant. With this one, they think the first shot gets you into like the 30s, and the second one into the 90s. So it’s a big difference.”

Because the county is still sending samples to a state laboratory for genetic sequencing, it’s impossible to get timely analysis of how many recent cases are the delta variant. (Mase’s department recently acquired sequencing equipment and should be able to genotype its samples as soon as next week, she said.) To date, 63 incidences of delta have been identified in the county, epidemiologist Jenny Mercado said, though it’s unclear what proportion of all cases that represents.

“It’s here,” Krilich said. “To what extent these hospitalizations are attributed to that, I don’t know the answer to that.”

Many in the medical community believe the public has become overconfident. With a strong majority of residents vaccinated and most restrictions on business and social gathering suspended, vigilance had fallen in proportion to virus rates. But that sense of precaution hasn’t necessarily rebounded in a similar arc.

“I think we’re letting our guard down, for sure,” Lossy said. “I see it in my friends and myself. If a lot of people you know are vaccinated, and you’re vaccinated, you’re feeling pretty safe.”

One result, she added, is a decline in coronavirus testing. The number of hospitalizations back in August 2020 is fairly close to what we’re seeing now, Lossy said. But there were something like five times as many positive tests, an indication that fewer virus cases are being detected lately.

“If what we’re seeing is increased numbers of hospitalizations without similar test numbers, there’s not that prior warning, where you let others in your household know,” Lossy said. “People are going about their business as usual, like it’s just a cold.”

Hospitalization numbers prepared by ImageTrend and presented to local medical executives Tuesday morning by Carly Sullivan, the county’s advance life support coordinator, differed only slightly from the figures on the county dashboard.

ImageTrend revealed that 22 of 23 staffed ICU beds were occupied at Santa Rosa Memorial Hospital, all 12 at Sutter Santa Rosa Regional, eight of nine at Kaiser Permanente Santa Rosa, three of four at Petaluma Valley Hospital and one of four at Sonoma Valley. Neither of the two ICU beds at Healdsburg District Hospital were occupied.

Sutter Santa Rosa had seven COVID patients in ICU, according to ImageTrend.

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.