Sonoma County opts out of Bay Area’s early COVID-19 shutdown

Sonoma County’s health officer decided against joining six other Bay Area jurisdictions that announced Friday they would embrace the state’s latest pandemic shutdown ahead of schedule to prevent COVID-19 from overwhelming their local hospital systems.

Though Sonoma County topped on Friday 1,000 new weekly cases for the first time and shattered on Tuesday its previous record for daily cases, Dr. Sundari Mase, the health officer, said the local coronavirus data did not justify at this point joining those counties. As soon as Sunday, they will impose tighter limits on retail businesses, close personal services like hair and nail salons and temporarily ban other indoor and outdoor activities.

“At this point, we’re just going to monitor the data and see where we go,” Mase said. “Very well next, if things look like they are going even further up, and we’re concerned, then we, along with our partners, will make that decision.”

Still, a second shutdown looms for Sonoma, Napa and other outlying Bay Area counties, based on projected growth in coronavirus cases, which already have quadrupled in the Bay Area in recent weeks, and spiking COVID-19 hospitalizations, which topped 1,000 regionwide, according to data presented Friday by health officers for the six jurisdictions pursuing a swifter order. They include Alameda, Contra Costa, Marin, San Francisco and Santa Clara counties and the city of Berkeley.

“An unprecedented wave of new infections” in those areas threatens to overwhelm hospital capacity, said Dr. Chris Farnitano, Contra Costa’s health officer, leading the coalition to act earlier than required by the state to stave off a greater surge.

“The dark COVID winter that we feared has arrived in the Bay Area,” Farnitano said. “I and other county health officers in the Bay Area don’t think we can wait for the state’s new restrictions to go into effect later this month. We must act swiftly to save as many lives as we can.”

Capacity within intensive care units used to treat the sickest COVID-19 patients has been a guiding factor for state and regional officials making such decisions. Among the advancing five counties, none has a lower reported ICU capacity under the state framework than Sonoma, where county and state websites showed just 4 of 82 intensive care beds were available on Friday, a capacity of less than 5%. The next closest among the advancing counties was Santa Clara, with about 14%.

Both would fall under the 15% threshold that is likely to force the Bay Area as a region into the second shutdown in a matter of weeks. The current regionwide ICU capacity is about 21%.

But in her Friday briefing, Mase and local hospital administrators said the county’s reported ICU capacity — as shown on its own COVID-19 dashboard and state reports — distorted the picture of critical care that could be made readily available in a surge. While the county has for months reported a total of 82 ICU beds between the six local hospitals, Mase said Friday the county had 77 staffed and licensed ICU beds, with 46 critical care patients in those beds, leaving 40% available.

That brighter assessment opened up a wide discrepancy county officials could not explain.

"We are in conversation with the California Department of Public Health for how these numbers differ with what the state is posting, and we hope to have some answers for you soon,“ Mase said.

State health officials did not immediately respond to a request for comment.

For example, Kaiser Permanente in Santa Rosa has a total of 20 licensed beds, with staffing for four beds, three of which are filled with patients, including one COVID-19 case, said Dr. Siamack Nemazie, a Santa Rosa-based kidney specialist with the hospital. “And if we got more patients throughout the nights, we would pull whatever levels we needed to staff back up.”

Mase said that local hospital leaders have assured her that they’ll be able to increase their ICU capacities by adding more staff.

“I think it really depends on what does the surge look like,” said Dr. Chad Krilich, the chief medical officer for St. Joseph Health, which runs Santa Rosa Memorial Hospital. It had 27 patients in its 35 ICU beds Friday. Only one was a COVID patient.

"It’s a very fluid process, and staffing is critically important,“ Krilich added.

Sonoma County began the week reporting a single-day high of 343 new COVID-19 cases on Tuesday, approaching double the previous record of 197 set back in mid-August. Since Saturday, the county has added 1,049 cases and at least three more deaths, reaching 160 total deaths and 13,098 cases, including 175 more on Friday.

Statewide, California topped a record 20,000 new cases on several days this week. About three quarters of the state’s hospital beds are full, and about a quarter of those patients are COVID-19 cases, according to San Francisco Health Officer Dr. Tomás J. Aragón. For every case that is confirmed, he said, an estimated six to 10 go undetected, fueling greater spread.

The state restrictions announced by Gov. Gavin Newsom Thursday are aimed at curbing the public mixing that fuels that spread, particularly indoors and particularly where eating and drinking might be involved. They would be implemented by counties grouped together in five regions — the Bay Area is one — and would limit restaurant service to takeout and delivery only, allow retail stores to operate at 20% capacity, close bars, wineries, hair salons, barber shops and nail salons, permit only-outdoor worship, close playgrounds and suspend overnight camping, among other activities.

The only difference for the five Bay Area counties going first is the earlier date, said Dr. Sara Cody, the health officer for Santa Clara County.

“We are not islands,” she said. “Yesterday, we had a record-breaking 67 new COVID patients admitted to hospitals across our county. So that’s an all-time record, and unfortunately, we are shattering records every day.”

Barring a dramatic reversal in the spread of the virus and the increasing number of hospitalizations, Sonoma County via the Bay Area region is expected to go under the state’s new shutdown rules sometime in mid-December, Mase said, noting that other regions will likely see their ICU bed capacity fall below 15% even sooner.

Because Sonoma County’s ICU figures will be aggregated with 10 other Bay Area counties to determine regional capacity, it may not make a difference whether the state changes how it looks at Sonoma County’s data, Mase said.

“We have a low number of available ICU beds within the whole region,” she said. “It may not impact the whole number as much.”

Mase affirmed Friday that it was her decision not to join the expedited Bay Area shut-down, making for the second instance in which Sonoma County has trailed its southern neighbors with pandemic closures. The first instance came in the wake of the same Bay Area coalition’s first-in-the-nation shutdown in March.

Mase said she briefed county supervisors Friday morning about the expedited restrictions and will be discussing Sonoma County’s status at the board’s regular Tuesday meeting, with the benefit of a fuller understanding of local ICU capacity.

Board Chair Susan Gorin conceded there could come a point at which supervisors supported a move to take additional precautions, rather than wait for the state, but she did not think it necessary immediately, given her new understanding of the available hospital capacity for critically ill patients.

Supervisor Lynda Hopkins said she has broached the idea with Mase of whether there might be middle ground — some step short of imposing the full scope of state restrictions that might be appropriate, depending where the county data stands Tuesday.

But Hopkins said she’s “absolutely” comfortable with the decision to hold back for now.

“I really believe that Dr. Mase is not making a knee-jerk policy decision, which I appreciate,” Hopkins said. “She really wants to dive into the data, to see how we might be different, how we might be the same as the other counties. I think it’s really important to acknowledge how severe the economic ramifications are at this time. We have small businesses who are realistically on their last legs right now, and they’ve made it this far, and they’re thinking they’re not going to make it any further. I think it’s appropriate to take a pause before making a decision.”

Gorin, likewise, said she appreciated the fact that the county might have a couple of weeks to prepare for more restricted business operations.

She added, “It’s important to message behavioral caution and note that the transmission we’re seeing is occurring in the large and small gatherings, that is then occurring at the workplace or from the workplace to home.”

“Exercise caution, wear a mask, do not go to work if you have COVID,” she said.

You can reach Staff Writer Will Schmitt at 707-521-5207 or will.schmitt@pressdemocrat.com. You can reach Mary Callahan at 707-521-5249 or mary.callahan@pressdemocrat.com.