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California coronavirus explosion continues as latest daily record crushed

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California has again recorded its most coronavirus cases in a single day amid a sustained and alarming wave in infections that threatens to swamp hospitals statewide.

The number of newly confirmed infections reported Monday, 21,848, surpasses the previous high of 20,654 set a week ago, according to data compiled by The Times. The latest figure was partially inflated by reporting lags stemming from the Thanksgiving holiday.

By Monday night, California was averaging about 14,000 coronavirus cases a day over a seven-day period — a level not seen at any point in the entire pandemic.

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The new record marks a distressing end to a month that saw the resurgent pandemic roar to unprecedented heights in California. About 298,000 of the state’s more than 1.2 million coronavirus cases were diagnosed in November alone, the most of any single month.

While some of the exponential growth stems from ramped-up testing, officials say the rate of tests coming back positive has also increased — demonstrating that the coronavirus is becoming more widespread.

The statewide 14-day positivity rate hit 6.2% over the weekend, a marked increase over where it was two weeks prior, 4.7%.

“That rate of growth on the cases, as well as positivity rate, is of concern,” Gov. Gavin Newsom said during a briefing Monday.

Policymakers and public health officials worry how the skyrocketing infection numbers will eventually affect California’s hospitals.

State health officials have estimated that 12% of those who have tested positive for the virus are hospitalized two to three weeks later — meaning that the recent high case counts would push even more people into the professional healthcare system.

That’s a particularly harrowing possibility, given that the number of COVID-19 patients in California’s hospitals is already growing at an unprecedented rate.

The average net increase in people hospitalized in California with COVID-19 is now about 333 patients a day over the last week, according to a Times analysis. The acceleration is twice as bad as the summertime surge, which saw the average net increase in hospitalizations top out at 173 patients a day over a weeklong period in late June.

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Officials are keeping an especially close watch on California’s intensive care unit capacity. According to numbers Newsom presented Monday, about 75% of the state’s 7,733 ICU beds are occupied — with 1,812 of them filled by coronavirus patients.

Given the way things are trending, the state could exhaust its existing ICU capacity by mid-December, Newsom said.

The rural counties of Northern California could exceed ICU capacity by early December, Southern California and the San Joaquin Valley by mid-December, the Sacramento area by late December and the Bay Area by early January.

Providing ICU-level care usually entails “specialized space, specialized equipment and specialized staff” — meaning that, while hospitals can expand their capacities, their ability to do so is not infinite, according to Dr. Mark Ghaly, California’s health and human services secretary.

The “bottom line is we are looking at intensive care unit capacity as the primary trigger for deeper, more restrictive actions,” he said Monday, as “when that capacity goes away or even when it gets stretched so far that staffing is stretched, that we have to have set up space that isn’t typically used for intensive care units, we know that the quality of care … sometimes takes a dip, and we see outcomes we don’t want to see” because resources are spread too thin.

Overall, there were 7,787 coronavirus patients hospitalized statewide as of Sunday, according to the latest available data. That’s roughly a tripling of hospitalizations since Nov. 2, when there were 2,602.

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It’s also the highest number recorded during the pandemic and the second consecutive day the record for COVID-19 hospitalizations has been broken.

The overall figure tells only part of the story, though. Given California’s immense and geographically dispersed population, the coronavirus stresses different parts of the state’s healthcare system in different ways.

“Some counties in California don’t themselves have a hospital, certainly don’t have many ICU beds, so they depend on regional networks of hospitals, different systems coming together,” Ghaly said. “So we are looking at this from a regional basis … because what matters is if a patient needs care and they can’t get it in a hospital in their community, in their county, then we need to make sure that surrounding counties’ hospitals are able to serve those individuals.”

As the surge in newly confirmed cases continues, officials are warning they may need to resort to drastic restrictions to change the state’s trajectory.

Those could include a new stay-at-home order for areas in the strictest purple tier of California’s coronavirus reopening system, according to Newsom.

Specifics as to when such an order may be handed down, or what precise form it would take, remain scarce at this point — though Newsom pledged “we will be coming out with some additional information, some additional recommendations in the very, very near future.”

While the notion of a stay-at-home order brings to mind the rapid, widespread lockdown of businesses and public spaces seen during the early days of the pandemic, state officials said they are endeavoring to be more precise in their approach this time.

“One of the most important things we’ve learned is we can be not just more surgical with what we do, but we can really prescribe it for a shorter or a different amount of time,” Ghaly said. “Early on, some of those orders really were open-ended; we weren’t sure. Today, we know that we can get impact from certain interventions in a reliable way more quickly, and that’s part of what we’re considering.”

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While many local officials and residents have pushed the state to be even more targeted — catering restrictions and enforcement efforts toward specific sectors or even individual businesses and facilities that data show are a source of spread — Ghaly said transmission of the coronavirus is so widespread that “everyone is somewhat vulnerable to having an encounter with somebody who’s infected.”

“Everybody wants us to identify the sector where spread is happening, and the truth is, when you have this level of community spread, it’s happening in our communities, first and foremost,” he said. “So the minute you walk in the door of any entity indoors, the chance of encountering someone with COVID who can actually transmit it is higher than it’s ever been.”

Though the possibility of additional shutdowns may increase resentment levels, officials stressed there is light at the end of the tunnel — including the potentially imminent arrival of a vaccine.

Newsom said California expects to receive approximately 327,000 doses of Pfizer’s COVID-19 vaccine within the next few weeks.

While no means a silver bullet — as widespread rollout to the general public is still likely months away — officials said the prospect of even a limited number of doses is still a silver lining.

“Our most vulnerable could be getting vaccinated, our frontline healthcare workers could be getting vaccinated in just a matter of weeks — opening the gateway to so many more receiving this important tool to protect us,” Ghaly said.

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