POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”

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“Newsom announced the new plans on Thursday amid an unprecedented surge of new coronavirus cases in the nation’s most populous state.

The state reported 20,759 new cases on Wednesday, shattering the previous record of more than 18,350 sets just last week. He has already imposed restrictions, including a nighttime curfew on 51 of the state’s 58 counties. That covers almost all of California’s nearly 40 million residents.

A record 8,500 people are in the hospital. The state has fewer than 2,000 intensive care unit beds available, and officials have said Christmas might fill them unless the virus spread slows.

The new order divides the state into five regions. Newsom said none of the regions currently meet the threshold for the new rules. When they do, the state will order them to close hair salons and barber shops, limit retail stores to 20% capacity and only allow restaurants to offer take-out and delivery. The rules don’t apply to school districts. He said the only one likely not to meet the threshold is the San Francisco Bay Area.

“This is not a permanent state,” Newsom said. “There is light at the end of the tunnel.”

Newsom is still isolating in his Sacramento-area home after three of his children were exposed to the virus. He did not hold a news conference on Wednesday. Overall, California has reported more than 1.2 million COVID-19 cases and more than 19,300 deaths…. 

San Joaquin County hospitals in a critical spot

San Joaquin County hospitals are now at a critical level with ICU units operating at 113% capacity, according to the San Joaquin County Emergency Medical Services Agency.

Positive coronavirus cases have doubled in the last two weeks alone — now at 169 cases in the hospital.

At the San Joaquin General Hospital, one of the largest hospitals in the county (out of seven), their ICU is operating at more than 180% capacity, which means this hospital is at a critical state. Health officials said they are inundated with patients, working around the clock, moving people around to make room for everyone in need.

“These hospitals are having to make space, make ICU space and space that was not created for that,” Marissa Matta, a spokesperson for the San Joaquin County EMS Agency said.

The county’s EMS agency said the majority of the county’s seven hospitals above 100% capacity are now operating at surge capacity…

Back in July, when San Joaquin County hospitals reached this level for the first time, they had two federal medical teams to help with two different hospitals overflowing, including San Joaquin General Hospital. But this time, they say, it’s not guaranteed. So they’re hoping the news of our second regional stay-at-home order will once again help slow the spread.

“Our hospitals were obviously less inundated when that first stay-at-home order was enacted. I’m hoping that this time around people will be willing to abide by that,” Matta said.

Matta added that despite these ICU capacity numbers, the 911 system is still in place and people should not be afraid to come to the hospitals to get the care that they need.” (A)

“Hospitals are filling up around the country, including in San Diego, with higher numbers of COVID-19 patients.

This surge is different from the beginning of the outbreak in March or the summer spike as COVID-19 hospitalizations have hit record highs, Dr. Christopher Longhurst of UC San Diego Healthcare said.

“The surge that we are seeing now clearly is a much greater concern. We’ve hit over 700 hospitalizations in the county of San Diego and there’s no end in sight, no plateau,” he said. “Our modeling locally shows that we will exceed 1,000 or even 1,400 hospitalizations in the next several weeks.”…

The plan at both UC San Diego Health and Sharp HealthCare for when their hospital systems get overwhelmed involves collaboration between different medical facilities in the region.

Sharp HealthCare previously helped coronavirus patients from Imperial County when hospitals in that area were overwhelmed with COVID-19 patients, Howard said

“We have all shared our beds between our facilities with one another and we will continue to do so,” he said. “I imagine Scripps, UCSD, Palomar and other facilities would all be viable candidates to help us, should we reach that point where we need additional capacity.”

Gov. Gavin Newsom warned in a Monday news conference that a stricter stay-at-home order may soon be put in place to help provide relief for the state’s strained health care system.” (B)

“Here’s What To Know About California’s New Regional Stay-At-Home Order

“The bottom line is if we don’t act now, our hospital system will be overwhelmed,” Gov. Gavin Newsom said.

Regions affected by the order will need to comply with restrictions for three weeks. The order ends all operations at the following businesses: Indoor and Outdoor Playgrounds; Indoor Recreational Facilities; Hair Salons and Barbershops; Personal Care Services; Museums, Zoos, and Aquariums; Movie Theaters; Wineries; Bars, Breweries, and Distilleries; Family Entertainment Centers; Cardrooms and Satellite wagering; Casinos; Limited Services; Live Audience Sports; Amusement Parks.

Retail stores and shopping centers are permitted to remain open indoors at 20% capacity, and restaurants can stay open for takeout only. Outdoor recreation facilities can also stay open with modifications, and entertainment production, including professional sports, can operate without a live audience.

Residents in counties affected by the order can still go to the doctor, buy groceries, go on a hike or worship outdoors. K-12 schools that are already open can continue operating indoors as no more than 20% capacity.” (C)

“The COVID-19 situation in East Tennessee is growing increasingly dire as concurrent hospitalizations continue to hit new highs day-after-day, and the Knox County Health Department is raising its final red flag for the first time because East Tennessee hospital ICUs are nearly full.

According to Wednesday’s weekly regional metrics from the Knox County Health Department, ICU capacity across all 16 East Tennessee counties is sitting just above 97% — and there are only 8 ICU beds open in the entire region out of the 284 available….

If ICUs reach capacity, hospitals will then have to care for COVID-19 patients by moving them to open beds in other areas of the hospital — limiting the total number of hospital beds available and creating the need to halt elective procedures once again. If there are no beds available, then the designated overflow sites will need to be opened and utilized.

Because of the limited ICU bed availability, record number of current hospitalizations across the region, and the high likelihood of an incoming surge of new patients infected over the Thanksgiving holiday, KCHD has placed its health care capability metric in the “red” based on current and forecasted surge capacity.

This is the first time the health care capability benchmark has been in the red, and the first time all metrics tracked by the county are red at the same time since KCHD began tracking them.

As of Wednesday, Knox County alone had 170 current hospitalizations — the highest it’s ever been. This does not include people who reside outside of Knox County transferred to hospitals here for care.

The most recent regional benchmarks as of December 1 showed there were 423 positive COVID-19 impatient at regional hospitals, with 90 of them in the ICU and 41 on ventilators. There were an additional 34 patients with pending lab results, with 6 of those in the ICU and 3 on ventilators.

At least 69 people died from COVID-19 in Knox County during the month of November — nearly double the previous monthly high of 35 set back in July. It’s likely the actual number of deaths that occurred in November will continue to grow as pending death reports are certified.

East Tennessee Regional Hospitals are currently at 83% total utilization for all hospital beds, which includes areas at hospitals not able to care for COVID-19 patients such as labor and delivery wards and behavioral health beds. It also includes pediatric beds that need to remain available for pediatric-specific needs.

Excluding pediatric beds, there are only 127 (roughly 7%) total adult non-ICU hospital beds remaining.

If Alternate Care Site and Medical Surge Task Force beds need to be implemented to manage hospital overflow, KCHD data shows an additional 543 ICU beds and 374 ventilators would be made available at designated overflow sites in the region. KCHD shows there would be 4,389 total hospital beds made available in that event.” (D)

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• A.Gov. Newsom announces new, regional stay-at-home order based on ICU capacity, https://www.abc10.com/article/news/local/california/california-coronavirus-surge-dec-3-2020/103-05fd1753-694d-4247-8488-1a979d25da73
• B.San Diego Hospital Staff Spread Thin, ICUs Nearing Capacity, By Jacob Aere, https://www.kpbs.org/news/2020/dec/02/san-diego-hospital-staff-spread-thin-icus-nearing-/
• C.California Introduces Regional Stay-At-Home Order Based On ICU Capacity, by  Sammy Caiola,   Chris Hagan   Scott Rodd   Nicole Nixon,  https://www.capradio.org/articles/2020/12/03/watch-live-gov-gavin-newsom-update-on-covid-19-for-dec-3/
• D.East TN hospital ICUs are nearly full, putting every COVID-19 benchmark in the red for the first time, https://www.wbir.com/article/news/health/coronavirus/all-knox-co-covid-19-benchmarks-are-now-in-the-red-as-regional-hospital-icus-near-capacity/51-cea1a3be-3b70-416c-a98e-540e1d67707b