Orange County Continues to Increase COVID-19 Hospitalizations

December 28, 2020 Updated: December 29, 2020

SANTA ANA, Calif. (CNS)—Orange County continued its record-setting pace of COVID-19 hospitalizations Dec. 28 with 2,031 patients, including 453 in intensive care, as officials worry about another holiday-related surge on top of the spike related to Thanksgiving.

The Orange County Health Care Agency (OCHCA) also reported 2,144 newly diagnosed infections, raising the county’s cumulative case count to 149,607, but the death toll remained unchanged at 1,846.

Hospitalizations jumped from 1,990 on Dec. 27, when there were 443 patients in intensive care units (ICU), according to the Health Care Agency.

The county’s state-adjusted ICU bed availability remained at zero, and the unadjusted figure declined from 7.3 percent on Dec. 27 to 5.9 percent on Dec. 28. The state created the adjusted metric to reflect the difference in beds available for COVID-19 patients and non-COVID patients.

Just because a county’s adjusted ICU rate may be zero, it does not mean there are no beds available. According to Orange County CEO Frank Kim, the difference in the rates reflects what is historically expected from non-COVID emergencies. County officials stressed that anyone with a medical emergency should still dial 911.

County leaders and health care professionals are bracing for another surge in cases related to holiday gatherings piled on top of the Thanksgiving-fueled wave.

“We knew Thanksgiving was going to provide a surge, but we didn’t know how much so we had surge capacity,” said Orange County Supervisor Lisa Bartlett.

“Hopefully, we’re on the downside of the Thanksgiving Covid surge, but now we’re going into Christmas and New Year’s [potential surges] and we don’t have any excess ICU capacity and that concerns me a lot.

“This is consistent within our entire region. It’s not like if we get overrun we can go to L.A. or San Diego or Imperial County.”

The Southern California region is at zero ICU capacity. The unadjusted rate is at 11.1 percent for the SoCal region, “but that’s 11 percent with a lot of stretching,” Bartlett said. “The concern is staffing [ICU beds].”

She added, “the concern is we have outdoor triage tents up,” without much room to expand much further than that.

Transportation Security Administration (TSA) figures for security screenings nationally reflect more traveling over Christmas than Thanksgiving. On the day before Christmas Eve, nearly 1.2 million screenings were done at U.S. airports, compared with 1.9 million on the same date in 2019.

Bartlett said the number of travelers in the airports isn’t what concerns public health professionals as much as where the airline customers are headed.

“It’s a matter of what they do when they leave the airport,” Bartlett said. “You’ve got mixing of households. Anytime you’re mixing households, small or medium or large, you have the potential to spread COVID.”

And it doesn’t matter whether it’s families gathering with relatives, because it’s still a mixing of households, she said.

Meanwhile, the outbreak in the county’s jails continued its upward trend with 1,099 inmates infected. The county is awaiting results of 1,080 tests.

Handling the Surge

Health Care Agency staffers have reported to Bartlett that hospital executives feel confident they can manage this surge, but some hospital workers have a different take, Bartlett said.

Hospital administrators “say they’ve got some diversions [of patients], some limited capacity, but things are copacetic,” Bartlett said.

“And then I talk to folks who work in ICUs at various hospitals and they’re very concerned. We are getting patients from other counties and the ICUs are overflowing, and the truth lies somewhere in the middle.”

Bartlett said she was “concerned because cases are rising now through the Thanksgiving spike, when we’re almost at a functional zero at availability of ICU beds, and we don’t even have the spike numbers coming from Christmas and New Year’s yet.”

Some of the rise can be blamed on COVID fatigue, Bartlett said.

The supervisor said her office received a complaint about three Orange County sheriff’s deputies dining Dec. 27 at a San Clemente eatery that was serving them outdoors while serving other diners indoors in violation of the state’s stay-at-home orders. The servers were not wearing masks and only some staff in the kitchen were wearing face coverings, Bartlett said.

New Guidance for Paramedics

On Dec. 26, the OCHCA issued new guidance for paramedics dropping off patients, as wait times to do so at some hospitals were getting so long there was a fear there would be no ambulances available for 911 calls.

When it takes more than an hour to drop off a patient, paramedics are able to drop them in a waiting room under certain conditions so the ambulance can be free to attend to another call, according to the memo from Dr. Carl Schultz, emergency medical services (EMS) medical director for the OCHCA.

“This directive is necessary as delays in off-loading ambulance patients at Orange County emergency receiving centers is now becoming very serious,” Schultz wrote.

“So many ambulances are being held at hospital emergency departments that Orange County EMS risks receiving calls asking for guidance as paramedics are not able to obtain ambulances to transport patients who have called 911.”

Paramedics may drop off a patient after alerting a triage nurse if they have had to wait for more than an hour.

The county has three mobile field hospitals operating, with 50 beds at the University of California–Irvine (UC Irvine) Medical Center in Orange and 25 each at Fountain Valley Regional Hospital and Los Alamitos Medical Center.

The county has four more mobile field hospitals left that have 25 beds apiece, Kim said.

At the recently reopened Fairview Developmental Center in Costa Mesa, 16 patients with milder symptoms are being treated.

Tracking Vaccines

County officials received doses of Moderna vaccines on Dec. 23. Larger hospital systems received doses directly on Dec. 22, and the county expected the Dec. 23 doses to be distributed to smaller hospitals.

About 100 Orange County firefighters received the Moderna COVID-19 vaccine on the morning of Dec. 26, part of an effort by the county’s health agency to prioritize first responders. The vaccinations took place at the Orange County Fire Authority Regional Fire Operations and Training Center in Irvine.

On Dec. 29, all five of the county’s supervisors will appear at a news conference regarding a new app created to help doctors and nurses track recipients of vaccines to ensure they get a booster shot and to monitor for side effects. Bartlett said it will serve as a central database for vaccine-related information.

The app will be called Othena, which is an homage to Athena, the goddess of war, Orange County Supervisor Doug Chaffee said.

The county reported another 20,307 COVID-19 tests on Dec. 28, for a total of 1,996,251.

All of the county’s metrics now fall within the state’s most-restrictive “purple” tier of the state’s four-tier COVID-19 monitoring system.

Orange County’s adjusted daily case rate per 100,000 stood at 51.8. The positivity rate was 15.2 percent.

The county’s Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, rose from 18.8 percent last week to 22.7 percent.