State prepares for holiday surge in COVID-19 cases

Stay-at-home order extension likely for San Joaquin Valley region as doctors plead for the public to follow guidelines

SACRAMENTO – Governor Gavin Newsom addressed Californians Dec. 28 for the first post-Christmas COVID-19 update, and said based on the four-week ICU projection modeling, the stay-at-home order for the San Joaquin Valley region—currently at 0.0% ICU capacity—will likely be extended.

While Newsom described the 38% increase in hospitalizations and 37% increase in ICU admissions as starting to see a “plateau,” the governor issued a stark warning on the days ahead.

“Particularly now as we move into this new phase where we brace, where we prepare ourselves for what is inevitable now based upon the movement, based upon the travel we have seen just in the last week,” Newsom said, “and the expectation of more of the same through the rest of the holiday season of a surge on top of a surge, arguably on top of, again, another surge.”

As Californians gathered in person for the holidays, defying the governors stay-at-home order and expert public health advice, healthcare professionals from hospitals around Tulare County gathered virtually Dec. 22 to express their concerns over the dire circumstances their exhausted, short-handed hospital staff are facing and the real threat gathering for the holidays poses to patients receiving proper care.

Dr. Harjoth Malli
ICU physician Kaweah Delta Medical Center

Dr. Harjoth Malli, an ICU physician at Kaweah Delta Medical Center, said he knows people in Tulare County are gathering based on the clinical history information they collect from patients that come into the hospital.

“Part of that is gathering information on how they think they contracted the virus, and a familiar story is that it was within the setting of a social gathering,” Dr. Malli said. “The vast majority of our patients are patients who could have made choices to prevent themselves from getting the virus because the time when they got infected was during some form of social gathering that was generally an elective form of gathering.”

Dr. Malli said that all it takes is for one family member to attend a social gathering to bring the virus back to infect the entire household.

“The bottom line is we’ve seen families just wiped out because of this,” Dr. Malli said, “there’s so much heartbreak. I don’t think the public understands the amount of crying and emotional trauma that our nurses, physicians and all of our healthcare providers end up going through because of this.”

According to the state, Since October 1, 65% of California ICU admissions and 80% of deaths are in the 61+ age group. The governor outlined the federal partnership with pharmacies to push the vaccine out to those most vulnerable, executed in two phases: Part A, in which pharmacies will receive doses—deducted from California’s Pfizer doses—directly from the feds to be used for skilled nursing facilities. Part B uses the same strategy towards assisted living facilities, residential care, and other long-term care facilities.

Newsom said pharmacy staff will administer the vaccine through scheduling and coordinating on-site clinic dates with each facility. The governor said between Pfizer and Moderna he expects just under 1.8 million vaccines to be in the state by the end of the week.

Teri Boggess, the infection prevention director at Adventist Health, said while the vaccine is a light at the end of the tunnel, the situation is currently much more dire than it was in July and August.

“We have stood in the ICU and watched family members stand outside the glass and watch their family member die. We want this to stop,” Boggess said. “This year we really need to think about who we’re gathering with, keep our gatherings small with immediate family, wear masks, wash hands, stay home if you’re sick, all of those things so that we can weather this storm that we are currently experiencing.”

Google’s Dec. 22 community mobility report, data from cell phones that shows how different types of travel have been impacted by COVID-19, shows only a 12% decline in Tulare County’s retail and recreation visits when compared to a baseline from the corresponding day of the week during Jan. 5-Feb. 6, 2020, before the massive social impact of the pandemic began. California as a whole is at a 20% decline in retail and recreation visits.

San Francisco County—where almost twice as many people live as Tulare County—is at -55% below the retail and recreation baseline, and is also reporting significantly less cases per capita at a 5.8% 14-day average test positivity rate than Tulare County at a soaring 24%.

Dr. Malli expressed his frustration with people in Tulare County not adhering to the safety guidelines of wearing a mask, hand washing, social distancing and avoiding social gatherings.

“It has been said a million times over since the beginning of this pandemic,” Dr. Malli said, “and I have a very difficult time understanding why you would make a choice to not adhere to this, especially when the people out there caring for your loved ones are pleading with you to listen to what we have to say.”

During the holidays and a time when local leadership, restaurants and businesses are being openly defiant of public health orders and guidelines, Dr. Malli said history will remember how Tulare County handled the pandemic.

“This is not going to escape any one individual from being able to talk about what their role was,” Dr. Malli said, “and when you look at your children, and they ask you, when they understand more about this in the years to come, why you decided to have a Christmas party, either you’re going to lie to yourself and your kids, or you can tell them the truth, and it’s not going to be pretty.”

Dr. Malli urged parents with young children and teenagers who may be going to winter formals to “do your part. Don’t let them do that, and as parents, be role models.” He said healthcare providers need all the help they can get.

“We’re not winning, don’t kid yourself,” Dr. Malli said. “None of these drugs that you hear about on national television are making the kind of impact that would suggest that we’re getting ahead of this virus. Nothing that we’re doing when it comes to critical illness is a cure-all for this.”

Dr. Sakona Sengh, an ER physician at Kaweah Delta Hospital, described what patient care looks like during a surge.

“We’re talking about seeing patients in chairs instead of beds. We’re talking about physicians and nurses being in the back of ambulance rigs for hours because we don’t have space inside the hospital to bring them in to.”

Dr. Sengh said with the surge comes lots of barriers to achieving a good level of care, and is certainly not ideal.

“It also tires out our care teams, and really puts a lot of stress upon the entire system,” Dr. Singh said. “I think we’re just here to just ask the public to do their part. The community is truly the front lines at this point.”

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