Impending winter surge of COVID leaves county vulnerable

A fifth wave of COVID-19 patients heading into winter months is expected to heavily impact places with much lower vaccination rates such as Tulare County

TULARE COUNTY – The presupposed “fifth wave” of COVID-19 cases coming this winter will predictably hit unvaccinated pockets in the state and country the hardest. That news has left local hospitals and public health officials preparing to hold on for dear life.

Tulare County has not handled the pandemic well, in particular when it comes to COVID-19 preventative measures, or vaccines. The summer surge through July and August was worse than last year, as the delta variant ripped through the unvaccinated population. And while the number of cases has steadily declined from the 55.7 cases per 100,000 people, there is a legitimate worry that a surge is coming as holiday activities move people in doors.

Health and Human Services Director Tim Lutz said that people in Tulare County should be concerned provided the local trend since the pandemic began.

“Our case rate has remained pretty high…we know COVID is continuing to circulate to the community…And this is when we had our biggest surge last year over that December and January time frame,” Lutz said.

From a hospitalization standpoint, Kaweah Health, the county’s largest hospital, was beset with a massive surge of patients earlier this month. Over 50 patients were admitted and waiting for a bed to open up, and 60 others were waiting to be seen in their emergency department. That triggered a “code triage” by the hospital putting high level directors on alert to open as many beds as possible.

Kaweah Health CEO, Gary Herbst pointed to the 30% capacity taken up by COVID patients for their lack of bedspace, during a press conference following the code triage call. He said over 80% of those patients were not vaccinated, and explained that he was an advocate for the vaccine.

“I’m a strong advocate of the vaccine and I’ve seen how effective it is at keeping patients out of the hospital,” Herbst said.

Vaccinations in Tulare County have been abysmally low for quite some time. There is still 48.6% of the total population that doesn’t have even one dose of the vaccine. On the other hand 45.2% are fully vaccinated and 6.2% are partially vaccinated. When compared to other parts of the state, the county has proven to fall far behind.

“It’s pretty bad,” Lutz said in an interview with The Sun-Gazette. “We’ve been averaging around, 4,000 to 6,000 doses a week, which is really small.”

For comparison, according to Kaweah Health earlier this month, there were 20 COVID patients hospitalized at University of San Francisco in a county whose vaccination rate is 76%. In Santa Clara County, 73.3% of the population is vaccinated and there are only 29 hospitalizations at the Stanford Medical Center. In Los Angeles County, where 72% of the population is vaccinated, University of California Los Angeles has only nine COVID patients while Cedars-Sinai Medical Center had only 13 COVID patients.

Vaccinations not only help prevent hospitalizations for COVID patients, but if patients who are vaccinated wind up in the hospital they are there for less time. And that would be a welcomed trend for the county’s three hospitals. Hospitalizations for COVID have floated between 155 and 175 for more than two months, and only now are they trending downward, although not as steep as Lutz would like to see.

“I don’t think it’s a coincidence that…We have seen those areas that have higher vaccine rates, their case rates come down much faster and lower than ours,” Lutz said. “So we definitely know that having fewer people in the community vaccinated puts us at greater risk for a larger and longer surge.”

Last winter’s mega surge of hospitalizations began in mid November and didn’t start seriously declining until February. There were over 150 hospitalizations in the county from early December through late January, and peaked at 231 on Jan. 4. Lutz doesn’t expect a surge of that size this year, but the cumulative effect of the pandemic month after month has ground down medical staves, making a lesser surge still difficult.

County health officials have consistently said that preventative COVID-19 measures are intended to help avoid massive deaths and keep hospitals off the brink of collapse. Unfortunately that message has not gotten through. Herbst said in his press conference on Nov. 4 that operating at or over capacity has had a real impact on patients. He said people who had a simple infection are coming into the hospital at the doorstep of sepsis, and cancer diagnoses are being caught later and later.

If another surge begins ambulance providers may begin “assess and refer” levels of treatment where only the most dire patients get a ride to the hospital.

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