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Surge Finally Releases Grip on Orange County, CA Hospitals

With mass immunization unfolding, health-care officials expect the sums of people with hospital-grade COVID-19 cases countywide to keep falling, further easing the pressure on doctors, nurses and other staff.

by JIan Wheeler, The Orange County Register / March 5, 2021
(TNS) - The number of people hospitalized with the coronavirus in Orange County has dramatically recovered from the winter surge that pushed hospitals and their frontline workers to the brink.
With mass immunization unfolding, health care officials expect the sums of people with hospital-grade COVID-19 cases countywide to keep falling, further easing the pressure on doctors, nurses and other staff.
But while the coronavirus is waning, the death toll keeps climbing. Orange County on Thursday, March 4, passed another sobering pandemic milestone: more than 4,000 COVID-19 deaths.
Coronavirus hospitalizations among Orange County's 33 hospitals crested about two months ago, Jan. 7, at 2,259 patients.
There was a spike in deaths to match. The first week of the new year was the pandemic's deadliest so far — an average of 57 Orange County residents died of COVID-19 each day over the seven days ending Jan. 7.
January quickly surpassed December to become the pandemic's deadliest month. Nearly a third of the county's coronavirus fatalities occurred over those first four weeks of 2021.
Emergency rooms were bottlenecked by a torrent of coronavirus patients; ambulance crews parked outside at times waited hours to offload their patients or moved on to the next ER.
Throughout December and January, intensive care capacity was top of mind as beds equipped with lifesaving ventilators became scarce. When COVID-19 patients in local ICUs reached a pandemic high of 547 people on Jan. 9, only 45 adult ICU beds were left in Orange County.
The turnaround since then has been swift.
By Thursday, March 4, 379 people with COVID-19 were hospitalized, less than a fifth of the record level in early January, though still higher than slower periods of the pandemic. In October, for example, coronavirus patient totals among Orange County's hospitals on any given day never exceeded 200.
ICU patient levels also have declined. By Thursday, 97 coronavirus patients were in intensive care and about a third of adult beds were open, according to OC Health Care Agency data.
However, ICU capacity across Southern California hasn't recovered as strongly as anticipated by state public health officials.
When the state's most recent stay-at-home order — introduced Dec. 5 in response to dwindling ICU bed availability — was lifted Jan. 25, Gov. Gavin Newsom presented projections that all of Southern California's supply of open adult ICU beds would reach 33.3% by Feb. 21.
On Feb. 22, California Department of Public Health data showed 19.5% of ICU beds were available in the Southern California region, defined by the state as 11 counties from Mono to San Diego. The predictions for other regions were mixed; Bay Area counties landed closest to their initial target at 25.4% capacity.
This week, Southern California's ICU capacity boosted further to 25.3%.
But being slower at appearing to empty ICUs of COVID-19 patients hasn't worried Dr. Charles Bailey, medical director for infection prevention at Mission Hospital in Mission Viejo and St. Joseph Hospital in Orange, because ICU capacity is a liquid number, and hospitals in pandemic mode can add and subtract ICU beds each day to meet demand.
"We may have seen the last of the big surges," Bailey said. "I think the decrease we've seen over the last month or two, to me, speaks more about maybe the virus burning itself out — the pandemic burning itself out."
Besides slowing spread, doctors and nurses have picked up new drugs and techniques that help some of the sickest pull through.
"If you're going to get COVID, better to get it in February or March of 2021 than February or March of 2020," Bailey said.
A few of Orange County's hospitals are now reconsidering what to do with tented mobile field hospitals that were set up on their campuses amid the mounting winter surge.
UCI Medical Center in Orange still is using its 50-bed field hospital, set up in one of the hospital's parking lots, for non-coronavirus patients, according to a Health Care Agency report published Wednesday.
"We have no plans to demobilize the tent yet and will continue to use it as needed to help manage patient care," said UCI Medical Center spokesman John Murray.
Fountain Valley Regional Hospital, meanwhile, will convert its tented site into a vaccination clinic, while Los Alamitos Medical Center has "demobilized" its field hospital and St. Jude Medical Center plans to, the report said.
An alternate care site at Fairview Developmental Center in Costa Mesa that exclusively treated patients with milder COVID-19 cases is slated to close on March 15. Staff will keep the site intact and prepared to reopen, if needed, within three days.
OC Health Care Agency director and county health officer Dr. Clayton Chau said hospitals should keep their surge contingencies while Orange County residents continue to be vaccinated.
"Until we reach herd immunity, I think we should always be prepared," Chau said.
Whether hospitalizations will ever get as bad as they did in December and January is a matter of whether enough people can be vaccinated before COVID-19 has a chance to mutate into more contagious variants, said Dr. Shruti Gohil, associate medical director of epidemiology and infection prevention at UC Irvine Medical Center.
"This is a race against time," Gohil said. "If we do our job really well and get the vaccine blanketed out there, then we stand a chance to stomp this out to a level where we really can end this pandemic."
Given COVID-19's unpredictability, surge strategies at UCI Medical Center "are currently on guard, and ready and able to be deployed and reused at a moment's notice," she said.
However, frontline hospital staff are optimistic, and morale has improved since vaccinations began.
"It's a really big deal that we believe our vaccines are going to be protective against most of the variants that have been detected so far — even if there are some more transmissible virus variants out there," Gohil said.
"So far the data seems to be that you will be less likely to get severely ill with COVID if you are vaccinated," she said. "so there is every reason under the sun to go ahead and get vaccinated."
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