CoViD-19: After Ruling, County Stops Violation Enforcement | Hospitals Induce Ambulance Diversion | County Down To 24 Staffed ICU Beds | More Than 50% Of SD ICU Patients Are COVID |

My Fam Celebrating Dad's Birthday in the Before Times (Taken 9.8.2019)

It's been a rough week. My dog doesn't seem to be getting better, so I was on DDD (doggie diarrhea duty) again last night to make sure she could get out when she needed to. Our yard currently looks like someone was trying to prospect for gold because you can't just hose it down or pick it up, sometimes you literally have to dig up a chunk of yard to throw away. This is extra unfortunate because we found out that the downstairs apartment has been rented and new tenants will be moving in on Thursday. Not gonna lie, having the whole yard to ourselves the majority of the pandemic has been awesome and we've never had to share the space before because it was so dumpy, none of the past residents made an effort to use the space. (I mean, there was literally a homeless person who the former handyman gave permission to sleep in my yard for a spell.) It's weird to think all the effort we made to make it nice may have actually been a selling point in how insanely high they have raised the rent in the past few years. 

Today the county had a media briefing and for the first time ever, they cut off questions for time constraints, but really I think the final questions were text questions from the asshole Mike McKinnon, Trumper and owner of KUSI, probably asking about today's court ruling, which stated that there was not enough evidence that strip clubs and restaurants were sources of infection and therefore could not be forced to close. I've said before, I'm so sorry for all the businesses and people suffering right now. We are in the same boat. But this is a public health crisis, with 200% and 300% and more, greater than anytime in the spring and summer, and the state telling us to stay home shouldn't be overruled. I will not patronize any businesses violating the order now or into the future, and while that isn't much of a threat or a boycott, I hope other sensible people follow suit.

Perhaps the County and State, in their appeal, will actually have to surrender to the other lawsuit, which demands identification and information about outbreaks. Like if I was a person who would go to Awaken church, then grab some stuff from Home Depot, then decide to relax for a couple hours at Pacers, am I really reporting the Pacers part to my contact tracer when I test positive? Just look at the weekly COVID Watch. In the past two weeks, 4,579 cases claimed they had no community exposure...55.4%, and since June, that number is 34,003, equaling 53.6%. They didn't just catch it out of thin air (unless it was aerosols in a GODDAMN COMMUNITY SETTING.) It makes me so mad. We could've been in such a different place with better leadership and frankly, better citizenry. But here we fucking are. Christmas is going to be so, so different. Let's accept it and do the things they've been telling us to do for months. 

• COVID-19:
• Reporters are just dying to get their soundbites during media briefings and keep trying to get politicians and health officers to say that when we run out of hospital capacity, they will have to say that some people will get care over others. While being super careful not to say so, there is precedent for how resources are allocated when under immense pressure. This is an old article from NEJM from earlier in the pandemic. Fair Allocation of Scarce Medical Resources in the Time of Covid-19 - New England Journal of Medicine (3.23.2020)
• San Diego Judge Rules In Favor of Strip Clubs Seeking To Remain Open - KPBS (12.16.2020) 
• Who is Judge Wohlfeil?
• This is an important article about the sensitivity of the home antigen tests that received an EUA from the FDA. Buyer Beware: Inflated Claims of Sensitivity for Rapid COVID-19 Tests - The Lancet (12.14.2020)
  "the reported accuracy of these rapid antigen tests is actually the percent positive agreement (PPA) and not sensitivity. The PPA is measured relative to an RT-PCR test, which is imperfect itself"
• Don’t repeat the mistakes of past vaccine distribution efforts - STAT News (12.15.2020)
  The assumption on their part is often that, once vaccines reach the market and are paid for, vaccine delivery is the easy part and they can somehow magically appear in people’s arms and mouths. Perhaps the dearth of toilet paper on store shelves this spring should be a lesson in the challenges of supply chains.
• Gaming vaccine priority - Popular Information 
• 'We're Backed Into a Corner': Two Experts on the Best Path to Reopening. Scripps Institution of Oceanography scientist Kim Prather and UC San Diego infectious disease specialist Dr. Robert Schooley joined our livestream series Voice of San Diego at Home last week to share what they’ve learned after studying the virus for months and how we can better protect ourselves. - Voice of San Diego (12.15.2020)
• Politics/News/Other Reading:
• ‘Tis the Season for — Recycling! - County News Center (12.16.2020)
• Severe Wildfires Are Devastating the California Condor. This year’s aggressive fire season wiped out a record number of the endangered birds, as well as a facility wildlife biologists use to track and care for them. - Wired (12.11.2020)
• County of San Diego Influenza Watch - (12.16.2020)
• Citizens’ Law Enforcement Review Board Accepting Applications - County News Center (12.16.2020)
• Global COVID-19 Stats (JHU 10:28pm 12/16):
• 74,226,214 Known Cases
• 1,649,032 Known Deaths
• US COVID-19 Stats (COVID Tracking Project):
• 232,258 New Cases/16,762,527 Known Cases (9.7%+ Change over 7 Days)
• 3,448 New Deaths/298,823  Known Deaths
• 113,090 Current Hospitalizations
• 21,936 Currently in ICU
• 7,778 Currently on ventilator
• California COVID-19 Stats:
• 53,711 New Cases/1,671,081 Total Cases (3.3% increase)
• 293 New Deaths/21,481 Total Deaths (1.4% increase)
• 11% 14-day test positivity rate
• 15,866 Hospitalizations (+688 patients, +4.3% from prior day)
• 3,287 ICU hospitalized in CA (+104 patients, +3.2% from prior day)
• 1,331 ICU beds available (-135 from prior day)
• San Diego County Media Briefing:
• Vaccines are here; Moderna approved and should be arriving soon.
• Vaccine Phased Approach
• Hospitals are stretched. 
• Ambulance diversions
• Delaying cancer tumor removals, organ transplants to keep beds available
• Global staffing issues, burnout, COVID infected
• See yesterday's state notes on hospital waivers for critical staffing shortages, vaccine rollout, new quarantine guidelines
• Everyone should get vaccinated when their phase is ready. Must wait 90 days after COVID-19 illness to get vaccinated. 
• Vaccine allocation: long and boring, watch the media briefing if this interests you
• Phase 1A Tier 1: Healthcare Personnel working in acute care and psychiatric hospitals. This is 82,623 individuals in San Diego. Currently allocated 28,275 vaccines, which doesn't even cover the 39,755 individuals considered the highest risk individuals within the personnel. 
• 82K San Diegans Are First in Line to Get COVID-19 Vaccine - County News Center
• San Diego Medical Reserve Corps wants your help. Retired physicians, doctors, nurses, can contact HR department of healthcarevolunteers.ca.gov
• Media Questions:
• Number of cases is because people are not adhering to the stay-at-home order, Thanksgiving, COVID fatigue. Age group 20-49 has highest number of cases. Older population 50+ has lowest cases but 80% of hospitalizations.
• Demand for public health rooms is increasing. Addressing homelessness and people staying at convention center. County is exploring continued partnerships for more rooms, ER discharge, etc. 
• Staff issues are best managed by hospitals. Reallocation of support services, medical reserve corps, temporary staffing services, not quite at that stage yet. 
• ICU Beds Capacity 696 vs Staffed Beds Available: 24. Currently there are enough people in holding to fill those available beds. County also passed 50% mark...meaning more than 50% of ICU patients are COVID patients.
• Volume of cars was backing up at drive-up testing, so for safety reasons, they had to move to appointment-based testing.
• Hospitals have their own surge plans. Patients are discharged (or DYING) daily, and patients are coming in with changing severity of illness requiring more or less care, so bed situation is always fluid. 
• All Hazard Health Services Task Force allows for hospital systems to work together to aid in surges and manage bottlenecking and have been able to decompress with shared mutual aid. All of this is so that standard of care doesn't drop. We're not in crisis contingency plan status yet. 
• County has applied for waivers to allow paramedics to vaccinate. Vaccinations are not currently in dentist and optometrist scope of practice. 
• Reporters are stupid, ask repeated questions until they get the answers they want, and don't ask the right questions to the correct authorities. The governor literally spoke about state staffing yesterday and obviously every hospital, every county, across the region, the state, and the country is LOOKING FOR STAFFING. Palomar Hospital 'lever will be pulled' when needed, but this facility IS NOT ICU BEDS. 
• Ambulance Diversion: Always had a tool to 'go on bypass' notify EMS system that hospitals are on bypass. There are some exemptions in this pre-hospital space. Some hospitals have gone on full ambulance diversion, meaning no exemptions to bypass. 
• State Data:
• Southern California ICU Bed Availability: 0.5%
• 1,863 New Cases/111,441 Total Cases
• 32 Deaths/1,194 Total Deaths
• 52.7 cases/100k population (Based on week ending 12/8, Assessed on 12/15. Unadjusted Case Rate)
• 10.9% Test Positivity (Assessed on 12/15)
• 13.5% Health Equity Positivity (Assessed on 12/15)
• 1,173 hospitalized patients (+91 patients, +8.4% from prior day)
• 307 ICU hospitalized patients (+17 patients, +5.9% from prior day)
• 175 ICU beds available (-18 from prior day)
• County Data:
• San Diego County COVID Update - County News Center
• San Diego is hitting 8 triggers: High adjusted case rate (29.5), high community outbreaks, COVID-19 syndromic increasing (6%), influenza like illness increasing (4%), low ICU Capacity 16%, high testing positivity 9.5%, low case investigation 42%
• 2,807 New Cases/114,248 Total Cases 
• 23 New Daily Deaths/1,217 Total Deaths
• 10% Daily Test Positivity/9.5% (7-day avg after 7-day lag)/8.4% Test Positivity (14-day average)
• 29.5 cases/100k population (Assessed on 12/15. Unadjusted case rate per 100,000 excluding prisons.) 
• Case Investigation is 42% (under 70% goal)
• Increasing Day Over Day Hospitalizations 11% (over 10% trigger. 227% increase over 30 days. 1,106 patients)
• ICU Capacity 16% (under 20% Trigger. 155% increase over 30 days, 293 patients)
• 6 New/43 Community Outbreaks (7-day)/219 Active Community Outbreaks
• Business 19
• Restaurant/bar 2
• Restaurant 1
• Faith-based Setting 7
• Daycare/preschool 8
• Healthcare 1
• Construction 1
• Food/Bev Processing 1
• tk-12 school 2
• Warehouse/Distribution 1
• Universities:
• SDSU COVID-19, UCSD COVID-19, USD COVID-19, CSU San Marcos, PLNU