CoViD-19 Spreading Like Wildfire | State To Deploy Exposure Notification App | San Diego River Not Doing Well: Earns D Grade | Pandemic Fatigue Hits Healthcare Workers The Most

Taken at San Diego Zoo Safari Park 11.11.2019

The stay-at-home order went into effect today and the outrage online is hard to avoid. I actually snoozed a group I'm in because the admin--who works for a restaurant--had been kinda outta control on his posts. Instead of engaging, I write here, take it or leave it. (haha) Instead of fighting about it all over there, this is what I know to be true: the pandemic is raging like wildfire. In the November issue of Wired, there's this fascinating article about the science of wildfires and how the science of fire has changed. There's a "dangerous phenomenon called plume-driven fire, in which a fire’s own convective column of rising heat becomes hot enough and big enough to redirect wind and weather in ways that can make the fire burn much hotter and, with little warning, spread fast enough to trap people as they flee." 

This is where we are in this pandemic. Things that were considered low-risk before are no longer so. There are a million things that could've and should've happened to avoid us getting to this place, but hindsight is 20/20. Bars should not have ever reopened. Mixed households should not have been allowed to dine together. The state could have required all stores, restaurants, salons, gyms to have a sign-in system. The exposure notification app that is finally rolling out on Thursday, CA Notify, should've been deployed months ago. 

For people who did lose work with the latest order, you should immediately file for EDD and CalFresh, businesses should be exploring all of the new measures, grants, loans, and tax holds from the state, plus all of the County and City offerings, too. I know it's really hard out there, but if we can just hang on until inauguration, we may begin to see some relief.  

There's a lot of reading and media briefing notes after the jump. 

• California Governor Newsom Media Briefing:
• California Legislature is back in session today with new members sworn in. 
• Google and Apple Have Created An Exposure Notification Apps :
• CA Notify available on Thursday via Google Play store and Apple 
• download and turn on notification settings
• Participation is voluntary. It is opt-in, not opt-out.
• 100% private and secure
• Does not track location
• Does not share personal information
• Phones exchange "keys" so once someone tests positive and is opted-in, the people who were in contact in past 14 days will get an anonymous notification that someone they'd been in contact with tested positive
• Nationally there is a testing backlog. California has it's own lab and has goal to keep results within 24 hours
• COVID-19 California Stats:
• 24,735 New Cases/1,366,435 Total Cases (% increase) - 21,924 7-Day Average
• 59 New Deaths/19,935 Total Deaths (0.3% increase)
• 8.4% 14-day test positivity rate/10.7% 7-day positivity rate (5.6% on 11/23/3.4% on 11/7)
• 72% increase in hospitalizations over 14-days
• 10,070 Hospitalizations 
• 2,360 ICU COVID-19 hospitalized in CA
• 69% increase in ICU admissions over 14-days
• 10,070/14% hospitalizations are COVID-19
• 46,858/63% of hospital beds in use
• 73,867 Total Bed Capacity 
• 1,714/14.2% Total ICU beds available now 
• 7,802 Total ICU Beds
• 21,209 Ventilators Available
• Regional Stay at Home order in effect when ICU capacity is under 15%
• Bay Area 25.7% (local health order has instituted stay-at-home voluntarily)
• Northern California 28.2%
• San Joaquin Valley 6.3%
• Greater Sacramento 20.3%
• Southern California 10.9%
• Staffing remains the number one issue as we take on this latest surge of COVID-19
• California is continuing to add staffing via contract staffing agencies
• 815 medical providers requested
• 435 to support ICU strike team
• 150 LVNs and 150 CNA to support SNFs, alternate care site, CDCR, and acute care hospitals
• 80 staff to fill various other needs like behavioral health technicians
• 566 expected by 12/14
• Imperial County 60-bed buildout
• NorCal bed buildouts at 4 hospitals
• CA has made federal requests, CAL-MATS, Limited Term State Staff 
• Home 02 Program- supports COVID-19 patients at home with oxygen and paramedic support
• 100 patient cap in Imperial County
• 100 patient cap in Riverside/San Bernardino
• RNs/Nurses in 2-day program for ICU Training
• Physician ICU Expertise 
• Health Corps- 2,538 shifts supporting 109 facilities, 900 ready to deploy
• California is deploying tent/pop-up hospitals statewide (details are boring)
• California is hoarding has been stockpiling PPE inventory for statewide distribution
• Ventilators: 14,189 available in state inventory/7,020 still available in hospitals
• Accelerating plans for quick, safe, and equitable vaccine distribution
• 327k doses from Pfizer around 12/15 to high-risk healthcare workers
• Facilities have plans in place to conduct vaccinations
• Community Vaccine Advisory Committee meets on Wednesday to discuss Phase 1B allocation (open to the public)
• FDA approval of Pfizer expected on 12/10. Moderna discussion on 12/17.
• Planning assumption for December: 2.16 million first doses
• watch the press conference for boring vaccine process of ordering/distribution
• CA has launched a public education campaign will billboards, PSAs, etc. 
• New CA Public Health Director - Tomas Aragon
• Media Questions:
• Can't force compliance for app, but it's only as good as people voluntarily using the app
• Vast majority of Californians are now under Stay-At-Home order. Facts determined status of when order was implemented
• Dr. Ghaly - constantly looking at actions, data, to determine what should be done. Didn't expect to have to issue order, but people didn't do shit they should've in October/November so here we are (my words, not his) Had to make decision not just based on COVID-19 hospitalizations but all typical winter hospitalizations. Levels of transmission is still going up because of activities around Thanksgiving.
• Health care plans/expansions: Xavier Bacerra as HHSA Secretary in new admin is a game-changer. State budgets can't even be considered without considering health care. Very enthusiastic with Bacerra's nomination.
• State has advanced education supports to deal with inequity with $5.4billion. Created protocols, processes, and procedures. Addressed ages, cohorts, data on how to open safely. (Governor Newsom does not like to be accused of not doing enough for education and continued breaking down every policy and program implemented during pandemic)
• Once below 15%, lodging is for essential workers only. No leisure. No tourists. 
• Specifics of regional stay-at-home will be amplified in FAQ online.
• "I'm deeply empathetic and deeply committed to advancing the cause of supporting our small businesses during this trying and challenging time." State put up half a billion in grants for small businesses, non-profits for interim support. Small business supports are all available now. 
• Facilities expect ICU and hospitalization increases in fall/winter, but COVID-19 care is generally longer, requires more staff, hospitals are more impacted. 
• World COVID-19 Stats (JHU 12/7 8:26pm):
• 67,564,565 Known Cases
• 1,544,148 Known Deaths
• US COVID-19 Stats (COVID Tracking Project):
• 180,193 New Cases/14.717,065 Known Cases (10.3% 7 day increase)
• 1,347 New Deaths/274,745 Known Deaths
• 102,148 Current Hospitalizations
• 20,098 Currently in ICU
• 7,073 Currently on ventilator
• San Diego County Stats
• State Data:
• Southern California ICU Bed Availability: 10.9%
• 1,703 New Cases/92,173 Total Cases
• 7 Deaths/1,062 Total Deaths
• 30.5 cases/100k population (Based on week ending 11/28, Assessed on 12/1. Unadjusted Case Rate)
• 4.7% Test Positivity (Based on week ending 11/28, Assessed on 12/1.)
• 10.6% Health Equity Positivity (Based on week ending 11/28)
• 871 hospitalized patients (4.3% increase from prior day)
• 221 ICU hospitalized patients (2.3% increase from prior day)
• 223 ICU beds available
• County Data:
• San Diego County COVID-19 Update – 12-7-2020 - County News Center
• San Diego is currently hitting 5 triggers: Adjusted Case Rate, Community Outbreaks, Increasing Hospitalizations, Increasing Testing Positivity, and Declining Case Investigation Initiation. 
• 1,998 New Cases/94,169 Total Cases 
• 0 New Daily Deaths/1,062 Total Deaths
• 9% Daily Test Positivity/8.7% (7-day avg after 7-day lag)/7.4% Test Positivity (14-day average)
• 15.3 cases/100k population (Based on week ending 11/28, Assessed on 12/1. Unadjusted case rate per 100,000 excluding prisons.) 
• Case Investigation is 52% (under 70% goal)
• Increasing Day Over Day Hospitalizations 11.5% (over 10% trigger. 176% increase over 30 days)
• ICU Capacity 24% (130% increase over 30 days)
• 6 New (12/6), 5 New (12/5)/87 Community Outbreaks (7-day)
• Business 30
• Restaurant/bar 3
• Retail 13
• Grocery 2
• Faith-based agency 8
• Government 4
• Daycare/preschool 6
• Healthcare 4
• Emergency Services 3
• Food/Bev Processing 3
• Higher Ed 1
• tk-12 school 3
• Warehouse/Distribution 3
• Gym 1
• Hotel/Resort/Spa 2
• Private Residences 1
• Universities:
• SDSU COVID-19, UCSD COVID-19, USD COVID-19, CSU San Marcos, PLNU
• COVID-19:
• From NYT California Today Newsletter:
  But Dr. Anne W. Rimoin, a professor at the University of California, Los Angeles, Department of Epidemiology and director of the Center for Global and Immigrant Health, said that these were difficult but necessary restrictions.
  “Restaurants are places where people are together in congregate settings with masks off for extended periods of time,” Dr. Rimoin said.
  This risk of transmission is compounded, she said, by the fact that dining tables are often made up of people from multiple households.
  “We’ve got such an incredible surge in cases,” Dr. Rimoin said. “We’re trying to do everything we can to save lives.”
• Who Will We Be When This Is All Over? The Covid-19 pandemic has brought incalculable suffering and trauma. But it also offers ways for people—and even societies—to change for the better. - Wired (12.7.2020)
• As virus slams rural California, many still pan restrictions - AP News (12.6.2020)
• On the Ground, the Pledge to Vaccinate 20 Million Against Covid-19 in December Seems Unrealistic - STAT News (12.7.2020)
• Pandemic Fatigue Is Real—But Now Is Not the Time to Give In to It - Vogue (12.5.2020) 
• What seven ICU nurses want you to know about the battle against covid-19 - The Washington Post (12.7.2020)
• Politics/News/Other Reading:
• Damon Albarn says UK government “has no empathy with the arts whatsoever” “We live in a pretty fucking miserable country at times and we need our arts to uplift us" - NME (12.6.2020)
• San Diego State of The River Report: Grade D due to invasive species, trash, water quality and more. 
• County Board of Supervisors Meetings Remain Virtual - County News Center (12.7.2020)