CoViD-19 Tuesday: Stay-At-Home Order Extended | Congressman-Elect Dies of COVID-19 | CoViD Variant Detected in CO |

 

So long ago before we knew what we know (Taken 4.29.2020)

It's been an exciting day around the household. Slept in. Woke up. Had burgers and homemade fries for lunch. Watched California media briefing. Hung outside until our property manager showed up and told us they have to get pest control to come out before the new neighbors can move in. (Just wait until it floods again, or in the summer when the ants take over, we wanted to tell him) We watched the evening news, I worked through my inbox, then we made amazing tacos, and now we're about to watch the second half of Hamilton. 
I was joking when I said it was an exciting day, but we're happy to be home and healthy and we can't really ask for more than that. 

• COVID-19:
• Colorado confirms first known US case of new COVID-19 strain believed to be more contagious - USA Today (12.29.2020)
• U.S.' COVID test requirement for UK travelers should extend to other nations -U.S. official - Reuters (12.29.2020)
• Frustration over vaccine rollout builds, as new variant reported in U.S. for first time - STAT News (12.29.2020)
• (This is a deeper dive into the clip I linked yesterday) WHO warns Covid-19 pandemic is 'not necessarily the big one'. Experts tell end of year media briefing that virus is likely to become endemic and the world will have to learn to live with it. - The Guardian (12.29.2020)
• Politics/News:
• $2,000 checks stall in Senate as GOP blocks vote - AP News (12.29.2020)
• Louisiana congressman-elect dies of Covid. Luke Letlow was to have been sworn in Sunday. - Politico (12.29.2020)
• Other Reading:
• Child labor in palm oil industry tied to Girl Scout cookies - AP News (12.28.2020)
• Global COVID-19 Stats (JHU 12/29 7:30pm):
• 81,968,448 Known Cases
• 1,789,007 Known Deaths
• US COVID-19 Stats (COVID Tracking Project):
• 194,512 New Cases/Known Cases (6.9%+ Change over 7 Days)
• 3,283 New Deaths/329,605 Known Deaths
• 124,686 Current COVID-19 Hospitalizations
• 22,838 Currently COVID-19 patients in ICU
• 7,885 COVID-19 patients currently on ventilator
• Secretary Ghaly 
• Stay-At-Home Order Extended (See Updates To Blueprint for a Safer Economy)
• Four week projections for ICU show demand exceeding capacity
• San Diego: Current ICU patients (12/27) 394/(1/28 projection) 559
• Projections will be reassessed daily 
• Based on current ICU, 7-day avg case rate, R-eff, Current ICU admission rate
• If projection is >15%, region is released from order
• If projection is <15%, region remains under order
• Southern California Case Rate 130.1/Transmission R-effective 1.10
• Crisis Care (California SARS-CoV-2 Crisis Care Guidelines -June 8 2020.pdf)
• Conventional - Space, Staff, Supplies, Level of Care all normal/usual
• Contingency - Post/Pre-Op beds used, singles converted to doubles, longer shifts, conservation/substitution/re-use of supplies,  
• Crisis- Cot-based care, Change in nurse to patient ratios, rationing of care, supplies, crisis care, triage medical care and ventilators
• Current Status
• Current surge is stretiching care, hospitals are handling as best as they can, adapting operations, some hospitals will have to resort to crisis care in which hard choices are made about allocating resources
• As resources become scarce, crisis care guidelines, planning, and implementations become critical. Guided by ethics, equity, and transparency. If an individual hospital reports crisis care, other hospitals are asked to share resources and temporarily change their operations. Less impacted facilities are required to help more impacted facilities.
• Kim McCoy Wade, California Department of Aging CDA
• State of California issued guidance to achieve 4 goals
• Hospitals are able to remain in conventional or contingent care as long as possible
• All regional hospitals work together to remain in contingent care as long as possible
• Hospitals have plans for crisis care rooted in equity, fairness, and transparency if needed as last resort
• The public has clear and transparent information about the crisis care continuum, and hospitals' approach to crisis care during this surge
• Person-centered and data-driven stakeholder input on Crisis Care Continuum (guidelines announced in June)
• Medical Decisions Cannot Be Based On Age, Race, Disability, Chronic Medical Conditions, Gender, Sexual Orientation, Gender Identity, Ethnicity, National Origin, Language Spoken, Ability to Pay, Weight/Size, Socioeconomic Status, Insurance Status, Perceived Self-Worth, Perceived Quality of Life, Immigration Status, Incarceration Status, Homelessness, Past or Future Use of Resources
• State doesn't determine when hospitals are in Crisis Care, but help allocate resources as needed to help hospitals get out as quickly as possible
• Tier Updates:
• Humboldt moving from purple to red
• Purple: 54 | Red: 3 | Orange: 1 | Yellow: 0 |
• California COVID-19 Stats:
• Aggregate California ICU Bed Availability: 0.0%
• 31,245 New Cases/2,187,221 Total Cases (+1.4% increase)/37,459 7-day average
• 242 New Deaths/24,526 Total Deaths (+1% increase)
• 12.6% 14-day test positivity rate/12.0% 7-day positivity
• 18.9% increase in test positivity over 14-days
• 21,240 COVID-19 Hospitalizations (+598 patients, +2.8% from prior day,+36.5% 14-days)
• 4,390 COVID-19 ICU hospitalized in CA (+30 patients, +0.7% from prior day, +35.1% 14-days)
• 1,428 ICU beds available (+43 from prior day)
• Media Questions:
• ICU beds are available but regions still reported at 0% because when ICU usage over 30% by COVID-19 patients, hospital is considered ill-equipped to handle other emergent needs (heart attack, strokes, other trauma). Rate is adjusted to make sure they have capacity for non-COVID cases. 
• Reflecting on 2020: grateful for state team, cooperation with counties, proud of stopping spring surge, able to save many lives across the state because of months of prep and learning best practices. COVID fatigue, level of trauma, level of day-to-day impact is difficult and asking people to hold on remains a challenge. Looking forward to greater vaccine distribution and inoculations and looking at how things can reopen safely again. 
• Crisis Care is a continuum not a switch, not just hospitals, but emergency services, EMS, are always making these decisions, especially in impacted regions. Doctors and clinicians are always looking at how they can best care for patients. State has asked for all hospitals and acute care to follow guidelines and checklist. 
• State has been looking seriously at oxygen and where it can be used or added because so many patients need high-flow oxygen in hospitals, clinics, external surge facilities 
• State has not been notified that any facility has moved into crisis care, however some facilities have definitely adopted some practices that would be used in crisis care. How ambulances are received, stretching staffing, making decisions on treatment for likeliness to survive. State hasn't been alerted that there are decisions between two patients.  
• Causes for concern: rate of rise of R-effective is lower, but R-effective is still rising. EMS is spending most of their days on diversion, hospitals are stretched, we're going into another holiday before even seeing results of Christmas
• Christmas exposures could be amplified on New Year's, especially among the pre- or asymptomatic. Hospitals are bracing for a significant surge. 
• San Diego County Stats
• State Data:
• Southern California ICU Bed Availability: 0%
• 1,751 New Cases/147,528 Total Cases
• 2 Deaths/1,404 Total Deaths
• 76.3 cases/100k population (Based on week ending 12/22, Assessed on 12/29. Unadjusted Case Rate)
• 13.7% Test Positivity (Assessed on 12/29)
• 19.2% Health Equity Positivity (Assessed on 12/29)
• 1,560 COVID-19 hospitalized patients (+34 patients, +2.2% from prior day)
• 399 COVID-19 ICU hospitalized patients (+1 patients,+0.3% from prior day)
• 176 ICU beds available (+1 from prior day)
• County Data:
• San Diego County COVID-19 Watch 
• Stay Home Order Extended for San Diego County & Update - County News Center (12.29.2020)
• In the past 14 days, 5,479 of the 9,677 people who tested positive for COVID-19 and were asked, CLAIMED TO HAVE NO POTENTIAL COMMUNITY EXPOSURES. 56.6%. Cumulatively, since June 5, 40,015 or 53.9% of interviewed cases claimed no exposures. 
• 2,534 New Cases/150,064 Total Cases 
• 31 New Daily Deaths/Total Deaths
• 15% Daily Test Positivity/% (7-day avg after 7-day lag)/10.8% Test Positivity (14-day average)
• 38.1 cases/100k population (Assessed on 12/29. Adjusted case rate per 100,000 excluding prisons.) 
• % Case Investigation (under 70% goal)
• % Increasing Day Over Day COVID-19 Hospitalizations (over 10% trigger. % increase over 30 days)
• % Increasing Day Over Day COVID-19 ICU (over 10% trigger. % increase over 30 days)
• ICU Capacity % (under 20% Trigger. % increase over 30 days)
• 3 New/57 Community Outbreaks (7-day)
• Business 22
• Restaurant/bar 1
• Restaurant 1
• Grocery 1
• Faith-based Setting 5
• Government 2
• Daycare/preschool 4
• Healthcare 9
• Construction 1
• Emergency Services 2
• Food/Bev Processing 1
• tk-12 school 2
• Warehouse/Distribution 2
• Hotel/Resort/Spa 3
• Comm-Based Org 1
• Universities:
• SDSU COVID-19, UCSD COVID-19, USD COVID-19, CSU San Marcos, PLNU