Skyrocketing coronavirus cases are putting heavy demand on Bay Area hospitals, and some counties fear they could exceed capacity in the next two to three weeks, especially if they see a further spike in cases after Thanksgiving, public health officials said Friday.
The dire warnings came as San Francisco officials said they expect the city to land in the state’s most restrictive purple tier early next week, perhaps on Sunday. That would place the city under California’s new curfew order and force almost all indoor activities to shut down.
Weekly new cases of the coronavirus have more than tripled over the past month, said Dr. Grant Colfax, director of the San Francisco Department of Public Health, in a news briefing. Models suggest that if the current surge continues unabated, “we could conceivably have hundreds of people in the hospital by late December or early January.”
Santa Clara County’s health officer, Dr. Sara Cody, said the county reported 407 cases on Friday, more than at any other time in the pandemic, and hospitalizations have increased 50% over the past week. If that rate of growth continues, the county will exceed hospital capacity in about three weeks, she said.
“Cancel your holiday plans,” Cody said during a news conference. “The choices each of us make in the next two weeks may mean the difference between enough hospital capacity to care for all of us and not enough.”
Daily coronavirus cases across California and the Bay Area have doubled over the past month, and the state passed 10,000 cases in a day five times this week — peaks not seen since the height of the summer surge. California reported a record 13,422 cases on Thursday. The state had 12,807 cases on Friday.
This wave is far more concerning than the summer surge, though. The rate of growth is already steeper, and Thanksgiving alone could lead to an even more dramatic increase in cases over the next couple of weeks. Public health officials have been issuing increasingly more urgent pleas for people to stay home during the holiday and not gather together.
The recent curfew is meant to try to curb some of that activity. Public health officials say a full lockdown, in the form of a new shelter-in-place order, is still an option.
“We are in a surge that has the potential to overwhelm our local health care system … and force us back to shelter in place,” Colfax said.
He said he expects the state to move San Francisco into the purple tier due to the rapidly escalating case rates. Indoor operations such as museums, movie theaters, gyms and places of worship would shut down within 24 hours. The curfew, which requires nonessential activities to stop between 10 p.m. and 5 a.m., would go into effect two days after the move to purple.
The new restrictions also would include a ban on indoor social gatherings, which currently are allowed for a maximum of three households. Assuming the new restrictions land before Thursday, that would force Thanksgiving get-togethers — which the city has strongly discouraged anyway — outside.
As of Friday, 41 of 58 California counties, accounting for nearly 95% of the state’s population, were in the purple tier. Gov. Gavin Newsom issued the monthlong curfew order for all purple counties on Thursday, and it goes into effect at 10 p.m. Saturday. Six of the nine Bay Area counties currently are in the purple tier.
Public health officials hope that the curfew, along with other efforts to discourage people from gathering or interacting with those outside their home, will help slow the rate of new infections and prevent hospitals from becoming overwhelmed — something the Bay Area has managed to do during previous pandemic waves. Even when hospitalizations peaked around 800 in the Bay Area in July, there was still plenty of capacity.
But just as cases are exploding at an unprecedented rate, hospitalizations are picking up, too. And hospital numbers tend to lag 10 to 14 days behind cases, so the new infections reported now aren’t yet straining the health care system.
As of Thursday, 511 people were hospitalized with COVID-19 in the Bay Area, and 4,755 in the state. Both numbers were up about 40% from the previous week. Intensive care numbers climbed about 35%, with 139 patients in the Bay Area and 1,240 statewide on Thursday.
Aside from the anticipated increase in COVID-19 patients, hospitals already are fuller than they were in the spring and summer, health care providers said. Hospitals are trying to catch up with patients who delayed care earlier during the pandemic, and this time they have not halted elective procedures or advised people to put off routine appointments.
“We’re definitely concerned that hospitals are starting from a place of more utilization and adding to that” with COVID-19, said Dr. Ahmad Kamal, director of health system preparedness for Santa Clara County.
Dr. Yvonne Maldonado, an infectious disease expert at Stanford, said the medical center is “nowhere near over-utilization” at the moment. But she’s worried about the increase in patients not just from COVID-19 but from influenza and other seasonal respiratory viruses. And like Kamal, she noted that the hospital already has less capacity than earlier in the year.
“Many of us are starting to brush off our surge plans that we pulled out back in March, and start to revisit those on the chance we start seeing overwhelming cases,” Maldonado said.
Bay Area public health officials aren’t alone in California in worrying over the demand on hospitals. This week, Imperial County on the southern border activated an “alternative care site,” and one patient was transferred to a neighboring county because hospitals ran out of space.
Los Angeles County officials announced hospital-based thresholds that would trigger new public health restrictions. About 1,400 people were hospitalized in Los Angeles on Thursday. If hospitalizations exceed 1,750, the county will shut down outdoor dining. If they exceed 2,000, the county will issue a new shelter-in-place order.
Frontline health providers said they are watching with concern as hospitals fill up in other parts of the country and wondering if that’s their fate. The Bay Area has avoided overrunning its hospitals twice before in earlier surges — they are hopeful the region can do it again. But the stakes feel higher now, said Dr. Jahan Fahimi, an emergency room physician at UCSF.
A record 82,000 people were hospitalized with COVID-19 in the United States as of Wednesday, according to the COVID Tracking Project. Ten states are currently reporting extremely high hospitalization rates, meaning people with COVID-19 make up more than 15% of all patients, according to federal reports. Dozens of counties across the country have had to open non-hospital sites to move less-critical patients and make room for the sickest individuals in intensive care.
Health care providers in some places have been told to keep working even after they test positive for the virus.
“If the other states and other locations are in any way a barometer for what we are bracing for, it looks worse than the first and second times around,” Fahimi said. “The caveat is that the Bay Area, and San Francisco in particular, did very well relative to these other places. I’m hopeful we’ll still do well. But that doesn’t mean it’s going to be great.”