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San Diego County sets a COVID hospitalization record as new surge hits home

San Diego Union Tribune logo San Diego Union Tribune 11/25/2020 Paul Sisson
a person in a costume: Vanessa Malibago, a registered nurse working in the ICU at Scripps Mercy Hospital Chula Vista, puts on her protective gear. (Nelvin C. Cepeda/The San Diego Union-Tribune) © Provided by San Diego Union Tribune Vanessa Malibago, a registered nurse working in the ICU at Scripps Mercy Hospital Chula Vista, puts on her protective gear. (Nelvin C. Cepeda/The San Diego Union-Tribune)

San Diego County set a new hospitalization record on Tuesday with 518 confirmed and suspected COVID-19 patients in local hospital beds, topping the previous high of 509 set on July 17.

The numbers in the count released by the county lag by one day. A more recent count kept by the Hospital Association of San Diego and Imperial Counties showed the number of hospitalized COVID patients had already grown to 576.

It is a toll that health officials saw coming. On Nov. 3, just three days after Halloween, Dr. Mark Ghaly, California's secretary of health and human services, warned that hospitalizations usually lag infections significantly and that communities would feel the full impact of that holiday's parties and get-togethers as Thanksgiving approached.

“As cases rise, I can almost predict, three, three and a half weeks later, that there will be some increase in hospitalizations,” Ghaly said then.

With another holiday looming on Thursday, the crunch at area hospitals is likely to get much worse. Daily new positive test results reported in the week following Halloween were in the 500-per-day range. Today, those new case totals look positively quaint.

San Diego County on Tuesday reported a fresh single-day case record, announcing 1,546 additional positives for Monday. It was the fourth day in the past week with a total over 1,000 and the third fresh record set in the proceeding seven days.

The county also reported 16 new COVID deaths, bringing its total to 984. Five women and 11 men died between Nov. 7 and 23. Their ages varied from early 60s to late 90s; 14 had underlying medical conditions.

As is the case with Halloween, the community can expect hospitals to feel the effects of these cases in three to three-and-a-half weeks. That's generally how long it takes for those infected to realize they're sick, get tested, convalesce at home, then go to their local medical center once their symptoms worsen to the point that staying home no longer seems safe.

As was the case with the last local COVID surge, which arrived in early summer, South Bay hospitals appear to be getting hit the hardest.

Chris Van Gorder, chief executive officer of Scripps Health, said Tuesday afternoon that a spike in COVID cases arriving for care at Scripps Mercy Hospital Chula Vista pushed planners to move patients north in order to balance "both bed capacity and staffing." Two patients were moved to Scripps Memorial Medical Center in La Jolla, with a third patient transferring to the hospital from Scripps Mercy San Diego in Hillcrest.

Scripps, Van Gorder added, has recently also accepted transferred patients from Riverside and Imperial County hospitals to help balance their workloads.

Though there are more COVID patients currently in hospital beds than has been the case at any time since the pandemic started, the local health care system has continued to manage. The total number of filled beds countywide increased only slightly, to 4,319, on Tuesday, from a previous-day total of 4,291.

Van Gorder said the holiday has been a help to keep the overall numbers below 80 percent occupancy, a threshold set by the county. Beyond that, more severe reductions in non-COVID-related work might be necessary.

"We are fortunate because this is a holiday week, and our scheduled cases were down as some physicians are out for the holiday week or patients did not want to be scheduled right before the holiday," Van Gorder said, referring to non-emergency patients and procedures. "So we had capacity to absorb the increase.

"If this increase continues, we will activate our process and notify patients that we will have to delay [non-emergency] cases."

He stressed that doctors, not administrators, would have the final say on which procedures end up getting delayed.

a messy bed in a room: Nurse Vanessa Malibago checks on her COVID-19 patient in the ICU at Scripps Mercy Hospital Chula Vista. (Nelvin C. Cepeda/The San Diego Union-Tribune) © (Nelvin C. Cepeda/The San Diego Union-Tribune) Nurse Vanessa Malibago checks on her COVID-19 patient in the ICU at Scripps Mercy Hospital Chula Vista. (Nelvin C. Cepeda/The San Diego Union-Tribune)

It was a similar situation at Sharp Healthcare, the region's largest health care system.

The hospital association report listed 193 confirmed COVID patients filling beds at Sharp on Tuesday, and 22 more with suspected infections. It's the largest COVID-related hit that the system has taken so far, confirmed Brett McClain, Sharp's executive vice president and chief operating officer.

"This has been unrelenting, and I'm definitely concerned about the long-term effects of all of this on our staff," he said.

There has been a bit of a silver lining in this go around, he said. Medical professionals have experience treating COVID-19 and now understand the possible positive effects of using drugs such as steroids earlier in the course of illness. Earlier proning — the process of turning patients from back to front and vice-versa to better fight the effects of lung inflammation — has also allowed more sparing use of breathing machines.

The result, he said, is an ability to continue performing non-COVID work than was possible in the spring, when the entire health care industry was still feeling in its way forward absent any codified standard of care for a disease that had descended on the world only months earlier.

An attempt to clear the decks in the spring — urging hospitals to avoid non-emergency work where possible — had a negative effect on those with growing medical problems who stayed home when they would otherwise have come in for care.

"We had way too many patients waiting way too long, and some of those 'elective' cases really became quite urgent," McClain said.

"I think we all agree we made an error shutting down as much as we did last time," Van Gorder added. "It undoubtedly resulted in delayed diagnosis of cases that were important to diagnose earlier and care that should have taken place earlier."

Both executives looked toward Thursday with more than a little trepidation.

If families could simply hold off on gathering as much as possible, then the region could avoid yet another surge of admissions just before Christmas.

McClain, who moved to San Diego from Arizona in March, said he is doing his part. With two college-age kids just returned home, he said his father, who moved to town at the same time and lives very near by, will not be celebrating around a shared table this year.

"We'll get him on Facetime, and I'll drop a plate on his doorstep," McClain said. "We've just got to be safe."

The spike in cases led the Vista Unified School District to announce Tuesday that its middle and high school campuses will be closed for the rest of the calendar year, and students will pivot to virtual classes. Elementary schools in the district will remain open for in-person learning.

Teri Figueroa contributed to this report.

This story originally appeared in San Diego Union-Tribune.

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