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COVID-19 Update [Hospital Data] - June 16, 2020
Charts included with this updatesubmitted by Zorgi23 to LosAngeles
I’ve added to the FAQ’s. FAQ #2 now has an explanation of the Prevalence Index. FAQ #3 has an explanation of the hospital utilization charts, which you’ll see today for the first time. It also has an explanation of the colors and range limits used on the snapshot table for Southern California [VS3]. Snapshot #4 has sources and notes, including sources for hospitalization data. Common definitions are now on FAQ #4. I’ll post these FAQ’s with every update. If you have any questions about the charts or calculations, please look at the FAQ’s first; your answer might be there.
Also, I wanted to clear up something about the links to the raw data and the charts. These links are to url’s created by Google for published spreadsheets. They are not user friendly. There’s no navigation, no row numbers, and they load very slowly. They are there strictly for those who would like to see the raw data and what is there. Please don’t draw any conclusions from those links about how I do my updates, though. They are just crude windows into the raw data, nothing more.
About the Hospitalization Charts - CH1 - CH6
You may have guessed the theme of this update: hospital data. Since the charts here are new, I’m going to explain them as best I can.
I get 4 pieces of data form the CA DHHS: patients confirmed, patients suspected, ICU confirmed, and ICU suspected. The numbers are for that day only; they are not cumulative, and I have no way to get those numbers. The ICU numbers are included in the “patient” numbers.
I combine the confirmed and suspected into a single number for “hospitalized” and the confirmed and suspected ICU into “ICU”. Then I do a 7 day moving average to smooth out the noise from day to day.
Why do we care about hospitalization numbers? Because we all saw what happened in NY, when hospitals got overwhelmed. Once that happens, the entire health care system is effectively shut down, and that is a disaster, resulting in more lives lost, not just from CV19, but from other medical emergencies that can no longer be handled.
So bed utilization rates are critical. Sadly, there are no easily accessible statistics on this. We all know that the number of licensed hospital beds and ICU beds can vary from week to week, but there’s no way to keep track of that. So I had to use static numbers from the CA Hospital Assn. and KPBS. From these sources, I got licensed hospital beds for each county, as well as licensed ICU beds.
The next question is what percentage of these beds are utilized. To get that, I consulted various sources, and the consensus is that around 60% to 65% of licensed beds are utilized during normal times. The utilization for ICU beds runs a bit higher -- around 68%.
That means that if CV19 patients take up 20% of available beds, we are near a crisis point. Why? For a couple of reasons. First, hospitals don’t hire staff for 100% utilization; they hire for the utilization rate that’s typical for them. So if there’s a surge of new patients, that means more overtime, longer shifts, no vacations, etc., and eventually hiring. Second, CV19 patients put an incredible amount of stress on a hospital -- PPE, isolation of patients, long stays, etc. Look at one of the YouTube videos from Bergamo and you’ll see what I mean.
From everything I’ve been able to read about it, a untilization rate of under 10% for regular CV19 patients and 15% for ICU patients is manageable. Anything above that results in stress on the system, and utilization rates at 25% and above are danger indicators.
Let me make one thing clear: I am not a hospital administrator, virologist, epidemiologist, scientist, etc. I am not an expert. I’m putting together data and giving you my interpretation of it. If any of you out there are experts, and see something I’ve got wrong, please correct me; I’m anxious to learn and get it right.
Back to the charts. There are five pieces of information.
What do these charts tell us?
I’m offering this commentary as a theory, in a way. It makes sense to me, but I hope that those of you out there with direct experience will set me straight.
LA County [CH1]
Cases show an upward trend, but hospitalizations as well as icu’s are going down. This may indicate that what the county has been saying, i.e. that the increased case count is a result of more testing, is true. Not only that, but hospital utilization rate (HUR) and icu utilization rates (IUR) are declining slightly. The HUR went from 8% 2 weeks ago to 7% today, and the IUR declined from a very high 22% to 18% today.
San Diego County [CH2]
The trend line for cases is slightly upward, but mostly flat. Hospitalizations and ICU’s have declined slightly. The HUR has been steady at 5%, and the IUR has declined from a high of 19% a couple of weeks ago to 17% today.
Orange County [CH3]
Mostly, this is the same situation as that in San Diego - almost flat case trend lines, slightly higher hospitalizations. The troubling thing here is the IUR, which has gone from 16% two weeks ago to 20% today.
Riverside County [CH4]
Here again we have sharply rising cases, but not mirrored in hospitalizations -- yet. Since the incubation period is up to 3 weeks, this may still happen. Indeed there is a slight increase in hospitalizations, but the increase is only about 20 per day over a two week period. The HUR and IUR remain relatively flat.
Ventura County [CH5]
Very much like Riverside, but here the increase in hospitalizations is slightly more pronounced, from 277 three weeks ago to 322 today. The HUR and IUR are flat.
Kern County [CH6]
This is the chart that could indicate some real trouble ahead. The absolute numbers are not huge, but the trend lines are moving upward more or less in unison. Over the past three weeks, cases have doubled, hospitalizations have doubled, and ICU’s have gone up by around 40%. The HUR is very high, at 25%. If their pre-pandemic HUR was 65%, and we add another 25% to that, it would give us an overall HUR of 90%. That doesn’t leave any wiggle room.
I’ve included the Vital Statistics tables just to keep you updated; discussion on that tomorrow.
Stay healthy and safe, everyone.
Donations: quite a few of you have offered various types of donations to show your appreciation for these updates. I have everything I need, so I’d rather you contribute to a great cause instead. The link below is to donate to the Black Visions Collective in Minneapolis. Sorry, no bank accounts, just credit cards.
Donate to Black Visions
Want to see the raw data? Here it is.
Want to see all the charts? Here they are.
[Discussion] Governor Newsom's 07/08 COVID-19 Press Conference
Please contribute with your personal examples, anecdotes, or stories! Let's all strive to work together to make our communities safe & healthy!
12:00 pm start, 1:02 pm end
Wear a mask. Wash your hands. Physically distance. Slow the spread! 111 lives lost in last 24 hours.
We will get through this. It's not a matter of "if," it's a matter of when. And that when depends on your decisions and efforts to slow the spread.
Shelter-in-place months ago was ordered to save lives & prepare our healthcare systems for a larger surge.
Update on Preparedness Plan in response to increases in hospitalizations
Need to meet growing demand for hospital care by ensuring Californians who need access, receive it. Maximize capacity within current hospital settings (converting old hospitals and other facilities to decompress hospitals) & in process of building additional capacity outside hospital settings.
Existing hospital footprint: 415 hospitals, but not equally distributed in the state. Roughly 21,000 licensed hospital beds in LA. In Sutter county, just have 14. Depending on where you live, capacity is very different.
On surge capacity in March vs. July: In March, we had surge capacity of ~20%, no established alternate care sites, no propositioned medical assets. We are better prepared now in July with: capability to treat 50,000 COVID patients, built alternate sites such as Sleep Train Arena, established new hospital capacity such as Seton, deployed federal medical stations.
96,000 applicants for CA Health Corps. 35,000 of those applicants for CA Health Corps had a valid license in professions needed; 741 Health Corps individuals deployed to Skilled Nursing, Corrections, & other facilities. If you are retired or professionally trained, encouraged to fill out application on covid19.ca.gov. Need to match needs in different areas of the state. YOU may have a unique license, experience that may be needed in certain parts of the state.
State Medical Supply Inventory
In March, we had 1 million procedure masks which was wholly inadequate. Now, we have 21 million N-95 masks available. Governator years ago stockpiled N-95 masks in CA.
In 1 contract, 189 million procedure masks, 72 million N-95 masks. We were able to deliver in promises from 2 months ago to stockpile.
DISTRIBUTED: 201 million procedure masks, 79 million N-95 masks distributed over past 4 months.
AVAILABLE: 232 million procedure masks, 46 million N-95. Still in process of getting more.
So successful in procurement that we have helped to distributed these supplies to other states in need & FEMA (federal emergency management).
Comprehensive Surge Plan presentation by person in charge of CA hospitals:
CA hospitals continue to ramp up prep to be ready for all Californians. The numbers are increasing in CA. More people will need hospitalization and intensive care in next few weeks. 49% increase in hospitalizations in last 2 weeks, 38% increase in ICU hospitalizations.
On Planning: Hospitals and teams have plans for surge. To be ready for any kind of emergency.
On Preparing: Hospitals are being prepared logistically. Building up inventory of PPE. Attempting to build up capabilities of testing supplies. Cross training staff like nurses who may typically serve bed-side, how can we train them up if they are needed in ICU. Looking at every nook and cranny to increase COVID-19 capacity.
On appreciation of staff: Thank you for the nurses, doctors, and other staff for their heroic work.
If hospitals work as teams, we can ensure that patients are transferred and decompressed properly and safely.
We have therapeutic drugs like remdesivir (shortens duration of hospital stay in patients). Have learned a lot over last 4 months on how to treat COVID-19 patients.
Surge is about finding balance between caring for COVID-19 patients and caring for every other non-COVID patient in CA.
Emphasis on social distancing, masks, hand hygiene in neighborhoods and communities that help nurses, doctors, and your community. Help us expand the capacity to care for those in need.
190 individuals from HHS (federal entity) to give relief to nurses & doctors. CA medical association sent trained healthcare professionals to NYC during the height of their pandemic months ago. These medical personnel came back to CA with more experience and knowledge on treating COVID-19 patients.
Health and Safety
Drivers of recent COVID-19 hospitalizations: not enough people wearing masks & physically distancing, increased mixing outside of households, skilled nursing facilities, prison/jail outbreaks, essential workplace outbreaks.
Younger "invincibles" are contributing. However, it's not just the young populace; some essential workforce & older populace also contributing with poor mask compliance & social distancing.
60% of the economy never shut down even with shelter-in-place order. Operational under modified orders.
18 counties issued local orders, 4 issued state, 4 awaiting action (colusa, napa, san benito, yolo)
Positivity Rate (Today's COVID-19 Statistics):
A metric to show changes in the rates of infection. Graphs pictured show the number of positive cases in the tests conducted. An increase in the rate indicates an increase in spread of the virus.
24 hr: 11,694 (July 7th) largest single day cohort since beginning of pandemic. 8,116 7-day average. NOTE: numbers include a backlog reported from labs in LA county. this cohort would bring number below 10,000. urges citizens to look at 7-day average.
avg 106,000 tests/day, up from 2,000 tests/day @ beginning of pandemic in March.
7 day: 7.1%, up from 6.0% 1 week ago
14 day: 7.1%, up from 5.1% 2 weeks ago
Conclusion: COVID-19 is spreading. Goals need to re-imagined. May talk more on testing, targeting on Friday's or Monday's press conference.
6,100 new (~8%) hospitalizations, +44% over 14 day, 4240 2 weeks ago
Non-ICU Beds: 44,199 admitted (6,100 COVID), 73,867 available
ICU: 1753 ICU patients, +34% increase over 2 weeks. 3908 ICU beds immediately available. 11,313 surge aggregate ICU capacity (total max CA capacity ICU), 11,300 ventilators available.
Q1: state is sending masks to other states. clarify how many masks? what was the threshold for the mask capacity we had as a state to send to other states?
A1: when we made multiple agreements for large procurement of masks, part of agreement (esp with FEMA) was consideration of giving to those in need who need it the most. We feel connected to the "American" spirit and have helped our other "brother and sister" states. We have prioritized the needs of the state (adequately met as for now), particularly those who are working on the front line. 35 million masks to CA grocer association. Many masks in other essential sectors.
Q2: concerns about "super spreaders." can recent increase be attributed to them? Should individuals get tested even if they are asymptomatic?
A2: testing site info available at covid19.ca.gov. Looking to target and modify testing criteria (modified Sunday) to test most vulnerable communities and diverse areas of the state.
Q3: about san quentin. are you decompressing more? are you personally going to the prison?
A3: visited San Quentin on a daily basis (including right after press conference). We've been able to decompress the prison (4051 on March 2nd -> 3000 goal). 3076 right now. using chapels and gyms, and other facilities differently to try and decompress.
Q4: President Trump said he will withhold federal funding from states that do not open schools. Are there repercussions for not having enough teachers to re-open? Vice President said conflicting info. Address?
A4: I'm not worried about [Trump's] latest tweets. We must safely open schools. It is non-negotiable. Need funding for K-12 and higher education to support efforts. Do more on face shields, gloves, gowns, masks, etc. Focus on procurement of equipment. We are providing flexibility in our statutory budget to allow for balance of in-person and online. Flexibility based on local conditions important as each county may be unique in class size, class environment, or accessibility. Need foundational framework to keep kids and teachers HEALTHY! I fear that more than a "tweet." We must protect bus drivers, children, janitors, etc. Have to make educated, data-driven decision to re-open schools.
Q5: followup on education. LA times said possible delay on August 18th start of school. Is it possible to have some form of classroom instruction in 5-6 weeks?
A5: decision will be based on data & where we are in a few weeks. We are not bystanders. We are agents of our own lives and decisions. local flexibility on distance learning. Acknowledges need of in-person for social/emotional development of children and teens.
Q6: as testing centers are backlogged and closing, some people are waiting for a week to get tested and a week for the results. what is the point of testing if it takes so long? How many teachers, students, staff are expected to be infected with in-person?
A6: No data or modeling for school infections. We are doing ongoing work in increasing statewide tests despite supply chain concerns. We are doing record number of tests. The challenge of the time it takes to get tests back was not as much of an issue a few weeks ago. Increased fears and testing have led to backlogs in testing sites.
(Old: 23) Fresno, Glenn, Imperial, Kern, Kings, LA, , Orange, Riverside, Sacramento, San Bernardino, San Joaquin, Santa Barbara, Solano, Stanislaus, Tulare, Ventura, San Diego, Monterey, Colusa, Madera, Marin, Merced, Contra Costa
(New: 3) Napa, San Benito, Yolo
(Removed: 1) Santa Clara
California Department of Public Health (CDPH) website
What to do if you start to develop symptoms of COVID-19 & want to get tested (courtesy: CDPH)
COVID-19 CA Emotional Support & Well-Being Resources
PSA on Masks
PSA #2 on Masks
PSA on Masks presented by current & past CA governors
PSA on Masks from NY, Comedy
Link to yesterday's discussion thread
Citizens are encouraged to file reports with their county website. Reports & complaints can also be filed at covid19.ca.gov or on specific, department websites (i.e.- OSHA). Many citizens have found that Twitter is an efficient platform is raising awareness to force government bodies and businesses to act. Please help in keeping your community safe! Report any unsafe businesses immediately!
Remember folks, spread the love, not the virus!