Valley region falls below 15% ICU capacity, triggering COVID lockdown starting Sunday night
A regional stay-at-home order will hit Fresno County and 11 other San Joaquin Valley counties Sunday evening after the collective capacity of the region’s hospital intensive-care units continued to plummet, dropping below 9% on Saturday. That’s well below a 15% threshold set for the new measures.
Once the order kicks in, new limits will be imposed on restaurants, hair salons and barber shops, and an array of other businesses from Kern County in the south to San Joaquin County in the north. The lockdown lasts at least three weeks, to be lifted when ICU capacity rebounds to above the 15% threshold.
“We have been asked by the California Department of Public Health to implement the actions in the order, as a region, by 11:59 p.m. on Sunday (Dec. 6),” the Mariposa County Sheriff’s Office stated in an advisory late Saturday morning. “This is slightly later than the 24-hour period we were told previously, but this will allow for businesses to operate through Sunday and implement on Monday morning.”
According to the state Department of Public Health, only 8.6% of ICU beds across the greater Valley region were available to receive new seriously ill patients as of Friday. Unless that number increased to more than 15% again on Saturday, that effectively triggers the regional orders announced Thursday by the department and Gov. Gavin Newsom aimed at slowing the increase in new coronavirus cases and keeping hospitals from being overwhelmed by COVID-19 patients.
The Valley is one of five health-care regions for which the state is monitoring ICU capacity. Southern California also fell below 15% on Friday, with capacity in that 11-county region reported by state health officials at 12.5%.
While the state’s order was announced Thursday afternoon, it was not scheduled to kick in until 12:59 p.m. Saturday. “For regions where the adult ICU bed capacity falls below 15% after the effective date of this order, the terms of this order shall take effect 24 hours after that assessment.”
In a statement released late Saturday morning, the Fresno County Department of Public Health confirmed that the regional order will become effective just before midnight Sunday night. After that time, restaurants in Fresno County – which under purple Tier 1 of the state’s color-coded Blueprint for a Safer Economy have been able to offer outdoor dining, will be officially barred from serving diners outside and limited to only take-out and delivery orders.
Barber shops and hair salons, nail salons, personal care businesses such as massage, tattoo, piercing, waxing, spas and others which have also been able to operate indoors under the purple tier must close.
Retail stores will be limited to no more than 20% capacity. That’s a reduction from the 25% that has been allowed under purple-tier restrictions.
Under the terms of the new order, people living in the affected regions are also expected to stay at home except for necessary trips or for outdoor recreation. For residents, and for businesses that are allowed to remain open, the order calls for all customers and staff to wear face masks and practice physical distancing aimed at reducing the potential for transmitting the coronavirus.
Intensive-care capacity in all five regions of the state on Friday were:
San Joaquin Valley (Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare and Tuolumne counties): 8.6%.
Northern California (Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Shasta, Siskiyou, Tehama and Trinity counties): 24.1%.
Bay Area (Alameda, Contra Costa, Marin, Monterey, Napa, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano and Sonoma counties): 21.7%.
Greater Sacramento (Alpine, Amador, Butte, Colusa, El Dorado, Nevada, Placer, Plumas, Sacramento, Sierra, Sutter, Yolo and Yuba counties: 21.4%.
Southern California (Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara and Ventura counties): 12.5%.
“COVID-19 continues to spread at alarming rates in Tulare County, and most concerning are the number of people needing to be hospitalized for COVID-19,” said Dr. Karen Haught, Tulare County’s public health officer. “It is imperative we take these protective actions in order to not overwhelm our local hospitals. The measures we all need to take is to avoid any gatherings outside our household, wear a face covering, social distance, and wash our hands. These are vital to decrease transmission of COVID-19.”
Up and down the Valley, other county health officers offered similar pleas.
“Home for the holidays takes on a new meaning this year. We acknowledge that this order will change what the holiday season traditionally looks like for families,” Madera County Public Health Officer Dr. Simon Paul said. “We are asking you to protect the vulnerable in your family and in your community by taking the order seriously and staying home.”
“We know that people are tired of the stringent measures, but they are the only weapons we have to combat the virus,” added San Joaquin County health officer Dr. Maggie Park said. “Now, more than ever, we need San Joaquin Valley residents to step up and take these actions seriously.”
Not unexpected
Dr. Rais Vohra, interim health officer for Fresno County, said Friday that it would not be unexpected if the lockdown order was to take effect in the Valley as soon as this weekend, given the surge in new coronavirus cases cropping up each day and the increase in hospitalizations for COVID-19.
“The way things are going, I won’t be surprised if it’s in the next couple of days,” Vohra told reporters Friday. “We’re bracing ourselves. We may get the announcement as early as (Saturday).”
In the central San Joaquin Valley of Fresno, Kings, Madera, Mariposa, Merced and Tulare counties, testing has confirmed an average of almost 1,000 new cases each day over the past week. And over a two-week span, the number of confirmed coronavirus patients being treated in hospital intensive-care units has nearly doubled, reaching 103 on Thursday.
On their own, ICUs across Fresno County have been well below 15% capacity – or about 23 out of 149 licensed intensive-care beds – since Nov. 20. On Friday, hospitals across the county reported that they had only five available ICU beds.
“If we as as county were being held to that 15% threshold, then we would already activate our shelter-in-place plan here in Fresno County,” Vohra said of the regional order. “However, they’re doing it by region. … As soon as the region drops to 15% or below, then we’ll be asking people to undergo that shelter in place.”
Dan Lynch, Fresno County’s emergency services coordinator, said Friday that the state makes its calculations of ICU capacity based on the number of intensive-care beds for which hospitals are licensed, regardless of what arrangements have been made within hospitals to increase their surge capability to handle an increased number of patients.
Up and down the San Joaquin Valley region, hospitals have a total of 657 licensed ICU beds, not counting specialty units like neonatal or pediatric ICUs. Figures reported by the state show that as of Friday, there were 237 confirmed or suspected COVID-19 patients in intensive care, and 92 available ICU beds to accommodate additional patients.
If all 657 licensed beds were in use and staffed, that would calculate to another 328 patients being treated in ICUs for something other than COVID-19.
The rising number of patients – those with COVID-19 and those with other maladies or conditions that require hospitalization or ICU care – isn’t the only strain on Valley hospitals. As coronavirus cases increase across the general population, health care workers are also dealing with the infection and missing work, either because they have tested positive for the COVID-19 or in quarantine or isolation because they have been exposed to the virus.
That means that even though a hospital may have open beds, including in their ICUs, the facility can only take in as many patients as it has staff available to provide care.
Fresno-based Community Medical Centers reported that as of Friday, it had 322 members of its workforce in isolation for the virus, including 113 who have tested positive, across its network of facilities including Community Regional Medical Center, Clovis Community Medical Center and the Fresno Heart & Surgical Hospital.
Also on Friday, Saint Agnes Medical Center in Fresno reported that 94 of its staff were in quarantine, including 84 who were confirmed COVID-19 cases.
In neighboring Tulare County, Kaweah Delta Medical Center had 102 of its employees who were positive for the virus as of Nov. 30.
What will be closed or face new limits?
If the ICU capacity across the 12-county Valley region stays below 15% on Saturday, affected sectors that must close for at least three weeks – even if they’ve been allowed to remain open under the tier system – include:
- Indoor recreational facilities, family entertainment centers and indoor and outdoor playgrounds.
- Hair salons, barber shops and personal care services such as nail salons and waxing, massage parlors, estheticians, and piercing and tattoo parlors.
- Museums, zoos and aquariums.
- Movie theaters.
- Wineries, bars, breweries and distilleries.
- Cardrooms and satellite wagering.
- “Limited services,” identified by the state as auto repair shops, car washes, landscapers, door-to-door services and sales, pet grooming, dog walking, dry cleaners and laundromats, and more.
- Live audience sports.
- Amusement parks.
Schools that had already reopened for in-person classes under the tier system or with a waiver from the state can remain open under the new order, but are required to follow guidance for masking and physical distancing.
Outdoor recreational facilities can remain open with 100% masking requirements and physical distancing, but are not allowed to have any food, drink or alcohol sales, and overnight camping at campgrounds is not allowed.
Retailers and shopping centers can remain open, but must keep counts of customers at entrances to remain at or below 20% capacity. No eating or drinking are allowed inside stores.
Hotels and motels are allowed to remain open only for essential travel.
Restaurants are allowed to only provide take-out, pickup or delivery orders, with no indoor or outdoor dining.
Offices are only allowed to be open remotely, except for critical services where remote work is not possible.
Churches, temples, synagogues, mosques and other houses of worship are only allowed to hold services outdoors.
Services deemed as critical or essential that can remain open include health care and public health, emergency services, food and agriculture, energy, water and wastewater services, transportation and logistics, communications and information technology, government and community-based essential functions, critical manufacturing, financial services, chemical and hazardous waste, defense industries, and other industrial, commercial, residential and sheltering facilities and services.
This story was originally published December 5, 2020 at 7:57 AM.
