How soon could the Fresno region emerge from its COVID-19 lockdown?
Fresno County and the rest of the San Joaquin Valley are in the sixth week of a regional stay-at-home order imposed by the state of California to slow the spread of the novel coronavirus and blunt a surge of COVID-19 cases and hospitalizations.
The 12-county region that ranges from Stockton to Bakersfield is one of four regions facing a dwindling availability of beds in hospital intensive-care units, triggering the restrictions. On Tuesday, however, the state lifted the stay-at-home order for the Greater Sacramento region, giving rise to the question: When might Fresno and the San Joaquin Valley follow suit and emerge from the regional lockdown?
In the Sacramento region – which includes Alpine, Amador, Butte, Colusa, El Dorado, Nevada, Placer, Plumas, Sacramento, Sierra, Sutter, Yolo and Yuba counties – the availability of ICU beds is estimated at 9.4% of capacity. But lifting the order there was based on a projection for ICU capacity to rebound to above 15% in the next four weeks.
The San Joaquin Valley, by contrast, continues to see an increase in new COVID-19 infections and hospitalizations, and little easing of the demand on hospital ICUs – indicators that the 12-county region including Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare and Tuolumne counties remains well behind the Sacramento region in when the regional order could be lifted.
“California remains in its most intense surge to date, but there are good things to report,” Gov. Gavin Newsom said Tuesday as he announced the immediate lifting of the regional order for the Sacramento region.
Newsom said the state is seeing stabilizing of ICU demand and testing positivity rates as well as a slight decline in new hospitalizations for COVID-19 statewide – “so much so that today, effective immediately, we’re pulling the Sacramento region out of the stay-at-home order.”
“There is light at the end of this tunnel,” he said in a short video posted on Twitter.
Relief for Sacramento. Will the Valley follow?
The Bay Area, Southern California and San Joaquin Valley regions all remain under the stay-at-home orders.
As of Tuesday, the California Department of Public Health calculated the Valley’s effective ICU availability at 0%. That’s a result of not only coronavirus patients, but a slew of patients with other serious illnesses and critical conditions requiring intensive medical treatment and care.
The region’s hospitals have a total of 657 licensed intensive-care beds. On Tuesday, ICUs held 470 confirmed and suspected COVID-19 patients, and had only 55 available beds remaining for other critical-care needs.
In Fresno and surrounding Kings, Madera, Merced and Tulare counties, the situation is even tighter. Fresno County has 149 licensed ICU beds – and more in practice as hospitals have enacted surge plans to handle more patients. Even so, only nine ICU beds were available on Tuesday, according to capacity data from the state.
Likewise, only nine ICU beds were available in neighboring Valley counties: none of 22 licensed beds in Kings County, two of 52 beds in Madera County, one of 24 beds in Merced County, and six of 65 beds in Tulare County. Mariposa County has no licensed ICU beds.
The numbers of open ICU beds is based not only on the physical presence of beds, but the availability of medical staff to care for patients in those beds.
Fresno County hospitals have had an average of about 627 confirmed COVID-19 patients each day over the past two weeks as of Tuesday – the highest daily average of any time during the pandemic. The 14-day average for confirmed ICU patients was more than 120 per day.
Sacramento County Supervisor Phil Serna stated on social media that the state projected the region’s ICU capacity to be at just over 19% four weeks from now – enough to lift the stay-at-home order.
Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said Tuesday that the state is evaluating each region’s four-week projected ICU availability. “So not today … but what do those ICUs look like in four weeks?” he said. “Because we know today’s cases, today’s sort of transmission environment, is going to end up in the hospitals in a few weeks, about four weeks out.”
Neither the Fresno County Department of Public Health nor the California Department of Public Health responded to queries Wednesday from The Bee about what the most recent four-week projection of ICU bed availability is for the San Joaquin Valley region.
When the order is lifted, then what?
The lockdown order took effect in the San Joaquin Valley on Dec. 6 for at least three weeks, extending until ICU capacity is projected to rebound to above 15%. Prior to the order, most Valley counties were in purple Tier 1, the most restrictive level of the state’s color-coded Blueprint for a Safer Economy. Tier 1 denoted widespread risk of transmitting the virus in the community.
Until the lockdown order is lifted for the San Joaquin Valley – whenever that may happen – many of the region’s businesses are supposed to be closed or be severely limited in their operations.
Sectors closed under the order include:
- Indoor recreational facilities, family entertainment centers, health and fitness clubs, 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.
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.
Some businesses and restaurants in Fresno and throughout the Valley, however, are continuing indoor operations in defiance of the order.
When the region does emerge from the stay-at-home order, each county will resume its place among the tiers of the state’s COVID-19 Blueprint. The tier system is based on the rate of daily new COVID-19 infections that arise per 100,000 people in a county over a one-week period, as well as the percentage of people tested for the virus for whom results come back positive.
From late September through mid-November, Fresno was in red Tier 2 of the blueprint, denoting “substantial” risk of coronavirus transmission in the community. In Tier 2, restaurants, churches and gyms could operate indoors with capacity limits and required safety protocols such as social distancing and face masks for staff and patrons. Schools were also allowed to reopen, if they had not already received waivers to operate under the more restrictive purple Tier 1.
But on Nov. 16, the metrics in Fresno, Merced and Kings counties deteriorated enough to send each back into the purple tier.
As of Tuesday, however, Fresno County and its neighbors have higher new-case and testing positivity rates than at any point since the blueprint was introduced in late August and are father than ever from qualifying for promotion into red Tier 2.
In Fresno County, for instance, there was an average of 76 new daily cases per 100,000 residents – more than 10 times higher than the threshold of seven cases per 100,000 to qualify for red Tier 2.
Also on Tuesday, the state reported that the testing positivity rate in Fresno County over the previous week was 19.4% – or that almost one out of every five people tested for the coronavirus were infected. The threshold to move from the purple to red tier is 8%.
This story was originally published January 14, 2021 at 5:00 AM.
