HomeMy WebLinkAbout12.29.20 FW_ SYASL COVID-19 Update
From:Ring, Brian
To:Alpert, Bruce;Bennett, Robin;Clerk of the Board;Connelly, Bill;Cook, Holly;Kimmelshue, Tod;Lambert, Steve;
Lucero, Debra;McCracken, Shari;Paulsen, Shaina;Pickett, Andy;Ring, Brian;Ritter, Tami;Rodas, Amalia;
Sweeney, Kathleen;Teeter, Doug
Cc:Pickett, Andy;Snyder, Ashley
Subject:FW: SYASL COVID-19 Update
Date:Tuesday, December 29, 2020 4:04:41 PM
Attachments:SYASL COVID-19 Update 12.29.20.pdf
Good afternoon –
FYI – latest State COVID information.
Brian Ring
Assistant Chief Administrative Officer
Administration
25 County Center Drive, Oroville, CA 95965
T:
From: SYASL County Info <SYASLCountyInfo@SYASLpartners.com>
Sent: Tuesday, December 29, 2020 3:39 PM
To: SYASL County Info <SYASLCountyInfo@SYASLpartners.com>
Subject: SYASL COVID-19 Update
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To: County Administrative Officers and Interested Parties
From: Paul J. Yoder and Karen Lange
Date: December 29, 2020
RE: SYASL COVID-19 Update
Please find attached our daily SYASL COVID-19 update.
-Paul and Karen
COVID-19 Updates
www.covid19.ca.gov
December 29, 2020
Newsom Administration - Resources / Mutual Aid / Executive Orders
This afternoon, California Health and Human Services Secretary Dr. Mark Ghaly provided an
update on COVID-19. As of today, the Northern California and Greater Sacramento regions have
been at above 15% ICU capacity for over three weeks and are no longer under the Regional Stay
at Home Order. However, the Bay Area region is currently under 15% and will remain under the
Order until further notice. The San Joaquin Valley and Southern California regions are still at 0%
ICU capacity, and the four-week projection does not show improvement according to the
factors that Dr. Ghaly described. They will remain under the Regional Stay at Home Order until
further notice.
Dr. Ghaly also provided an update on the County Tier status:
o Counties moving from Purple (widespread) to Red (substantial): Humboldt
o Purple: 54
o Red: 3
o Orange: 1
o Yellow: 0
here and SYASL staff notes here.
You may view covid19.ca.gov for more updates and the California Department of Public Health
website for the latest guidance documents.
Homekey
Governor Newsom has announced that all 94 Homekey projects have closed escrow and that
6,029 buildings will provide critically needed housing units for people experiencing
homelessness throughout California. A total of $750 million in federal Coronavirus Relief Fund
dollars has been allocated to 51 applicants for the 94 projects. All 51 awardees have also
received at least one Operational Support Grant from philanthropic or General Fund sources.
View here.
Legislative / Budget News
-19 page here for updates.
The LAO has been releasing a series of reports regarding Federal actions affecting California
related to developments around COVID-19. View here.
CHHS Statewide Update on COVID-19 Response, December 29, 2020
CHHS Secretary, Dr. Mark Ghaly
Thank you for joining us
Lot of info to get through
Spend some time on crisis care and the continuum and state efforts to work with counties and hospitals
Joined by Director of Department of Aging, Kim McCoy Wade who will help me talk through this
Then go to Regional Stay At Home and dig into projections
Then it is Tuesday, and we will talk about tier updates
COVID-19 Case Numbers
o 31,245
Dec 29th
o 37,459
7-Day Average
o Total Tests vs. Test Positivity
245,955 Tests
12.6% 14-Day Positivity
o Averaging over 300,000 tests
o 7-Day Positivity
12%
o 14-Day Positivity
12.6%
o Closer Look at 14-Day Positivity Rate
10.6% Dec 15th
12.6% Dec 29th
18.9% increase
COVID-19 hospitalizations have increased 36.5% over last 14 dayscurrently 20,390
COVID-19 ICU hospitalizations have increased 35.1% over last 14 dayscurrently 4,308
o This is not evenly distributed across the state
o Northern part of state still seeing capacity, surge and routine
o In Southern, quite a different story
o Hospitals that are running out of staff, longer than normal wait times in Emergency departments
etc.
Overview of the Crisis Care Continuum
o As demand increases so does the risk to patients
o Conventional
Spaceusual beds fully utilized
Staffusual staff, including called in off duty
Suppliesusual or cache/stockpiled
Level of Careusual care
o Contingency
SpacePost-op or pre-op beds used, singles conversion to doubles
StaffLonger shifts, different staff configurations and supervision
Suppliesconserve, adopt, substitute, re-use supplies
Level of Carefunctionally equivalent care, but may be delayed
o Crisis
Spacecot-based care, ICU-level care in stepdown or monitored units
Staffsignificant change in nursing and MD ratios, major changes in clinical
responsibilities
Suppliesrationing of select supplies and therapies
Level of Carecrisis care, may have to triage medical care and ventilation
Plan and prepare and do everything we can from keeping hospitals across the state from going into crisis
care
Current status of Crisis Care Continuum
o With the current surge in the pandemic, many Hospitals are being stretched to provide the care
we want and expect for all Californians
o Hospitals are handling this surge as well as possible, by adapting their operations and space
o We need to be prepared for the possibility that some Hospitals will need to resort to crisis care,
in which medical professionals have to make hard choices about allocating resources
Hospitals and Crisis Care Continuum
o As resources have become more scarce, and as Hospitals are p
crisis care guidelines, planning, and implementation become critical to ensure the best care
possible is delivered to all Californians
o Care must be guided by ethics, equity, and transparency
o If an individual Hospital in a county or region reports implementing crisis care, other Hospitals
will be asked to share resources or temporarily change their operations
May need to call on bigger facilities to support smaller, less impacted to support more
impacted
Great deal of planning and with haste
Kim McCoy Wade, CDA Director
The state of California issued guidance to achieve the following four goals:
o 1) Hospitals are able to remain in conventional or contingent care as long as possible
o 2) All Hospitals in a region work together, along with County partners, to support each hospital
to remain in contingent care as long as possible
o 3) Hospitals have prepared plans for crisis care, rooted in equity, fairness and transparency, if
needed as a last resort
o 4) The public has clear and transparent information about the crisis care continuum and
Stakeholder Input on Crisis Care Continuum
o Guidelines announced in June informed by various stakeholders including Hospitals, Health
Systems, Local Health Jurisdictions, Emergency Services Managers, Aging community, Disability
community
o Advisory group formed including Doctors, Medical Ethicals, Aging, Disability, and Health Equity
o Also Informed by:
Existing state and national guidelines
Existing recent medical literature on Crisis Care
Medical Decisions Cannot be Based on:
o Age
o Race
o Disability
o Chronical Medical Conditions
o Gender
o Sexual orientation
o Gender Identity
o Ethnicity
o National origin
o Language spoken
o Ability to pay
o Weight/size
o Socioeconomic status
o Insurance status
o Perceived self-worth
o Perceived quality of life
o Immigration status
o Incarceration status
o Homelessness
o Past or future use of resources
Medical decisions primarily are grounded in likelihood of survival in near term
Dr. Ghaly
Thank you, Kim and for your tremendous leadership on this topic
CA is better because of your leadership
o Help Hospitals prevent Crisis Care
o Ensure Hospitals are planning for crisis care continuum
Tried to help plan; gave guidelines
Worked this
o Help Hospitals remain in crisis care mode for as brief a period as possible
o The State does not determine when a Hospital resorts to crisis care standa
determined by the Hospital based on need for hospitalization and available resources
o We have worked as a state so hard and so long to be ready
Given time to learn from our experiences and experiences across the Globe
We must continue to work to make sure Hospitals have chance to provide care to all
who need it
We want to do all we can to make sure patients in underserved, lower income
communities, that we give as many of those patients as possible care in areas where
they have capacity even
Working hard to do all we can to keep Californians safe
Regional Stay at Home Order
o Current available ICU capacity by region:
Bay Area 10.4%
Greater Sacramento 19.1%
Northern California 27.9%
San Joaquin Valley 0%
Southern California 0%
o What 0% really means is that those two regions are in their surge capacity in the aggregate, a
part or portion of the region may be at capacity while other parts of the region may have
capacity
o Regions must remain under the Order for at least three weeks and shall continue until ICU
capacity projections are above or equal to 15%
o Order will remain:
San Joaquin Valley
Southern CA
o Four-week projections show available ICU capacity not improving with demand exceeding
capacity
o Projections will be reassessed daily and update daily
Four-week projections of ICU capacity
o San Joaquin Valley
Current case rate: 97.5
Transmission 1.13
4-week ICU projection ICU demand exceeds capacity
o Southern CA
Current case rate 130.1
Transmission 1.10
ICU demand exceeds capacity
o These two reasons will continue under regional stay at home
Regional Stay at Home Order Projections
o Projections are made on a daily basis
Run by CDPH Data Team, incredible scientists, statisticians, epidemiologists
o Projections are based on 4 regional inputs:
Current ICU capacity
If very very low, likely to remain under order
Current 7-day average case rate
If very very high, likely to remain under order
Current transmission rate (Reff)
How fast is virus spreading, higher it is, less likely projection will be under 15%
Takes into account rates of actual transmission, takes into account our stay-at-
home order and the likelihood of following state mandates
Some regions that still have very high transmission rate
Current rate of ICU admission
Seen average age has risen, had been below 60 now it is above
Most individuals who have worse outcomes are our oldest Californians and
those with underlying conditions
Important factor to serve and support them and overall healthcare delivery
system
o If projection is equal or greater than 15%, the region is released from the order
o If projection is below 15%, the region remains under the order
Blueprint for a Safer Economy
o Counties moving from Purple (Widespread) to Red (Substantial):
Humboldt
o Today:
Purple: 54
Red: 3
Orange: 1
Yellow: 0
Together, we can stop the surge
o
Wear mask
Stay home
When we go out, keep distanced
No mixing
o Simple tools, many of you are tired of hearing and doing it
o Are in moment where it can really make difference
o We can all get transmission rate down
As the rate of transmission gets stronger, we will too
comes out of it
I will end with that
Questions
Can you explain in plain language how ICU capacity is calculated?
o From the beginning we have looked to make sure our whole health care delivery system is not
just available to take care of COVID patients but all our patients
o When we have seen ICU, capacity used for COVID above 30%, we consider that ICU ill-prepared
to care for other needs
o WE protect some of that capacity to make sure we can take care of much needed services
o Adjust to make sure we have that capacity for COVID and others
o capacity is used
primarily for COVID we consider that region at risk
How might it be appropriate to look back at last 9 months, can you share what CA has done well and
of control?
o Important question and I do save some time with the team and others to reflect on last 10
months
o We started this in Jan talking about repatriation, cruises
o Try to be concise
o at made hard decisions early
o First few months we could have had tremendous level of spread if not for local leaders and
decisions made
o That may have been our worst surge
o But because of decisions made we had a chance to prepare and learn
Treatments
Staffing
Tracing
o We have been able to learn and save lives
o Learned what it means to reopen and do that successfully, bring counties along and address
diversity across CA, quite different communities and personalities
o Make sure we have messages, form and method that balances needs
o The piece that I think is really important is COVID fatigue, the level of exhaustion
o The trauma, level of impact on day to day lives is tremendous and wherein we might have been
able to do it for a few months, getting here it feels long for people
o Californians in large numbers, because of
actions due to fatigue
o How do we change messaging, look to local leaders
o Some of the highlights that I think about often and I reflect on with other leaders and continuing
to try to do all we can
o Prepare for a time where we do have widescale distribution of vaccine, when we bring back
things,
o Do in the best way possible while making sure we stay safe and with as much of CA standing
stronger
Are you aware of hospitals that have had to declare crisis care and will this be publicly disclosed?
higher? Finally, can you discuss oxygen shortage?
o No doubt, this is a continuum
o
delivery systems
o
sick enough to need hospital level care
o In some ways, that is an example of doing something that is a form of contingency care
o Happening throughout impacted regions
o Emergency nurses and doctors looking at how they should stretch themselves effectively
o If you stretch far enough
is suffering because of the level of overwhelm
o About transparency, we have asked and part of what Director McCoy Wade was discussing is a
newly released to all facilities about their obligation to be prepared to think through crisis care
ahead of time, checklist, doing what they can to prevent going into crisis care and when they are
moving toward that to have a notification made to both local public health and CDPH
o On oxygen, we have been looking at issues on oxygen
o Not just availability, but the ability for hospitals
oxygen to be able to do it
o t
when the capacity of building is stretched, we are working with partners at county and local
level
o Partners at Cal OES to meet all of those needs
o Buy specific hospitals around those needs
o Not just meet state level, but partnering with nearby facilities to make sure needs are met
dropping off, patients being treated in ambulances. Can you go into more detail about Southern CA that
makes it so concerning, what is it about Southern CA that really concerns. Third, I know there was a
reference to state team that will be coming down, are they here yet and what will they be doing?
o We have not been noticed by a facility that they have instituted crisis guidelines
o True that some hospitals in Southern CA have put in place some practices that would be part of
crisis care
o Whether those are decisions about ambulances, how stretched staff become, looking at
effectiveness of certain treatments, that is happening in facilities
o We have not heard yet that any hospital is at point that they need to make decisions about two
patients who both need ventilator and had to make decision
o Greatest concern is ration critical care and staff
o But we know certain facilities are in crisis and have started to implement and we hope they are
doing so with great care
o In terms of second question, the specifics around LA
Wherein rest of state is seeing potentially trend of reduced transmission, a reduction in
test positivity, and hopefully reduction of demand by COVID patients for hospitalization,
we are not seeing that in Southern CA
Still seeing transmission over 1 and fact that it is still rising is concerning
Expect high number of patients asking for care
Ambulances that need place to drop off patients
A significant number, over 95% of hospitals in LA have been in diversion
Spending a majority of day on diversion
o All of those trends give me continued concern that we need to work to prepare for next holiday
trend of cases and likely projections in Jan that we will see significantly higher number of COVID
patients that need hospital care
o We can change this, we can make decisions to bend curve and help hospital system, all of those
who are day in and day out providing care to have relief
On point in what
their concern that we will see compounded spread? Christmas and then New Years? Is that more issue
that general prevalence of virus will be an issue?
o
o A number of people will be newly exposed over weekend that the urge of many Californians to
gather will lead to some transmission
o Hope some celebrations are cancelled and done differently, but we know and expect that some
of that will happen
o infected, others that are asymptomatic
o Concept of surge upon surge, exposure upon exposure is real
o Christmas exposure become amplified because of New Years and we could see worst of it in
early Jan and some of the leaders are bracing for that
o Significant surge, need to deal with more extreme conditions
Dr. Ghaly (Close)
Appreciate chance to answer questions and tell the story of the state
Plead with you to ask all Californians to consider decisions over next weeks as we work our way through
surge
Tough time for thousands of Californians
Look forward to seeing you soon