California's COVID catastrophe shows worst-case holiday scenario

Public health officials are pointing to California as a cautionary tale of how the coronavirus can spread during holidays, just before the next holiday season threatens to amplify outbreaks that could overwhelm the nation’s most populous state.

As the pandemic raged for months in epicenters across the country, California residents abiding by lockdown orders and advisories from public health officials managed to avoid a calamity of contagion. Infection rates, hospitalizations and even deaths lagged well below national averages.

But California is now one of the worst epicenters in the nation, second only to Tennessee, as a wave of infections likely spread during the Thanksgiving holiday threatens to overwhelm public health systems across wide swaths of the state.

“The Thanksgiving holiday season has hit us really hard,” Nathan Fletcher, a San Diego County supervisor, told reporters at a briefing.

The virus is spreading rapidly especially across Southern California and the Inland Empire. Los Angeles County is averaging 145 new cases per 100,000 residents every day, or 1 percent of its entire population every week. The numbers are higher in San Bernardino and Riverside counties that border Arizona, and in Fresno and Monterey counties to the north.

On Monday alone, California reported 62,000 new cases, the highest single-day case count ever reported in the state. In the last week, the Golden State is averaging 45,000 new cases a day, a spike seven times higher than the weekly average just a month-and-a-half ago.

Test positivity rates stand at 13 percent, the highest level since April; in places like Los Angeles County, it is even higher. The average infected person is creating an estimated 1.3 new cases statewide, a figure that means case counts are still growing.

The number of daily deaths is rising too, up fivefold over the same period, according to data maintained by the Covid Tracking Project, a group of independent researchers. More than 18,000 Californians are currently hospitalized with COVID-19, twice as many as were in hospital on Dec. 1.

Statewide, only about 2 percent of intensive care unit beds are available. In Southern California, ICU beds are full, and hospitals are scrambling to create new beds in operating and surgical recovery rooms. Sixty-two patients are being treated in temporary hospitals set up to handle overflow surge.

A statewide tier system implemented by Gov. Gavin NewsomGavin NewsomNewsom taps Shirley Weber to serve as California secretary of state Newsom picks Padilla for California Senate seat California governor reentering quarantine MORE (D) after the harsh wave of lockdowns has now been triggered across much of California. Four of five regions in the state are under stay-at-home orders, and Newsom said Monday it is likely that at least Southern California will remain in lockdown beyond the current scheduled end date of Dec. 28.

Newsom himself is in quarantine for the second time in a month, after coming into contact with someone who subsequently tested positive for the virus.

The state’s trend lines are worrying. Models from the University of California-San Diego and the Children’s Hospital of Philadelphia show case counts continuing to rise for weeks, perhaps into mid-January. Hospitalizations tend to trail confirmed cases by a week or two, raising the frightening prospect of a month of rising hospitalizations at a time when capacity is already strained.

“With Christmas at the end of the week, the potential for catastrophe is high,” said George Rutherford, an epidemiologist at the University of California-San Francisco. “We have quite a ways to go, and the ERs and the ICUs are just being hammered.”

The threat of an overwhelmed health care system goes beyond the rising number of those who need treatment for severe COVID-19. Hospitals are beginning to take even more drastic steps, delaying tumor removals for cancer patients or organ transplants for those in need of surgery. At the same time, hospital staffers working round-the-clock shifts are becoming exhausted.

“Our inability to control the spread of COVID-19 is causing hospitals to take extraordinary action in order to free up space,” Fletcher said. “The staffing challenges are real, and it could mean we may not be able to actually staff the available ICU beds that we have today.”

For weeks, public health officials warned residents against traveling during the Thanksgiving holiday. But the new infection data show Californians, and others across the country, did not heed that advice.

At the same time, several high-profile public leaders seemed to flout their own rules, at least in spirit if not in the letter of the law. Newsom was photographed at a large dinner at the French Laundry, one of Napa’s most prestigious restaurants; San Francisco Mayor London Breed (D) visited the establishment the next day.

“There’s a disconnect between what people hear and what they believe they need to do, and we no longer have a solid partnership between the government and the community, or the public health enterprise and the community,” said Andrea LaCroix, chief of epidemiology, family medicine and public health at the University of California-San Diego’s School of Health Sciences.

“It’s just somehow not horrific enough for people to say, ‘I shouldn’t do this,’” she said.

Experts watching the rising case counts say California has been hit hard in this latest round, too, because it had avoided so many infections early on in the pandemic. While states like New York and New Jersey in the first wave, Arizona in the second wave and the Dakotas early in the third wave suffered widespread infections, relatively fewer infections in California means more of the population remains at risk.

“The virus is like a psychopathic hitchhiker. It needs a ride to the next person, and the only way it gets a ride really is from person to person. But it’s invisible and it’s only lethal some of the time,” LaCroix said. “The vast majority of the population hasn’t been infected yet and remains vulnerable.”

California’s experience, too, is a sign of what can happen when viral infections hit a critical mass. There are so many infections circulating now, especially among asymptomatic carriers who can spread the virus without knowing they are doing so, that even harsh lockdowns cannot prevent contact between those who are infected and those who are not.

“The greater the number, the greater the risk for possible exposure,” said Matthew Mimiaga, an epidemiologist at UCLA and director of the university’s Center for LGBTQ Advocacy, Research and Health. “In Southern California, the numbers have been high for a good amount of time now.”

Now, officials are desperate to rebuild public vigilance that has crumbled under the weight of pandemic fatigue and the happy news of a vaccine on the way. The fate of some of the largest public health systems in the nation depend on it.

“We have to take action different at Christmas than we did at Thanksgiving. If our individual actions at Christmas resemble those at Thanksgiving, we very well could overwhelm the system that we are holding together on a daily basis,” Fletcher said. “Our actions that we take on the holidays are a downpayment to put us in a better position after the first of the year to be able to come out of this strong and to prepare for the arrival of large numbers of vaccines.”