Over 1K Hospitalized In Orange County, Surge Plans Underway

ORANGE COUNTY, CA —A record number of COVID-19 patients were hospitalized in Orange County Thursday morning. Having reached their "pandemic high," Orange County hospitals were being directed Thursday to implement surge plans and cancel elective surgeries in response to a "crisis" situation that could cause the emergency medical system to "collapse."

The number of patients hospitalized rose from 974 on Wednesday to 1,025, a new record which includes 257 in intensive care. The grim record supersedes the previous peak of 245 in mid-July.

The Orange County Health Care Agency also reported 1,521 new coronavirus diagnoses on Thursday, raising the cumulative to 94,647.

The agency also reported seven new fatalities, raising the death toll to 1,640. One of the deaths was a skilled nursing facility resident.

Late Wednesday night, the HCA sent a letter to hospitals, ambulance providers, and 911 paramedic providers, saying the county's health care system "is now in crisis" due to the surge in COVID patients, with more hospitals requesting diversion of ambulances to other medical centers due to patient volumes.

According to the letter, "This results in dangerous delays in initial patient assessments to ensure they don't have an emergency medical condition. Hospitals are overwhelmed with admitted patients to both the floors and the ICUs. At the current rate of deterioration, the EMS system may collapse unless emergency directives are implemented now."

The letter from Dr. Carl Schultz, HCA's EMS medical director, urges hospitals to activate surge plans, establish alternate treatment areas in emergency departments to expand capacity, cancel all elective surgeries, apply for state waivers in support of surge plans and establish emergency operations centers.

"To those facilities that have activated these initiatives, all healthcare partners and the citizens of Orange County are grateful," Schultz wrote. "To those who have chosen not to take this painful but necessary actions, there is still time, but you must act now."

Schultz's letter was a recommendation at this time, but could precede an order from Dr. Clayton Chau, the county's chief health officer and director of the Health Care Agency, said Orange County Supervisor Lisa Bartlett.

Bartlett, who is also on the Orange County Fire Authority board, said ambulance services are experiencing delays in transferring patients.

"When you get a 911 call, and a patient is coming into the ER ... and they say they're completely full, and we're referring you to another hospital, there could be a 15- to 20-minute delay getting that patient into another hospital," Bartlett said. "When you get a 911 call, time is critical, and every minute makes a difference."

Bartlett said the county is likely now just experiencing a surge of cases from Thanksgiving.

"It further emphasizes my point that it's not things like outdoor dining at restaurants causing Covid surge. It's small- to medium-sized gatherings," Bartlett said.

"This is basically a Hail Mary pass," said Andrew Noymer, a UC Irvine associate professor of population health and disease prevention, of the county's directive to hospitals.

"It illustrates the gravity of the situation," Noymer said.

The statistics this week are reflecting Thanksgiving gatherings, he said.

"There will be people who strictly didn't get it from a Thanksgiving gathering but are getting it from someone who was at a Thanksgiving gathering," he said.

The county has seen an uptick in ambulance requests, said Orange County Fire Authority Capt. Thanh Nguyen.

"We have noticed a slight increase in the time it takes to offload some patients at hospitals, but so far, it hasn't affected our ability to provide service at all," Nguyen said. "But if it continues down this route, we do have a surge plan in place."

Part of that plan includes increasing paramedic staffing, Nguyen said.

"The public health implications caused by the pandemic have no doubt been challenging," said Anaheim police Sgt. Shane Carringer, a spokesman for the city's fire department as well. "Anaheim Fire and Rescue is continuously gathering information from the county, and we will consider all appropriate measures, including considering a change in personnel deployments, to meet the potential needs of our community and the medical needs of patients. This instance serves as a reminder to those in our community of the importance of personal responsibility and taking the appropriate precautions to slow the spread of the virus."

The county's percentage of available ICU beds went from 11.2% to 11.3% Thursday. Still, according to a new state metric for "adjusted" ICU bed availability, the rate went from 4.9% to 3.5%, according to the HCA.

Kim said the "adjusted" case rate essentially reflects the estimated number of beds available for COVID-19 patients when factoring in the number of beds needed for patients without the coronavirus.
The county has 53% of its ventilators available.

The 11-county Southern California region's available ICU capacity diminished from 9% to 7.7%.

Orange County's adjusted daily case rate per 100,000 rose Tuesday to 30.3, up from 22.2 last week, with the positivity rate increasing from 8.8% to 10.6%.

The county's Health Equity Quartile Positivity Rate, which measures the cases in highly affected, needier parts of the county, rose from 13% last week to 16.2% this week.

All of the county's metrics now fall within the state's most- restrictive, purple tier of the four-tier coronavirus monitoring system.

Again, county officials were focusing on a surge in coronavirus cases in skilled nursing and assisted living facilities, Kim said.

Two dozen skilled nursing facilities in the county have reported two or more cases of COVID-19 in the past two weeks, and 22 assisted living facilities with two or more cases in the past 14 days.

County officials were asked to provide personal protective equipment, more training, or staffing to help curb the spread of COVID-19 in those facilities. The main reason for the spread is likely from employees who contract the virus off-site, Kim said.

The current city-wide coronavirus totals are as follows, as of Thursday morning:

• Aliso Viejo - 740 Total Cases
• Anaheim - 15695 Total Cases
• Brea - 997 Total Cases
• Buena Park - 2720 Total Cases
• Costa Mesa - 3130 Total Cases
• Coto de Caza - 82 Total Cases
• Cypress - 979 Total Cases
• Dana Point - 524 Total Cases
• Fountain Valley - 1107 Total Cases
• Fullerton - 4479 Total Cases
• Garden Grove - 5595 Total Cases
• Huntington Beach - 3875 Total Cases
• Irvine - 3343 Total Cases
• La Habra - 2448 Total Cases
• La Palma - 271 Total Cases
• Ladera Ranch - 325 Total Cases
• Laguna Beach - 366 Total Cases
• Laguna Hills - 577 Total Cases
• Laguna Niguel - 846 Total Cases
• Laguna Woods - 124 Total Cases
• Lake Forest - 1468 Total Cases
• Los Alamitos - 389 Total Cases
• Midway City - 248 Total Cases
• Mission Viejo - 1563 Total Cases
• Newport Beach - 1645 Total Cases
• Orange - 4428 Total Cases
• Placentia - 1659 Total Cases
• Rancho Mission Viejo - 116 Total Cases
• Rancho Santa Margarita - 604 Total Cases
• Rossmoor - 79 Total Cases
• San Clemente - 1074 Total Cases
• San Juan Capistrano - 1015 Total Cases
• Santa Ana - 17998 Total Cases
• Seal Beach - 434 Total Cases
• Silverado - 52 Total Cases
• Stanton - 1142 Total Cases
• Trabuco Canyon - 333 Total Cases
• Tustin - 2228 Total Cases
• Villa Park - 106 Total Cases
• Westminster - 2185 Total Cases
• Yorba Linda - 1427 Total Cases

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City News Service, Patch Editor Ashley Ludwig contributed to this report.