The latest and deadliest coronavirus surge has blazed across California, leaving no county untouched in the massive and diverse state, from dense, bustling metros to sprawling suburbs to vast rural and agricultural swaths of land.
Still, different parts of the state have felt the impact very differently.
The main stressor of the latest surge is the availability of intensive care units. State officials, fearing a post-Thanksgiving spike in cases would overwhelm hospitals, set a 15% ICU availability threshold to trigger regional lockdown orders. The restrictions are in effect for four of five regions, comprising more than 98% of the state’s residents.
In Northern California, the only region not under the stay-at-home orders, nearly one-third of ICU beds are still available. Greater Sacramento is at 17.4%, and the Bay Area region was last reported at 7.5%.
Both the San Joaquin Valley and Southern California regions are at 0%.
These and other data comparisons highlight the differences among the state’s most populated counties and metro areas, especially between the northern and southern parts of the state.
THE BAY AREA
The Bay Area as a whole is performing better than some of the most populated areas in and around Los Angeles. The Bay Area’s rate of new daily cases per 100,000 population has ranged from the 40s to mid-50s for the past few weeks.
“This could reflect the high mask compliance, high ventilation in our area due to its location and general adherence to distancing in the Bay Area compared to other regions,” said Monica Gandhi, an infectious disease specialist at UCSF.
She added that a “general trust of public health officials in the Bay Area, leading to greater compliance with stay-at-home measures” may also explain why the surge isn’t as bad here compared with Southern California.
Case rates differ quite a bit in individual Bay Area counties. San Francisco and Marin counties have lower recent daily case rates while Solano, Santa Clara and Napa have seen cases about twice as high. But they still fall below the state’s daily case rate, which has been in the high 90s and low 100s in the past week.
Solano County continues to lead the Bay Area with the highest daily case rates. The county’s health officer has attributed the surge to Thanksgiving and other weekend gatherings and activities, and individuals still gathering with others or going to work even if they know the risk or are symptomatic.
Santa Clara County has also recorded high daily case rates recently — mostly in the mid-60s per 100,000 people. Dr. Ahmad Kamal, the county’s director of health care preparedness, said Santa Clara had 28 ICU beds, or 8.5% availability, as of Wednesday. He said pandemic fatigue is a main driver, and communities of color in the southern and eastern part of the county are bearing the brunt.
Kamal said that five days after Christmas, the county has not yet seen a surge comparable to the one that occurred after Thanksgiving, and he hopes that residents canceled plans and took extra precautions over the holiday.
“We have major concerns coming up with New Year’s Eve, which has traditionally been a common time for gathering, particularly among young people who feel they are at low risk or not as susceptible to the virus,” he said.
Any further increase, Kamal said, will “tip us over the edge” to the point of Southern California, where patients are being treated in hospital gift shops and hallways.
“We’re teetering on the threshold, and with bated breath awaiting what happens over New Year’s Eve,” he said. “We’re not quite there yet but really close to it.”
GREATER SACRAMENTO REGION
Sacramento County’s case rate has recently been near the Bay Area average, dropping a bit from the low 60s to the mid-50s per 100,000 population. In a Board of Supervisors meeting on Wednesday, Public Health Officer Dr. Olivia Kasirye said that before Christmas, the county was averaging 800 cases and 10 additional deaths a day, and after the holiday it’s been 664 cases and six deaths per day.
“It seems we are beginning to head in the right direction but it is still too early to tell,” she said. “We have not seen the impact of Christmas and the travel that our residents did during that time, so we are still very cautious about the direction that the numbers are going.”
While ICU availability in Sacramento County is currently above the state’s 15% lockdown threshold, the health officer said the shelter-in-place order might not be lifted soon if there is a holiday spike, and patients in other overwhelmed areas might need to be moved to Sacramento-region hospitals. Earlier this month, the county began treating some COVID-19 patients at an alternate care facility set up at Sleep Train Arena.
Southern California has been overwhelmed by the latest surge, with cases so rampant that they have pushed the state’s rate to No.1 in the country.
Robert Kim-Farley, a professor at the UCLA Fielding School of Public Health, attributes the surge to pandemic fatigue. Counties in Southern California were also starting from a higher baseline, and many never reached the very low levels that Bay Area counties saw in October.
“With such high levels of the disease, the chance of going to the store and coming into contact with the virus is much higher,” he said. “It becomes a snowball effect.”
The composition of Southern California’s workforce has also made the region vulnerable. San Bernardino and Los Angeles counties, in particular, have large numbers of people working essential jobs in the manufacturing sector. Many are Latino and live in densely populated, lower-income areas where the virus can more easily spread.
According to the state’s data, San Bernardino County has the highest seven-day average case rate in the state at 165.5 per 100,000, the highest positive test rate at 23% and the highest positivity rate among disadvantaged communities at 26.8%.
Los Angeles County also has one of the highest case rates at 132.7 per 100,000, according to state metrics, with a positive test rate of 16.5% and health equity test positivity rate of 23.4%. Hospitals in Los Angeles County have been completely overburdened, with some diverting ambulances and placing patients in gift shops and conference rooms. Officials fear if things get much worse, hospitals might need to start rationing care.
Los Angeles County has the largest population in California by far, with more than 10 million residents, and is racially and economically diverse. Experts say the city was vulnerable from the start to a pandemic. According to the CDC, the county has a high social vulnerability score, which indicates how a natural disaster or disease outbreak can affect a community’s health. Neighboring San Bernardino and Riverside counties have even higher scores.
Kim-Farley said occasional mixed messaging from county leaders has led to confusion for residents, including from the divided Board of Supervisors, some of whom want to see the economy reopened, and others who want strong measures from the public health department to continue.
“People are not unified around a common vision and common message, and that confuses people,” Kim-Farley said. “This has been a problem at many levels of government.”
In neighboring Orange County, the case rate has averaged 104 per 100,000 people in the past week. Hospitalizations increased by 225% compared to a month ago. While the stay-at-home order in the Southern California region has been extended, meaning restaurants are shuttered for in-person dining, some Orange County restaurant owners have defied restrictions using the hashtag #OpenSafe.
On Tuesday, Riverside County recorded 73 deaths, an all-time high for the county.
The California National Guard deployed medical corps members to support a county hospital that has been understaffed, and overflow patients waiting for beds to open up have been placed in the facility’s cafeteria.
Kim-Farley said the Southern California counties are having their “New York moment.” At the beginning of the pandemic, New York City’s case rates skyrocketed and hospitals were overwhelmed.
“I think we’re going to see another increase over the next couple of weeks because of the amplification occurring over the holidays,” he said. “There is a light at the end of the tunnel with vaccines, but the tunnel is looking uglier and uglier to get through.”
Todd Trumbull designed the graphics in this article.
Kellie Hwang is a San Francisco Chronicle staff writer. Email: firstname.lastname@example.org