California's regional stay-at-home order has been extended for all but Northern California, as both Southern California and the San Joaquin Valley remain at 0% capacity for intensive care units.
The state's order applies to any region where the ICU capacity has fallen below 15%, according to Dr. Mark Ghaly, secretary of the California Health and Human Services Agency.
Here's the current capacity by region:
Ghaly noted that 0% does not mean there are no beds available. Instead, the state takes a more protective stance on capacity: if too many COVID-19 patients are occupying a hospital's ICU beds, that hospital may be unable to provide adequate care for other urgent care patients. So the state caps the number of ICU beds that can be taken up by COVID-19 patients. It also measures capacity by region, so even though one hospital may have fewer COVID-19 patients, others may have more patients than beds. It may have to divert patients, which spreads the impact around.
In the San Joaquin Valley and Southern California in particular, the ICU capacity is not improving, Ghaly said.
A region can reopen once its ICU capacity rises above 15% again. Ghaly said the state will continue to provide daily updates to its projections.
AVERTING THE NEED FOR CRISIS CARE
The state's overarching goal is to keep as many hospitals as possible from needing to implement crisis care for as long as possible.
Ghaly described three levels of care as the surge takes a greater toll on hospitals, from conventional to contingency to crisis care.
Contingency Care: Hospitals are converting singles to doubles, instituting longer shifts for staff, reusing and adapting supplies, and potentially being forced to delay care.
Crisis Care: Hospitals are resorting to cots, rationing certain supplies and therapies, seeing a significant change in nursing and doctor ratios, and possibly triaging medical care and ventilators.
That last scenario, Ghaly said, is something that "we need to plan for, be prepared around, but do everything in our power today to keep us from being in this situation across the state."
Hospitals are currently handling the surge as well as possible by adapting operations and space, Ghaly said, though he warned that it's time to prepare for the possibility that some hospitals may have to move into crisis care mode.
Ghaly noted that it is the hospitals, and not the state, that make the call on whether to resort to crisis care. The state's role is to provide assistance.
But if a hospital reports shifting to crisis care, other hospitals in the region will be asked to share resources or modify operations temporarily.
PLANNING AHEAD
In Los Angeles County, some hospitals have had to turn away ambulances and convert conference rooms and gift shops into makeshift patient holding areas.
Dr. Shruti Gohil of the UC Irvine School of Medicine says her hospital hasn't reached that point yet, but hospital officials there formed contingency plans for additional space back when the pandemic began.
"When we hear about a pandemic, there are groups within the hospital who are scoping out spaces in advance, so some of this stuff may sound scary, as though it's happening overnight. But actually, plans have been, probably, depending on the hospital, laid out in preparation for some time."
OVERALL LOOK AT CALIFORNIA'S NUMBERS:
Here's a look at longer-term trends in the state. To see more, visit our California COVID-19 Tracker and choose California or any county in the state that interests you. These numbers are current as of Monday, Dec. 28:
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