Californians will soon be under yet another series of strict restrictions limiting travel, in-person shopping and other business activities — this time it all hinges on the level of strain on hospitals.
Welcome to what Governor Gavin Newsom called the “final surge,” the most challenging moment since the beginning of the coronavirus pandemic.
Newsom made the announcement for a new regional stay-at-home order while quarantining at home. This time around, the restrictions will be triggered in regions running low on intensive care unit beds.
The order takes effect on Saturday, December 5. The tighter restrictions apply once a given region has 15% or less of its Intensive Care Unit beds available. If 85% or more of all Southern California’s ICU beds become occupied, the order kicks in within 24 hours and lasts at least three weeks.
The Southern California region for the purposes of this order includes Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura, Imperial, Inyo, and Mono counties.
Southern California may be just days away from reaching that ICU threshold. In Los Angeles County alone, 76% of ICU beds were filled on Thursday, according to the Department of Public Health.
“The bottom line is if we don’t act now, our hospital system will be overwhelmed,” Newsom said. “If we don’t act now, we’ll continue to see a death rate climb, more lives lost.”
He added that California is currently on track to hit 112% ICU capacity by mid-December.
Dr. Brad Spellberg, Chief Medical Officer at the Los Angeles County-USC Medical Center, says his emergency department has seen more patients with COVID-19 than even the peak in July. “Where we typically run well above 90% of our ICU beds occupancy because we're such a busy trauma center. And this is taking us to almost capacity,” he said.
The issue for hospitals isn’t entirely with beds, he said. “The limitation is not space. The limitation is qualified people. We can create a bunch of new beds. Who's going to take care of patients in those beds?” Spellberg said.
Spellberg explains that the restrictions aim to further stop gatherings and transmission to avoid “battlefield-type medicine” in the health care system.
So why is ICU capacity the new marker?
Spellberg says it's the correct approach to take. “The thing that has always been the Achilles heel in the health system is ICU level care,” he explained, “When hospitals become overwhelmed, they're going to become overwhelmed in the intensive care unit and then it's going to spill over to all other aspects of health care.”
Once ICUs hit capacity in a region, there will be mandated closures of a wide range of businesses including hair and nail salons, indoor recreation centers, movie theaters, bars, wineries and museums — much like the strict statewide shutdown in March. Occupancy at grocery stores and all retail outlets will be restricted to 20% capacity.
Other regions of California would have to follow Los Angeles County’s suit regarding restaurants. Outdoor dining under the new rules becomes off the table and restaurants will only be able to offer take-out and delivery services.
The order also restricts nonessential travel. State officials acknowledge travel restrictions are hard to enforce but say that hotels and other lodgings will only be allowed to stay open to serve essential workers not leisure travel.
K-12 schools are not affected by the new rules, and public school campuses that were already allowed to open for at least partial in-person instruction when conditions were better in early fall can stay open.
Public parks, beaches, and hiking trails are also unaffected. State officials are encouraging people to recreate outdoors to keep mentally and physically healthy.
The restrictions are not quite as drastic as those in March, and could be confusing to Californians who have been hearing a wide variety of new City and county measures nearly every week like clockwork. But Spellberg said the best way for public health departments and governments to fix their messaging is to stick to the basics.
“There is light at the end of the tunnel, but we're not at that light yet. And if we don't do things correctly, if we don't stick to the basics, that tunnel could collapse on us before we can get to that.”