ICU bed capacity has plunged to nearly zero in vast portions of the state as patients rush into hospitals, which are struggling to manage strains on resources and personnel.
"We're experiencing an explosive and very deadly surge," Los Angeles County Public Health Director Dr. Barbara Ferrer said.
State and local officials are continuing to enact lockdown and quarantine protocols for residents and visitors, even as the Pfizer vaccine rollout has provided some long-term hope. While it may be too early to tell due to the virus' long incubation time, aggressive stay-at-home measures put forth throughout California two weeks ago have yet to slow the spread.
As the nation's most populous state and home to approximately 1 in 9 Americans, California would understandably lead in a category such as total cases in a pandemic felt nationwide. However, it is the sheer volume of sick residents and the rate of increase that is particularly driving alarm.
On November 1, the seven-day average for new daily cases in California was 4,183. On Thursday, it was 38,774.
Multiple factors are at play when it comes to California's sudden acceleration of coronavirus cases, including Covid-19 fatigue, resistance to stay-at-home regulations, the huge number of essential workers and the socioeconomic factors of the pandemic affecting poorer and minority households.
More than 22,000 Californians have died
The California Department of Public Health announced 379 Covid-19 deaths on Thursday, the state's highest one-day total yet, shattering the prior record of 293 lives lost announced on Wednesday. Friday's numbers also cleared the earlier record, with 300 deaths reported. More than 22,000 Californians have died from Covid-19.
California's overall case number is more than 1.7 million, with 52,281 new cases added Thursday. More than 41,000 new cases were announced Friday, as officials noted some were from earlier and had yet been reported.
The daily increase of more than 50,000 cases is staggering for the state, particularly when compared to other outbreaks around the world. According to Johns Hopkins University (JHU) Covid-19 data, California's daily average of new cases outpaces Canada, Spain and Argentina, all nations with similar populations.
Even more populated countries such as Germany and the United Kingdom have not approached the same level of new infections as California, let alone the entire United States.
The forecast for the California health care system's response to Covid-19 is worsening. More than 16,000 people on Friday were in hospitals, with at least 3,000 patients in intensive care, and more are expected in the coming days and weeks during the holiday season. Fewer than 1,300 ICU beds in the state remained available Thursday.
"LA County is moving toward becoming the epicenter of the pandemic," Dr. Brad Spellberg, chief medical officer at LAC + USC Medical Center, warned in a media briefing Friday.
"We're getting crushed," Spellberg said about the county's hospitals. "I'm not going to sugarcoat this. We are getting crushed."
Hospitalizations in Los Angeles County have doubled since the start of December, according to officials, who have pushed to discharge patients and continue care at home to handle the influx of arrivals.
Santa Clara County, part of the Bay Area, had only 15 ICU beds remaining of the 317 available as of Wednesday.
In preparation for the fallout of additional thousands dying from Covid-19, California activated its "mass fatality" program Tuesday to better coordinate assistance between state and local agencies. An additional 5,000 body bags were purchased, and 60 refrigerated storage units will be used throughout the state for emergency overflow for coroners and morgues.
'This virus uses our humanity against us'
The arrival of the holiday season led to concern among health officials that families lulled into a false sense of security may gather in large groups over Thanksgiving, sparking infections in multiple households.
The surge may have proven their worries correct.
California, which in months prior did not face the same rate of increase as other parts of the country, accelerated in December to near the top of the list of states per capita with new daily infections, according to JHU data.
Yet the spike cannot be attributed to Thanksgiving alone. California cases were already beginning to rise earlier in November. State officials at the time directly tied it to Covid-19 fatigue, with more instances of private, indoor gatherings that can expose individuals to greater risk of infection.
"Unfortunately, the stories I hear from the patients, it's all been the same story. People are just having Covid fatigue," Dr. Thomas Yadegar, the ICU director at Providence Cedars-Sinai Tarzana Medical Center, told CNN's Paul Vercammen in an interview Friday.
Yadegar explains that his patients often described practicing social distancing and being mindful until Thanksgiving arrived, even going as far as checking symptoms and testing before meeting family.
"This virus uses our humanity against us. We want to be with our loved ones, especially around the holidays. And unfortunately as soon as you start mixing households, as soon as you come indoors, this is how the virus spreads," he said.
The early spring outbreak and later successes the state had against Covid-19 seem like a distant memory. After a summer of stop-and-start measures to reopen the state, the onset of winter has pushed California to return to lockdown plans.
"We're going through perhaps the most intense and urgent moment since the beginning of this pandemic," Gov. Gavin Newsom said Tuesday.
Divided into five regions, California kicks in stay-at-home orders whenever a region falls below 15% ICU capacity in area hospitals. Initially limited to Southern California and the San Joaquin Valley on December 6, the Sacramento and Bay Area regions have since followed suit, impacting 98% of California's population. Rural parts of Northern California have avoided the 15% ICU threshold for now.
The orders require the closure of businesses like bars, hair salons, museums, movie theaters and indoor recreational facilities. Retail businesses are allowed to stay open at 20% capacity, while restaurants are limited to takeout and delivery service. Travel is prohibited except for essential activities.
San Francisco announced those returning or traveling to the Bay Area must face a mandatory 10-day quarantine, beginning Friday and lasting through January 4.
"Covid-19 cases are surging in San Francisco and across the country. Hospitals in the Bay Area are close to being overwhelmed," Mayor London Breed said Thursday. "We must do whatever we can to contain the virus and stop its circulation in our community."
Essential workers are particularly vulnerable
The frustration of Californians in response to the latest restrictions, however, may be an indicator of Covid-19 fatigue paired with the difficulties of navigating an ever-shifting lockdown landscape that some find inconsistent.
Restaurant and bar owners protested the shutdown of outdoor dining as large indoor retailers and grocery stores remain open in limited capacity.
Ruth Benzor, a charge nurse for the Covid-19 unit at Arrowhead Regional Medical in San Bernardino County, told CNN's Anna-Maja Rappard she sympathized with the small businesses impacted by the pandemic, but she is faced each day treating dying patients with a shrinking number of ICU nurses and beds.
"I definitely want them to work, but they just have to understand that this is real and we just got to, you know, protect each other as a community."
The state department of health closed access to outdoor playgrounds in early December, yet reversed its decision after public and legislator backlash.
"It is necessary for the mental and physical health of children to have opportunities to expend their physical energy and play. However, especially in lower-income communities, families may have little to no outdoor space of their own available," California lawmakers wrote in an open letter to Gov. Newsom, citing the comparative decreased risk of infection via surface transmission.
The pandemic's differing effects on Hispanic, Black, White and Asian communities are also evident.
Dr. Ferrer, the LA County Public Health Director, said on Wednesday that Hispanic residents in the county have been hospitalized at three times the average rate of White and Asian residents since early November. Black residents are twice as likely on average to be hospitalized than White and Asian residents.
Ferrer also noted the socioeconomic consequences of Covid-19 in LA County, stating that the death rate among those living in areas with the fewest resources is now four times higher than those living in the most prosperous.
"The widening gaps are a stark reminder that many of our essential workers are Black and Brown, and many are not able to telework or stay home," she said.
"Many work at jobs with low wages, and many live in under-resourced neighborhoods. During the surge all our essential workers are taking on increased risk at their jobs because community transmission rates are so high."
A recent UC Berkeley Labor Center analysis highlights the millions of Californians who were considered essential workers during the earlier portions of the pandemic.
While parts of California are some of the wealthiest in the nation, poverty still affects a wide number of residents. A 2019 Census Bureau study found that, when accounting for additional expenditures and adjusted costs of living, nearly 1 in 5 Californians lived in functional poverty. The percentage was the highest rate in the nation among states.
A lesson for the nation to stay diligent
Despite having a supermajority of Democrats in its legislature, California is far from a homogenous bastion of blue. Much like the nation writ large, pockets of a state can have a fervent base of an opposing party's supporters.
The Covid-19 numbers statewide do not reflect a scenario where more conservative parts of California are failing while liberal parts are thriving, albeit according to state figures some of the hardest struck counties per capita reside in Republican US House districts.
The statistics illustrate the politization of wearing masks and the reluctance to take the threat of Covid-19 seriously has created undue volatility for governments, businesses and individuals alike, and California's surge can serve as notice for the rest of the nation to stay diligent regardless of location.
"It's really not California, it's the entire country, unfortunately," Dr. Edward Jones-Lopez, an assistant professor at the Keck School of Medicine of USC, told CNN.
Speaking to the need to wear masks and avoid family gatherings, he added, "The next two months are going to be critical to really understand how bad this can be. And even after the vaccine is slowly rolled out, we will need to continue with the basic interventions that we all know now."
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