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California Introduces Regional Stay-At-Home Order Based On ICU Capacity

Jae C. Hong
AP Photo

Updated 3:18 p.m.

With COVID-19 cases and hospitalizations passing the peaks set this summer, California introduced a new regional stay-at-home-order based on intensive care capacity to try and slow the spread moving into the winter holidays.

The new public health order, released Thursday, affects regions of California that have less than 15% of ICU capacity remaining. None of the five regions designated by the state currently meet that criteria, but some are expected to as early as this week.

“The bottom line is if we don’t act now, our hospital system will be overwhelmed,” Gov. Gavin Newsom said.

Regions affected by the order will need to comply with restrictions for three weeks. The order ends all operations at the following businesses:

  • Indoor and Outdoor Playgrounds
  • Indoor Recreational Facilities
  • Hair Salons and Barbershops
  • Personal Care Services
  • Museums, Zoos, and Aquariums
  • Movie Theaters
  • Wineries
  • Bars, Breweries, and Distilleries
  • Family Entertainment Centers
  • Cardrooms and Satellite Wagering
  • Casinos
  • Limited Services
  • Live Audience Sports
  • Amusement Parks

Retail stores and shopping centers are permitted to remain open indoors at 20% capacity, and restaurants can stay open for takeout only. Outdoor recreation facilities can also stay open with modifications,  and entertainment production, including professional sports, can operate without a live audience.
Residents in counties affected by the order can still go to the doctor, buy groceries, go on a hike or worship outdoors. K-12 schools that are already open can continue operating indoors as no more than 20% capacity.

The order splits the state into five regions:

  • Northern California: Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Shasta, Siskiyou, Tehama, Trinity
  • Bay Area: Alameda, Contra Costa, Marin, Monterey, Napa, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma
  • Greater Sacramento: Alpine, Amador, Butte, Colusa, El Dorado, Nevada, Placer, Plumas, Sacramento, Sierra, Sutter, Yolo, Yuba
  • San Joaquin Valley: Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare, Tuolumne
  • Southern California: Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura

While no region currently meets the criteria that would trigger the added restrictions, Newsom said four of the five regions are projected to meet ICU capacity by mid-December.

“The Bay Area may have a few extra days," Newsom said. "But all within just the next few weeks, our ICU capacity will drop.”

A slide from Gov. Gavin Newsom's presentation Thursday projects when regions may hit ICU capacity.

Once regions fall under the stay-at-home order, they have to remain under it for three weeks. The order can end once a county’s ICU capacity projected out four weeks is above or equal to 15%.

The state will assess regions on a weekly basis. Once released, a county will return to its color category in the state’s tiered system, based on its case and test positivity rates.

More Californians Hospitalized Than Ever Before

The new order comes as more than 8,500 Californians are hospitalizedwith COVID-19, more than any other time in the pandemic. At least 2,000 of those are in intensive care units.

Marta Induni, senior director of research for Public Health Institute, an Oakland-based nonprofit focused on health equity, said focusing the new order on ICU capacity made sense.

“Sheltering in place, it’s always been ‘we don’t want to overwhelm our health care system,’" Induni said. "We see that we are approaching overwhelming our healthcare system, so triggering it when we get to less than 15% of ICU capacity, I think that makes a lot of sense.”

Newsom hinted at the new orders on Monday, when state officials shared projections showing many parts of the state could be weeks away from COVID-19 cases overwhelming ICU capacity at hospitals. More than 99% of California residents were already under a 10 p.m. to 5 a.m. curfew order Newsom introduced Nov. 19.

It follows more restrictive orders in the Bay Area and Los Angeles earlier this week.Santa Clara County announced travel restrictions requiring anyone who travels 150 miles from the county to quarantine for 14 days.

Wednesday night Los Angeles Mayor Eric Garcetti announced restrictions requiring city residents to remain in their homes and avoid all gatherings, but with nine pages of exemptions for businesses, religious institutions and other activities. Los Angeles County introduced its own restrictions, including a ban on outdoor dining, earlier in the week.

But even as cases rise, state and local officials have received more challenges from business and religious leaders on the restrictions. On Wednesday, a judge asked Los Angeles County to show scientific evidence supporting its decision to stop outdoor dining after the California Restaurant Association sued to overturn the ban. And on Thursday the U.S. Supreme Court sided with a California church challenging the state's restrictions on religious gatherings, sending the case back to a lower court to revisit an earlier ruling.

Following the announcement, California Republican leaders called on Newsom to release more data that would support the need for new restrictions.

“Governor Newsom continues to disrupt life as we know it without releasing the full data behind his decisions or showing the impact his actions are having on our lives," state Senate Republican Leader Shannon Grove wrote in a statement. "And to be clear, it’s not just about the numbers of COVID-19 cases and hospitalizations he runs through in his almost-daily press conferences, but the data and facts about the toll his shutdown orders are taking on Californians’ mental health, on our children’s education, including the achievement gap, on domestic violence and child abuse rates.

Health Care Systems Worry About Capacity, Staffing

The announcement comes amid fears that the ongoing surge will overwhelm California’s health system, particularly when it comes to intensive care unit capacity.

On Monday, state health officials said 75% of ICU beds are currently occupied, and that number is projected to reach 112% by Dec. 24.  It could be even worse for Northern California hospitals, where 85% of ICU beds are currently full. All regions are expected to hit their ICU capacity by early January according to state projections, assuming new restrictions aren't put in place.

The ICU is the landing place for COVID-19 patients who need the highest level of care, and those beds need to be staffed by a certain number of specially trained providers, said Peggy Broussard Wheeler, vice president of rural health for the California Hospital Association.

“If you have patients in those beds, then you have to have the adequate staffing to be able to take care of those patients,” she said. “And that's where the crisis is going to be, is in staffing.”

This is particularly challenging for short-staffed rural hospitals with small or nonexistent ICU’s.  Wheeler said these hospitals have historically leaned on larger facilities as a safety net, working to stabilize patients so they can transfer them elsewhere for more specialized treatment.

“Now is that is whittling away because the larger facilities are all tremendously impacted by COVID and other patients,” she said.

She says hospitals have had to “MacGyver” solutions to try to keep staff and patients safe.

“You now have to ask a nurse or maybe even a physical therapist or a respiratory therapist assigned to the COVID beds to be the deliverer of food so that you're not exposing other people in your hospital,” she said. “You're having to do this on the fly to keep those patients safe. You're needing to explore innovative options that maybe you wouldn't have even thought about in the past.”

Earlier this year the state set up “field hospitals” at arenas and fairgrounds to serve overflow COVID-19 patients. Newsom says there are 11 facilities ready to move from “warm status” into “active capacity” and begin receiving patients. That includes the Sleep Train Arena in Natomas, which is scheduled to open Dec. 9 with 224 possible beds.