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“Everything that should be up is up, everything that should be down is down,” said California Governor Gavin Newsom on Monday as he sought to explain his sudden decision to end the state’s Regional Stay-at-Home Order. Newsom said he was referencing to Covid-19 numbers and vaccinations. Many in the state, however, have felt less certain of the nature of up vs. down.
While case and hospitalization numbers are indeed falling, the number of daily deaths attributed to the virus has remained stubbornly high, setting a new record of 761 on Thursday. The percentage of those dying in overcrowded ICUs has doubled since October.
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The governor said the decision to end the order was said to be based on four-week ICU projections, the formula for which the state had been unwilling to divulge before Monday. Newsom sought to open that black box at his news conference.
The state, he said, has been calculating available ICU capacity based on four factors: current estimated ICU capacity available, current community transmission, current regional case rates, proportion of cases admitted to the ICU. That’s for a modified realtime capacity. That available capacity is distinct from the the four week projections on which Monday’s reopenings were predicated. Confused yet?
Dr. Mark Ghaly said those projections are based on a commonly-used formula throughout the pandemic. That is: predictably two weeks after a daily case count, 12 percent of that day’s cases will be hospitalized, a predictable percentage of those will land in the ICU (in LA, that has been 23% of late) and a certain percentage of ICU patients end up dying. Ghaly pointed out that those percentages pertain not just as cases rise, but as they fall, and that is how the four-week projections were calculated.
For example, given falling cases and hospitalizations, the state projected on Monday that L.A. will rapidly move from 0% ICU capacity now to 33% capacity in four weeks. Curiously, that would take it from the state’s least-resourced region to the most resourced region.
When asked if the sudden turnaround was a result of the ongoing recall campaign and lawsuits against him, the governor said succinctly, “That’s just complete and utter nonsense.” Newsom attributed state’s reopenings to the aforementioned four-week projections.
Going forward, CA will revert to the its Blueprint for a Safer Economy, which color codes each county and uses actual transmission rates, not projections.
Authorities cited improving conditions in hospitals but noted that counties remain subject to the restrictive “purple tier” of guidelines for economic reopening. Individual counties are able to impose stricter restrictions than the state. It was unclear whether Los Angeles County — considered a national epicenter of the current surge in the virus — would be easing any of its restrictions.
But the state’s move today may lead to a resumption of outdoor dining and at least some services at gyms, barber shops and nail salons, among other businesses.
“California is slowly starting to emerge from the most dangerous surge of this pandemic yet, which is the light at the end of the tunnel we’ve been hoping for,” said Dr. Mark Ghaly, secretary of California Health and Human Services. “Seven weeks ago, our hospitals and front-line medical workers were stretched to their limits, but Californians heard the urgent message to stay home when possible and our surge after the December holidays did not overwhelm the health care system to the degree we had feared.”
The regional stay-at-home order was imposed in Southern California early last month when intensive-care unit capacity dropped below 15%. The regional capacity subsequently dropped to an adjusted 0%, and the order was extended on December 29.
The state’s vaccination efforts have been lackluster by most measures. As of last week, California had administered just 891,000 of its first 3.4 million doses of both vaccines. That’s barely 26%, according to data compiled by Bloomberg News. Only Alabama, Georgia and Virginia have lower percentages than California at administering their allotments.
Newsom said on Monday that the state had “tripled the pace of vaccinations from 43,459 per day on January 4 to 131,620 on January 15.” In a statement made later, he admitted that the “ten-day effort to ramp up vaccinations exposed key improvements needed to administer even more vaccines when increased supply becomes available.”
Local health officials have plead with state and federal officials for more vaccine — or even just to fulfill the allotments promised but not delivered.
On Thursday, L.A. County’s Chief Science Officer, Dr. Paul Simon said that if the region’s weekly allotment doesn’t dramatically improve beyond the current average of about 150,000, “the vaccination effort will likely extend well into 2022.”
When asked about those numbers, Newsom said the state never receives any actual doses and that local officials and the federal government are responsible for the actual delivery and administration of vaccines.
“We’ve had a very conservative approach to administering doses at the local level,” said the governor. He said some counties are very slow at recording data “because they consider it tertiary” to the objective of getting shots in arms.
“Data has become a big issue. [Vaccine] data has become a big challenge for us,” admitted the governor. “The [federal] data lag our internal data — what the national numbers show.”
Then there are the new variants of the virus, some of which are thought to be more infectious, others of which may be vaccine resistant. It is unknown how those will impact numbers going forward — or how Monday’s reopenings may impact the spread of the new variants.
Asked about his concerns, Ghaly said, “Of course we’re concerned about it. We don’t know what’s out there.”
The HHS director compared it to playing an unknown team in sports.
“We have an opponent we’ve never seen before,” said Ghaly. “We have no game film.”