With hospitals full, Central California pleading to send COVID-19 patients to L.A.

The COVID-19 surge still affecting Central California is so dire that health officials are pleading with state officials to make it easier to transfer hospital patients to areas like Los Angeles County.

"We don't have enough hospitals to serve the population and the needs," said Dr. Rais Vohra, the Fresno County interim health officer. Hospitals across the entire San Joaquin Valley are "often running over capacity, so that they're holding dozens and dozens of patients in the emergency department."

Officials in the San Joaquin Valley are expecting a difficult winter. Vaccination rates are still relatively low, and in Fresno County, the region's most populous county, the COVID-19 hospitalization rate is quadruple what is being seen in L.A. and Orange counties, and more than quintuple that of the San Francisco Bay Area.

Hospitals are consistently operating above capacity, and emergency rooms are still so packed that ambulances are stuck waiting outside hospitals to drop off patients, said Dale Dotson, operations coordinator for the Central California Emergency Medical Services Agency.

Some hospitals are so crowded that ambulance patients suffering from strokes or cardiac-type symptoms are diverted to different facilities than typical to ensure that there's enough staff available to take care of them when they arrive. Hospitals and ambulance providers continue to report struggling with staffing, Dotson said.

Officials from the San Joaquin Valley are pleading with California state officials to find a way to make it easier to transfer hospital patients to other, less impacted areas.

"It's really hard to transfer across counties in the state of California," Vohra said. "When you look at Los Angeles ... they have hundreds and hundreds of open beds in Los Angeles County."

"If we need to transfer patients out to keep our hospitals operational, we should really be able to do that with one or two phone calls. That's not the situation right now. And so that's a point of frustration that we're hearing from multiple different facilities," Vohra said. "We're trying to really decompress as much as possible in anticipation of those winter numbers."

It was not immediately clear why Fresno County hospitals are reporting difficulty in transferring patients to other parts of the state.

"The red tape ... it's quite opaque," Vohra said. "Obviously, every hospital has a transfer center, and they're very used to doing transfers. But then that actually requires other hospitals to accept."

The L.A. County Department of Health Services said in a statement that it "welcomes patients from other counties while ensuring healthcare services are readily available for residents in our county."

The San Joaquin Valley has the worst COVID-19 hospitalization rate in all of California, with nearly 800 COVID-19 patients hospitalized in a region of more than 4 million people. By contrast, all of L.A. County has 558 COVID-19 patients, despite having a population of more than 10 million people.

For every 100,000 residents, Fresno County has 22 COVID-19 patients in its hospitals; while L.A. and Orange counties have six, and the San Francisco Bay Area, four. Some experts say it's a sign of concern when the COVID-19 hospitalization rate is five or worse.

Just 55% of Fresno County's residents are fully vaccinated. Statewide, the rate is about 63%; it's 65% in L.A. and Ventura counties, 66% in Orange County, 69% in San Diego County and 78% in San Francisco.

A big test of the late fall and early winter will be the weeks following Thanksgiving, when officials will be looking at COVID-19 numbers closely to see if a surge emerges from gatherings from the holiday weekend.

One plausible scenario could be that the San Joaquin Valley is hit relatively hard from a winter surge, the San Francisco Bay Area is hit much less so, and Southern California is somewhere in the middle, said Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco.

A surge in infections in the Central Valley could place a great deal of strain on local hospitals if many people who are infected are unvaccinated, who are far more likely to get seriously ill than those who've had their shots and are only suffering breakthrough infections.

"I think to a large extent, [the Central Valley] will continue to be suffering from a straining of hospital resources. So I think it's very wise and prescient of them to already start making arrangements" to prepare for a winter surge, Chin-Hong said.

Getting kids ages 5 to 11 vaccinated probably will have a major effect on the severity of each region's winter surge. While only 7% of Fresno County's children in this age range have received at least one dose of COVID-19 vaccine, about 12% of these children have done so in L.A., San Diego and Orange counties.

The rates in the Bay Area are far greater: 28% in Santa Clara County, 30% in San Francisco, and 46% in Marin County.

"That's going to give even more force-fields to the Bay Area compared to Southern California. So I think Southern California might be like the intermediate zone," Chin-Hong said.

While some places in California with low vaccination rates might not yet be seeing a surge, they may see one develop as the weather cools, sending people indoors, where transmission spreads more efficiently.

Some places might be "doing all right, but that may not last. Once this thing kicks off, it goes exponential," said Dr. Eric Topol, director of the Scripps Research Translational Institute in La Jolla.

California's statewide rate of full vaccination, 63%, is still too low to expect that we've created a wall of immunity, Topol said. "If we were at 90% of the total population, 85%, you know, then we'd have a chance to really hold off this," he said.

Nationally, the outlook looks discouraging. Although cases and hospitalizations have recently stabilized in California, the nation is seeing a clear rise in cases; the U.S. is now averaging about 91,000 new coronavirus cases a day, up from 74,000 cases per day a month ago. New daily COVID-19 hospital admissions are up 8% since Nov. 1 nationwide.

How regions fare during the winter will also depend on how many adults get their booster shot, Topol said.

"We know that their risk for severe disease is substantial" for vaccinated people over the age of 40 who haven't been boosted and are more than six months out from their initial vaccination series, he said.

For younger vaccinated adults who haven't been boosted, "their risk of symptomatic infection is increased. And the problem with that is, then, they can go on and infect other people. So that's why I strongly believe boosters are vital as part of our defense."

At a news conference in San Francisco on Monday, Gov. Gavin Newsom promoted shots for kids and boosters for adults.

Newsom warned that other states seeing increases in disease, such as Michigan, Colorado and New Hampshire, are potential warning signs.

"I don't want to see that happen here in California," Newsom said. "Get that booster shot."

Dr. Anthony Fauci, President Biden's chief medical advisor for the pandemic, agreed that weakened immunity among vaccinated people is a very real problem, and urged people to get their booster.

"You have waning immunity. It's a reality. We just have to face it," Fauci said Monday on "CBS Mornings." "When you get vaccinated, you get a high degree of protection but after several months, the immunity wanes. Even if you are infected and recover, the immunity wanes."

This story originally appeared in Los Angeles Times.