Nearly a fifth of Fresno County residents have caught COVID. When could things get better?

The unbridled spread of coronavirus and its highly contagious omicron variant continues to fuel a surge of cases in Fresno County that is unprecedented since the first COVID-19 infections were confirmed more than 22 months ago.

On Wednesday morning, the number of total laboratory-confirmed coronavirus cases reported to date by the Fresno County Department of Public Health stood at more than 198,000 since the beginning of the pandemic.

That figure that is likely to surpass 200,000 cases, or almost one-fifth of the county’s overall population of about 1 million residents, before the coming weekend.

Nearly one-quarter of all of the county’s confirmed cases in the COVID-19 pandemic have surfaced since Jan. 1.

Slowdown on the way?

Yet there may be indications of a slowdown in the spread of the virus that could, over the next several weeks, provide a much-needed reprieve to hospitals and health-care workers who have been inundated by a flood of patients requiring care.

That influx of patients are not only those being treated for COVID-19, but for myriad other illnesses, ailments and conditions aside from the pandemic.

The transmission of a virus in a community is measured through what epidemiologists call the R-effective, or the effective reproduction number – an estimate of the average number of people to whom one infected individual can transmit the virus.

In Fresno County, that number has fallen in recent weeks.

“It looks like the whole state may be experiencing a downward shift in the R-effective number, which is usually the first number to change, even before the case counts start to drop and certainly before the hospitalizations drop off,” said Dr. Rais Vohra, interim health officer with the Fresno County Department of Public Health.

An R-effective number higher than 1.0 indicates that the spread of a virus is likely increasing in a community, while a number less than 1.0 suggests that the spread is decreasing, according to according to the state Department of Public Health.

As recently as Jan. 5, the R-effective in Fresno County was estimated at 1.58, the highest level since March 2020, reflecting a significant rate of spread of COVID-19. By early this week, computer modeling estimated the R-effective at .67 – the lowest it’s been since the start of the pandemic nearly two years ago.

But a lower R-effective number is not always a hard and fast predictor of future infections or hospitalizations, Vohra said in a media briefing Wednesday afternoon.

“It is a fickle number. It can sometimes change for various different reasons,” he said. “You have to look at it over time and really see the trend of the R-effective.”

Vohra and Dan Lynch, emergency services director for Fresno County, said that while other parts of the state are showing signs of the omicron surge easing up, the same cannot necessarily be said for Fresno County and neighboring counties in the central San Joaquin Valley.

“The hard experience from the delta surge (in the summer and fall of 2021) has taught us that while other regions seem to drop very quickly whenever these surges start to abate, for many different reasons the Central Valley seems to plateau instead of drop right down,” Vohra said.

“So we are always very cautions and we almost have to wait to exhale before we actually declare that our surge is behind us.”

But he added that he is relieved to see the R-effective number drop to below 1.0. “If that trend holds, it means transmission is slowing down, and we should start to see the number of new cases per day come down and then eventually – usually a week or two later – we see the number of new hospitalizations start to come down as well.”

That would be good news for a hospital system that Lynch said remains strained by large numbers of patients.

Hospitals across Fresno County were providing inpatient care to 581 confirmed cases of COVID-19 as of Tuesday, Lynch said, including more than 80 who were sick enough to require admission to intensive-care units.

That’s a significant jump from a week earlier, when there were 489 coronavirus patients in hospitals, including 69 in ICUs.

“The number is not waning; it’s continuing to rise,” Lynch said Wednesday. As other parts of California are seeing some relief, “it’s going to be a couple more weeks before we start to see a change in our hospitalized numbers.”

The burden of COVID-19 on hospital emergency rooms prompted Lynch and officials in other neighboring counties to once again implement an “assess and refer” policy starting on Jan. 12.

The policy calls for ambulance crews responding to a call to assess the patient and determine if their case is an actual medical emergency requiring immediate transport to a hospital.

If not a true emergency, the patient is referred to instead call their regular doctor, visit an urgent-care clinic, or use a “telehealth” service to connect by phone or video conference with a doctor for a consultation, Lynch said.

Over the past two weeks, 409 patients were referred to those services instead of transported by ambulance in Fresno, Madera, Kings and Tulare counties – between 30 and 35 patients a day, Lynch said.

“We’re continuing that program; we have no intention of closing it at all” while hospital capacity remains strained, he added.

The policy has been implemented and relaxed several previous times over the past two years of the pandemic, depending on the ability of emergency rooms to handle the volume of patients.