Los Angeles County health officials are warning of a possible surge in COVID-19 cases following family gatherings and out-of-town trips during the holidays, despite pandemic guidelines that asked the public to stay home.
Under one scenario, experts predict there could be a boost in new coronavirus cases by mid-January, a surge in hospitalizations by late January and early February, and another burst of deaths by early to mid-February.
The quick succession of holidays in the fall and winter months typically allows people to celebrate and spend time with loved ones in a brief period.
But that leaves little time for coronavirus cases to start falling before they spike again, creating surges on top of surges.
People may be getting together in small groups to try to be safe because of the COVID-19 surge, but those interactions can still fuel the spread of the virus, said UCLA infectious disease specialist Dr. Tim Brewer.
“I'm very concerned about the next two months,” Brewer said.
Dr. Robert Kim-Farley, a medical epidemiologist and infectious disease expert at the UCLA Fielding School of Public Health, said a person who is exposed to COVID-19 at a Christmas gathering could be infectious by New Year’s Eve.
However, the individual may be asymptomatic, go to a New Year’s Eve party and unknowingly spread the disease, he said.
Coupled with a high infection rate — about 1 in 95 in Los Angeles County are contagious with the virus, according to county estimates — the holidays are creating a “viral wildfire,” he said.
In Los Angeles County, the pace of daily deaths is higher than ever — with a person dying of the coronavirus about every 10 minutes.
On Saturday, county health officials reported 29,423 new coronavirus cases over Christmas Day and Saturday combined. Friday's numbers — 15,538 cases — were delayed because of an interruption with Spectrum internet service in the L.A. area.
Local health agencies also reported 136 deaths over the two-day period. The county averaged about 14,000 new coronavirus cases a day and 88 COVID-19 deaths daily over the past week.
Statewide, the number of people hospitalized for COVID-19 continues to rise, with about triple the number of deaths and hospitalizations on Christmas, compared with Thanksgiving.
On Saturday, Orange County broke the record for highest count of new coronavirus cases in a single day, with 5,953 cases, breaking the record last set on Dec. 20, when 4,606 cases were reported. The county averaged about 3,500 new coronavirus cases a day over the past week.
Orange County on Saturday also posted its highest tally of COVID-19 deaths reported in a single day, with 63 new deaths, breaking the record last set on Sept. 29, when 33 deaths reported that day. The county averaged 12 deaths a day over the past week.
In Los Angeles County, COVID-19 hospitalizations rose to 6,815 on Christmas, more than triple the figure from Thanksgiving.
ICUs across Los Angeles County are effectively full, and on Christmas, 1,368 people with COVID-19 were in the ICU, nearly triple the comparable figure from Thanksgiving.
The rate of increase in hospitalizations has slowed recently. In mid-December, COVID-19 hospitalizations statewide were increasing at nearly 5% a day; on Christmas Eve and Christmas Day, hospitalizations rose by less than half a percent each day.
But stable hospitalization numbers at a time when the ICU system across much of the state is bursting at the seams may mean little if gatherings that took place on Christmas result in a huge surge of hospitalizations and deaths in the coming weeks.
A doctor at a public hospital in L.A. County said that physicians from wide-ranging departments are being recruited to help out with an anticipated uptick in COVID-19 patients.
Already, staff have been asked to postpone any vacations they may have had planned.
"It's getting worse, and we haven't even hit the Christmas or New Years surge yet," one doctor at an L.A County hospital said. "I feel like the number of people that are going to die because the hospital system is beyond overwhelmed will shoot up."
The quality of care for COVID-19 patients and others who need hospitalization for another illness or trauma is going to decline if hospitals become more overloaded, said UCLA's Kim-Farley.
UCLA epidemiology department chair Karin Michels said she understands that people are feeling isolated and deprived of social contact. But it's important for people to limit contact with those they don't live with and not give up on precautions, she said.
"For many of us, it will be one of the most significant things in our lifetime....it'll be sometime until we're through this, but we need to get through it together," she said.
People tend to feel safer indoors and also have a false sense of security when they are around their family members, said Ali Mokdad, an epidemiologist at the University of Washington.
"These are your loved ones ... You're more likely to take off your mask and let down your guard," he said.
Celebrations that bring together multiple generations may be particularly dangerous, with younger people who are more likely to be asymptomatic potentially exposing older, more vulnerable family members, he added.
Mokdad said that his model, run out of the Institute for Health Metrics and Evaluation at the University of Washington, shows that most of the state’s surge is being led by indoor gatherings.
His data suggests that California's cases will peak in mid-January.
Before Gov. Gavin Newsom put in place the stay-at-home order earlier this month, the model predicted a peak in February and there "would've been way more infections," he said.
California has issued a travel advisory for nonessential travelers, including returning California residents, asking them to quarantine themselves for 10 days upon arrival in the state.
San Francisco and Santa Clara County have issued mandatory orders requiring travelers to quarantine upon their arrival from places outside the Bay Area — 10 days for San Francisco, 14 days for Santa Clara.
Health officials urged those who traveled over the holidays to quarantine themselves for 10 days to see if they develop signs of illness.
“It’s a really big disaster if people come back and then just go straight back to work,” said L.A. County Public Health Director Barbara Ferrer said on Thursday.
Ferrer also said county inspectors will be scrutinizing malls over the post-Christmas weekend on whether malls are getting too crowded, increasing the risk for virus transmission.
Under the state’s regional stay-at-home orders, shopping malls are supposed to be capped at 20% of capacity, but it’s clear that those limits are not being followed.
“We’re going to take a hard look this weekend at the shopping malls because the pictures we’ve been seeing are … another little mini disaster,” Ferrer said Thursday. “The occupancy is supposed to be down to 20%. But when you look around, they look way more crowded than 20%. And that just means a complete breakdown of what we are requiring.”
The regional stay-at-home order for Southern California, which went into effect just before midnight Dec. 7, will last until Tuesday, although state officials have already signaled it is likely to be extended.
If officials do decide they need to take a stronger approach to the existing stay-at-home order, it could either be imposed by the state for the entire region, or by an individual county.
L.A. County chief medical officer Dr. Jeffrey Gunzenhauser said the overwhelming number of people coming down with COVID-19 in recent weeks has exceeded even the health department’s expectations.
The highest number of people hospitalized with COVID-19 in L.A. County during the summer surge was around 2,200.
Now it’s more than 6,800.
"We were planning to handle a lot, but we just didn’t see it going this far," Gunzenhauser said. “It’s heart-wrenching.”
This story originally appeared in Los Angeles Times.