A summer coronavirus surge driven by the delta variant is again straining some California hospitals, particularly in rural areas, but the trend shows signs of moderating and experts predict improvement in coming weeks.
The pattern is similar to the infection spikes California experienced last summer and much more severely over the winter when intensive care units were overflowing. But this time the moderation is coming without the shutdown orders that previously hobbled California's economy, businesses and schools.
“We’re hopeful, definitely,” Dr. Erica Pan, the state epidemiologist, said Tuesday.
The state's latest projection “does look encouraging that we are plateauing and or peaking," Pan said in an interview with The Associated Press. But she added that the "one thing we've learned" about COVID-19 is its unpredictability.
Serious cases are still climbing, with more than 8,200 patients in hospitals and nearly 2,000 in intensive care across California. One of the highest daily spikes in new hospital admissions was just last week, Pan noted.
Deaths have begun increasing and state models project nearly 2,000 people will die within the next three weeks, adding to California's death toll that is approaching 65,000, the most in the nation.
The state's epidemiological models show the rate of hospitalizations leveling off, with a peak of about 9,300 hospitalizations around Labor Day before numbers start declining. ICU admissions are projected to follow the same pattern, peaking just below 2,200. During the worst of the pandemic in January, hospitalizations topped out at nearly 22,200 and ICU admissions at almost 5,000.
Importantly, the statewide infection rate has dropped 25% in the past three weeks, from a high of 7% of those tested to 5.2%
“We’re hopeful that things are kind of leveling out and that we’re going to be on the other side of this particular surge relatively soon,” Pan said.
San Francisco and other areas with high vaccination rates are seeing a "definitive decrease,” while Los Angeles County is starting to improve, said Dr. Monica Gandhi, an infectious disease expert at University of California, San Francisco.
That tracks a UCSF epidemiological model that predicted the current surge would peak in mid-August and that the state will be back to low case numbers by mid- to late September, she said.
While various locations re-imposed indoor masking requirements after briefly lifting them last spring, this time health officials avoided reinstating capacity limits or shutting down businesses. Yet California remains in much better shape than states like Florida and Texas that have seen hospitals overwhelmed by delta variant cases.
Gandhi said higher immunity levels in the state, rather than broad lockdowns, made the difference this time.
Vaccinations were just starting as the winter surge ebbed, but natural immunity also is increasing as the unvaccinated get sick and recover.
“All of that immunity is bringing down our cases in California,” Gandhi said.
She and other experts expect vaccination rates to increase as more employers mandate the shots and proof of vaccination is required to participate in more activities.
The experts also expect some people will be more comfortable with getting the shots after the U.S. Food and Drug Administration on Monday gave full approval to the Pfizer vaccine for people 16 and older.
About two-thirds of eligible Californians 12 and over are fully vaccinated, and another 10% have gotten their first shots. Areas with higher numbers of new cases and hospitalizations tend to be areas with lower immunization rates.
In Del Norte County, in the state's far northwest, only 44% of eligible people have received at least one shot, and it averaged 170 new COVID cases per 100,000 residents in the last week, a rate nearly triple any other county. Tuolumne, Kings, Yuba and Sutter counties all had rates above 50 new cases per 100,000. The state average is 28. All those counties have vaccination rates well below the state average.
But statewide, the rate at which each infected person spreads the disease, known as the R-effective, has been dropping steadily since mid-July. In many counties including Los Angeles and San Francisco, it has dropped below one, meaning the number of infected persons will decrease.
The agricultural San Joaquin Valley remains a key concern largely because the current surge started there later and is still increasing, said Pan, “but we're also hopeful that the rate of rise is not quite as steep as it was before.”
To help in hard-hit areas, the state is again requiring hospitals with ICU space to accept patients from those with less capacity. It is also still waiving rules for out-of-state health care workers who help in California on a contract basis.
Pan and California Hospital Association spokeswoman Jan Emerson-Shea said exhaustion is an increasing issue for medical staff who have been fighting the pandemic since early last year, particularly with a smaller pool of traveling doctors and nurses because of the surge in other states.
Some counties are seeing more hospitalizations now than they did during either of the two previous surges.
For instance, Tuolumne County, near Yosemite National Park, had 22 hospitalized patients, double its peak in December. Lake County had double the number of patients, 20, as it did previously.
The spread in rural areas reflects both the low vaccination rates and that many had remained relatively untouched during earlier surges, said Dr. Rajiv Bhatia, an affiliated professor of medicine at Stanford University.
“In the larger counties you're not seeing a significant increase or a challenge — the hospitals are not being challenged right now,” he said. “For me, the only interpretation of that is the vaccine is effective at preventing severe disease, regardless of the variant.”
