(UPDATE: Story has been updated from an earlier version as of 6:50 p.m. May 21.)
IMPERIAL COUNTY — As public health officials continue to press forward with meeting state criteria to continue opening up businesses and modify health orders in Imperial County, the high rates of hospitalization and the infectiousness related to COVID-19 have put any real movement on the resumption of normal life on hold.
Over a two-day period, May 18 and May 19, an explosion in COVID-positive patients requiring hospitalization caused rates and numbers of cases to skyrocket locally, at least one of Imperial County’s two hospital emergency departments to temporarily divert COVID patients to other facilities, and necessitate the establishment of a “federal medical station” inside the Imperial Valley College gym, possibly as soon as May 22, to handle the overflow of novel coronavirus patients.
Some of the issues with hospitalization rates are homegrown, but health officials acknowledged May 19 that a great deal of the rapid rise in admissions were due to COVID-19 conditions in Mexicali, where local health officials say the health system in Baja California’s capital is becoming overwhelmed. Many U.S. citizens who live in Mexico have traveled north to seek treatment in local hospitals, causing an increase in numbers at local emergency rooms.
In general, county officials believe that a combination of “cabin fever,” recent holidays, cross-county travel and more people not adhering to existing stay-at-home orders, might be influencing local new case numbers.
Meanwhile, ever-evolving changes to health metrics at the state level is allowing Imperial County Public Health Department officials to inch closer to being able to speed up its efforts to open businesses considered higher risk in what is considered Stage 2 of the state and county’s four-stage Roadmap to Recovery.
Local Numbers as of May 21
There have been 21 deaths reported in Imperial County, with 1,076 total positive cases, 588 of which are active and some 90 that are considered “new” cases, as of 6:10 p.m. May 21.
Some 467 patients are considered recovered, and 7,567 people in Imperial County have been tested to date. Some 6,491 tests have come back negative.
Of the deaths, 17 of those have been people age 70 and older, including one person over 100 years old. Two deaths were between 50 and 59, and two deaths were between ages 40-49. All were Hispanic and all were Imperial County residents.
There were 60 COVID-positive cases in both hospitals as of May 21, and one suspected case of COVID. There were 18 COVID patients in both hospitals’ intensive-care units, and 35 out of 63 total ventilators were in use, all as of 6:10 p.m. May 21.
The Latest Developments: IVC as a ‘Field Hospital’?
The U.S. Army Core of Engineers has identified and designated the IVC gymnasium, known as the DePaoli Sports Complex, for use as a “federal medical station” with the ability to accommodate 80 COVID-patients to be medically treated and quarantined, Imperial County Emergency Medical Services Manager Chris Herring said during a May 20 press conference.
“This is not a hospital. Patients admitted to the federal medical station will be transferred from local hospitals. The patients admitted here are not the sickest patients in the hospital,” Herring said.
The facility will be staffed by the California National Guard and California Assistance Medical Teams (CAL MAT) and is scheduled to open by May 22, Herring said.
However, Public Health Director Janette Angulo said she could not confirm when the facility would open during a press conference May 21.
“This facility will be used to quarantine patients that do not need much attention to open up space in the hospitals for high-risk patients,” Imperial County Public Health Officer, Dr. Stephen Munday, said May 20. “The ability to handle a surge has multiple components like having the ability to send patients to other facilities.”
Angulo said the federal medical station would be on site for a minimum of two weeks and staffed by a team of outside critical-care nurses, medical-surgical nurses, and respiratory therapists.
Patients would not “go there directly” for treatment; rather, they would be transported or sent there after being triaged at local emergency departments, she said May 21.
On the morning of May 19, the chief executive officers of El Centro Regional Medical Center and Pioneers Memorial Hospital in Brawley put their emergency departments on “divert,” according to ECRMC CEO Adolphe Edward, meaning they would no longer accept any new COVID patients following a surge in COVID-positive cases from Mexicali that started late May 18.
The diversion, which ended sometime in the evening May 19, did not affect patients seeking treatment at either of the hospital E.R.s for conditions or problems not related to COVID, Edward said. Edward announced the diversion was called off during his daily Facebook Live chat around 9 a.m. May 20.
“Yesterday (May 19) we were notified that there was a 27 percent increase in hospitalization of new COVID patients between (May 18 and 19),” Herring said May 20. “There are currently 93 patients in both hospitals in the Imperial Valley (with COVID).”
A Pioneers Memorial Hospital spokesperson stated in an email May 20 that the Brawley E.R. never actually went on “divert,” and that it was open to all manner of patients during the two days of increased cases.
Pioneers CEO Larry Lewis said May 21 that during the surge of COVID patients at both hospitals, nine patients were transferred from Brawley and 17 patients were transferred from ECRMC. Speaking only about Pioneers’ patients, Lewis said three were sent to Scripps-affiliated facilities in San Diego County, three were sent to Temecula in Riverside County and three were sent to hospitals in other parts of Riverside County.
Additionally, Edward said May 21 a team of 12 registered nurses, one respiratory therapist and three E.R. physicians (including one pediatrician and one internist) had arrived to assist at ECRMC from the U.S. Department of Health and Human Services, and seven registered nurses from the California Department of Public Health are there as well.
On May 19, Munday confirmed that Imperial County was ranked No. 1 in the state for COVID hospitalizations per 100,000 residents, with 37.4 COVID patients per 100,000 residents.
He said that was a 13 percent change from one day to the next.
Imperial County is still “on the front-end of our epidemiological curve,” Munday told the Imperial County Board of Supervisors during a Public Health Department update May 19.
During a press conference May 21, Munday explained that ranking can vary drastically from one day to the next given the small “denominator” Imperial County is dealing with, meaning its total residents (the population estimate is 180,000).
“We do have the highest rate in the state,” but he said “small changes (in numbers of hospitalized patients) in either direction” can cause “large changes (in ranking) in either direction.”
Herring said during the May 20 press conference that local medical officials were working closely with the state government to meet the care needs presented from the two-day surge.
“Our mutual-aid system has been working well from our perspective. We were notified about the surge around 7:30 (a.m. May 19) and immediately reached out for help from the state, who only took two to three hours to respond. We feel we are getting the help we need,” Herring said.
He explained how the state was able to help local hospitals.
“We reached out to the state because we needed to move patients out of the hospital to free up space. The ambulance strike team helps find hospitals that can handle the sickest patients and arrange transportation,” Herring said May 20.
Some 40 patients were moved from local hospitals to other healthcare facilities in Southern California, he added.
The Mexicali Effect on Local Conditions
It has never been precisely clear how serious the conditions are in Mexicali and Baja California, but anecdotally local officials described the situation as dire and that hospital facilities there are “overwhelmed.”
While Edward said earlier in the day May 19 that reports were that all hospitals in Mexicali were full and no longer accepting COVID-positive patients, ECRMC officials modified that message toward the end of the day.
“Patients presenting at the emergency room (were) reporting hospitals in Mexicali weren’t taking any more COVID patients. We have confirmed two of the private hospitals were not accepting additional COVID patients as of this morning. Keep in mind this is a very fluid situation, so what was true this morning, may have changed,” El Centro hospital officials stated in an email to this newspaper around 3:30 p.m. May 19.
County public health officials have long said that conditions in Mexicali would mirror conditions in Imperial County, and they confirmed the situation with COVID cases in the city of more than 1 million people was worsening.
The numbers Imperial County are seeing are a direct reflection of what is happening in Mexicali and along the Baja California border, Munday said May 19.
Although he had no firm data available at the time, “There is a very difficult situation in northern Baja (California),” Munday told the county board.
Mexicali hospitals and emergency services are “overwhelmed,” supplies of personal protective equipment are exhausted and “overwhelmed,” and COVID hospitals have “turned people away, because there’s not enough capacity to help them,” Munday said May 19.
Angulo agreed May 21 that Mexicali certainly impacts Imperial County, but to what degree is not known. “It’s difficult to quantify and put a number on it,” she said.
As of 4 p.m. May 21, Mexicali had reported 141 COVID-related deaths, a total of 1,613 COVID-positive cases and 233 cases pending confirmation. Baja California as a whole reported 637 deaths and more than 3,700 confirmed positive cases.
Roadmap to Recovery Status
Angulo updated the county board May 19 regarding the department’s efforts to meet state health metrics, known as “regional variance criteria,” to move further along in opening more high-risk businesses and ease up on health orders.
Part of that presentation was informing the board and the public that what were hard and fast metrics established by the state as little as two weeks ago, had shifted over the weekend to make it easier to meet certain health bars to open businesses more quickly.
Angulo informed the board that her department has just about completed a report for the state that shows Imperial County has met nearly every “regional variance criteria” standard with the exception of one: the all-important “epidemiologic stability of COVID-19.”
Formerly (as in last week), based on the population of Imperial County, Public Health had to show that there were no more than 14 new cases a day of COVID-19 for 14 consecutive days, something the county was nowhere near achieving as new cases have consistently been in the upper 30s to 60s for a least a week or more. Some 90 new cases were reported May 21.
However, Angulo said May 19 those epidemiological stability standards were substantially “modified over the weekend” by the state.
Under the new rules, the criteria went from 14 days to a seven-day period of stable or decreasing numbers for testing positive. The state is now requiring less than 8 percent positive tests for the past seven days, while Imperial County was at an average of 24 percent for the seven-day period between May 8 and May 14, which is significantly above the metric.
However, in every other category, Angulo said Imperial County met the metric, including a second requirement in epidemiological stability related to hospitalization rates.
Other categories successfully met are ability to protect essential workers; county-wide testing capacity/availability; containment capacity; local hospital capacity; and plans for protecting vulnerable populations, including skilled nursing facilities and the homeless.
Angulo informed the county board that the report to the state is considered all but complete, so that the minute Imperial County meets the final criteria, the report can be approved by the health officer and sent to the Governor’s office.
Meanwhile, even though so many of the metrics have been met, Munday and Angulo reminded the public that it will take significant work to reach the final bar, and to do that, the stay-at-home health orders and face-covering requirements must remain.
“We’re counting on the public’s continued compliance with the orders to enable us to relax restrictions. We are committed to making sure that Imperial County is in the best position to continue to protect the health and safety of our community as we progressively get back to normal,” Munday said.
Imperial County is presently in the “low risk” end of Stage 2 of the roadmap, and is trying to move deeper into Stage 2, which would include modified openings of nonessential businesses, including some level of dining in at local restaurants and opening nonessential businesses beyond curbside pickup. That includes the opening of personal care businesses like hair and nail salons and barbershops, and tattoo and massage parlors.
Churches Request Moving Up on Roadmap
Prior to Angulo’s presentation May 19, Christ Community Church Senior Pastor Walter Colace went before the county Board of Supervisors during public comment to formally request churches be moved into a different stage of the roadmap to open sooner.
Although churches and other religious organizations can now attend to their members through food pantry or feeding programs and attend to some spiritual needs in controlled settings, widespread church services are still in Stage 3 of the roadmap with no timeline attached to when they might reopen.
Colace brought a single-page proposal to the county board that he wanted to get acted upon. However, due to the fact it was presented in public comment, the board could not act and did not move to place it as an emergency agenda item. The board will not meet again until June 2.
Before being told this, Colace spoke about how the local clergy feels churches are more important and essential than “the Walmarts and the Costcos,” and that they are “rooted in the spiritual and emotional well-being of Imperial County.”
Leaning heavily on the theme of “our buildings,” Colace said it’s within “our buildings” that marriages are consecrated, lives are fixed, children are baptized, and funerals are held.
“Shame on our Governor” for liquor stores being considered as essential business in Stage 2 yet churches are relegated to Stage 3, he said.
“You can go to a liquor store and drink spirits” but you “can’t come to a church and drink of the Holy Spirit,” Colace added.
He said 3,000 churches in California have opened already, “rebelling” against Newsom’s orders.
Colace said at least one local church openly defied the orders and had Sunday services on May 17, but he would not say which church when contacted later May 19.
He said 25 Imperial County pastors had signed the proposal.
The county board, which normally limits public comment to three minutes per person, allowed Colace 10 minutes to speak.
Following Angulo and Munday’s update later in the meeting, District 5 Supervisor Ray Castillo, who attended the meeting remotely from home, said he would like to be able to see churches somehow hold local services May 31, which is the Pentecost.
There was no discussion beyond what Castillo said.
Supervisors Discuss Recent “Movement” in Community
As discussions on COVID began to wrap May 19 and Munday spoke of some of the effect of Mexicali on local numbers and cases, District 4 Supervisor Ryan Kelley commented that although there are still stay-at-home orders in place, there seemed to be a lot of “movement” in the county over the weekend.
Munday said there was indeed a higher volume of traffic coming from Mexico recently than at the end of March and April.
In general, Munday said Imperial County is in a difficult position as conditions change and more businesses reopen in San Diego County, Riverside County and Yuma County, Arizona, all of which is having some effect on travel within Imperial County.
Although a health order remains in Imperial, social media was afire with posts from families and individuals traveling to Yuma over the weekend to eat at restaurants and shop in stores.
Recently, the New York Times published a “heat map” of novel coronavirus hotspots in the nation that include information showing cases doubling in Imperial County every 14 days and doubling in Yuma County every 6.5 days.
On May 19, Yuma County communications director Kevin Tunell was asked about changing conditions in Arizona despite an increase of cases in Yuma. He said Yuma County is following the directives of Gov. Doug Ducey, who lifted Arizona’s stay-at-home orders May 15.
Tunell said nowhere in Arizona has there been the requirement to wear masks in public, and he scoffed at the idea that California wanted people to wear “masks at the beach.”
Referring to the rise in documented positive cases, he said the New York Times information is misleading because the state recently began expanded “blitz testing.”
Three weeks ago, numbers began to rise in Yuma when “blitz testing” began at one or two spots in the county. Last weekend, he said, 250 to 300 people were tested at three to four events.
“It bolsters the number of positives,” Tunell said. “We’ve known for a very long time that we’re at community spread.”
He added Yuma expects to see its peak of COVID-positive patients in mid-May or the first week of June.
There were seven deaths and 508 confirmed total cases of COVID for Yuma County, as of May 21.
Rise in Local Cases and Role of the Public
Meanwhile, with a three-day holiday weekend coming up, Public Health officials are concerned there could be another spike in the numbers. Some of what was seen this week could have been related to increases in activity tied to Mother’s Day, which was May 10.
Munday explained during a May 21 press conference that although families want to gather during holidays like Mother’s Day, not all relatives reside within the same household, and that’s when the virus can spread. He reminded the community that the stay-at-home orders extend to families, too.
At one point, Munday and Angulo were asked what the Public Health Department was doing to ensure the public’s safety, especially in light of essential businesses closing with a high number of COVID-positive cases among essential workers. Recent temporary closures at Walmart and some restaurants were referenced.
Munday said there are reports of “clusters of cases” in Imperial County, and the Public Health Department does find out and has its epidemiologists tracks those instances. In some cases, the environmental health division is also brought in to advise the businesses how to clean and manage their operations to prevent future outbreaks.
Angulo said Public Health does not announce those clusters because it must maintain the privacy of those infected with COVID-19, but the department is making sure the businesses are ready to re-open to serve the public.
Imperial County Board of Supervisors’ Chairman Luis Plancarte, in wrapping up, acknowledged there is a sense of “cabin fever” among the community, but people need to adhere to the county health orders and stay put if headway is going to be made in stemming the transmission of COVID-19.