(UPDATE 3:25 p.m. July 24: Additional information added on data, including death rates, and health order enforcement updates.)
Imperial County hospitals experienced some of their highest intensive-care unit head counts this week, with El Centro Regional Medical Center reporting a record-setting 24 patients in its ICU on July 22, yet hospital officials announced they believe the numbers are starting to come under control.
“First of all, I want to thank the public for doing a great job. We’re seeing some control to the numbers. The numbers were escalating like crazy; (but) it seems to be flattening the curve,” said ECRMC Chief Medical Officer, Dr. Christian Tomaszewski, during a July 24 daily report.
“So, thank you for keeping your physical distancing. Thank you so much for wearing your masks. I think it’s working. I know it hurts a lot, but it’s paying off,” Tomaszewski added.
Although the number of ICU patients peaked July 22, the patient count was steadily decreasing to 18 patients in ICU (14 of whom are COVID-related), hospital Chief Executive Officer Adolphe Edward said July 24.
“That has been the highest amount of beds we’ve actually had in ICU being full” since 2016, said Edward during a similar daily census update report July 22, clarifying later that day he had the available staffing for up to 26 ICU beds, which will soon be increasing to 30.
There are a total of 41 ICU beds available between El Centro and Brawley’s Pioneers Memorial Hospital, which had eight ICU patients on July 22, seven of whom were COVID-positive.
Total patient census for El Centro Regional on July 22 was 103 patients of 161 total beds; 51 of those 103 were being treated for COVID, Edward said. On July 24, patient census was down to 96 from a daily peak of 105 on July 23.
Although the COVID numbers for Imperial County in general have remained consistently high since mid-May, other areas of California, including San Diego County, have begun to experience new surges of coronavirus cases in recent days and weeks, which might be having an effect on ICU rates and hospitalizations in general for Imperial County, according to area health experts.
There’s also the continuing high volume of cases crossing the border, as Mexicali residents with U.S. citizenship continue to seek treatment locally.
The stats and raw numbers for Imperial County are alarming, for certain. Still, it appears a lot of the numbers being put out there aren’t always being given proper context. Some of that context is difficult to come by, considering the media usually doesn’t receive cumulative briefings from Public Health Department officials until Mondays at noon; rather, raw data is posted daily through the county Public Health Department’s surveillance dashboard with little explanation from public health officials.
A new report in the New York Times on July 23 that showed where around the country the virus was sending people to hospitals highlighted Imperial County again, providing unfiltered data that indicated while positive cases of COVID in Imperial County were down over last week by 37 percent (there were 269 positive cases per 100,000 residents), hospitalizations in Imperial County were up 5 percent (53 per 100,000 cases).
While ICU staffing numbers in Imperial County are indeed increasing due to an influx of state and federal assistance, which allows for more serious cases to stay in the county, there are also a dwindling number of beds available for patient transfers outside Imperial County due to surges elsewhere, explained county Emergency Medical Services Agency Medical Director, Dr. Kathy Staats.
“We do continue to transfer patients out. However, the number that we have transferred out have decreased. We think this is likely for a few reasons. First, both hospitals have increased their ICU capacity, so they are able to keep more ICU patients within (the) county,” Staats said during a weekly county Public Health Department press conference on July 21.
“Second … as we’re seeing COVID-19 cases increase throughout California, other hospitals’ capacity is less. … We are really trying to focus on being able to increase our ability to care for patients. That being said, the state is still looking for ways to help Imperial wherever they’re able. … We do continue daily conversations about transferring patients out if needed,” Staats said.
Although she did not provide hard data for the week, through July 13 Staats reported that nearly 600 patients had been transferred from local hospitals since May 19.
Further, Staats said recently that the alternative care site she runs at Imperial Valley College is equipped to handle more acute cases of COVID that had previously required people be transferred from the Valley.
“We are now back to normal transfers, which are all non-COVID but critical ill patients that needs higher levels of care, and that is what we would be doing daily on a normal day minus all the COVID infections,” El Centro Regional’s Edward said July 22, referring to the day’s record-setting ICU traffic.
Although July 22 was abnormally high for the ICU, the numbers of COVID-positive patients this week seemed to be consistently high in El Centro, starting with 62 COVID patients of a total of 99 admitted patients on July 20; 55 of 97 on July 21; and 50 of 105, as of July 23, ending with 50 of 96 on July 24.
Pioneers did not have data available for July 24 as of noon.
The latest countywide hospitalization data were from July 21, with 20 COVID-positive patients in local ICUs of a total of 41 beds. For total admitted patients (also as of July 21), there were 89 COVID patients and one suspected COVID patient of a total of 268 available beds (161 at ECRMC and 107 at PMH).
Raw COVID numbers for Imperial County as of 11:20 a.m. July 24, were 173 deaths, 8,967 total COVID-positive cases, 990 of which are considered active and 7,804 of which are considered recovered.
Meanwhile, in assessing the weekly data, county Public Health Officer, Dr. Stephen Munday, was asked July 21 what numbers he is most concerned with when getting a snapshot of present conditions in the county.
“All of the numbers are important, and they give you different snapshots about what’s happening. So, the testing positive percentage is really a measure of what’s going on in the community. … Let’s just assume if the testing that we’re doing is stable, meaning the number of tests, then changes in that percentage give us an idea of how this might be spreading in the community,” Munday said.
“If the number of people we can test changes, then it makes that number more difficult to interpret. But in general, if you assume that the testing capacity stays constant and you’re testing people, then if the testing percentage is going up, that suggests that there’s more spread in the community. And when it goes down, there’s less spread,” he said.
On July 24, the epidemiological stability of the virus for the last seven days was at 16.65 percent; down from 17.68 percent on July 23. Overall, the number has been consistently in the 16 percent to 17 percent range for the week. It rose into the 20s last week for a few days, but also dipped into the lower teens the week before.
At one point last week, during a report to the county Board of Supervisors, county Public Health Department Director Jeanette Angulo said positive cases were coming back in the 300- to 400-case-per-day range, whereas two weeks earlier that was around 600 cases a day.
This comes amid many news reports about the lack of testing materials and increased testing times around the country, with county public health officials acknowledging those conditions the last two weeks. Anecdotally, people on social media have said testing results seem to be taking a few days longer than what was experienced some weeks earlier.
However, Munday said July 21 that the shortages in materials has yet to have a significant effect on testing in Imperial County. In fact, he said testing capacity is at its highest levels since the pandemic began.
Munday said there are “four lanes” of state-sponsored, free testing at the three OptumServe sites in Imperial County, with one lane each in Calexico and Brawley and two lanes (or double the daily capacity) at the site in the city of Imperial.
The county is also processing more test samples with the assistance of a federal mobile analytical laboratory in the parking lot of the County Administrative Center.
“There’s typically a delay between what happens with the testing in the community and what happens in the hospital. They both give us useful information because if we start seeing an increase in the percentage of positive tests in the community, then we are very careful to watch our hospital numbers, our emergency department visits, our hospital admissions, our ICU beds and our ventilator use, because we have an expectation that if the (positive numbers are) increasing in the community, then there may be (an increase in the hospitals,)” Munday said.
COVID Deaths in the Region Remains a Concern
It appears for the last week or more, the mortality rate of COVID in Imperial County has remained fairly consistent, around 1.9 percent, even though the number of deaths is consistently rising as well.
With 173 deaths reported as of July 24, the percentage to total positive cases (8,967) is at 1.92 percent, down a few hundredths from the previous day. Still, it’s significantly lower than the percentage of deaths to total cases in the country as a whole. Using data from July 23, there was 144,320 deaths reported in the United States vs. 4.04 million total positive cases, for 3.57 percent.
Any of that data pales in comparison to what is happening in Mexico, and more specifically, Mexicali, a region inextricably tied to Imperial County by way of families, economies, workforce and any number of other ways, including the cases of COVID being treated at local hospitals.
It should be noted that county Public Health Department officials continue to say that all reported death data on the local dashboard are from verified Imperial County residents and do not include Mexicali residents who might hold either dual citizenship or Imperial County post office boxes. Public health information officers emailed this newspaper last week to say county officials (investigators) verify residency through several methods.
Mexico in general has some of the highest mortality rates in the world, with 41,908 dead of a total of 370,712 total positive cases, for 11.3 percent, as of July 23.
For Mexicali, the percentage was 17.65 percent as of 1 p.m. July 24, with some 1,170 deaths reported of a total of 6,628 confirmed positive COVID cases.
For the entire state of Baja California, the percentage was 19.61 percent, or 2,480 deaths of a total of 12,649 COVID-positive cases. That percentage was pushed higher due to the explosive death rates in Tijuana, which was listed at 28.34 percent (1,049 deaths of a total of 3,701 total COVID cases), as of July 24.
Bloomberg News Service recently reported that more than 43 percent of all hospitalized COVID cases in Baja California have resulted in death.
In Imperial County, it remains unclear why it seems more people are dying at a faster rate, but for the most part it is the elderly that appear most susceptible to the virus. The highest number of deaths are those concentrated in their 60s through 90s, which would seem logical.
In terms of data, 128 of 173 deaths were concentrated between those 60 to 89 (41, ages 60-69; 46, ages 70-79; and 41, ages 80-89), or 73.9 percent of the total deaths.
Last week (July 13), county Public Health Department Nursing Manager Steven Solis said 27 total deaths had been reported out of Imperial County’s three skilled nursing facilities since an outbreak of cases was reported in June. It wasn’t known how much that number has increased, but the Calexico Chronicle knows of at least one additional death from a nursing home that occurred after that tally.
According to data from the state Public Health Department as of July 22, there have been 17 reported COVID deaths from El Centro’s Valley Convalescent Center and no reported deaths from Imperial Manor in the city of Imperial. Although the numbers are masked from public view on the state’s website from Brawley’s Imperial Heights Healthcare & Wellness Centre, that would mathematically leave 11 from Imperial Heights.
Dr. George Fareed, the medical director of Imperial Heights, who initially reported an outbreak at his facility more than four weeks ago, confirmed July 14 that at least eight of his patients of the 33 who came down with COVID had died from the virus.
If the numbers hold true and no more deaths can be attributed to the nursing home outbreaks since mid-June, than roughly 16.1 percent of all the deaths reported from COVID in Imperial County since March 31 (nearly four months total) came by way of skilled nursing homes, which would seem to be a statistically significant amount.
An Update on Health Order “Enforcement”
In El Centro during a one-week period that ended at the July 21 El Centro City Council meeting, the city’s police department had seven calls for a variety of COVID-19 related issues, primarily a person or group not wearing face masks, El Centro Police Chief Brian Johnson reported.
Other complaints include a business open that is not essential and a group gathering.
Five of those calls were unfounded, and two resulted in warnings being given, he said.
Most of the time, though, people are willing to comply with the regulations.
“We believe that really nine times out of 10, the warning has been sufficient,” Johnson said. “There’s a unique balance for all communities dealing with this coronavirus. Our community has really been very supportive of helping to do their part to help us get through this pandemic.”
There had been one person cited by the El Centro Police Department a couple weeks ago for not wearing a face covering, and that case has been sent to the District Attorney’s Office, Johnson added. It might be weeks or months before the department hears back on whether the District Attorney’s Office will pursue that case, as it was a misdemeanor citation and no one is in custody.
Some are concerned, though, that suggesting might not be enough. It was reported last week that Imperial County Supervisor Jesus Escobar had grown tired of the suggestive nature of the language around health order enforcement and wanted the Imperial County Board of Supervisors to take up whether stricter enforcement was needed.
“Do we need to move from a ‘strongly encouraging’ to an actually administrative fine, citation or penalty for people not wearing face coverings, for the lack of social distancing, for the lack of people respecting social gatherings, for businesses not respecting social distancing and numbers required when they open up their doors?” Escobar asked during a COVID-19 update at the July 14 meeting.
“I just don’t see us flattening the curve and the strongly encouraging overall is not working. Do we need to take it to the next level?”
Munday reminded the board members that there is an enforcement mechanism written into the health order that discusses fines of up to $1,000 and even arrest, but he said it was always the intention that enforcement was educational and, hopefully, self-policing.
Munday added that was never something that could be undertaken at the public health level but must come from law enforcement.
“We don’t have the option of fining people,” Munday said. “We don’t want to fine people. We want to keep people safe.”
Escobar suggested during the meeting that enforcement of the Public Health Order is the only way to hold everyone accountable and recommended the issue come back to the board at a later meeting.
District 4 Supervisor Ryan Kelley understood where Escobar was coming from.
“Encouragement with a hammer behind it,” Kelley said during the meeting.
County staff also recommended addressing it administratively during weekly meetings with area city managers and public safety chiefs.
With no county board meeting this week, it wasn’t known if the issue had been addressed to Escobar’s satisfaction, and he did not return several calls since July 22 seeking an update on his request.
Similar Concerns Brought Up in Calexico
Meanwhile, Calexico City Council members Lewis Pacheco and Bill Hodge brought up similar concerns about health-order enforcement in their city with Police Chief Gonzalo Gerardo at the tail end of the council’s July 15 meeting.
Because it was not an issue on the agenda, no action was taken, and it was more of an informal update. The Calexico council is not scheduled to meet again until Sept. 5.
Pacheco asked whether police were enforcing the county’s rollback of nonessential businesses to curbside-only pickup, and Hodge inquired whether there would be stricter enforcement of the mask rule, especially at businesses like Wal-Mart, where he has witnessed the store not enforcing its own mask policy and not taking temperatures.
If COVID numbers don’t start to improve, state officials will consider shutting down nonessential businesses entirely, Gerardo said he was told by a county public health official last week.
“We were the only city, when COVID first started, that dropped the hammer the way it should have been done,” the chief said July 15. “We were complimented as a city at a county of Imperial meeting.”
As far the mask enforcement, Gerardo told Hodge it comes down to enforcement and manpower, adding the fines and mechanisms are in place to issue the citations, but there are not enough police on the streets to seek out or respond to every report of someone not wearing a mask.
“We’ll take enforcement action when we have to, but people who are out there having parties, shame on them,” Gerardo said.
Speaking to the council, but expounding on the issue for whomever community members were listening or watching via livestream, Gerardo told members of the community that the numbers will no go down and the curve will not flatten until people report the parties and get-togethers going on in their neighborhoods.
“If they don’t listen to us, we’ll cite them. And we’ll cite them for every time that they violate it. If it’s a party at 11 o’ clock at night and we go back at 1 in the morning, that’s two citations,” Gerardo explained. “The thing is, we shouldn’t be reaching that citation. Why do we have to be punishing people for that?”
The community needs to do its part, he said.
“We are mentally tired as city employees,” the chief said. “We have to clean and fog and disinfect” in addition to enforcement and all the other jobs required of public safety and city workers.
Elizabeth Varin contributed writing to this story.