A fully built-out, temporary 50-bed medical-surgical wing expansion was erected starting Friday, Nov. 13, in the north parking lot of El Centro Regional Medical Center off Ross Avenue. The tents were constructed by the California Emergency Medical Services Authority’s Medical Assistance Team. | PHOTO COURTESY OF ECRMC
As the state rolls back regulations amid rapidly increasing new cases of coronavirus to a place where Imperial County has never left, local health officials continue to put the pieces in place to deal with this latest surge, including elevated testing efforts, increased capacity at hospitals and pleas to the public to limit exposures as the holidays approach.
Like most regions of the United States, Imperial County continues to see its COVID rates skyrocket daily. Active COVID-19 cases reached 843, for 14,431 total cases, a positivity rate of 20.35 percent, and some 35.63 new cases of COVID per day per 100,000 residents (unadjusted), as of Wednesday morning, Nov. 18.
Between El Centro Regional Medical Center and Pioneers Memorial Hospital in Brawley, there were 68 COVID-positive patients of 171 total hospital admissions (207 total-bed capacity), as of Nov. 18. El Centro had the lion’s share of the cases, with 51 COVID patients.
“It is very concerning. Not only is Imperial County seeing a surge, the rest of California and the rest of the country is seeing a surge,” Imperial County Public Health Director Jeanette Angulo told the county Board of Supervisors during her weekly report Nov. 17.
The situation, while increasing at a fast clip, still seems relatively stable in Imperial County, as agencies calmly brace for the worst. The same cannot be said for most of California, which saw 9,890 new COVID cases for a total of 1.03 million total cases, and 3,852 people hospitalized with coronavirus, as of Monday, Nov. 16, when Gov. Gavin Newsom went on the airwaves to announce a new round of rollbacks.
While cases themselves are certainly a problem, it’s the massive number of hospitalizations across the country that is indicative of a worsening crisis. More than 73,000 people were reported hospitalized in the United States on Nov. 16, with more than 11 million total positive cases — 1 million of those confirmed in just the past six days.
“This is simply the fastest increase California has seen since the beginning of this pandemic. … Just put this in perspective, the highest rate increase that we have experienced since the beginning of this pandemic we experienced in June, you see June 15th to June 21st, we saw a one week increase of 39.2 percent of new cases. Compare that to … the first week in November, a 51.3 percent increase in just a one-week period puts the rate of increase simply without precedent in California’s pandemic history,” Newsom said during a press conference.
California has seen a 48 percent increase in hospitalizations over the last 14 days, and a 38.8 percent increase in the last 14 days in intensive-care unit patients, Newsom reported.
In a sweeping clamp-down, he announced that 40 California counties were moved backward on the state’s color-coded Blueprint for Recovery. The state jumped to 41 counties in the most-restrictive purple, or “widespread,” tier (which includes Imperial County) and 11 counties in the second-worst red tier on Nov. 16, up from 13 purple and 22 red just a week ago.
“Every age group, every demographic, racial, ethnic in every part of the state we are seeing case rates increase and positivity rates increase as well. No longer concentrated in just a handful of counties, we are seeing community spread broadly now throughout the state of California,” Newsom added.
With the changes at the state level, Imperial County saw its numbers adjusted as well. One thing that changed as of Nov. 16 was the reporting frequency; the state’s tier system will now be updated every four days, instead of the seven days that had previously been in place.
Imperial County’s adjusted numbers were 35.1 new COVID cases per 100,000 residents, 37.6 was the adjusted case rate “per tier assignment,” and the positivity rate was at 16.5 percent, all as of Nov. 16. That data is expected to be updated Thursday, Nov. 19.
Hospitals Bracing for Impact
Although COVID hospitalizations in Imperial County have steadily increased since Oct. 1, there has been a sharp incline in the past few weeks.
Pioneers Memorial Healthcare District, which doesn’t get nearly the amount of COVID cases that El Centro Regional does, started to see its COVID numbers enter the double digits early last week. On Nov. 18, there were 17 positive patients in the 54-bed Brawley hospital. PMH had 19 COVID patients on Nov. 17.
Although Pioneers Chief Executive Officer Larry Lewis announced a coming expansion of patient capacity during a press conference on Thursday, Nov. 12, he more formally announced late Nov. 17 that 10 additional beds are to be added with the help of the California Emergency Medical Services Authority.
Pioneers and EMSA are converting the inside of the hospital’s Walker Auditorium into an expanded medical-surgical wing.
EMSA will also help equip and staff an additional 10 med-surg patient beds on the second floor adjacent to the hospital’s “Definitive Observation” and ICU beds, according to a Pioneers press release.
Additionally, Pioneers received support nursing staff on Nov. 16, with more staffing to arrive later this week. Two intensivist physicians will also be added from EMSA in the hospital’s COVID-19 surge preparation, the release stated.
As for El Centro Regional, where the brunt of the COVID patients are being treated, numbers of positive patients have been in the high 40s for several days but spiked to 51 patients on Nov. 18. There had been 48 on Nov. 17.
Adolphe Edward, ECRMC chief executive, had been planning for the surge for several weeks, announcing some time ago the impending arrival of a massive 50-bed expansion effort and several temporary staffing additions.
Those efforts came to pass on Friday, Nov. 13, when EMSA’s California Medical Assistance Team arrived to construct the 50-bed temporary med-surg expansion in the north parking lot of the hospital campus. The massive tent is fully up.
Edward said Nov. 12 that El Centro Regional can treat more than 65 COVID-positive patients at once.
With the right staffing, Edward has said he can expand the ICU to handle more than 30 patients. At last confirmation, the ICU had the capacity to handle between 20 and 24 patients.
Edward has requested staffing from both state and federal sources in the form of physicians, phlebotomists, respiratory therapists, and med-surg and ICU nurses, to name a few disciplines.
Meanwhile, the state-staffed and locally run Alternative Care Site at Imperial Valley College remains in “patient-ready” status, up from “warm” status for well over a week. As of Nov. 17, Imperial County Emergency Medical Services Agency Director Chris Herring said no COVID patients have been transferred to the ACS.
Although county Public Health spokespeople could not confirm it Nov. 17, the ACS is believed to be the “surge center” Gov. Newsom referred to in his press conference. He said there were 11 “surge centers” established by the state during the spring/summer crest of cases, and he mistakenly said Imperial County’s was the first to be re-opened on Nov. 16 when it had already been open.
A new development announced by Pioneers on Nov. 17 was the fact that as of noon that day, county-based ambulances that retrieve patients from the border will be alternating hourly to transport patients to ECRMC and Pioneers, respectively.
“This method will be tested in hopes the patient load can be better balanced between the two facilities prior to sending patients out of the county,” the Pioneers release stated.
Testing Capacity to Increase
County Public Health Officer, Dr. Stephen Munday, reported Nov. 17 that Imperial County’s request for additional testing capacity was approved and reinforcements should be arriving soon.
At present, the county has only one free state-sponsored OptumServe site open in Brawley, down from four testing “lanes” at the height of the first wave.
Although there is outpatient testing available at doctors’ offices and urgent-care clinics throughout the Valley, public health requested additional resources that included the ability to retain the current OptumServe site, and two “flexible” testing options, Munday said, in the form of a “strike team” and a separate “mobile unit” and staff.
Munday said both options will be able to collect specimens in the field, which he said will be especially useful in reaching targeted populations like farmworkers, the homeless, residents and staff of skilled-nursing facilities, and incarcerated populations.
County Environmental Health Deputy Director Jeff Lamoure, who oversees COVID testing coordination, went into more detail on the mobile options.
“The traveling team/strike team will be used for more targeted testing due to its greater flexibility to quickly mobilize. The team consists of three to four local staff. When called upon, they can quickly be deployed to a business experiencing an outbreak to collect specimens from staff, they can be used to set up an alternative testing site in Imperial County, or can used to increase the testing capacity at the fixed OptumServe testing site,” Lamoure stated in an email Nov. 17.
The traveling team can used to collect specimens at alternative-care facilities and skilled-nursing facilities, among other targeted groups. The team can be used as little as one day a week or as often as six days a week. Once deployed, the team would operate in 12-hour shifts and have specimen-collection capacity for 164 tests a day, he continued.
“The mobile-testing bus can be used in a similar manner, but it is designed for larger testing events. The mobile unit consists of a team of three to four staff, which has a maximum specimen-collection capacity for 528 tests a day, operating eight-hour shifts,” according to Lamoure. “They can be deployed to underserved communities and communities requiring lengthy travel and/or communities that do not have readily accessible transportation to access a testing site. The mobile unit will be utilized for testing large groups such as farm labor groups, large private/public employers, outbreaks in correctional facilities, etc.”
Along those same lines, Public Health Director Angulo said Nov. 17 that a request has been put in at the state level for 15 bilingual contact tracers to aid in investigating the spread of the illness in the community.
Some county staff that had been temporarily cross-trained and drafted into the service of Public Health’s epidemiology department as contact tracers during the first wave have been called back into action, Angulo reported.
Vaccine Updates Bring Good News
Federal, state, and local governments are still preparing for the delivery of the first COVID vaccine as early as mid-December, although it still hasn’t been made clear how much or which vaccine could be on the way.
The big news Nov. 16 was that a second biotechnology/pharmaceutical company, Moderna, had released the results of its limited trial, announcing that its vaccine had an efficacy rate of 94.5 percent against COVID-19.
This comes just one week after Pfizer said its vaccine was 90 percent effective against the novel coronavirus.
Both companies are now collecting their safety data in order to apply for emergency-use authorization with the U.S. Food and Drug Administration at the end of November.
It was stated by health authorities on all levels that a limited amount of the vaccine would be shipped initially to inoculate targeted populations, which are still being decided at the state and local levels.
Newsom on Nov. 16 said he expects that only about 20 million doses of vaccine will be distributed across the U.S. in mid-December, with 12 percent to 15 percent of that making its way to California.
That’s roughly between 2.4 million and 3 million doses for the state’s 39.5 million residents.
Newsom added, “those primarily will be first responders and help workers.”
“We have a long way to go to get to a vaccine that is widely distributed,” he added.
He did say that state public health officials are involved in “microplanning” with others states and federal government partners as well as with the incoming Biden administration on distribution plans that address “equity” concerns, making certain that elderly populations are taken care of and “making sure Black and Brown communities disproportionately are benefited because of the impact they have felt disproportionately because of COVID-19,” he said.
Meanwhile, in sharing the news about the Moderna findings with the county board on Nov. 17, Munday told the board that with the Moderna version, the requirements to transport, store, and administer the vaccine are much “less onerous” than the Pfizer version.
He was referring to the need for the Pfizer vaccine to be handled at sub-zero temperatures, requiring specialized freezers and transport in dry ice.
The Moderna vaccine requires temperatures already available in conventional laboratory settings, without the need for specialized equipment, Munday said.
Efforts to Limit the Spread
With 40 California counties rolling backward this week, there seemingly is nowhere further Imperial County could go. At purple since the color-coded system was adopted several months back, as of last week, Munday said the state had not required the county to take any additional measures that would further lockdown businesses or people.
Still, Munday said during a Nov. 12 press conference, “the state has had some discussion to impose a more stringent stay-at-home order as possibilities.”
Newsom himself floated the idea of a statewide curfew for the first time Nov. 16, making no firm plans one way or the other, just putting the idea on the table if conditions worsen.
For Munday’s part, he said last week that he “has the option to issue a more restrictive health order” if the data, that is, the spread of the illness in the community, requires it.
He made no mention of that during his report to the county board Nov. 17, only further explaining the travel advisory handed down by the state late Friday, Nov. 13.
Munday explained the travel advisory is “recommended” and is not mandatory but was issued to dissuade interstate and cross-border travel, which ramps up significantly during the holidays.
Dr. Mark Ghaly, secretary of California Health and Human Services, explained the advisory on Nov. 16.
“This is not a mandate. This is not a travel ban. This is not a restriction. This is really to discourage non-essential out-of-state travel. We’re asking people who do go out of state and come home or have guests from out of state, to do a 14-day self-quarantine in the state before they mix with people outside of their household,” Ghaly said. “This allows us to be confident and certain that we aren’t having additional risk of transmission, especially when visitors are coming to our state or you’re returning to California from places with really high levels of transmission.”
Simply put, Americans — Imperial County residents included, of course — are feeling the fatigue of pandemic-related measures and have been for some time.
Imperial County Executive Officer Tony Rouhotas Jr. acknowledged as much on Nov. 12, when he agreed that Valley residents are indeed over the requirements to stay apart, to wear masks, and socially distance, to some extent.
He explained that there have been anecdotal reports of larger-than-allowed gatherings at homes, but he said that authorities have not been receiving those reports.
Vigilance has long been a key word used by Rouhotas and others to encourage measures like wearing face coverings and practicing social distancing. That will continue, and even increase in the weeks ahead, Munday reported Nov. 17.
Likely among the least-popular of the state and local health orders is the limit on gatherings that directly impact upcoming Thanksgiving and Christmas holidays, two times of the year where homes are often filled with extended families and friends.
The state mandated that no more than three families could gather under a single roof back in October, which was tightened even further by Munday, who limited those gatherings in Imperial County to no more than 16 individuals.
He reminded the public of this order during his report to the county board, adding that “there will be additional messaging.”
Cases Increase, But Treatment Improves
As the numbers of those hospitalized and the spread reaches the same levels they did in late spring and early summer, health officials did put some of what we’re seeing during “COVID 2.0” in perspective.
In addition to a vaccine on the horizon, Munday said Nov. 10 and again Nov. 12, the reports of a new medication approved by the FDA for emergency use was equally significant.
He was referring to the drug bamlanivimab, a monoclonal antibody therapy, for the treatment of mild-to-moderate COVID in adults and child in the outpatient environment.
ECRMC’s Edward was perhaps the most eloquent in his assessment of the current state of treatment, and how “COVID 2.0” differs dramatically so far from “COVID 1.0.”
“We’ve sophisticated ourselves in the treatment of the disease itself,” he said Nov. 12. “We’re seeing patients discharged faster and sent home. That’s good news … something we didn’t have in the first wave of corona.
“We’re wiser in the treatment of COVID,” Edward added.
(EDITOR’S NOTE: This story was updated at 10:50 a.m. Nov. 18 with new COVID data from the county Public Health Department, El Centro Regional Medical Center, and Pioneers Memorial Healthcare District.)