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The Nooner for Saturday, December 5, 2020, presented by SYASL Partners
¡Buenos dias mis amigos! It was the second night in a row of eight hours of sleep for the first time in a long time. And, I got in a pre-shutdown haircut late yesterday thanks to Jason Iverson. (Kevin is great too!) No, Jason didn't ask for the plug. It was a disturbing walk around downtown. Amidst shuttered familiar businesses were equally familiar ones in open defiance of the state and county health order. It's not my job to name names, but both defiant businesses and their patrons share blame for closing other businesses temporarily or permanently.
Well, it's certainly not a quiet weekend. I won't be getting reading the news until after The Nooner goes out. Too many factual things going on.
Last night, when the state posted the updated ICU capacity numbers, there were significant changes from the data posted Thursday. The San Joaquin Valley and Southern California regions will be under the state's Stay At Home Order when it takes effect at 1259PM PST today (or is it meant to be 1159PM PST?), meaning that residents and affected businesses and organizations need to come into compliance within 24 hours of whenever that is.
Additionally, yesterday, five Bay Area counties in a joint press conference that they would implement the state's order proactively to get ahead of the curve. Those counties are Alameda, Contra Costa, Marin, San Francisco, and Santa Clara.
Combined, there are 28 counties under the two regions and the two regions with a total of 33,619,577 Californians, or 84.5% of the state's population.
Meanwhile, Sutter and Yuba counties, which share a public health office, issued an order that is a bit more suggestive of stay at home, although they did require all schools to close in-person instruction and closed all restaurant dining -- indoor and outdoor.
COVID-19: Yesterday, 204 deaths were reported in the state, (increase of 32 yesterday) bringing the total to 19,798. Here is what we've seen this week:
As I've written before, two metrics that aren't all that relevant are cases (variable by testing) and, sadly, deaths (lagging indicator). What does matter are positivity of testing (leading indicator), hospitalizations (current indicator), and ICU beds occupied (capacity concern for all causes) by confirmed or suspected COVID-19 patients.
I am not spending my Saturday morning diving deep on this data to be create panic and I'm not a hypochondriac as someone alleged this morning. If I was, I wouldn't have been out getting a haircut (total precautions of course), walking around to get a sense of what's happening in the neighborhoods we Capitol folks rely on (very sad), or going to Market 5-ONE-5 to pick up some ingredients for dinner.
Unlike conventional media who may see more revenue covering this story, it's the opposite for me. I cover it because it's undoubtedly the biggest political and policy issue in California today.
As Stay at Home orders will affect 84.5% of Californians starting tomorrow and likely all of us eventually, I want to share and to the best of my ability explain what the experts are looking at in making these very difficult decisions that they are well aware of cause economic devastation for many.
Let's look at those three charts as we do occasionally to understand why public health officers are so concerned. These charts and referenced data are from the California Department of Public Health State Dashboard, captured this morning. Click to see each chart larger or you can look at them on the dashboard, where you can see the actual data.
The first chart is somewhat deceptive as it may look as if the state has just experienced a modest increase in test positivity, but that is a fallacy. I need not tell you that the formula is (number of positive cases) ÷ (number of tests). In April, very few people had access to tests, primarily those either with symptoms in a clinical setting or those in high-risk environments like skilled nursing facilities.
But, let's look at the positivity rates in the recent months when testing has been widely available.
Hospitalizations need little explanation, except that hospitals are not admitting COVID-19 patients with mild symptoms. Too often, this is a 7-day leading indicator of ICU beds needed for at least a portion of these patients. It also raises the question about hospital capacity for all causes. Fortunately, there is essentially no flu activity in California. It could be a very low flu year because more people are now accustomed to taking precautions against respiratory viruses and because more people got a flu shot because of COVID-19 and such things as free flu shot clinics and drive-through immunization availability.
The final chart is the most concerning to health officials. ICU beds require a licensed bed and equipment AND staffing. Both are having capacity issues right now, particularly in small, rural counties. See below this chart for the listing of counties with five or fewer ICU beds available.
Here is the list of counties with five or fewer ICU beds available, which is why the regional rather than county approach is being used given the large decline in available beds statewide. ICU beds need to be available for all causes, not just COVID-19. Our hopes are that we have no disasters or tragic events while we get COVID-19 under control, but the job of public health officers is to be prepared for what could happen. To find the lastest on these numbers (this is from this morning), go to this dashboard (there are two dashboards), and choose "ICU Available Beds" in the dropdown menu in the top left of the screen.
All of a sudden, Sacramento's 79 available ICU beds don't seem like that many. Sacramento has the region's only Level I trauma center and has an obligation to maintain a certain number of beds available for arriving trauma cases (I don't know that number). Additionally, the county has to basically assume the population and cases/positivity of a large number of counties around it. Lots of counties above are not in the Greater Sacramento Region and already have few or no ICU beds.
That's the rationale for regions. Are they perfect? Folks smarter than me determined them based on a modified version of the state's existing mutual aid map.
TIERS: No changes to county tier assignments. Purple/Widespread=52; Red=5/Substantial; Orange/Moderate=1
STAY-AT-HOME: As written above as per data posted last night, unless the state's Stay At Home Order is changed or a data error is discovered, the San Joaquin Valley and Southern California regions are on the 24-hour clock for compliance beginning at 12:59pm today. Additionally, five Bay Area counties have proactively issued their own orders, with slightly different emplementation times (without a 24-hour clock, as notice has been given).
Here are the days when the Bay Area orders take effect, and it sounded like the orders will mirror the state order below. While I listened to the call and times were stated, my notes were great so I'm not listing them. Consult with your county to find out the effective time.
Press conference on 12/03 with Governor Newsom and HHS Secretary Dr. Mark Ghaly:
Regions: Here are the five regions, which are based on existing regions used to assess utilization and capacity of critical hospital resources. For example, it may sound silly to have Mono County in with San Diego County, but if there is a tragic accident in Mammoth, victims are likely being taken by ambulance or air to San Bernardino County or the greater Los Angeles.
Generally, rural and small counties have very few ICU beds for both resource and staffing issues, and in normal times rely on hospitals in larger counties for more than a few critical patients. Equipment statewide for COVID-19 is very much available, but it requires trained staff to manage patients on a ventilator.
If someone gets in a bad accident on I-80 between Sacramento and San Francisco, they could be hospitalized in Sacramento, Yolo, Solano, Contra Costa, Alameda, San Francisco, or even San Joaquin counties. Those are counties in three different regions. Play that out around the state, such as if a person is being life-flighted after a bad accident on the 405...
Thus, regional capacity is what public health officials (state and local, urban and rural) are looking at and, regardless of pandemic, their job is to be prepared for calamities that can happen at any time.
*County has voluntarily adopted the state's Stay At Home Order
Cite: COVID19.CA.GOV: About COVID-19 restrictions (Under "Regional Stay Home Order")
Restrictions when a region falls under Stay At Home order:
NO JUICE FOR YOU: As NorCal folks were looking with sympathetic "we know the feeling" eyes down to SoCal over the last week, Pacific Gas and Electric yesterday forecasted a public safety power shutoff (PSPS) for next week affecting 130,000 customers in at least parts of fifteen counties. The PSPS is forecasted to begin in the early morning hours Monday, December 7, moving north to south as usual, with counties such as Monterey forecasted to be affected in Monday evening.
The affected counties are Alpine, Amador, Calaveras, El Dorado, Fresno, Lake, Monterey, Napa, Nevada, Placer, Sierra, Sonoma, Tulare, Tuolumne, and Yuba. Again, generally, it's only part of counties. Look up an address or view the forecasted outage map here.
Meanwhile, last week's PSPS in Southern California Edison territory has been completely resolved. In the San Diego Gas & Electric territory, only 1,047 customers are awaiting restoration.
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SENATE VACANCY: On CNN this morning:
Former Senator Barbara Boxer on CNN re: Senate vacancy: "I think there should be a caretaker and then an open election."
ASSEMBLY LEADERSHIP: Yesterday, Assembly Speaker Anthony Rendon (D-Lakewood) announced that he is appointing Assembly member Eloise Reyes (D-San Bernardino) as Majority Leader. Reyes succeeds Ian Calderon, who didn't run for reelection this year and his being succeeded by his mother, Lisa Calderon (D-Whittier). Reyes is the fourth woman and first Latina to serve in the role.
...cakeday and classifieds after the jump
CAKEDAY: Happy birthday to Marc Aprea, Ann Blackwood, Samantha Draper, and Lara DeLaney!