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The Nooner for Sunday, December 6, 2020, presented by SYASL Partners
I've switched it up today and moved COVID-19 beneath the other stories. That's not suggesting it is no longer the most important policy and political story in California (it is), but rather to ease into Sunday.
NO JUICE FOR YOU:
LEGISLATIVE ORGANIZATION: Tomorrow is swearing-in and organizational session for the 2021-22 California Legislature. Not surprisingly, it's going to be a bit different. The State Senate is meeting in its chambers at 12pm. However, like we ended the 2019-20 session, the Capitol will have very limited access and strong protocols. Individuals are encouraged to watch the activities online (link will appear tomorrow).
The Assembly, with a body double the size of the State Senate but a chamber of the same size, physical distancing is not possible with all 80, let alone the customary guest. The "lower house" will be having its organizational session at the Golden 1 Center four blocks west (use donated), providing excitement to the towering downtown arena that hasn't been seen since March 11, when the Kings and the New Orleans Pelicans sat around waiting to see if their game would be canceled. Fans had loaded up on food and beer and when it was finally announced that it was canceled, there were audible boos and many fans remained in their seats unwilling to leave.
Tomorrow is going to be a barn-burner! Oh, wait, that's the place six miles north, which is now waiting for patients... It's not still called Sleep Train, is it? We always tried to avoid calling the 7pm-7am or 11pm-7am shifts "graveyard" when I worked at CHOC.
With no "Horcher" moments expected, I think March 11 will go down as more exciting, even though a basketball game wasn't played that night. Like the Senate, the Assembly's organizational session at 12pm is expected to be livestreamed here.
ANOTHER PARLOR GAME? With California Attorney General Xavier Becerra being interviewed by the Biden campaign for Attorney General of Health and Human Services, politically ambitious lawyers are salivating at a second major appointment by Governor Gavin Newsom. Of course, Secretary of State Alex Padilla is happy to be weigh in on what a Becerra nomination would mean to the Biden Administration. Who are some of the names that could be part of the discussion?
Remember, like an appointment to the upcoming Senate vacancy, an appointee other than a caretaker will have to run in a primary that is 548 days from today. And, as we saw with the challenge of Dianne Feinstein by Kevin de León in 2018, a cush primary is not assured.
Here are some names I have heard, alphabetically:
Like with the U.S. Senate vacancy, an appointment opportunity by Newsom to AG would draw calls from a variety of constituencies. Interestingly, Kamala Harris "checked off" three boxes -- first woman, first Black, and first Asian-American. Becerra is the first Latino. (I believe, but am not 100% certain and only have 7 hours to research and write this morning.)
If there is a vacancy in AG, it would follow the U.S. Senate appointment. The largely expected appointment of a person of color to the Senate seat would expand the field Newsom could choose from with less criticism, although there would still be significant demand for the appointment of a Black attorney general because of the police use-of-force issues. That would be heightened if Kamala's Senate seat is filled by a Latino. I just haven't heard any names. Had Jackie Lacey survived her reelection as Los Angeles district attorney, perhaps? But not now. Please send in any names you have heard or think of.
Of course, Becerra himself became AG through appointment by Gov. Jerry Brown to fill the seat left vacant when Kamala Harris was elected to the Senate.
COVID-19: Yesterday, 84 deaths were reported in the state, bringing the total to 19,882.
Confirmed by data yesterday (discussed below), the twelve counties in the San Joaquin Valley region and the eleven counties in the Southern California region officially are under the Stay at Home order at 11:59pm tonight. It will last until at least December 28. Lifting the order will be based on a four-week look forward at ICU capacity in the region to ensure it's on track to stay under 15%. Upon lifting, each county will be returned to the color-coded tier system based on the data at the time of re-placement.
Here are the days when the Bay Area orders take effect. Each of these five counties have orders are in place until January 4, 2021.
Press conference on 12/03 with Governor Newsom and HHS Secretary Dr. Mark Ghaly:
Regions: Here is the latest ICU capacity by region, which is from this state page.
*County has voluntarily adopted the state's Stay At Home Order
Cite: COVID19.CA.GOV: About COVID-19 restrictions (Under "Regional Stay Home Order")
ICU Capacity: There are lots of questions about why the ICU capacity in the San Joaquin Valley and Southern California regions dropped significantly from the first data displayed after the announcement of the order on December 3. There are plenty of conspiracy theories out there, but it's something that was done by the state and local public health officers and not by a politician. Here is the explanation, found in the Q&A under Regional Stay at Home Order on this page.
In short, the December 3 data included NICU and PICU beds. As I've written in this space, I spent three years working in exactly this environment at Children's Hospital of Orange County. I was trained as an EMT and worked as a unit secretary in the PICU (much easier to do homework than in an ambulance cab). Loved the job and hated leaving it, but UC Davis called.
Anyway, you can't fit a 47-year-old guy (for 12 more days!) in either a PICU or NICU bed, and we know that the COVID-19 impact on those units is minimal. The capacity concern is really on the adult units with space for new admits from all causes.
I have mentioned that a duty of public health officers, working with local hospitals and regional parties in normal times and 2020, is to ensure that the county/region has the resources to serve the foreseeable and unforeseeable. They work with good data that can forecast load for routine illnesses, and automobile accidents and the like. They also prepare for mass casualty events. Undoubtedly you've heard of or even volunteered for one of the routine county drills for exactly this. This is part of routine emergency planning and includes hospital usage, including the need for intensive care beds.
Let's look at the data for the first three days of state reporting:
While there is no explanation of "standardizing current adult ICU capacity," I believe it is related to population. I'm working on getting an answer.
Let's talk about San Joaquin Valley. The vast region begins just south of Sacramento with San Joaquin County and stretches to just north of Los Angeles with Kern County. Hospitals may need to start diverting as early as today. They aren't going to Southern California which has similarly troubling numbers. They instead are likely going to the Bay Area and Greater Sacramento.
Looking at the regions not yet under the Stay At Home Order, this morning (likely last night when the data were updated) Northern California had a combined 32 available ICU beds this morning, the Bay Area had 337, and Greater Sacramento had 135.
We can (and should) normalize rates by population, but at the end of the day when a region hits a crisis point, it is about beds.
Thus, don't rest on your laurels Bay Area and Greater Sacramento as you may be accommodating patients from the San Joaquin Valley and Southern California regions very soon. Meanwhile, we know that hospitalizations is a leading indicator (reportedly ~7 days) to ICU demand. While Sacramento County had 73 beds available this morning, the hospitalizations trend is troubling.
Source: Sacramento County Public Health COVID-19 Dashboards
Please note that the ICU data in this chart is only COVID-19 patients. Capacity varies with patients with other causes and staffing.
For those curious, San Joaquin Valley had 92 available ICU beds this morning and represents 4.5 million (11.4%) of the state's population. Southern California had 1,030 and represents 23.1 million (58.1%) of the state's population. Yeah, this is what I do when I get up at 4:30 on a Sunday.
...cakeday and classifieds after the jump
CAKEDAY: Happy birthday to John Connelly, Assembly member Jordan Cunningham, Katie Hardeman, John Monsen, and Stuart Waldman!