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- SacTown Talks: Assembly member Cristina Garcia (2020-12-18)
- If I Couid Change One Thing (SDSU): Dr. David "Davey" Smith on Operation Warp Speed" and vaccinations (2020-12-02)
- Inside Golden State Politics (Bill Boyarsky and Sherry Jeffe): Becerra: Another Bright Spot For California And The Rest of The Country (2020-12-10)
- Then There's California (Senate Democratic Caucus): State Senator Maria Elena Durazo, the new Chair of the California Latino Legislative Caucus, talks about public policy, health, and social justice priorities for our Latinx communities in 2021. (2020-12-09)
- Capitol Weekly Podcast (John Howard and Tim Foster): Vaccines are coming with Dr. Dean Blumberg, Associate Professor of Pediatrics, UC Davis School of Medicine and Acting Chief, Pediatric Infectious Disease Section, UC Davis Medical Center. (2020-12-07)
- Look West Podcast (Assembly Democratic Caucus): Introduction to new Assembly Democrats (2020-12-07)
- KQED's Political Breakdown (Scott Shafer and Marisa Lagos): Dr. Anthony Fauci on California's New COVID Restrictions and Lessons from the HIV/AIDS Epidemic (2020-12-04)
The Nooner for Tuesday, December 29, 2020, presented by SYASL Partners
- LA homicides
-tiers for fears
-LA County crunch
-LA County travel
- Cakeday and classifieds
Frankly, you won't find that much good news below although Rep. Devin Nunes's (R-Tulare) lawsuit against the Washington Post was dismissed. Anyway, like my former yoga instructor always said child's pose is only one breath away, you can always return up here to watch animal videos before continuing with the power vinyasa exercise that is the news of the day.
Meanwhile, it's a beautiful day outside here at Nooner Global HQ with a balmy high of 60 forecast for the afternoon.
It won't be much warmer in SoCal today. Yesterday, residents acted like puppies discovering snow for the first time as hail blanketed some communities. I have to admit that there were indeed some pretty pictures.
I'm looking forward to a longer walk today than I did yesterday, when I just spent time walking around neighboring Southside Park. As I feared when critics got a reversal of the stay-at-home order to allow the reopening of playgrounds, there were plentiful adults unmasked and not distanced interacting while the children played. It didn't appear that they were from the same household and it's not like SacPD is enforcing that.
Don't get me wrong. I know it's very good for the physical and mental health of children to be outside, and the playground equipment itself is of low risk. However, the argument to allow playgrounds to reopen were that the adults would follow all of the guidelines. They are not.
On the food front, folks keep posting queries on the Capital Eats Local Facebook group (where people share tips about great take-out and delivery options of locally owned restaurants and home chefs and chefs like the great Taka Watanabe of Ju Hachi posts his delivery schedule and menu highlights) to ask where they can eat indoors or outdoors at an area restaurant. Of course, neither is allowed under the stay-at-home order (and indoor wasn't under the purple tier), but people who know it's not allowed are asking for the speakeasies out of compliance.
Fortunately, the moderators are quick to delete the posts and before that happens, the "crowd" jumps all over them in the invite-only group (so exclusive that there's over 11,000 members; just exclusive to avoid spam). The common refrain these days is "Go to Lake County, that is the closest."
LA HOMICIDES: In the LAT, Matthew Ormseth and Nicole Santa Cruz report on the tragedy in Los Angeles County that is not COVID-19.
Amid the COVID-19 pandemic, a rancorous presidential election and social upheaval over police abuses of Black people, Los Angeles endured another crisis in 2020 as killings and other serious violence rose sharply. Homicides rose by 20% in the county, to their highest level in a decade.
The week Walton died stands out. From June 29 to July 5, 29 people were killed across Los Angeles County — the deadliest week on record since 2008. Nine of the week’s victims died or were found by law enforcement on its first day; at least two people were killed on each day that followed.
In an attempt to understand the year’s violence, The Times examined several of the lives that were lost that week and what they showed about the forces driving the bloodshed.
This highlights the issue of impacted hospitals and 0.0% ICU capacity, which is further discussed below under the COVID-19 item). All too often this year I've heard opponents of county health orders that COVID-19 only hits the old and those with underlying health conditions (which a majority of Californians have), the fact is that we're all susceptible to accidents that require emergent care and possibly critical care capacity.
In Los Angeles County, if Los Angeles County-USC Medical Center is closed to incoming ambulance traffic for 12 hours on a weekend night, it's a tragedy far more than for COVID-19 patients. There are four Level I (the highest-level) trauma centers for adults (CHLA is also Level I for peds) in Los Angeles County. Ambulances bouncing around looking for open doors with critical gunshot victims means more deaths, and I needn't tell you that it hits the same communities already the hardest hit by COVID-19.
COVID-19, cakeday and classifieds after the jump...
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Sorry for the nags, and I know it's irritating, but I also know you're seeing them across media properties, or at least I do every day including all the ones that take money from my account monthly.
COVID-19: California added 257 deaths yesterday for a total of 24,545 since the pandemic began. The catch-up from the reporting lag over the holiday weekend continues. There's also this disturbing graf from yesterday's release from Los Angeles County:
The Los Angeles County Department of Public Health (Public Health) has confirmed 73 new deaths and 13,661 new cases of COVID-19. Public Health estimates there are an additional 432 deaths that reflect the delayed reporting associated with the Spectrum outage and the holiday that are in the final stages of confirming.
Here are the charts for today with data through yesterday, which are from the California Department of Public Health dashboard.
There are some signs of a plateau, although there are also known data delays because of the holiday weekend and the internet outage Saturday in Los Angeles County as noted above.
For CalMatters, Ana B. Ibarra provides a very good overview of the grim forecast after the holidays.
Despite the glimmer of hope that the arrival of the vaccine provides, its arrival may be too late for people who will become infected following holiday travel and gatherings.
Nationally, the Transportation Security Administration screened more than 1.2 million people at airport checkpoints on Sunday — about half the number of people who traveled on that date that last year, but still the highest number since the start of the pandemic.
Newsom, who has been questioned on many occasions about enforcing stay-at-home orders and travel advisories, has said repeatedly that he believes Californians are in large part doing the right thing. Still, he acknowledged that based on early travel data, many people likely didn’t follow the state’s recommendations.
“That suggests that we are going to see an increase in cases,” Newsom said. And as cases rise, so does demand in hospitals and their ICUs, setting January to be possibly one of the hardest months for California.
-Vaccines: In the Bee, Andrew Sheeler reports on Governor Newsom's admonition against providers who would violate the state's prioritization order for vaccine administration, which he detailed in yesterday's update.
“I just want to make this crystal clear: If you skip the line or you intend to skip the line, you will be sanctioned, you will lose your license,” Newsom said during a press conference. “You will not only lose your license, we will be very aggressive in terms of highlighting the reputational impacts as well.”
The first wave of coronavirus vaccines are intended for health care workers and those in high-risk congregate settings, such as skilled nursing facilities. Future phases of vaccine distribution likely will be targeted at those who work in education or child care, emergency services, food and agriculture, Newsom said.
But as the state receives “millions and millions of doses,” the Democratic governor said, it is clear “not every individual may hold themselves to those higher ethical standards, the Hippocratic oath which they’ve taken, and we are mindful of that.”
The governor spoke as California, a state of 40 million people, is expected to receive a total of nearly 1.8 million COVID-19 vaccines by the end of this week. Each person will need two doses of the vaccines currently available.
The language was interesting, as the admonition sounded aimed at those receiving the vaccine, but the enforcement is clearly against the provider.
The vaccine prioritization starts around here in the YouTube video of yesterday's presser.
-Regional stay-at-home: The announcements of the stay-at-home order extension will be made today at noon by HHS Secretary Dr. Mark Ghaly, according to Governor Newsom in his update video yesterday (links below). It is clear that the San Joaquin Valley and Southern California regions will be extended based on the four-week forward projections on ICU capacity. It sounds like the Bay Area and Greater Sacramento regions won't be determined until their respective initial three weeks are up. If there's anything different announced in the next hour, I'll send out a seperate email.
While the Greater Sacramento region's three weeks are up on December 31 at 11:59pm, that doesn't mean things reopen when the proverbial ball drops. Sacramento, like most county orders include this language in its county order "shall become effective at 11:59 pm on December 10, 2020 and will continue to be in effect until it is rescinded or amended in writing by the Health Officer."
The county order aligns with the state's order and is equally enforceable. Until the county health department issues a new order, ostensibly after a change in the state's categorization of the region, the same stay-at-home guidelines remain in effect.
--Update on 12/03 with Governor Newsom and HHS Secretary Dr. Mark Ghaly:
--Update on 12/07:
--Dr. Ghaly update on 12/08:
--Governor Newsom update on 12/18:
--Governor Newsom update on 12/28:
--the regions: Here are the regions with the latest ICU capacity (available physical beds and necessary staffing). The benchmark to avoid falling under the stay-at-home order is 15% capacity.
No new data have been posted for today as of 11:40am, so these percentages are yesterday's using data as of Sunday.
- Northern California: Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Shasta, Siskiyou, Tehama, Trinity
ICU capacity as of 12/28: 29.3%
- Bay Area: Alameda, Contra Costa, Marin, Monterey, Napa, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma
ICU capacity as of 12/28: 9.5%
- Greater Sacramento: Alpine, Amador, Butte, Colusa, El Dorado, Nevada, Placer, Plumas, Sacramento, Sierra, Sutter, Yolo, Yuba
ICU capacity as of 12/28: 16.6%
- San Joaquin Valley: Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare, Tuolumne
ICU capacity as of 12/28: 0.0%
- Southern California: Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, Ventura
ICU capacity as of 12/28: 0.0%
--the violators: Los Angeles County Public Health lists businesses that have received a citation from the department for violating the county's order. There are lots of salons, gyms, and churches, and mom-and-pop restaurants. But, there are also the Denny's in El Monte, a Chipotle on Beverly Blvd., the Ramada Inn LAX, Citadel Outlets, The Grove (big outdoor shopping mall), the Burbank Town Center, an AT&T store in Sun Valley, Walmarts (Burbank, Compton, and South Gate), and on and on...
Anyway, I looked at it because there has been a lot of chatter that only "the little guy" is under enforcement, which may be true in some counties. However, in Los Angeles County, they're not shying away from the big fish.
The question is why such a list isn't available for every county. Obviously, it's all public information. We all see the lists of restaurants cited for cockroaches in normal years, which often require a Public Records Act request. But this year is anything but normal and LA County (and maybe others -- I don't check 58 county websites daily) should be applauded.
San Diego does list cease-and-desist orders, but that's usually only for repeat violators and not first citations or fines. County counsel would much prefer fines over orders that requires work in the courtroom.
-tiers for fears: There are no changes to the tiers that counties in theory will return to after regional stay-at-home orders are lifted.
- Purple/Widespread=55 counties
- Red/Substantial=2 (Alpine, Mariposa)
- Orange/Moderate=1 (Sierra)
-Oxygen: From my days as a sick kid to my time working in peds ICU at Children's Hospital of Orange County to my pandemic re-bingeing of the great show "House" starring Hugh Laurie to get away from politics, "O2 sat" was a key indicator of a patient's health. You likely have at one point had one of those monitors on a finger and the monitor started beeping if it fell below 95. If you aren't already on a nasal cannula, that'll be the first addition. If you are on a cannula, it'll become a mask. And the invasiveness continues from there. Hypoxia begins in most patients below 92%, and below 85% saturation, intubation is indicated in COVID-19 patients, according to UC Health (Greater Cincinnati Health System). There has been debate about exactly when to intubate COVID-19 patients because the mortality outlook may not be appreciably better and ventilators have at times and in some locations been necessarily rationed.
Anyway, the point of this item is that the Los Angeles County O2 sat is below 85%. I'm not referring to a patient where we measure it in the arterial bloodstream but rather in the supply of oxygen to meet the needs of the deluge of current and expected patients. A team in the LAT writes:
Officials are having problems getting the amount of oxygen needed by critically ill COVID-19 patients who are struggling to breathe as their inflamed lungs are being damaged or destroyed.
Problems on Sunday caused at least five hospitals in L.A. County to declare an internal disaster, which closed the facilities to all ambulance traffic — not just certain types of ambulance patients, as is more typical.
It’s not simply a shortage of oxygen itself, county and hospital officials say. There’s a shortage of canisters, which patients need to return home, and aging hospital pipes are breaking down due to the huge amounts of oxygen needed to be distributed around the hospital.
There are two problems with the distribution of oxygen at aging hospitals.
First, there are so many patients needing a high rate of oxygen that the system cannot maintain the sufficient pressure needed in the pipes.
The second is that there is such high flow through the pipes that they freeze, “and obviously, if it freezes, then you can’t have good flow of oxygen,” said Dr. Christina Ghaly, L.A. County health services director.
Some hospitals are forced to move patients to lower floors, because it’s easier to deliver oxygen there without needing the pressure to push it up to higher floors, Ghaly said.
There's lots more in the article, which is definitely worth a read.
Governor Newsom addressed this in yesterday's update linked above. He said that the state had dispatched teams to assess staffing and supply needs, including oxygen. A team is going to be sent down on an ongoing basis as the crisis continues and that the state was working on procuring more oxygen.
The problem is that if the pipes are insufficient or suppliers don't have sufficient canisters, it's not like it's like finding a warehouse in China full of PPE.
-Staffing: On the good news front, during yesterday's update linked above, Governor Newsom said that the state is expecting a surge of more nurses and other health care professionals the week beginning Sunday. Some of that is part of regular contracts that hospitals have for traveling nurses from out-of-state as they scale up for the flu, some from additional contracts the state has signed, and some from federal assistance.
While existing physical hospital space is a problem, the state has the supplemental sites such as Sleep Train Arena in Sacramento and Imperial Valley College that are ready to go but staffing is needed. It's unclear whether these sites will be for COVID-19 critical or acute patients or for other patients, as the description has changed throughout the pandemic. Given the shortage of oxygen and the infrastructure needed for high-volume oxygen, they will likely be for non-COVID patients to make room for the car accident, etc. acute-level patients that need hospitalization but not ICU-level care.
-Morgues: In the SDUT, Paul Sisson reports on the end point of far too many Californians with COVID-19 and picture isn't just grim for the families losing loved ones.
San Diego County’s health care system reached a stark milestone over the weekend as dwindling morgue capacity forced the county medical examiner to begin storing the deceased.
A medical examiner transport vehicle removed five bodies from Sharp Grossmont Hospital in La Mesa over the weekend, officials confirmed in an email, after the facility’s morgue filled past capacity.
Dr. Steven Campman, San Diego County’s interim medical examiner, said in an email Monday afternoon that four different hospitals have notified his office in recent weeks that their morgues were near capacity. The situation has unfolded as San Diego County experiences the most-significant surge in COVID-19 deaths to date.
“They were ultimately able to handle the situation after contacting local funeral homes,” Campman said. “Sunday, Dec. 27, was the first day a hospital exceeded its capability, so the facility management plan has been put into use, and the county is storing some of the decedents from that hospital.”
-LA County crunch: A team at the Times reports on the weekend impact in Los Angeles County which led to major hospitals shutting down for all new patient arrivals and even putting patients in the gift shop.
At Los Angeles County-USC Medical Center, the breaking point came Sunday night.
There was not one available bed for at least 30 patients who needed intensive or intermediate levels of care, and the hospital had to shut its doors to all ambulance traffic for 12 hours. Some patients, including the very sick who required intensive oxygen, experienced wait times as long as 18 hours to get into the intensive care unit.
The crisis at Los Angeles County hospitals hit new levels as patients continued to stream in during the holiday weekend, and the medical system is bracing for a new wave of coronavirus spread arising from Christmas travel and gatherings. L.A. County’s cumulative COVID-19 death toll is expected to climb past 10,000 this week.
Hospitals are so inundated that they’ve resorted to placing patients in conference rooms and gift shops. But even so, many facilities are running out of space. Virtually all hospitals in L.A. County are being forced to divert ambulances with certain types of patients elsewhere during most hours. On Sunday, 94% of L.A. County hospitals that take in patients stemming from 911 calls were diverting some ambulances away.
“But soon, there won’t be any places for these ambulances to go,” said Dr. Christina Ghaly, the L.A. County health services director. “If every hospital is on diversion, then no hospital is on diversion.”
-LA County travel: Leila Miller and Rong-Gong Lin II report on changes to quarantine requirements for people traveling into Los Angeles County, whether resident or non-resident.
As Los Angeles County continues to see an unprecedented wave of coronavirus cases, travelers returning to the region must quarantine.
Everyone who traveled out of the county is required to quarantine for 10 days upon return, the L.A. County Department of Public Health announced in a news release Monday. If a person begins to experience symptoms of the virus or tests positive, they should isolate for 10 days and until they are fever-free for 24 hours.
Individuals in quarantine should not leave their home or receive visitors, and should instead find others who can buy groceries or other essential items for them, according to the department.
“For those who traveled outside of L.A. County and recently returned, you may have had an exposure to COVID-19,” officials said. “The virus can take up to 14 days to incubate, and for many people the virus causes no illness or symptoms. If you go back to work, go shopping or go to any gatherings at any point over the next 10 days, you could easily pass on the virus to others.”
The announcement did not indicate whether people who violate the requirement will be penalized. It was all-encompassing, and didn’t specify any particular type of travel or distance traveled that would trigger a quarantine.
There is a lot of confusion about the quarantine announcement as was widely talked about on social media last night. It was buried beginning with the sixth paragraph in the daily release we geeks read on cases, hospitalizations, and deaths. It doesn't match up with the current order on quarantine issued December 17, which has similar language but is limited to those coming in from outside from the county who have had "close contact with a person who was diagnosed with COVID-19," while yesterday's release (and the LAT article excerpted above) makes it sound like it's everyone.
Well, there are health care workers, first responders, and other essential workers who move in and out of Los Angeles County every day -- to Ventura, Orange, San Bernardino, Riverside, and Kern. Clearly, the order is not intended to require them to quarantine for ten days after every shift.
I'm guessing we'll be getting clarification on this in the next couple of days.
Meanwhile, there still is a mandatory statewide 14-day quarantine for people traveling into California from outside of the state, whether they are residents or not. According to my Facebook feed with lots of Christmas holidays in Hawaii and subsequent movement, lots of people aren't following it and likely don't even know about it.
Cakeday and classifieds after the jump...
CAKEDAY: Happy birthday to April Young!
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Grants Program Director – California Business, Consumer Services and Housing Agency
Homeless Coordinating and Financing Council Division
Monthly salary: $8,173.00- $9,280.00
Application Deadline: Tuesday, December 22, 2020.
Expert in grant management directs all operations of grant programs, including developing and delivering public facing interactions with eligible grantees to provide technical guidance and evaluating data related to grant programs for the purpose of reporting and influencing statewide policy.
For more information about this position and to apply online please visit: https://jobs.ca.gov/CalHrPublic/Jobs/JobPosting.aspx?JobControlId=225782
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McGeorge School of Law, University of the Pacific
Built on the foundation of nationally ranked and world class programs, McGeorge School of Law offers an online master (MSL) degree for individuals seeking in depth knowledge of law and policy, but who do not require a traditional law degree. Our MSL’s two concentrations in Government Law & Policy and in Water & Environmental Law offer students the flexibility to work while they learn and still engage in a highly interactive master’s program. To learn more and to sign up for our monthly webinars, please visit our website, Online.McGeorge.edu, or contact us at firstname.lastname@example.org.
Statewide Coalition Manager – Preschool Development Grant
Are you a relationship builder? Do you love policy analysis? Do you have a background in public policy, public administration, child development, or a similar field? Do you want to work somewhere that makes a difference in the lives of children across the state? Then YOU’RE the person we’re looking for! Come join us at Child Care Resource Center as our new Statewide Coalition Manager!
You will work in partnership with regional Resource and Referral (R&R) hub agencies throughout the state of CA to nurture and build out the partnerships of Regional Hubs and their local R&R partners. This position will focus on expanding regional and local relationships and building regional strategies for the delivery of early childhood services, including Parent Café and Early Childhood Café programs, throughout California, and will also coordinate the development of other regional partners including California Quality Consortia, California County Offices of Education and Tribal partners appropriate to each region. Reporting to the Chief Strategy Officer, this position utilizes a high level of collaboration and relationship building to create effective internal and external relationships, communicate the CCRC Mission, Values and Vision to external stakeholders, and work in collaboration with other CCRC Departments and organizational partners.
Political Data Inc.
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