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Why California Is One of the Worst COVID-19 Hot Spots and What the Future May Hold

California, once a model of COVID-19 mitigation earlier in the pandemic, has seen its cases steadily rise throughout the summer, culminating in an ongoing crisis.

The state is now seeing case positivity rates of nearly 13 percent, with Los Angeles County seeing as many as 1 in 5 people test positive for the novel coronavirus.

Along with this comes reports of hospitals filling to capacity.

The scene is a severe version of a trend playing out across the country, as COVID-19 deaths nationwide have reached more than 367,000.

How this happened

As with other states and countries, swift business lockdowns and encouraging people to shelter at home helped flatten the curve of the pandemic.

But as states began to reopen, coinciding with the summer and leading into the fall holiday season, cases started to rise sharply again.

“[Lockdown and other restrictions] began in February, and now we’re all the way into [a new year]. People are really fatigued and tired… People just, I think people just got very, very tired, and there really wasn’t enforcement,” said Dr. Bernadette Boden-Albala, DPh, director and founding dean of the program in public health at the University of California, Irvine.

Then there’s the fact that simply sheltering in place isn’t financially sustainable for many people or businesses.

“The solution relied on by the state was having strict adherence to working from home, and minimizing contact was not going to be seriously viable in a long-term sense without sufficient financial support to workers and business owners,” said Dr. Sunny Jha, an anesthesiologist and co-organizer of a currently closed Los Angeles “surge clinic” for COVID-19 cases.

“The folks being infected and dying are predominantly ‘essential’ blue-collar workers who cannot protect themselves adequately due to the nature of their work and their living conditions. The cost of living, among numerous other socioeconomic factors, in California is exorbitantly prohibitive for folks with blue-collar jobs,” Jha said.

These factors have led to COVID-19 cases exploding, particularly burdening population-dense areas like Los Angeles County.

“People are close together. Homes are small and, in many families, multiple generations live in that one small house,” said Dr. Peter Plantes, FACP, a physician executive with hc1, a health company that assembled a coalition of labs and other partners to create the public CV19 Lab Testing Dashboard.

And where the current mega-surge in cases is concerned, “it is a repeated cycle — and the next few weeks will be a further amplification of that cycle,” Plantes told Healthline.

Worsening conditions

Coming out of the holidays — with a lag between the time someone has been exposed to the virus and can pass it on to others versus when they show symptoms — things are likely to get worse before they get better.

“An accelerating rate of infection with COVID-19 occurs as people gather for holiday events. Christmas and New Year’s gatherings are now superimposed by the high prevalence created by Thanksgiving,” Plantes said.

“Approximately half the folks infected become symptomatic a week to 10 days later, and in the next week approximately a third of these become sick enough to go to the hospital ER,” he said.

Following that, hospitals will begin to overflow, and people needing ICU beds will mount.

“This cycle is dependent on how many people are originally infected in the community. We are only 10 days out from New Year’s celebrations, so the next 4 weeks will be filled with an accelerating rate of hospitalizations, ICU transfers, and deaths. The hospitals, ICUs, and morgues are already full,” Plantes said.

Grim outlook

In the short term, the outlook is grim.

“Obtaining control of this virus is unlikely to happen in the near future. I think, unfortunately, the virus will run its course through LA County because the public seems unwilling or unable to abide by the safety recommendations,” Jha told Healthline.

Dr. Richard Pan, a Democratic state senator from California, agreed that the system is stretched to its limit and could hit a breaking point.

“Given that ICU capacity in Southern California and the Central Valley is already at or below zero, already overburdened systems may have to go into crisis mode, where people with lower chances of survival need to be abandoned to provide care to other patients who are more likely to benefit from care,” Pan told Healthline.

“Los Angeles has already ordered their ambulances not to take patients who cannot be resuscitated in the field to hospital ERs as ambulances wait hours before they can transfer care to a hospital,” he said.

Beyond that, people who need medical care and who don’t have a coronavirus infection will be affected by this surge and may not get lifesaving treatment.

“The impacted healthcare system is not just a danger for people infected with COVID. It endangers everyone who needs hospital care for trauma, heart attacks, strokes, cancer, or any other reason,” Pan said.

“The pandemic is so severe that the death rate is projected to rise by 15 percent with a significant drop in U.S. life expectancy anticipated for 2020,” he said.

Can California get COVID-19 under control?

While the surge is ongoing, hospitals and municipalities are pulling in all the help they can.

The question is whether it will be enough.

“We are currently working hard to move nurses into California by using emergency medical services licenses (EMS) to ensure local facilities have access to reliable and high-quality travel nurses,” said Adam Francis, president and CEO of Host Healthcare, a company that provides travel nurses to hospital systems. “With EMS, we have the ability to staff a qualified travel nurse in California within 24 hours.”

What’s encouraging is that we are also seeing an increase in requests from our travel nurses to travel to California or extend their current assignments in California as our nurses look to help the communities most in need (i.e., communities with large populations),” Francis told Healthline.

In terms of bringing this surge under control, however, experts have known what to do for a while: by following the lead of other countries more successful at containing the pandemic than the United States, Pan said.

“The primary hurdles are the resolve of people to keep themselves and their community safe, and providing sufficient support for families so people will not lose their homes and jobs, or go hungry or lose their businesses to follow public health guidelines,” Pan said.

“We also need the capacity to test every person who has symptoms or is exposed within 48 hours, to contact trace every case to identify the source of the infection as well as who was exposed, and isolate people and households who have the infection or who have been exposed for at least 10 days while providing them with food and income during isolation,” he said.

“To achieve this will require federal funding and leadership as well as state and local efforts. Other countries, such as Australia, New Zealand, Taiwan, South Korea, and Vietnam, have shown success,” Pan added.

Then there’s the bright light of the existence of COVID-19 vaccines beginning to be rolled out nationwide.

“I don’t think we’ve seen the worst yet, but I think we’ll start making a turnaround by the end of January or February if we can get the vaccine,” Boden-Albala told Healthline.

“What we need to do now is get the vaccine distributed. And we need to give people hope that they can just hold on and really not see people at all at this point for the next 4 to 6 weeks — then we may have turned the corner,” she said.

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