Mixed Messages 

As this issue went to press and December and 2020 drew to a close, it seemed clear the COVID-19 case surge officials have long warned of is upon us. The only question remaining is how much worse it will get.

Fueled by what officials described as a perfect storm of pandemic fatigue, holiday get-togethers and the onset of cold weather pushing ill-advised social gatherings indoors, December saw cases spike dramatically on the North Coast, with hospitalizations and deaths following. As the Journal went to press, the month had already accounted for 47 percent of 1,678 cases confirmed to date throughout the pandemic's first 10 months, as well as 55 percent of COVID-related deaths and 27 percent of hospitalizations. The month also saw the county's test-positivity rate — which sits at 3 percent for the duration of the pandemic — more than double to 7 percent. And officials remained braced for the spike to worsen in the weeks after the Christmas and New Year holidays.

Despite escalating case counts, the state on Dec. 29 moved Humboldt County from its most restrictive purple "widespread" risk tier to the "red" substantial risk level, loosening restrictions in some sectors. Specifically, the county's new red tier designation will allow movie theaters, places of worship, gyms and restaurants to re-open limited indoor operations. But it's unclear exactly why Humboldt County's status was reduced. The state depends mostly on two metrics — test-positivity rates and the average number of new cases confirmed daily over the span of a week per 100,000 in population — and had previously held that if those metrics were split between the state's tiers, a county would be placed in the more restrictive one. In Humboldt's case, a test-positivity rate of 4 percent would put the county in the state's orange "moderate" risk tier, while an adjusted average daily case rate of 14 per 100,000 residents would put it in the purple tier.

In a press release, the county's Joint Information Center said the state's decision came as a "surprise" and later Dec. 29, as the Journal went to press, the county issued another press release noting county officials' "concerns" with the tier reassignment.

"In many ways, the data doesn't support this decision," Humboldt County Public Health Officer Ian Hoffman said in the release. "Our case rates are the highest they've ever been and our contact investigation teams are tracking more cases, not fewer. It's unfortunate that we didn't get to have a conversation with the state before this decision was handed down."

Earlier in the day, during a media availability, Hoffman also urged local residents who have tested positive for COVID-19 to abide by the full 10-day isolation period. He said the Joint Information Center has received reports that some residents have been trying to get re-tested before the period is up, potentially needlessly exposing others to infection.

"There is nothing you can do to change that 10-day isolation period," Hoffman said. "If you're in isolation — if you had a COVID-19 positive test — you need to stay home away from everyone else for those 10 days. Please don't get re-tested. Please stay home."

Humboldt County, meanwhile, remained one of only 11 California counties not yet under a state stay-at-home order that will be triggered when regional cumulative available hospital intensive care unit capacity dips below 15 percent. According to a state database, the Northern California region had a cumulative available ICU capacity of 27.9 percent as of Dec. 29, though regional health officials have warned the situation is precarious, as the entire region has only about 120 ICU beds and could quickly become overwhelmed should cases spike further.

Statewide, conditions also steadily worsened, despite Gov. Gavin Newsom's implementation of new restrictions for 98 percent of the state's population earlier in the month. As of Dec. 29, the state was reporting 0 percent cumulative ICU capacity throughout California, though that number is clearly imprecise, since (as reported above) the state is also reporting 27.9 percent ICU capacity in Northern California and more than 1,300 beds are available statewide.

According to a report in the San Jose Mercury News, that's because the state adjusts "ICU capacity" based on a number of metrics, including the percentage of COVID-19 patients in a particular ICU.

"If a region is utilizing more than 30 percent of its ICU beds for COVID-19 positive patients, then its available ICU capacity is adjusted downward by 0.5 percent for each 1 percent over the 30 percent threshold," the California Department of Public Health said in a statement to the newspaper.

Healthcare providers in some regions, meanwhile, have said they don't feel like the state's formula accurately reflects the availability of staffed ICU beds, while providers at St. Joseph Hospital told the Journal earlier this month that the hospital's emergency room was seeing more critically ill non-COVID patients than ever before due to deferred care and other factors.

Statewide, more than 20,300 COVID-19 patients were hospitalized as of Dec. 29, with more than 4,300 in intensive care and both figures representing more than 40-percent increases from a week earlier. The daily statewide total of COVID-19 hospitalization set a record Dec. 27 for the 30th consecutive day, according to the Los Angeles Times' reporting, with 19,766 people hospitalized with the virus in the state. As the Journal went to press, the state was on track to record nearly 25,000 COVID-19 deaths this week.

In Los Angeles County, providers are already triaging care and turning patients away. The Los Angeles Times reported Dec. 29 that Los Angeles County-USC Medical Center shut its doors to ambulance traffic for 12 hours Dec. 27 and had at least 30 patients in need of intensive care without a single bed available. Other area hospitals were struggling to keep enough oxygen and supplies on hand to meet demand, while others were placing patients in conference rooms and gift shops, the paper reported. "It's a crisis — there's no doubt about it," Memorial Hospital CEO Kevan Metcalfe told the Times. "And they just keep coming."

Cases continue to surge nationally, as well. The Centers for Disease Control reported that 176,974 new cases were confirmed Dec. 29, bringing the national tally to 19.2 million, which included 334,029 deaths. And while the rollout of vaccines from Pfizer and Moderna this month have offered a glimmer of hope amid the pandemic, it was reported this week that the United States will fall far short of its goal of vaccinating 20 million people by Jan. 1. Humboldt County, Hoffman said, had received approximately 5,500 vaccine doses as of Dec. 29, which were being administered to healthcare providers in high-risk situations and skilled nursing residents. He said he doesn't expect vaccines to begin to become available to people in the state's next vaccination tier — potentially including first responders, teachers, grocery store workers and others in "essential" jobs — until late January or early February.

While an outbreak at Eureka's Granada Rehabilitation and Wellness skilled nursing facility is responsible for all of the 11 deaths recorded in December, as well as a total of 98 confirmed cases in residents and staff since Nov. 25, local officials have repeatedly cautioned that it has only been a small factor in Humboldt County's escalating case counts, which they attribute largely to people gathering and traveling over the Thanksgiving holiday.

In a potentially ominous sign, the Transport Security Administration reported this week that it screened almost 1.3 million passengers at airports throughout the country Dec. 27 — the most on any single day since March 16.

Just days before Christmas, Public Health Director Michele Stephens released a plea to local residents not repeat the mistakes made over the Thanksgiving holiday.

"I wanted to reach out to everyone today to highlight the significant and extraordinary amount of cases that we're getting lately, in the last several weeks," she said. "They are not Granada driven. We think that the Thanksgiving holiday is really what we're starting to see in the rise in positive cases and, with the Christmas holiday this week, we really want to implore everyone to not gather with loved ones that are outside of your household and be safe.

"As hard as it is, and as hard of a decision as it is to keep your household only, it's something we all need to do," she continued. "I have a 7-year-old who's doing distance learning. He misses his family, he misses his friends and he has a mom that's working a lot. But we all need to do our part as community members and I implore you: The worst present we can give to your family members right now is COVID-19. So please don't gather for the Christmas holiday and be safe."

How many local residents heeded the pleas of Stephens and other health officials seems likely to determine what local restrictions and hospital capacities look like in the weeks and months to come.

Thadeus Greenson (he/him) is the Journal's news editor. Reach him at 442-1400, extension 321, or [email protected]. Follow him on Twitter @thadeusgreenson.