California’s Maxed ICU Capacity and Lockdowns

January 8, 2021
California’s Maxed ICU Capacity and Lockdowns

California led the nation in early lockdown measures for COVID during the holiday season at the end of 2020.  This followed the pattern set in spring 2020, when California locked down early and swiftly, stemming a tide of rising COVID cases and flattening the curve successfully.

This time, the state pointed to dire forecasts for December to justify another rapid shutdown, with the trigger being ICU capacity.

The state is divided into five regions. If available ICU capacity drops below 15% in a given area, that region goes on lockdown for at least three weeks.

Two days after the announcement was made, two regions were already in that category, with a third voluntarily adopting the lockdown pre-emptively to stem the tide sooner rather than later.  By the middle of December, Central California had reached zero percent ICU capacity.

The California Government’s About COVID-19 restrictions site provides updates on lockdown status based on ICU capacity.

Video Spotlight: 

This post is based on the AP News article, Most of California to enter sweeping new virus lockdown, by Jocelyn Gecker, December 5, 2020; the California Government’s About COVID-19 restrictions site; the Los Angeles Times page, Tracking the Coronavirus in California Hospitals, by Los Angeles Times Staff; the Fox News article, California governor’s coronavirus lockdown likely to hit parts of state this weekend, by Brie Stimson, December 5, 2020; and the YouTube videos in the Spotlight. Image source: Fuse/Getty Images

Discussion Questions:

1. How is capacity defined, and how does this relate to the problems California faces?

Guidance: Capacity is the upper limit on the load that a facility can handle.  It is not only the physical size of a facility (i.e., square footage of a factory, store, or hospital).  It also includes the amount of equipment available.

Thus, the capacity of a hospital is not only defined by its square footage.  One must also consider the number of rooms and/or beds.  Furthermore, one must look at the amount of equipment available.  For COVID-19 cases, ICU capacity is critical. Simply adding beds, either in the hospitals or offsite in other locations such as tents or other buildings like gyms or convention centers, does no good if the other care equipment, such as ventilators and equipment to monitor vital signs, is not available.

Beyond physical space and equipment, however, the personnel needed to run to equipment and/or staff the system must be present in the right quantity and skill level. The biggest capacity constraint in California is not just a lack of ICU beds, but a lack of trained ICU doctors, nurses and other staff to care for those patients.

Several things account for the labor shortage, including soaring numbers of COVID patients, up to 25 percent of ICU workers out sick from COVID, and an inability to quickly train other nurses for this type of care.  In addition, unlike in the spring of 2020, where certain regions of the country could request help from other areas that were not as hard hit, swelling numbers of COVID patients across the nation mean little additional help is available.  Calls for additional staffing have resulted in only a few coming forward, even as those in retirement have asked to consider re-entering the workforce to help.

2.  What were the current ICU capacities of the regions which first went into lockdown?

Guidance: In a matter of two days, the ICU available capacity of Southern California and the San Joaquin Valley (Central California) went from over 15% to 12.5% and 8.6% respectively.  About half of California’s 40 million residents live in these two areas of the state.  In addition, about half of counties in the San Francisco Bay area communities pre-emptively moved into lockdown, while ICU capacity remained at about 21%.

3. What do the new lockdown measures involve?

Guidance: The lockdown measures involve complete closure of many newly-reopened businesses, such as hair and nail salons, zoos, museums, and playgrounds.  Many restaurants which had recently incurred costs adding outside dining in order to be able to operate on site, are now restricted to take-out. Retail stores and shopping malls drop from 50 or 25 percent to 20 percent capacity restrictions.  In addition, gatherings with anyone outside of one’s immediate household are forbidden.

Time will tell how that played out during the holiday season, as enforcement was expected to be minimal.


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