REGIONAL — As the plans for vaccinating California’s 40 million residents begin to take shape, Gov. Gavin Newsom warned that the most difficult days of the COVID-19 pandemic may still lie ahead.

“We likely will experience in two weeks — 10, 14 or 18 days from now — this surge stacked on top of these other surges related to holiday activities,” he said.

Covering a wide range of topics related to the pandemic during a Dec. 28 press conference, Newsom expressed concern over the high number of holiday travelers and the impact that travel is expected to have on the pandemic in the coming weeks.

Dr. Mark Ghaly, secretary for the California Department of Health and Human Services, echoed those concerns.

“We certainly anticipate that the middle of January is going to be a pretty difficult time in our hospitals, where the cases from this week and next week really start to stack on top of one another impacting the emergency rooms, our hospital wards and our (intensive care unit) wards,” Ghaly said.

Ghaly announced Tuesday, Dec. 29 that shelter-in-place orders in the Southern California and San Joaquin Valley regions will remain in effect until those regions once again have intensive care unit (ICU) capacity of at least 15%. The order went into effect for these regions on Dec. 6 and were to remain in effect for three weeks. Both regions are currently reporting 0% ICU capacity prompting the extension of the order.

Diminishing ICU capacity in the Bay Area region, which includes Alameda County, triggered implementation of a regional shelter-in-place order on Dec. 17. It is set to expire Jan. 8. However, as ICU capacity has not yet recovered in the region, it is likely that the order will be extended into the foreseeable future. 

In Alameda County, the number of patients hospitalized with COVID-19 continues to climb. The county reported 418 hospitalizations on Dec. 27, the highest number reported to date, and a 38% increase over the last two weeks. The number of COVID-19 patients in county hospitals is now more than eight times higher than it was in mid-October, when the latest surge started.

The number of patients in an ICU hit a low point of 11 patients on Oct. 23. Currently, there are 115 ICU patients in the county, more than 10 times the mid-October low point. That number is likely to rise as admission to the ICU tends to lag hospital admissions by 10 to 14 days for COVID-19 patients.

“This surge makes our summer case rates minimal by comparison,” said Neetu Balram, public information manager with the Alameda County Public Health Department. “We are experiencing a huge influx of cases, and we need everyone to do their part in stopping the surge by staying home as much as possible, avoiding gatherings of any size and wearing masks if going out for essential activities.”

While Bay Area hospitals are reporting ICU capacity of 9.5% in aggregate, ICU capacity in Alameda County is much less dire. As of Dec. 27, the county reported that 34.2% of its ICU beds are available. Balram noted that the county’s capacity could be used to provide aid to nearby counties, should patient demand exceed their capacity.

“Alameda County has more hospital beds than many other counties in our region and responsibility to provide mutual aid for our neighboring counties when they reach capacity,” Balram said. “Thus the 34% is a measure of hope for our region and not a true reflection of beds available in Alameda County.”

Newsom also announced Monday that California has opted in to the federal COVID-19 Pharmacy Partnership. Under this partnership, CVS and Walgreens will administer the Pfizer vaccine to residents and staff in long-term care facilities. Those pharmacies will start with nursing homes, which will take an estimated three to four weeks; and then vaccinate staff and residents in assisted living, residential care and other long-term care facilities. Pharmacists, pharmacy technicians and nurses will administer the vaccines. Pharmacy technicians are participating under a recent waiver by the Board of Pharmacy that requires appropriate supervision under California law and specialized training.

“Vaccinating those most vulnerable among us is critical to fighting this virus,” Newsom said. “By leveraging CVS and Walgreens resources, we can effectively deploy vaccines to residents and staff at our long-term care facilities, which are at higher risk of Covid transmission – and do it at no cost to the state or local government.”

The state expects to receive approximately 1.8 million doses of the COVID-19 vaccine by the end of the month, including those doses already received. The next phase of the state’s vaccination plan, Phase 1B, will include two tiers. According to Newsom, the first tier will include residents over 75, and workers in education, childcare, emergency services, and food and agriculture. The second tier is expected to include persons over 65 with underlying medical conditions, workers in transportation and logistics, those incarcerated, unhoused individuals and those involved in critical manufacturing.

The Community Vaccine Advisory Committee was expected to meet Wednesday, Dec. 30, to discuss the distribution of vaccines for Phase 1C. The results of that meeting were not available as of press time.

With an increasing number of vaccine doses flowing into the state, Newsom indicated that the state will have little tolerance for medical personnel that deviate from the prescribed distribution plan.

“I just want to make this crystal clear,” Newsom said. “If you skip the line or you intend to skip the line, you will be sanctioned. You will lose your license. You will not only lose your license, we will be very aggressive in terms of highlighting the reputational impact as well.”