Los Angeles Mayor Eric Garcetti decided to take bold action on the COVID-19 pandemic. In a Public Order under his emergency authority, he has ordered all residents living within the City of Los Angeles to remain in their homes. All businesses must cease operations and they cannot require in-person attendance. It should not shock you that protests are allowed, and, begrudgingly, outdoor church services. All other gatherings of people from different households are verboten.
In the order, Garcetti told residents:
The Coronavirus is widespread in our community, and the latest data from the Los Angeles County Department of Public Health shows more Angelenos are infected with COVID-19 than ever before.
Our City is now close to a devastating tipping point, beyond which the number of hospitalized patients would start to overwhelm our hospital system, in turn risking needless suffering and death. These unfortunate facts about the spread of COVID-19 in our City mean that we must resume some of the more restrictive measures we instituted in the Spring.
A devastating tipping point sounds horrifying. However, given that the city just closed all restaurants to in-person outdoor dining in the absence of any data, I decided to look for some on my own. According to the COVID-19 dashboard for Los Angeles County, all daily metrics went up following the holiday weekend.
They fell again by the last date reported, November 30. On November 28, nearly 6,000 positive tests were recorded, which had fallen to under 4,000 by the 30th and 2,686 on Dec. 1. Deaths have a similar inconsistent pattern, indicating that some of this spike is data entry-related. Of the tests conducted, Los Angeles County has a seven-day rolling average of 7.3% of tests being positive.
It appears that in Los Angeles County, there are approximately 17,000 regular medical beds and 2,500 ICU beds in 70 hospitals. As of the week ending November 28, there were 11,431 patients in regular beds and 2,002 patients in ICU beds on average. This excludes the four Department of Health Services (DHS) hospitals with a small number of beds.
The actual problem is underutilized hospital capacity, not limited capacity. According to a county DHS report from December 3, Los Angeles County only has 84% of their estimated ICU beds staffed and 70.9% of their estimated regular beds staffed. In the current census, the county has 94.7% of ICU beds occupied and 94% of regular beds. If fully staffed, the utilization rates would be 80% in the ICU and 62% in regular beds. It may be partially a function of the state-mandated nurse-to-patient ratios, but it appears hospitals can apply for waivers during the pandemic.
Non-COVID-19 patients occupy the vast majority of beds. Twenty-four percent of ICU patients have tested positive for COVID-19, and 12% of those in regular beds have. I use the phrase tested positive because most hospitals are testing all patients admitted, whether they exhibit symptoms or not. So, even those flagged as COVID-19 may be hospitalized for a completely different reason given the tests’ high sensitivity. There are also financial incentives to list COVID-19 in the diagnosis. Residents of Los Angeles should insist that these statistics reflect patients hospitalized for COVID-19 instead of with COVID-19.
By way of comparison, Georgia ran between 11% and 15% positive test rates all summer. The hospital system has bounced between 80% and 85% occupancy since the summer when normal operations resumed. There was a dip and then an uptick over the holiday, which is not unusual. People avoid getting treatment until the holiday is over. Of the total, 14% are COVID-19 positive, but again, all inpatients are tested. It is impossible to know what percent are hospitalized for COVID-19. The state is fully open, and there is no talk of new restrictions.
Florida is also open, including Disneyworld and sports stadiums, and has a 7.48 test positivity rate. They are currently using 77% of hospital capacity statewide, and 9% of patients test positive for COVID-19. This is astonishing given that, as of 2018, 20.5% of Florida’s population was over the age of 65, giving them a large at-risk population. Governor Ron DeSantis has explicitly said the state would not shut down again.
Not to be outdone by Garcetti, California Governor Gavin Newsom decided to snap back restrictions on individual counties:
Sectors that will remain open when a region is placed into the Regional Stay-At-Home, include:
– Schools that are already open
– Critical infrastructure
– Retail (20% capacity to reduce exposure)
– Restaurants (take-out and delivery)
— Gavin Newsom (@GavinNewsom) December 3, 2020
It must be wonderful to be able to pick winners and losers like that—and go to fancy dinners that violate your own orders. Sadly, at least in Los Angeles County, hospital capacity is scarce because of poor resource utilization. Los Angeles County residents should be asking is why the full hospital system is not staffed, and demand leaders increase staffed capacity so that healthy individuals can go to work and leave their homes.