Little room left in Fresno’s hospitals amid COVID surge – and it could get worse
Fresno County began 2022 with the highest volume of new COVID-19 cases – and some of the largest numbers of hospitalized patients from the virus – since the start of the coronavirus pandemic in March 2020.
It’s ending the year with far fewer new cases and deaths, but hospitalizations are lurching higher for the third straight winter, causing local health officials to continue sounding the alarm about the burden of COVID-19 – and a simultaneous flurry of other respiratory infections – on hospitals and their emergency rooms.
All of Fresno’s major hospitals, including Community Regional Medical Center, Saint Agnes Medical Center and Clovis Community Medical Center, are operating at or above 100% of their capacity, said Dan Lynch, emergency medical services director for the Fresno County Department of Public Health.
Emergency rooms are so full of patients that waiting times for patients to be seen have become significantly extended, he added.
In Fresno County, the number of people hospitalized with confirmed COVID-19 cases reached 234 this week, up 61% from late November and higher than it’s been at the end of any week since February.
Ambulance crews ‘assess and refer’
The patient load at emergency rooms is so acute, in fact, that an “assess-and-refer” policy calling for ambulance crews in Fresno, Tulare, Kings and Madera counties to deny rides for all but true emergency patients to emergency rooms remains in effect for a third straight week with no end in sight, Lynch said.
If ambulance paramedics and emergency medical technicians arrive to a 911 call and find that the patient does not have a life- or limb-threatening emergency, they work to refer the patient to a different source of care – their primary doctor, urgent-care clinics, or telehealth services – instead of taking them to a hospital emergency department.
It’s the third time this year that the policy has been invoked to relieve the burden of non-emergency cases on hospital emergency rooms: first in January, at the peak of last winter’s coronavirus surge; again in July, as new infections and hospitalizations climbed in a summer surge; and now as rising cases and hospitalizations signal another rising tide.
It’s also the sixth time since the pandemic began in the spring of 2020 that the policy has been invoked.
An average of about 20 to 25 patients per day are being referred to other options instead of being taken by ambulance to hospitals, Lynch said of the latest incarnation of the assess-and-refer policy.
“Assess and refer will be maintained until we see some improvement with the hospitals,” Lynch told The Fresno Bee this week. “The jam-packed emergency departments is one of our biggest issues.”
Emergency rooms are holding many patients who have already been admitted but are awaiting for a hospital bed to open up. And between COVID-19, flu, respiratory syncytial virus (RSV) and other respiratory viruses, Lynch said intensive-care beds for the most seriously ill patients are few and far between.
Vaccine rates lagging
In the first full year of widespread COVID-19 vaccine availability to the broad population, the proportion of Fresno County residents who have been vaccinated has been at a virtual crawl even as more people, including children, became eligible for the shots and boosters.
At the beginning of 2022, just over 55% of the county’s one-million-plus residents had been fully vaccinated. As of this week, it’s about 61%, with nearly one-third of eligible people still to get even one dose of vaccine, according to the state Department of Public Health.
That’s well short of the county’s mid-2021 goal of reaching a vaccination rate of 65% to 75%, a level that was hoped to be able to provide a degree of “herd immunity” against the coronavirus and its growing array of highly contagious variants and strains.
Since new “bivalent” booster products aimed at protecting against “classic” COVID-19 and its newer omicron variants became available in recent months, only about 13% of booster-eligible residents have gotten those shots.
That’s a particular worry for local health officials who fear that many Fresno County residents, especially children, are being left more vulnerable to the coronavirus now that most of the safety guidelines – including masking, social distancing and other measures – are more relaxed this winter than at any point of the past three years.
People are increasingly resuming typical holiday activities including large social and family gatherings at which COVID-19, flu and other infections are prone to spread.
Statewide, almost 76% of California residents are considered fully vaccinated, and almost 34% of eligible residents have received the bivalent booster.
One concern locally is the three-day Hmong New Year celebration coming up Dec. 29-Jan. 1, expected to attract 100,000 people or more to the Fresno Fairgrounds.
Joe Prado, assistant director of the Fresno County Department of Public Health, said his agency is working with an array of community organizations to distribute COVID-19 tests and face masks to vulnerable populations in both rural and urban areas of the county, and expect to also hand out the materials at the Hmong event.
“The good news is that the vaccines work,” Dr. Rais Vohra, Fresno County’s interim health officer, said last week. “The bad news is that not enough people are getting vaccines, especially the bivalent boosters” that are now approved for children as young as six months.
Vohra implored people to not only get their shots, but to get tested, avoid large gatherings and wear face masks when out in public – the same COVID-19 precautions recommended during the previous two winters and largely credited with reducing the prevalence of seasonal flu, colds and other infections.
“We’ve got the playbook; we just need to put the playbook into action,” Vohra said. “It’s ‘go’ time to do that.”
Through two years and nine months of the pandemic, more than 283,000 coronavirus cases have been confirmed through laboratory testing in Fresno County. Of those, at least 2,905 patients died from the respiratory virus.
Valleywide, cases to date have totaled almost 592,000, including at least 6,225 fatalities.
What could 2023 hold?
The upswing in Fresno County’s COVID-19 cases and hospitalizations could continue beyond Dec. 31 and into the new year, according to forecast models for the pandemic and testing of wastewater samples showing growing amounts of coronavirus particles being shed by residents and flushed into local sewage-treatment systems.
Those wastewater samples are often considered a leading indicator of future cases.
“What we saw in late November was wastewater indicating some of the highest levels throughout this entire year, and then we saw the corresponding increase in COVID cases and the corresponding activity in the community,” Prado said.
The virus’ presence in samples dipped slightly in the last week of November, but crept higher again in early December. “It is still extremely high,” Prado said.
Prado added that he expects that in newer samples, “we will probably see sustained high levels in the wastewater, corresponding to the predictions that we’re going to have a busy season in January after everyone comes back from the holidays.”
“Whether it’s the flu, whether it’s RSV, or whether it’s COVID,” he said, “there’s going to be a lot of respiratory virus.”
Forecasts by the state Department of Public Health indicate that new cases in Fresno County are likely to remain elevated at an average of more than 220 new cases each day through mid-January – well over the current average of about 158 cases per day.
State pandemic models show that similar upswings are expected in neighboring Kings, Madera, Merced and Tulare counties, where vaccine rates also lag behind the state average:
Kings County: Current daily average of 32 new cases per day; projected average of 62 new daily cases through Jan. 18.
Madera County: Current daily average of 24 new cases per day; projected average of 38 new daily cases through Jan. 18.
Merced County: Current daily average of 27 new cases per day; projected average of 63 new daily cases through Jan. 18.
Tulare County: Current daily average of 44 new cases per day; projected average of 117 new daily cases through Jan. 18.
