Virus update: 12-2-20; Dark time

Merced County Public Health Department reported 9.8 rate of infection; 185 dead, addition of 2 since yesterday).



Sacramento Bee

Coronavirus updates: 20,000 cases set California record; ICU capacity at all-time low Michael McGough, Tony Biziak


California reported more extremely concerning data on coronavirus activity from the current surge on Wednesday, especially with regard to hospital space for the most critically ill patients.

require(["medianetNativeAdOnArticle"], function (medianetNativeAdOnArticle) { medianetNativeAdOnArticle.getMedianetNativeAds(true); }); The state health department said there were 2,006 patients in intensive care units with coronavirus and only 1,810 ICU beds remaining available. That patient load ties for the second-highest of the entire pandemic, and the state’s intensive care capacity is now officially at its lowest point ever during the health crisis.

California health officials also on Wednesday reported 20,759 new lab-confirmed cases, crushing the previous single-day record of 18,350 while coming from a much smaller pool of diagnostic tests. The sky-high case total emerged from a batch of just 138,000 tests, which works out to an alarming positivity rate of 15%.

The addition boosted California’s two-week rolling average to 6.9% of tests returning positive, up from 6.5% just one day earlier.

Topping it all off, the state reported 113 new deaths, the most in a day since Oct. 21.

New COVID-19 cases and hospital admissions are both at all-time highs in California’s capital region as well. As winter arrives, the level of concern has never been higher.

Sacramento County Public Health Officer Dr. Olivia Kasirye said her staff’s contact tracers are already seeing a link between new infections and people who took part in Thanksgiving gatherings among family and friends.

Due to COVID-19’s typical incubation period of more than one week, this could mean some of the cases returning positive soonest after the holiday could involve a higher probability of those infected residents exposing loved ones to the virus rather than contracting it from Thanksgiving observances.

The spike could also be emerging early from those who gathered with family or others several days in advance of the holiday. The Friday through Sunday before Thanksgiving saw the most U.S. air travelers in any weekend since the start of the pandemic, federal data show.

Kasirye said the county isn’t considering its own stricter stay-at-home orders, such as those recently imposed in places like Los Angeles or Santa Clara counties, but that it will support more restrictive action if Gov. Gavin Newsom’s health office orders it.

She called the potential move toward a fuller stay-at-home order, which Newsom on Monday hinted could come any day in response to exploding virus numbers, a “really tough decision.”

“A part of the concern is that in a few weeks we are going to be at the Christmas break, another holiday that brings families together,” she told The Bee this week. “We’re wanting to get ahead of that, so that it doesn’t compound the surge that we are experiencing right now.”

The county added 1,115 new infections Tuesday, a single-day record that broke the high mark of 957 reported one week earlier. Its latest tally of 363 virus-positive patients in hospital beds as of Wednesday also continues to expand on a record high, and is approaching 100 more patients than the peak of the summer surge.

“It is concerning whether the hospitals will be able to keep up,” Kasirye said. “They are doing a good job in creating additional space, but the other concern is the (limited hospital) workforce.”

She added that as case growth becomes more rampant in the region, it isn’t just linked to a few different settings such as family gatherings or congregate care facilities.

“It is everywhere as far as I can see.”

Hospitals under stress, ICUs filling in Northern California

Hospitals are facing sharply increasing burdens throughout the greater Sacramento area.

All of the six-county Sacramento region has hit a record high in COVID-19 hospitalizations this week, the state’s data dashboard for COVID-19 activity in hospitals shows.

Placer County, which has the second-most hospital space after Sacramento, reported Tuesday on its local health dashboard having 128 COVID-19 patients hospitalized. That’s more than 17% of the licensed hospital beds at the county’s three hospitals. Of those patients, 17 are in intensive care, the most ever for Placer.

Adventist-Rideout, the Yuba-Sutter region’s only general acute care hospital, had 45 positive patients as of Wednesday’s state data update, which is even higher at 20% of its bed total. Eight of those patients were in intensive care, leaving only one available ICU bed.

For residents of the rural bi-county region, which has two of the highest test positivity rates in the entire state, the nearest alternatives for treatment are in Butte, Placer and Sacramento counties. Like the Sacramento region, Butte County hit a new high in hospitalizations for the pandemic on Monday, at 46 patients.

As of Wednesday, hospitals in the six-county region had just over 110 COVID-19 patients in intensive care and a little over 100 ICU beds remaining available, the dashboard showed.

Newsom on Monday said that based on his health department’s modeling and projections, the greater capital region could exhaust ICU space by about Christmas. Eleven surge sites are set up across California to handle overflow patients if health care systems are overwhelmed as state officials predict they will be.

One of those sites is in Sacramento.

Sleep Train Arena in Natomas, the former home of the NBA’s Kings, was transformed into what is effectively a field hospital in April. The facility has laid dormant, with 244 beds in “warm” standby mode since mid-June.

Statewide, there are now more than 8,500 coronavirus patients in hospital beds. The state has surpassed 2,000 COVID-19 patients in ICUs for the first time since late July, and is now just 50 shy from its all-time record in that mark.

California’s brutal November by the numbers

November was indisputably California’s worst month of the coronavirus pandemic by all critical metrics except deaths, which are a lagging indicator and started to increase in the second half of the month.

The rolling two-week average of daily new cases erupted from 4,275 on Nov. 1 to more than 14,000 by Dec. 1, an incredible 231% increase, according to California Department of Public Health data.

While testing averages also increased over the course of the month, the rate of those returning positive boomed from 3.2% to 6.9% as a 14-day average, indicating true spread of the virus is still climbing very rapidly. In the past week, test positivity is up to 7.3%. In the summer surge, it peaked at 7.6%.

Like infections, the state’s concurrent hospitalized total also more than tripled, going from about 2,500 to 8,517 in one month. The ICU total for COVID-19 started November at 708 and started December at 2,006, a 183% leap.

Even deaths, while still well below summer’s peak of a two-week daily average topping 140, are starting to creep back up. On Nov. 11 the rolling two-week average for COVID-19 deaths dipped to 41, the lowest point since early April. Since then, the average has jumped back up to 69 a day, the highest mark in nearly two months. The fatality increase has corresponded to the hospitalization spike on about a two-week delay, as has been typical throughout the global health crisis.

To date, at least 19,324 Californians have died of COVID-19 among 1.25 million who have tested positive for the respiratory disease, according to CDPH.

Latest Sacramento-area numbers: Infection total near 60,000

The six-county Sacramento area has combined for at least 772 deaths and more than 59,000 total confirmed infections during the health crisis.

As of Wednesday, hospitals in those six counties were treating a reported 572 COVID-19 patients, including at least 112 in intensive care.

Sacramento County has recorded 39,367 lab-positive coronavirus cases and 591 resident deaths from the virus.

Health officials reported 1,115 new cases Tuesday, blowing past the previous single-day record of 957 set Nov. 24. Wednesday added a comparatively low 368 infections.

The county now estimates more than 8,600 lab-confirmed cases — more than one-fifth of the all-time total — are currently active.

Hospitalizations continue to surge and have blown past the summer record of 281 concurrent patients. By Wednesday, the countywide total reached 363, including 77 in ICUs, according to state data. Only 64 ICU beds remain available, a decrease by 14 compared to Tuesday.

At least 63 Sacramento County residents have died from Nov. 1 through Nov. 26, health officials said Wednesday. The month has surpassed October’s death toll.

Yolo County has reported 4,930 total lab-confirmed cases during the pandemic, adding 37 on Tuesday. The county set a single-day record last week, on Nov. 25, with 114.

At least 77 Yolo residents have died of COVID-19 to date, including one fatality reported Monday. Forty-nine of those deaths have been linked to skilled nursing or assisted living facilities, most of them in Woodland.

Recent outbreaks at Cottonwood Post-Acute Rehab in Woodland and Riverbend Nursing Center in West Sacramento have resulted in at least two deaths and one death, respectively, according to the county’s health office.

Yolo as of Wednesday had 20 hospitalized virus patients including nine in ICUs.

Placer County has reported 6,664 cases, reporting 42 new cases Tuesday. That followed 268 cases reported Monday, for a period including the weekend, following 130 for Thanksgiving and Friday, for an average of 80 daily cases in that five-day span.

The countywide death toll has increased to 71, with two new fatalities added in Monday’s update and another added Tuesday.

Placer’s spike in hospitalized cases continues to break records on essentially a daily basis, hitting triple-digits for the first time early last week. The county on Tuesday evening reported having 128 patients in hospital beds with confirmed coronavirus, 116 of them (91%) in hospitals specifically “because of COVID.” The county says 17 were in ICUs, all of them being treated specifically for the disease.

State data, which varies slightly from the county’s own numbers, on Wednesday showed 130 hospitalized with 17 in ICUs.

El Dorado County is one of a few California counties with a single-digit death toll, with just four fatalities since the start of the pandemic. But new cases are coming at an accelerated pace and hospitalizations are rising fast as well.

County health officials added 35 new cases Tuesday, bringing the cumulative total to 2,546. El Dorado reported 231 new cases covering the weekend and Monday and 185 cases Friday for the two-day period including Thanksgiving.

El Dorado had 14 hospitalized COVID-19 patients as of Wednesday, down one from the previous day, with one patient in an ICU, down from three total on Tuesday.

Sutter County health officials have reported a total of 3,637 people positive for the coronavirus and 19 deaths, including two fatalities Tuesday.

The county added 70 new cases Tuesday after a record-smashing 168 on Monday.

Yuba County has reported a total of 2,221 COVID-19 infections and 10 deaths. Yuba added 65 cases Tuesday and 70 on Monday.

Sutter and Yuba, sister counties that share a public health office and have just one general acute hospital between them, have seen their COVID-19 patient total skyrocket: from two patients on Nov. 7 to 48 by the end of November — 30 Sutter residents and 18 Yuba residents, the local health office says. Six in each group are in ICUs.

According to state data updated Wednesday, Rideout in Marysville was treating an all-time high 45 coronavirus patients, including eight in ICUs. Just one staffed ICU bed remained available as of that time.

The Yuba-Sutter dashboard, last updated Tuesday, said 51 residents of those two counties were hospitalized, including 11 in intensive care, though not all of those were necessarily at Rideout.

The Bee’s Cathie Anderson, Sophia Bollag and Noel Harris contributed to this story.



11-20-20Bottom of Form

Harvard T.H. Chan School of Public Health


Frequent, rapid testing could turn national COVID-19 tide within weeks

Boston, MA – Testing half the population weekly with inexpensive, rapid-turnaround COVID-19 tests would drive the virus toward elimination within weeks—even if those tests are significantly less sensitive than gold-standard clinical tests, according to a new study published today by Harvard T.H. Chan School of Public Health and University of Colorado Boulder researchers.

Such a strategy could lead to “personalized stay-at-home orders” without shutting down restaurants, bars, retail stores, and schools, the authors said.

“Our big picture finding is that, when it comes to public health, it’s better to have a less sensitive test with results today than a more sensitive one with results tomorrow,” said lead author Daniel Larremore, an assistant professor of computer science at CU Boulder. “Rather than telling everyone to stay home so you can be sure that one person who is sick doesn’t spread it, we could give only the contagious people stay-at-home orders so everyone else can go about their lives.”

For the study, which was published online November 20, 2020 in Science Advances, Larremore teamed up with collaborators at CU’s BioFrontiers Institute and Harvard Chan School to explore whether test sensitivity, frequency, or turnaround time is most important to curb the spread of COVID-19.

The researchers scoured available literature on how viral load climbs and falls inside the body during an infection, when people tend to experience symptoms, and when they become contagious.

They then used mathematical modeling to forecast the impact of screening with different kinds of tests on three hypothetical scenarios: in 10,000 individuals; in a university-type setting of 20,000 people; and in a city of 8.4 million.

When it came to curbing spread, they found that frequency and turnaround time are much more important than test sensitivity.

For instance, in one scenario in a large city, widespread twice-weekly testing with a rapid but less sensitive test reduced the degree of infectiousness, or R0 (“R naught”), of the virus by 80%. But twice-weekly testing with a more sensitive PCR (polymerase chain reaction) test, which takes up to 48 hours to return results, reduced infectiousness by only 58%. In other scenarios, when the amount of testing was the same, the rapid test always reduced infectiousness better than the slower, more sensitive PCR test.

That’s because about two-thirds of infected people have no symptoms and as they await their results, they continue to spread the virus.

“This paper is one of the first to show we should worry less about test sensitivity and, when it comes to public health, prioritize frequency and turnaround,” said senior co-author Roy Parker, director of the BioFrontiers Institute and a Howard Hughes Medical Institute investigator.

The study also demonstrates the power of frequent testing in shortening the pandemic and saving lives.

In one scenario, in which 4% of individuals in a city were already infected, rapid testing three out of four people every three days reduced the number ultimately infected by 88% and was “sufficient to drive the epidemic toward extinction within six weeks.”

The study comes as companies and academic research centers are developing low-cost, rapid turnaround tests that could be deployed in large public settings or commercialized for do-it-yourself use.

Sensitivity levels vary widely. Antigen tests require a relatively high viral load—about 1,000 times as much virus compared to the PCR test—to detect an infection. Another test, known as RT-lamp (reverse transcription loop-mediated isothermal amplification), can detect the virus at around 100 times as much virus compared to the PCR. The benchmark PCR test typically provided by medical professionals requires as little as 5,000 to 10,000 viral RNA copies per milliliter of sample, meaning it can catch the virus very early or very late.

In the past, federal regulators and the public have been reluctant to embrace rapid tests out of concern that they may miss cases early in infection. But, in reality, an infected person can go from 5,000 particles to 1 million viral RNA copies in 18 to 24 hours, said Parker.

“There is a very short window, early in infection, in which the PCR will detect the virus but something like an antigen or LAMP test won’t,” Parker said.

And during that time, the person often isn’t contagious, he said. The authors recently used these findings to call for a shift in the way we think about test sensitivity in the New England Journal of Medicine.

“These rapid tests are contagiousness tests,” said senior co-author Michael Mina, an assistant professor of epidemiology and a faculty member in the Center for Communicable Disease Dynamics at Harvard Chan School. “They are extremely effective in detecting COVID-19 when people are contagious.”

They are also affordable, he added. The rapid tests can cost as little as $1 each and return results in 15 minutes. Some PCR tests can take several days.

Mina envisions a day when the government sends simple, cheap DIY tests to every home in the United States. Even if half of Americans tested themselves weekly and self-isolated if positive, the result would be profound, he said.

“Within a few weeks we could see this outbreak going from huge numbers of cases to very manageable levels,” Mina said.

Rapid testing could also be the key to breathing life back into former superspreader threats like football stadiums, concert venues, and airports, with patrons testing themselves on the way in and still wearing masks as a precautionary measure, Larremore said.

“Less than .1% of the current cost of this virus would enable frequent testing for the whole of the U.S. population for a year,” said Mina, referencing a recent economic analysis published by the National Bureau of Economic Research.

The authors say they are heartened to see that several countries have already begun testing all of their citizens, and are hopeful that the new U.S. administration has named rapid testing as a priority. On Tuesday, the Food and Drug Administration approved the first at-home rapid test.

“It’s time to shift the mentality around testing from thinking of a COVID test as something you get when you think you are sick to thinking of it as a vital tool to break transmission chains and keep the economy open,” Larremore said.