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August 6, 2020
Paul Gipe

Covid-19: Back with a Vengeance--National Guard Called in


It's bad here. How bad is it? California's National Guard was called in to help area hospitals handle the flood of Covid-19 patients, reports the Bakersfield Californian.

I've been planning to write an update on Covid-19 in Kern County, but every day the situation deteriorated further, prompting me to delay.

This will give a sense of the scale of the outbreak here.

  • Kern County has as many patients in ICU as the entire country of Canada.
  • Kern County has two-thirds as many hospitalized as Canada.
  • Kern County has twice the active cases as Canada.
  • In mid-August, Kern County had as many new cases as Canada.
  • 2% of Kern County is or has been infected with Covid-19.
  • Kern County has one of the highest rates of Covid-19 in California (the Californian).
  • Kern County's ten hospitals reached capacity in late July (the Californian).
  • Kern County signed a $12 million contract to bring in more nurses (the Californian).
  • Models predicted that the county would exceed ICU capacity in late July, and it did (the Californian).
  • Models estimate that expanded hospital capacity will be exhausted by November (the Californian).
  • Models forecast an additional 400 deaths this month or next (the Californian).

Kern County is big. It's the size of Connecticut, Rhode Island, and Delaware combined. But it's not as big as Canada. Nor is it as populous. Kern County has a population less than 1/38th that of Canada.

So yes, the situation is bad here--in raw numbers, in hospital beds occupied, and relative to other locales in North America.

To be fair, Canada reached a peak in infections mid-spring with some 2,000 new cases per day and they've kept a lid on infections since then. Kern County may not have yet reached its peak.

What Went Wrong?

No one knows for sure. On the surface it seems Kern County has been doing everything right. Yes, they reopened too soon, but so did many other places. And the county has shut down again when required by the state. 

Nor have there been big political fights between Republican-led Kern County and the Democratic Governor that might have led to lapses in needed actions. There have been some potshots for sure, but no outright revolts against state directives. Kern County hasn't fired the county health officer for ordering measures they've objected to as we've seen in Orange County, another traditional Republican stronghold.

There was a big slug of cases move through two weeks following the 4th of July celebrations, indicating that partiers ignored pleas to not gather in groups. Infections are now community wide and not just in care homes.

Kern is also big in prisons and packing houses (we're the nations #1 supplier of carrots). Outbreaks have hit the prisons. Tehachapi had 300 cases from the prison there alone. Packing houses have had to shut down following outbreaks.  The United Farm Workers are suing one packing house for a big outbreak among their Hispanic staff.

The Hispanic community has been hit hardest by the pandemic. Hispanics in the Central Valley are one of the most medically underserved communities in the nation, says Leticia Perez, the Chair of the Kern County Board of Supervisors. Many are considered essential workers so they haven't been able to shelter-in-place, and those that are not often can't afford to take time off when they're sick. Many also live in multigenerational homes. If one gets sick, it's then passed on to others, including elderly family members.

I saw one stat that said 75% of those in ICU here are Hispanic while they represent about half of the total population. I can't confirm that number at the moment.

We had early infections in care homes as had been seen elsewhere. The Californian reported 4 August that of the 19 care homes in the county 13 had outbreaks among residents, 15 had cases among its staff, eight residents have died of the 144 total deaths in the county, and one staff member has died. The state and county eventually stepped in and staffed some care homes to ensure proper care and quarantine procedures were followed.

We probably won't know what went wrong here for several years. Academics will be poring over the Covid-19 pandemic and the US' poor response for decades to come.

Kern in Exponential Growth

Covid-19 never left Kern County--and California. That is part of the answer to the question dogging health officials, "What did we do wrong." We never got the infection rate down low enough before we reopened. There was a reservoir of infection and, like a smoldering fire, once it got going it just took off, exploding into a conflagration.

In early July Kern County entered the exponential growth phase of the pandemic here. This is the part of the growth curve that approaches the vertical and why we say that cases began "skyrocketing." It's like a rocket shooting into space. (For more on exponential growth and why it's so dangerous in a pandemic see Covid-19 in Full Flower in Kern County and in the USA.)

Fortunately, deaths have been growing linearly and not exponentially. What happens when we exhaust the number of beds available and start triaging patients in temporary shelters is unknown.

Note that in the chart, the sudden decline of new cases is an artifact of how quickly test results are reported and not a sudden decline in the disease's spread. Kern County may have turned a corner, but that's not evident in this chart.

Kern County hospitals had extra bed capacity that was held in reserve. The hospitals just didn't staff them. Then the hospitals found that they were physically exhausting their staff. The hospitals not only needed more staff to open up the beds in reserve but also to relieve the staff they were overworking.

The state and the county were monitoring the situation and when the hospitals asked for help, both stepped in. As noted the county is hiring more nurses and the state has called in the National Guard to provide doctors and nurses where needed.

Just a few weeks ago administrators at the major hospital systems here in Bakersfield were issuing reassuring assessments. Then some nurses began speaking out on their case loads. It seemed as though only a week later, bang, in comes the National Guard and the county announces its contract to hire more nurses.

With all the modeling available, with all the experience elsewhere with a highly infections disease, it's hard to imagine that the hospitals were caught flatfooted. Still, it's a bit disconcerting from the sidelines when the headlines declare that the National Guard has arrived.

In early July, the 7-day average of new cases was growing from 3% to 4.5% per day. (The 7-day average is used to dampen the wild fluctuations in day-to-day infections that are partly due to problems reporting test results and subsequent data recording.) This equates to a doubling time of from two to three weeks. For example, if you're reporting 500 cases per day, in two to three weeks you will be seeing 1,000 new cases per day. If there are no changes in the growth rate from a policy intervention, for example, within one month to a month and a half you will see 2,000 new cases per day. That is exponential growth and why it's critically important to "stop the spread."

New Cases and Testing

President Trump has charged that the growth in cases is due to the growth in testing. This isn't true. It would be partly true if the rate of positive tests remained the same or declined as we continued testing. It hasn't. In Kern County, the rate of positivity has been steadily increasing. Increased testing here is showing that Covid-19 is spreading and not declining.

Until early July, Kern's positivity rate was just under the state's limit of 8% for limited reopening of the economy. Since then, the positivity rate has steadily increased and is now twice the state's limit for limiting Covid-19 spread.

Central Valley Now Center of California's Covid-19

The Los Angeles Basin and the San Francisco Bay area were early hot spots in the Covid-19 outbreak in California. They still dominate in total number of cases because of their large populations. (The LA Basin alone has one-quarter of California's population.)

However, the rate at which Covid-19 is spreading is much greater in California's heartland--the Great Central Valley. Relative to population, the southern Central Valley--the San Joaquin Valley--now leads the state in cases and in the rate of positive tests.

Kern County has the second highest 14-day case rate in California behind only Colusa. Kern County is in the San Joaquin or southern portion of the Central Valley, Colusa is in the northern portion, the Sacramento Valley. Most of the top nine counties in California with the highest case rates are in the San Joaquin Valley.

The Central Valley is the nation's breadbasket. Its fields produce a wide array of products from almonds to zucchini and are one of the world's major producers of cotton.

The spread of Covid-19 here could, in part, be due to the vulnerable population required to tend the fields and pick the crops.

Covid-19 Modeling

While I haven't tried to model the development of Covid-19 in Kern County, others have. The state of California models the pandemic of course. And Kern County has its own epidemiologist. Others have modeled the outbreak as well.

One of those is Covid Act Now. Their online analysis warns that "Kern County is either actively experiencing an outbreak or is at extreme risk. COVID cases are exponentially growing and/or Kern County’s COVID preparedness is significantly below international standards."

Ouch.

According to their analysis, Kern County is experiencing about 60 new cases per day per 100,000 people, putting the county in a "critical" zone. This case rate is comparable to my tracking of Kern County's 7-day average of new cases in mid July. My tracking indicates that the case rate has halved since then. Good, but not good enough. We still fall in the critical zone.

They also displayed a high infection rate when I visited their web site. This leads Covid Act Now to warn, "As such, the total number of active cases in Kern County, California is growing at an unsustainable rate. If this trend continues, the hospital system may become overloaded."

They got that right.

My observation is that Covid Act Now may be relying on data from a few weeks ago when Kern County was in the exponential growth phase. Their charts may not reflect current data. I hope that's the case. We don't want it to get any worse than it is already.

Official modeling is more optimistic. California COVID-19 Assessment Tool (CalCAT) is an ensemble of different models tracking and forecasting the spread of Covid-19 in the state by California's Department of Public Health.

The ensemble of the models forecasts that the total deaths in Kern County from Covid-19 will more than double within the next month to 340 from the 144 deaths at the end of July.

The good news is that CalCAT's ensemble projection of the effective reproduction number, R, has fallen below one in Kern County. That is, each infected person will infect less than one other so total new cases should begin declining. That's not evident yet on the ground here. And the "ensemble" is an assessment of half a dozen different models, some of which don't forecast such a rosy picture. (Covid Act Now is also reporting an infection rate of less than one as of 6 August.)

Nevertheless, the CalCAT ensemble forecasts are a small bright spot in a very dim picture for Kern County and its citizens.

Covid-19 and its effect on the health of the nation, both its people and its economy, is the most momentous event we have faced since WWII. The repercussions in Kern County and nationwide will be felt for years to come. And it's not over yet.

 

 

 

 


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