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By Zach Cavanagh

Hospitals around California received their first doses of the coronavirus vaccine on Monday, Dec. 14, and Tuesday, Dec. 15, at a critical juncture as the numbers of COVID-19 hospitalizations, ICU availabilities and coronavirus case continued dramatic jumps around the state and locally.

Hospitals at four locations in Los Angeles, San Diego, San Francisco and Eureka received 33,150 doses of the Pfizer coronavirus vaccine on Monday with 24 additional locations expecting their shipment on Tuesday and five more expected on Wednesday, including those to Orange County. In a state update on Tuesday, Gov. Gavin Newsom reported that those deliveries represent roughly 60% of the 327,600 originally allotted doses from Pfizer.

Newsom said the state is expecting 393,900 more doses from Pfizer next week with 672,000 doses from Moderna by the end of December.

Newsom laid out the details of the early phases of the state’s vaccine distribution program.

The program begins with Phase 1A which represents California’s healthcare workers and residents of long-term care settings. Newsom said that Phase 1A consists of roughly 3 million people divided into three tiers.

Tier 1 of Phase 1A includes acute care, psychiatric and correctional facility hospitals; skilled nursing facilities, assisted living facilities, and similar settings for older or medically vulnerable; paramedics, EMTs and others providing emergency medical services; and dialysis centers.

Tier 2 of Phase 1A includes intermediate care facilities; home health care and in-home supportive services; community health workers; public health field staff; and primary care clinics (including federally qualified health centers, rural health centers, correctional facility clinics and urgent care clinics).

Tier 3 of Phase 1A includes other settings and health care workers, such as specialty clinics, laboratory workers, dental and oral health clinics and pharmacy staff not working in settings of the higher tiers.

Discussion on Phase 1B continues this week, but Newsom said that group would represent roughly 8 million people and could include teachers, farm workers and grocery workers.

The arrival of the vaccine provides hope that the end of the pandemic could be on the way, but the current coronavirus numbers show there is a lot to take care of between now and that end.

“There is light at the end of the tunnel, but we are still in the tunnel,” Newsom said. “We’re going through the most intense and urgent moment since the beginning of this pandemic.”

Where California’s regions stand with the state’s stay-at-home order as of Dec. 15. Graphic: California Department of Public Health

As of Tuesday, Orange County and the Southern California region were in the second week of a three-week stay-at-home order with the region’s available ICU capacity well below the 15% threshold. The Southern California region is at 1.7% adjusted ICU availability on Tuesday, and Orange County was at a 1.4% adjusted ICU availability. Orange County hit a 0% adjusted on Monday.

According to the county, the adjusted ICU availability is being used “to preserve the capacity of the ICU to also treat non-COVID-19 conditions. …  If a disproportionate number of ICU beds are being utilized to treat COVID-19 patients, then patients with non-COVID medical issues may not be receiving or be able to receive the level of care they need.”

If a region is using more than 30% of its ICU beds for COVID-19 patients, an extra 0.5% is removed in the adjusted capacity for every 1% over that 30% threshold to preserve those necessary resources and beds.

As of Tuesday, Southern California had an unadjusted available ICU capacity of 13.4% and Orange County was at 10.4%.

The San Joaquin Valley (1.6%) and Greater Sacramento (14.9%) regions are the other two of the state’s five regions under the stay-at-home order. The San Joaquin Valley hit 0% over the weekend and is now operating in surge capacity. The Bay Area is at 15.8%, and Northern California is at 29.8%. The Bay Area counties voluntarily went under a stay-at-home order last week.

State hospitalizations have risen 68% in the last 14 days, and state ICU patients have gone up 54% in 14 days. Orange County hospitalizations have risen 99% in the last 14 days with ICU patients increasing by 73%. Both the state and county are at a record number of COVID-19 hospitalizations at 15,198 and 1,371, respectively. Orange County is at a record number of ICU patients with 296.

Where California’s counties stand in the state’s four-tiered, color-coded coronavirus monitoring system as of Dec. 15. Graphic: California Department of Public Health

Nationally, the United States is now over 16.5 million coronavirus cases. There have been 300,479 deaths in the United States, and the national seven-day average testing positivity is at 11.39%.

As of the state’s tier update on Tuesday, Dec. 15, California’s case rate and positivity rate continued to rise as the state reached 63.9 daily new cases per 100,000 and the 14-day testing positivity average rose up to 10.7% from the 8.7% of last Tuesday and the 6.6% of the week before that.

The state has continued to see its record-high new cases and case averages climb higher. The 14-day rolling average of daily new cases rose up to 28,012.9 on Monday, Dec. 14 up from 18,290 on Sunday, Dec. 6. Friday, Dec. 11 posted the largest single-day number of the pandemic by far with 35,729 cases.

Nearly all of California is now in the purple tier with 55 of the state’s 58 counties at the highest risk level. There are only two counties at the red “substantial” level, one county at the orange “moderate” level and none at the yellow “minimal” level. Just seven weeks ago, only nine California counties were purple.

The state’s four-tiered, color-coded coronavirus monitoring system is the main component of the state’s Blueprint for a Safer Economy for determining in what capacity different sectors, businesses and activities can reopen safely as the COVID-19 pandemic continues.

Orange County’s coronavirus monitoring metrics continued dramatic rises higher in purple tier this week. Daily new cases per 100,000 continued to trend sharply upward this week as the metric jumped to an adjusted 42.7 daily new cases per 100,000, up from the 30.3 new cases last week and the 22.2 of two weeks ago. The metric jumped to the purple level at 10.8 four weeks ago.

The state reports an adjusted case rate, which is adjusted for the volume of testing. The unadjusted rate is 55.2 daily new cases per 100,000.

The county also saw a marked rise in its testing positivity, as the countywide number climbed into the purple level to 13.2% from last week’s 10.6%. The metric was at 8.8% two weeks ago. The threshold for the purple tier is 8%.

The county’s health equity positivity rate was reported at 18.8% up from last week’s 16.2%, which was more than double the purple-level threshold. The health equity rate measures the testing positivity in county’s low-income and more racially diverse neighborhoods.

To move back down to the red tier, Orange County would need to have its metrics at red levels for two consecutive weeks. If the county’s daily case rate is stable or declining but not at the next level, there would be the possibility of moving down if the testing positivity and health equity metrics meet the level for two tiers lower—that is, orange tier levels while in the purple tier.

The red tier requires the case rate to sit between 4.0 and 7.0, the testing positivity between 5.0% and 8.0% and the health equity rate between 5.3% and 8.0%. The orange tier requires the case rate to sit between 1.0 and 3.9, the testing positivity between 2.0% and 4.9% and the health equity rate between 2.2% and 5.2%. The yellow “minimal” risk tier, the lowest of the four tiers, requires a case rate lower than 1.0, testing positivity below 2.0% and health equity rate lower than 2.2%.

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