What's happening in NORTHERN California.

What's happening in NORTHERN California. - Printable Version

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RE: What's happening in NORTHERN California. (YEAH for SCC!) - burger - 06-21-2020

(06-21-2020, 03:33 AM)M T Wrote: California's monitoring of its counties is shown on this page. I'm frustrated that counties (LAC is opening bars & cardrooms!!) are creating more opportunities for exposure despite already exceeding the thresholds, growing number of infections, with already excessive death rates.

Thresholds: >100 or >25 2-wk case rate/100K with >8% positive tests, >8% positive tests, >10% increase in hospitalized C19 patients, <20% ICU availability or <25% ventilators availability
The counties with any reports over the thresholds:
Fresno: 69.2 2-wk case rate/100K, 8.3% positive tests, 15.8% increase in hospitalized C19 patients.
Imperial: 835.9 2-wk case rate/100K, 22.3% positive tests
Kern: 13.6% increase in hospitalized C19
Kings: 170.7 2-wk case rate/100K, 31.2% increase in hospitalized C19, 6.2% of ICU available.
Los Angeles: 170.1 2-wk case rate/100K
Riverside: 120.2 2-wk case rate/100K, 9.4% positive tests, 19.1% increase in hospitalized C19
San Joaquin: 95.6 2-wk case rate/100K, 8.7% positive tests, 18.3% of ICU available
Stanislaus: 111.7 2-wk case rate/100K, 9.1% positive tests, 21.1% increase in hospitalized C19
Tulare: 135.0 2-wk case rate/100K, 11.0% positive tests, 52.7% increase in hospitalized C19, 18% of ICU available

Also, there is a threshold for 7-day test rate/100K of <150. Most counties are <150 in actual tests, but most of those are >100. It may be that the county must have the capacity to handle 150 per 100K per week, not that the residents must chose to be tested at that rate.

I know some counties are above the 25 2-wk case rate/100K, but are not shown as exceeding threshold, presumably because their percent positive tests are less than 8%. (If they are > 100 2-wk case rate/100K, they are flagged as exceeding threshold, no matter what their percent positive test rate is.)

The page was last updated June 20. I find it very suspicious that LA County is not flagged for percent positive rates. When I calculate the numbers for June 20 (ie, June 6-13), I get 8.4% (above the 8% threshold). The county's last single day less than 8% was 7.88% on June 1.

I read somewhere that Newsom has said that the thresholds are basically for informational purposes and that the decisions about scaling back reopening are up to the county health officials. I've said this before here: our county official in Sacramento is an idiot and seems to care only about reopening. He keeps saying that the steady increase in cases in Sac lately is due to "parties and family gatherings" so they don't need to do anything about this.

Unless Sacramento County has the world's greatest contact tracers (unlikely, as the county health official earlier declared that they need fewer tracers than what Newsom was calling for) , I doubt they know the origin of most of these cases. And, even then, whatever they are doing does not seem to be working. On Friday we shattered our previous record for most new positive tests. Things are getting worse steadily.

Leaving decisions about what's open and closed to the counties was a stupid way to do this. Perhaps legally there was no other option, but the county officials do not seem to be making good decisions in many places, as M T has pointed out. If we wait until things start looking like Florida before taking action, it will be too late.

Leftcoast - Leftcoast - 06-22-2020

In Santa Clara new cases continue to climb with 89 new cases reported in the county dashboard today - a usually low Sunday. Triple digits sometime this week would not be a surprise. Thankfully, no deaths were reported.

At least temporarily, we’ve stepped of the pedestal and are no longer California’s prototype of good pandemic management.

RE: Leftcoast - Mick - 06-22-2020

(06-22-2020, 12:59 AM)Leftcoast Wrote: In Santa Clara new cases continue to climb with 89 new cases reported in the county dashboard today - a usually low Sunday. Triple digits sometime this week would not be a surprise. Thankfully, no deaths were reported.

At least temporarily, we’ve stepped of the pedestal and are no longer California’s prototype of good pandemic management.

https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx

At least ICU and Acute Hospital bed availability is at 42.92% and 40.49% respectively, ventilator availability is 88.28%. Based upon the behavior i witnessed this weekend, I suspect we're going to need it.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - M T - 06-23-2020

122 cases reported today. Testing results on Saturday was > 3% positive.
The biggest day (86) of onset of symptoms was June 16.

SCC is now worse off than ever (previously, it was 1 week after SiP was ordered).
It still looks like a wave of infections & then another wave almost a week later. (Only 20 & 10 with symptoms appearing on June 13 & 14, in the dip between the waves) But it looks more spread out now.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - Farm93 - 06-23-2020

(06-23-2020, 01:52 PM)M T Wrote: 122 cases reported today. Testing results on Saturday was > 3% positive.
The biggest day (86) of onset of symptoms was June 16.

SCC is now worse off than ever (previously, it was 1 week after SiP was ordered).
It still looks like a wave of infections & then another wave almost a week later. (Only 20 & 10 with symptoms appearing on June 13 & 14, in the dip between the waves) But it looks more spread out now.

Southern California is a mess. The weather is favorable, there are a fair number of anti-mask types roaming around, and they are only a 4-6 hour drive from Northern California.

Too much of the USA is experiencing a surge in hospitalizations to believe that the SF Bay Area will be able to keep low daily case/hospitalization/death counts down for much longer.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - dabigv13 - 06-23-2020

Southern California right now is in an interesting pattern. Hospitalizations have been trending up rather quickly, not as steep as the initial stage in late March, early April, but pretty steep. Meanwhile ICU usage has been trending up as well, but not nearly as steeply.

I think this reflects three things, to differing degrees 1) the virus is now spreading in the community, but that community is different than the initial pandemic. The more vulnerable are probably being more careful with distancing and masks than the younger, healthier, less vulnerable. Nursing homes and hospitals have better systems in place to check spread amongst the most vulnerable (though how long PPE will last in a broader pandemic is a real open question to me). So while some people are getting sick enough to require admission, less are the type of patient that will need intensive care or a ventilator. 2) We are just at an early stage of the next outbreak, and not enough people are hitting that second week where many covid patients really go downhill. 3) We have gotten better at treating patients, perhaps with more broad usage of remdesivir or steroids. I think 3 is less likely. My understanding is remdesivir isn't going to many patients who aren't already in the ICU, and lots of patients were already getting steroids even before the dexamethasone study results were publicized (and only showed a mild improvement in any case.)

The idea the virus has mutated to be less lethal is possible but I think the least likely explanation.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - burger - 06-23-2020

I made some graphs for northern California counties because it's hard to see what's happening from the numbers alone. These are 7-day moving averages in cases per million population. Good job SF and SM. Everyone else :/ (note different y-axis scales)

[Image: eDy9Vkzl.png]

And southern CA. :( all around. Notice that Imperial Co. is an order of magnitude above the rest.
[Image: QKhHkCa.png]

RE: What's happening in NORTHERN California. (YEAH for SCC!) - BostonCard - 06-23-2020

(06-23-2020, 03:08 PM)dabigv13 Wrote: My understanding is remdesivir isn't going to many patients who aren't already in the ICU, and lots of patients were already getting steroids even before the dexamethasone study results were publicized (and only showed a mild improvement in any case.)

Ironically, that seems to be where remdisivir is least effective. I think it makes more of a difference early.

BC

RE: What's happening in NORTHERN California. (YEAH for SCC!) - UltimateCard - 06-23-2020

Came across this chart posted on FB that shows the difference between Bay Area and rest of California
Source: https://www.revealnews.org/article/how-a-national-health-crisis-fell-on-the-backs-of-local-leaders/
[Image: charts-01.png]

(06-23-2020, 03:34 PM)burger Wrote: I made some graphs for northern California counties because it's hard to see what's happening from the numbers alone. These are 7-day moving averages in cases per million population. Good job SF and SM. Everyone else :/ (note different y-axis scales)

And southern CA. :( all around. Notice that Imperial Co. is an order of magnitude above the rest.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - Genuine Realist - 06-23-2020

(06-23-2020, 04:04 PM)UltimateCard Wrote: Came across this chart posted on FB that shows the difference between Bay Area and rest of California
Source: https://www.revealnews.org/article/how-a-national-health-crisis-fell-on-the-backs-of-local-leaders/

[quote="burger" pid='283815' dateline='1592951682']
I made some graphs for northern California counties because it's hard to see what's happening from the numbers alone. These are 7-day moving averages in cases per million population. Good job SF and SM. Everyone else :/ (note different y-axis scales)

And southern CA. :( all around. Notice that Imperial Co. is an order of magnitude above the rest.

122 new cases today in Santa Clara County, a real bummer. That's about 500% from a week ago (around 20). Hospitalizations plus 5.

I think the public has to learn that the end of lockdown does not mean the end of social distancing.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - dabigv13 - 06-23-2020

(06-23-2020, 04:03 PM)BostonCard Wrote:
(06-23-2020, 03:08 PM)dabigv13 Wrote: My understanding is remdesivir isn't going to many patients who aren't already in the ICU, and lots of patients were already getting steroids even before the dexamethasone study results were publicized (and only showed a mild improvement in any case.)

Ironically, that seems to be where remdisivir is least effective. I think it makes more of a difference early.

BC

I think it is a supply issue.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - Goose - 06-23-2020

(06-23-2020, 04:20 PM)Genuine Realist Wrote: 122 new cases today in Santa Clara County, a real bummer. That's about 500% from a week ago (around 20). Hospitalizations plus 5.

I think the public has to learn that the end of lockdown does not mean the end of social distancing.

If we knew that was the source of the increase, that would be something we could act on. However, we don't know this, we are guessing. The other thing that we can't explain is why New York and New Jersey peaked and then dropped way down and the bay area counties did not. Something is going on that we don't understand, and we are not getting any closer to understanding it, AFAIK.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - BostonCard - 06-23-2020

(06-23-2020, 04:23 PM)dabigv13 Wrote:
(06-23-2020, 04:03 PM)BostonCard Wrote:
(06-23-2020, 03:08 PM)dabigv13 Wrote: My understanding is remdesivir isn't going to many patients who aren't already in the ICU, and lots of patients were already getting steroids even before the dexamethasone study results were publicized (and only showed a mild improvement in any case.)

Ironically, that seems to be where remdisivir is least effective. I think it makes more of a difference early.

BC

I think it is a supply issue.

Agreed. But my colleagues and I were musing that there will be a tendency to give less severe patients dexamethasone (even though it is less effective) because it is easy and cheap, while they will give more severe patients remdisivir (even though it is less effective) because of lack of availability and the fact that it has to be given IV.

If you really thought this through, you would give high risk patients (those >65, those with risk factors) remdisivir, and you would do so early. You would wait to give patients dexamethasone until they were starting to crash.

BC

RE: What's happening in NORTHERN California. (YEAH for SCC!) - dabigv13 - 06-23-2020

I trained giving our big surgery postops 8mg dex q8 hours x 3. And I prescribe plenty of high dose prednisone in routine outpatient practice these days. There are risks with high dose steroids but most patients tolerate well so I think with the favorable side effect profile, we will see them prescribed very commonly now for covid patients, even as outpatients. They'll probably make patients feel a little better anyway.

And I think there is benefit in trying to keep the immune system from going into overdrive before you get bad lung disease. Personally, if I get it bad enough to land in the hospital, one of the first things I'm asking the ER doc for is a slug of dex.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - 82 Card - 06-23-2020

(06-23-2020, 04:31 PM)Goose Wrote:
(06-23-2020, 04:20 PM)Genuine Realist Wrote: 122 new cases today in Santa Clara County, a real bummer. That's about 500% from a week ago (around 20). Hospitalizations plus 5.

I think the public has to learn that the end of lockdown does not mean the end of social distancing.

If we knew that was the source of the increase, that would be something we could act on. However, we don't know this, we are guessing. The other thing that we can't explain is why New York and New Jersey peaked and then dropped way down and the bay area counties did not. Something is going on that we don't understand, and we are not getting any closer to understanding it, AFAIK.

Until the surge yesterday and today, CA was running at about the same level or lower than NY after their drop, on a per capita basis. For example, if you adjust the new cases in NY two days ago, it amounts to 3,904 in CA. CA had 3,589 that day. The big jump in the last two days in CA is very troubling. But things are peaches and cream in NY either. They are just now starting to open up. I wouldn't be surprised if they take off again.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - Goose - 06-23-2020

(06-23-2020, 05:06 PM)82 Card Wrote:
(06-23-2020, 04:31 PM)Goose Wrote: The other thing that we can't explain is why New York and New Jersey peaked and then dropped way down and the bay area counties did not. Something is going on that we don't understand, and we are not getting any closer to understanding it, AFAIK.

Until the surge yesterday and today, CA was running at about the same level or lower than NY after their drop, on a per capita basis. For example, if you adjust the new cases in NY two days ago, it amounts to 3,904 in CA. CA had 3,589 that day. The big jump in the last two days in CA is very troubling. But things are peaches and cream in NY either. They are just now starting to open up. I wouldn't be surprised if they take off again.

Good data. I guess I should modify my question to "Why didn't anybody drive the case load down to very near zero?" There are possible answers to this question, including non-compliance, essential workers that can't social distance, influx from other areas, etc. But we just don't know, and as long as we don't know we have an underlying disease baseline we can't get rid of or place bounds upon.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - BostonCard - 06-23-2020

(06-23-2020, 04:54 PM)dabigv13 Wrote: I trained giving our big surgery postops 8mg dex q8 hours x 3. And I prescribe plenty of high dose prednisone in routine outpatient practice these days. There are risks with high dose steroids but most patients tolerate well so I think with the favorable side effect profile, we will see them prescribed very commonly now for covid patients, even as outpatients. They'll probably make patients feel a little better anyway.

And I think there is benefit in trying to keep the immune system from going into overdrive before you get bad lung disease. Personally, if I get it bad enough to land in the hospital, one of the first things I'm asking the ER doc for is a slug of dex.

The study is available in preprint here:

https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1

If you look at figure 2, the Forest plot, you see that among the patients who started out not on oxygen, not only does dexamethasone not improve survival, it may worsen it (though confidence intervals don't exclude no effect at all). And there is some plausability behind that, since early in the disease you are worried about viral replication more than cytokine storm and dex is immunosupressive.

So, I would definitely not give it to outpatients. But once it gets bad enough to require admission and oxygen, I would probably move in with the dex.

BC

RE: What's happening in NORTHERN California. (YEAH for SCC!) - 82 Card - 06-23-2020

(06-23-2020, 05:19 PM)Goose Wrote:
(06-23-2020, 05:06 PM)82 Card Wrote:
(06-23-2020, 04:31 PM)Goose Wrote: The other thing that we can't explain is why New York and New Jersey peaked and then dropped way down and the bay area counties did not. Something is going on that we don't understand, and we are not getting any closer to understanding it, AFAIK.

Until the surge yesterday and today, CA was running at about the same level or lower than NY after their drop, on a per capita basis. For example, if you adjust the new cases in NY two days ago, it amounts to 3,904 in CA. CA had 3,589 that day. The big jump in the last two days in CA is very troubling. But things are peaches and cream in NY either. They are just now starting to open up. I wouldn't be surprised if they take off again.

Good data. I guess I should modify my question to "Why didn't anybody drive the case load down to very near zero?" There are possible answers to this question, including non-compliance, essential workers that can't social distance, influx from other areas, etc. But we just don't know, and as long as we don't know we have an underlying disease baseline we can't get rid of or place bounds upon.

Just realized I screwed up. I googled NY popoulation but should have put in NY state population. The actual state population is 19.45 million, not 8.4 million. The proper adjustment of NY state number to CA size would make it 1,686. That's a little less than half of what CA had that day. Sorry for the confusion. Given the concentration of problems in NYC metro part of state, the real story is somewhere in between. California was last at that level in mid-May. Right about the time restlessness started in CA.

The problem remains the same. Neither state squashed infections to near zero before starting reopening.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - M T - 06-23-2020

(06-23-2020, 03:34 PM)burger Wrote: I made some graphs for northern California counties because it's hard to see what's happening from the numbers alone. These are 7-day moving averages in cases per million population. Good job SF and SM. Everyone else :/ (note different y-axis scales)

I'm not sure why you say "Good jobs SF and SM". Their numbers stayed higher than the others.

It is worrisome that SCC is climbing so rapidly, considering that it has opened up less. That means the increase can't be attributed to just things like barbers & bars, but more likely on the other things that opened up (restaurants & such), or perhaps the demonstrations (if the chain of cases could be traced back to that, but as I recall that was a verboten question).

If I recall rightly, SCC wanted to be able to track 75 new cases a day, but we blew past that number a couple of days ago.

Maybe one difference is getting the populace to really see the bad outcomes. ("Get the fear of God into them".) I think NYC saw that. If it were scary enough, maybe those 5 teens I just saw in close proximity at a table at an SCC park would have worn masks, or maybe this older guy would have gone over and let them know that being in close proximity without masks is contributing to killing more people that speeding & drunk driving combined.

RE: What's happening in NORTHERN California. (YEAH for SCC!) - burger - 06-23-2020

(06-23-2020, 07:21 PM)M T Wrote:
(06-23-2020, 03:34 PM)burger Wrote: I made some graphs for northern California counties because it's hard to see what's happening from the numbers alone. These are 7-day moving averages in cases per million population. Good job SF and SM. Everyone else :/ (note different y-axis scales)

I'm not sure why you say "Good jobs SF and SM". Their numbers stayed higher than the others.

I'm much more concerned with rates of change than levels.