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Why California's new stay-at-home order is broken down by region and not just county

Often, hospitals will transfer patients to neighboring counties if they become overwhelmed.

SAN DIEGO — San Diego County had less than 20% of its Intensive Care Unit (ICU) beds available Sunday for the first time since the pandemic began. Health and Human Services Agency reported 570 of the 708 ICU beds were in use. About 39% of them were in use by patients with COVID-19.

The county, and nine others in the Southern California region, will be under a stay-at-home order for at least three weeks, starting Sunday at 11:59 p.m. after the state calculated fewer than 15% of the total ICU beds within the region were available. The state is going through its worst surge of COVID-19 cases to-date.

On Sunday, San Diego County reported 1,703 new COVID-19 cases and seven new deaths. While those numbers are high, they did not break daily records.  

“The bottom line is, if we don't act now, our hospital system will be overwhelmed. If we don't act now, we'll continue to see a death rate climb [with] more lives lost,” said Gov. Gavin Newsom when announcing the order last Thursday.

California divided the state into regions based on existing healthcare agreements. Often, hospitals will transfer patients to other counties if they become overwhelmed. Imperial County has sent coronavirus patients to San Diego and other, further counties during previous surges. 

“When capacity can't be met within a specific county, we lean on neighboring counties and their hospital delivery systems to care for a number of individuals,” explained Dr. Mark Ghaly, Secretary of California Health and Human Services. “We do expect that many patients will be staying closer to their region and that's why we looked at the regional capacity of ICUs.”

News 8 used data from local health departments, the California Department of Public Health and COVID Act Now to compare counties within the region. 

Imperial County, which has the worst case rate in the region, had just two open beds out of 28. CDPH reported Riverside County had 50 open beds Friday out of 384, or about 13% availability. The percentage is expected to decrease once data is updated after the weekend. 

Los Angeles County drew significant ire from San Diegans when the stay-at-home order was announced because of its rising case rate. However, L.A. also is home to half the ICU capacity in the entire region. CDPH reported it had 425 available beds out of approximately 2,305, as estimated by CAN. 

San Diego County, with 708 ICU beds, has the second-most in the region, followed by 679 in Orange County. Comparatively, rural Inyo County has just four ICU beds, one of which is in use, and Mono County has two beds, which are both available.

The simple fact is we will be below 15% in San Diego County in the coming days or weeks. We are on that trajectory. We are on that path and we'll be awfully glad if we ever need regional help from another county that it is there,” said Supervisor Nathan Fletcher.

In three weeks, CDPH will consider whether the stay-at-home order can be lifted by county. Once projected ICU availability is above 15% approximately four weeks out, the county will return to the purple tier restrictions and continue to follow the state’s Blueprint for a Safer Economy metric.

“We know that by seeing that transmission rate come down three weeks after putting the order in place, that we should see projections of our ICU capacity improve increase above 15 percent, which allows us to lift that regional stay at home order effectively,” said Ghaly. “Why do we say it [ends] by counties? Because each county will then and go back to the appropriate tier based on their independent data, individual data, not regional data, but their county data into a tier within our blueprint.” 

Credit: covid19.ca.gov
California regions tied to ICU capacity level tracking to determine Stay Home Order