Local hospitals are seeing slightly shorter stays for noncritical COVID-19 patients, as health care providers learn more about testing, diagnosis and treatment for the disease, according to Dr. Lynn Fitzgibbons, an infectious disease physician for Santa Barbara Cottage Hospital.
The number of COVID-19 patients in the hospital is an important indicator of a community’s disease spread, and the fact that Santa Barbara County’s hospitalization number dropped by half since a month ago is a “really, really tremendous win,” she said Tuesday.
Fitzgibbons noted that positive and negative trends in behavior take several weeks to show up in hospitalization numbers.
“The actions that lead to my patients being discharged today, tomorrow or perhaps Thursday, that case was the result of a transmission event that occurred probably two to four weeks ago,” she said.
When asked by Noozhawk how clinical care of COVID-19 patients has changed during the past six months, Fitzgibbons said, “How long do you have?”
Physicians have learned the value of therapeutic treatments, including steroids and the antiviral medication remdesivir, she said.
For COVID-19, “when patients have low oxygen levels and need to come into the hospital, we can save their lives if we give them steroids,” she said.
“When we think about medications like remdesivir, an antiviral targeting the virus — again, in April we had the ability to use it in very rare circumstances by a very kind of dramatic last Hail Mary effort where we tried this. And I think anecdotally, we do think that back then it made a difference for some patients.
“We now have solid data that corroborates and supports the fact that, again, for patients who are sick in the hospital with this disease, we can save people’s lives by using this treatment.”
Fitzgibbons said patients with less-critical cases of COVID-19 have been having shorter hospital stays now versus several months ago, which likely can be attributed to the increased knowledge of diagnosing and treating the disease.
“We know that if we give people steroids, for example, or some of these other treatments that we have, we know that they get better faster and get out of the hospital and feel better quicker.”
Criteria for admitting people with COVID-19 to the hospital haven’t changed much, she noted.
Significant breathing problems, oxygen levels dropping, changes in mental status or confusion related to the infection, and organ system issues are some of the serious symptoms.
Testing for the novel coronavirus, which causes the COVID-19 disease, is evolving quickly. Most testing to this point has used nasal or throat swabs for a PCR test, which is labor-intensive and has experienced long delays for results because of laboratory backlogs.
Fitzgibbons said that test is sensitive and looks for the RNA of the novel coronavirus itself, and that people can test positive several months after they stop being infectious.
Several quicker testing methods are being developed and commercially produced under emergency-use authorizations from the Food and Drug Administration, including an antigen test and saliva test, both which look for an active infection but may be less sensitive than the PCR test, she said.
There are also serology tests, also called antibody tests, which show the presence of antibodies to the virus, from a current or past infection.
County Reopening Status
During a briefing Tuesday, Public Health Director Van Do-Reynoso said the county’s COVID-19-related numbers continue to trend better, with a decline in hospitalizations and new cases being reported.
Below-normal testing for the Labor Day weekend caused fewer test results and cases to be reported Tuesday, she said, with only three new cases announced.
The department ordered beach restrictions over the weekend to prevent crowding from nonlocal crowds, and Second District Supervisor Gregg Hart said that objective was met.
It probably helped that other counties kept their beaches open, including San Luis Obispo, Ventura, Los Angeles and Orange counties.
Do-Reynoso said there were 44 people hospitalized with COVID-19 as of Tuesday, including 17 people in intensive-care units.
“Our numbers are reflective of our individual and collective action,” she said, urging everyone to commit to wearing face coverings, physical distancing, and avoiding gatherings and crowds so Santa Barbara County can move into the next tier.
The county is categorized in the state’s “widespread” virus transmission tier because of its rate of new daily cases being reported (8.3 per 100,000 population), which is essentially the same thing as being on the monitoring list.
The positivity rate of 5.5 percent meets the standard for loosening restrictions, but the case rate must also drop below seven average daily cases per 100,000 population (about 31 cases per day) for Santa Barbara County to move into the next, less-restrictive tier of the state reopening system.
That level would allow Santa Barbara County to fully reopen schools for in-person learning, and also reopen indoor places of worship, indoor restaurants, and indoor gyms, all with limited capacity.
To do that, the county needs to keep the positivity rate below 8 percent, report fewer daily new cases, and keep hospitalizations from significantly increasing.
Neighboring San Luis Obispo and Ventura counties are in the same “widespread” tier, and are also exceeding the standard for daily new cases, but reporting positivity rates below 8 percent.
With Santa Barbara County’s current reopening status, only K-6 schools granted a waiver by county and state public health departments can hold in-person classes.
Nineteen schools have applied, and as of Friday, four small, private schools on the South Coast have been granted waivers. Some plan to open this week.
School modifications include “cohorting” students, by keeping them in smaller groups that stay together for the whole day, as well as physically distancing desks, face-covering mandates for staff and older students, and regular staff testing.
Local public health officials seem reluctant to shut down schools again once they open, even if community spread increases and there are outbreaks reported within a school, but individual classes and schools could be required to boost testing and temporarily shift to remote learning in those circumstances, according to county Public Health Officer Dr. Henning Ansorg.