Public health officials estimate there is 50-percent compliance with social-distancing guidelines in Santa Barbara County, and modeling shows that level of compliance long term could flatten the curve to a point where there are enough local hospital beds to handle the peak number of COVID-19 cases.
On Tuesday, the Public Health Department reported 218 cases to date, including two deaths.
County Public Health Director Van Do-Reynoso told the Board of Supervisors Tuesday that the long-term projections are changing daily as more data come in, and there is still a lot of uncertainty about how the novel coronavirus and COVID-19 infects people, and how to measure compliance with social distancing.
She presented two models, including the University of Washington model (used by the federal government and several states) and the Penn model, which is recommended by the California Department of Public Health. (Scroll down to view her presentation.)
The projections of each model are wildly different from each other, but they both rely on long-term social distancing.
The Penn model is typically run for 100 days, but Do-Reynoso presented 200 days out to show a full bell curve.
The higher the percentage of the community practicing social distancing, the farther out the peak of the curve goes, and the number of cases reduces – which officials call flattening the curve.
It’s important to slow down transmission so the number of severe cases doesn’t exceed the healthcare system’s capacity, leading to shortages in hospital beds, ventilators and other critical-care equipment.
Based on Monday’s modeling, if 40 or 45 percent of county residents comply with social distancing guidelines, the number of cases would eventually exceed the local healthcare system’s capacity for hospital beds and intensive care unit beds, Do-Reynoso said.
However, even increasing social distancing compliance to 50 percent, a 5-percentage-point increase, could push the local cases within capacity for hospital beds, she said.
At that point, “the healthcare system may be challenged, but it will not get broken,” she added.
All of the models show the demand for ventilators exceeding the current capacity of 97 countywide. Hundreds more have been requested, including disposable models, according to Public Health.
The University of Washington model anticipates a peak need in resources next week for California, and no bed shortages locally. However, projections for Santa Barbara County under this model are merely as a percentage (1.13 percent) of the overall California population, with no way to account for local policy impacts.
That model projects 57 deaths in the county by August, Do-Reynoso said. Two COVID-19 deaths have been reported as of Tuesday afternoon.
Current social distancing compliance is based on cell phone data usage, and anecdotal reports from law enforcement and Public Health staff driving around the community, Do-Reynoso said. In general, public spaces are not hosting masses of people like they would on a typical day before COVID-19, she said.
All of the county supervisors asked Do-Reynoso about the potential for long-term social-distancing guidelines.
“Personally, I know that I struggle with it, I have a family that struggles with it, so I fully understand how difficult it may be, especially for members of our community who live in a high-density situation,” she said.
“However, I’m also seeing, what worries me, is where there is no social distancing and the impact it has on the community in terms of severe hospitalizations, deaths and a healthcare system that is so overwhelmed that healthy people are also affected.
“So, do I think that is it sustainable all the way out to November? I’m not sure, but I think as a conversation that needs to happen in a variety of contexts and variety of settings, so we as a community can land on a solution that is doable, that protects the vulnerable members of our community as well as safeguarding our healthcare system.”
Fourth District Supervisor Peter Adam said he was concerned about the impacts to the economy that have already happened and will happen if the current social-distancing guidelines continue for months.
“As time goes on, this is going to start wearing on people more and more, and I think we’re going to be subject to more demands to lift social-distancing guidelines and try to find the people who are at the highest risk and protect them rather than getting everybody,” Adam said.
“I think that we should start those discussions sooner rather than later, until we run into failure or rebellion. At some point people are going to stop cooperating.”
First District County Supervisor Das Williams said he agrees with Adam that it will become a policy question for the Board of Supervisors.
“(Adam) is right that on some level it’s a policy question, because destroying an economy kills people, too, it does. At some level you have to work out as a policy matter where to balance this, and it is not just a realm for public health, but also a realm for the people the voters elect.
“My view is that if workplaces were properly equipped, if preparations were made, more people could go back to work while maintaining a certain level of social distancing, and that would be an important job for Public Health to advise employers.”
Second District Supervisor Gregg Hart, who has been moderating the daily Public Health briefings, said it was encouraging to see the difference people can make to slow down the spread of the virus.
Hospital Capacity Countywide
Noozhawk had a hard time getting answers in the form of numbers when writing about hospital capacity and surge planning in late March, but Do-Reynoso presented bed counts to the Board of Supervisors Tuesday.
“We did not know this a week ago,” she said.
The five hospitals in the county assume they will dedicate 60 percent of their medical, surgical and ICU beds to COVID-19 patients, which is 226 beds and 55 ICU beds overall.
The majority of beds are available in the larger hospitals – Santa Barbara Cottage Hospital and Marian Regional Medical Center in Santa Maria – with fewer in Goleta Valley Cottage Hospital, Lompoc Valley Medical Center, and Santa Ynez Valley Cottage Hospital.
As of Tuesday, 42 confirmed COVID-19 patients were hospitalized in the county, including 19 in ICUs. Of the county’s 218 total cases, there have been two deaths, 51 people have fully recovered, and 120 people are recovering at home.
Hospitals told Public Health they can create another 343 “surge” beds – including 56 cots – in their facilities, and another 75 ICU beds between Santa Barbara Cottage Hospital and Marian Regional Medical Center in Santa Maria.
Existing and surge beds together makes 699 total beds available for COVID-19 patients, including 131 ICU beds. There are 97 ventilators available in the county.
The county plans to get 100 hotel rooms for COVID-19 patients discharged from the hospital who need lower levels of care and may not have a home environment that is supportive to recovery, or a congregate living setting (like a jail, shelter or nursing home) that is ready to take them back, Do-Reynoso said.
They are also building capacity for 400 beds in alternate care sites, including equipment and staffing.
If hospitals countywide hit 50-percent of their surge capacity (350 beds full of COVID-19 patients), Public health will activate the alternate care sites, Do-Reynoso said.
San Luis Obispo County, which wants to add the same number of alternate care site beds, has already transformed the Cal Poly Rec Center into a healthcare facility for COVID-19 patients between hospitalized care and home care.