Nurse Jean Marll works in an isolation room on the COVID ward at Salinas Valley Memorial Hospital last January. Though coronavirus hospitalizations are now rising, improved treatments are resulting in better outcomes for many patients.
Gabrielle Lurie, Staff / The ChronicleIn March 2020, Dr. Jorge Bernett saw his first-ever COVID-19 patient, a young man from Contra Costa County on a ventilator. “He gestures for a piece of paper and pen, and he writes, ‘Am I going to live?’” recalled Bernett, an infectious diseases doctor with John Muir Health. The patient survived.
Nowadays, Bernett is much more confident in answering “yes.” Even as COVID cases rise in California and across the country, illness is on average less severe. Young, otherwise healthy patients with no immunity are a rare sight. Some treatments are no longer effective againstthe newest subvariants, but there is still a toolkit of other available therapeutics inconceivable just 2½ years ago.
“We’re seeing some ventilators and some deaths, but not a huge number like before,” Dr. Bernett said.
As California enters its third COVID winter, there is still cause for concern: The “moderate COVID surge” is mostly sending older and immunocompromised people to the hospital, said Dr. Bernett and other Bay Area physicians. It’s also straining Bay Area hospitals struggling to cope with staff shortages amid therespiratory virus tripledemicof COVID, RSV and flu.
California currently leads the country in total COVID cases and hospitalizations, and ranks 4th in cases per 100,000 and 13th in hospitalizations per 100,000, according to the New York Times’coronavirus case tracker.About 4,508 patients are hospitalized with COVID, according tothe state COVID-19 dashboard— a150% increase in one month,though Bay Area hospitals report fewer patients requiring critical care than in past winter waves.
In San Francisco, there were 114 people hospitalized with COVID as of Dec. 12, a 115% increase from a month earlier,according to city data.在加州,住院的数量is at less than one-third the peak of last winter’s omicron-driven surge, though it’s still higher than it was at this time last year.
COVID patients make up 10% to 12% of all Kaiser Permenante hospital admissions, according to Dr. Stephen Parodi, executive vice president of external affairs, who also practices as an infectious diseases physician.
“If you think about that (10% to 12% figure), three years ago, the disease didn’t exist. So that’s a significant contributor still to what we’re taking care of in our healthcare system,” Dr. Parodi said.
Starting in November, COVID admissions started “creeping up,” more so in John Muir Health’s “much older” Walnut Creek population than among its patients in Concord, Bernett said. Similarly, over the past month, Kaiser Permanente hospitals have seen a 75% to 80% rise in patients with COVID, Dr. Parodi said. Three-fourths of those patients are over the age of 65, and people 50 to 64 years old usually have underlying medical conditions that put them at greater risk, Parodi said.
Like at John Muir Health, most patients are not landing in the ICU, and if they are, “most are surviving the intensive care stay,” Dr. Parodi said.
UCSF Medical Center — which mostly handles “more complex” cases, including transplant patients and other immunocompromised people — is seeing infections among a wider age range than before, according to chief medical officer Dr. Adrienne Green. She thinks it may be because the omicron subvariant is infecting “larger swaths of the population.”
Also unlike past surges, UCSF is seeing both vaccinated and unvaccinated patients, another sign of how infectious the current strains are, though severe illness is more pronounced among those who haven’t gotten their shots, Dr. Green said.
Some increase in COVID transmission is expected: “Any winter season, we always anticipate an uptick in respiratory viruses,” said Dr. Nona Mei, medical director of critical care at Saint Francis Memorial, all the more so with holiday travel picking up and waning vaccine efficacy.
Complicating matters, the COVID subvariants currently in circulation are more capable of getting around immunity developed from vaccines or past infections than earlier strains of the virus. This is leading to a rise in infections, even among cautious people such as 81-year-old Areta Fleming, who was admitted to John Muir for COVID on Monday after waking up feeling ill.
Worried about the contagiousness of COVID and seeing more of her friends getting sick, Fleming had been mailing her Christmas cards to friends or putting them through door slots. But she hadn’t gotten around to taking care of presents before being hospitalized. “It’s kind of a lonely thing,” Fleming said about getting COVID right before Christmas.
Fleming said she has a bad cough, not much appetite and feels weak and exhausted. She last got vaccinated six months ago and may have had a light COVID case in the past — “my memory has been addled by this whole thing,” she said.
In California, patients are tested for COVID upon hospital admission. Of all patients with COVID at Kaiser hospitals, half were admitted for COVID-related disease, and half were admitted for other reasons and tested positive with have mild or asymptomatic COVID, Dr. Parodi said. It’s also 50/50 at UCSF, according to Green.
Even if COVID isn’t the primary reason someone is in the hospital, it can make their other health issues worse, requiring special isolation protocols and affecting when and where patients they may be discharged, Dr. Green said.
Plus, a COVID diagnosis can complicate treatment for other conditions. Paxlovid, an antiviral COVID medication, interacts badly with anticoagulants and medication prescribed to those who’ve had transplants, Dr. Bernett and Dr. Green said. This is especially tricky now thatmore COVID patients rely on Paxlovid:Monoclonal antibodies, a key treatment for immunocompromised patients, are no longer authorized for usage because they’re ineffective against the newest subvariants.
Along with COVID, hospitals are seeing a rise in cases of RSV and the flu. Some 13 out of 21 Kaiser hospitals have opened up tents, “because literally, the hospital itself is completely full,” Dr. Parodi said.
The total amount of respiratory illness this winter is higher than what Kaiser experienced during last winter’s omicron surge, “which is extraordinary to say, actually, considering how much omicron strained the system,” Dr. Parodi said.
The recent rise in COVID cases exacerbates hospital labor shortages, already an issue as people quit the healthcare profession after a grueling three years, leaving hospitals even more stretched. “I almost feel like every day, one of our nurses, our doctors, staff members is out with COVID,” Dr. Mei said.
Drs. Green, Mei, Bernett and Parodi all urged people to get the bivalent booster, which specifically targets the omicron variant. Dr. Green recommended testing before large gatherings over the holidays, and Dr. Bernettrecommended masking, particularly for the elderly and immunocompromised.
“We don’t see the obvious masking, the disruptions in our personal lives anymore. I think for a lot of people, we think the pandemic is over. And it really is not,” Dr. Bernett said.
Claire Hao is a San Francisco Chronicle staff writer. Email: claire.hao@sfchronicle.com Twitter: @clairehao_
