In 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 bit 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 far more confident in answering “yes.” At the same time 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 aren’t any longer effective against
the most recent subvariants, but there continues to be a toolkit of other available therapeutics inconceivable just 2½ years ago.
“We’re seeing some ventilators and a few deaths, but not an enormous number like before,” Dr. Bernett said.
As California enters its third COVID winter, there continues to be cause for concern: The “moderate COVID surge” is generally 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 deal with staff shortages amid the
respiratory virus tripledemic
of COVID, RSV and flu.
California currently leads the country in total COVID cases and hospitalizations, and ranks 4th in cases per 100,000 and thirteenth in hospitalizations per 100,000, in response to the Latest York Times’
coronavirus case tracker.
About 4,508 patients are hospitalized with COVID, in response to
the state COVID-19 dashboard
— a
150% increase in a single month,
though Bay Area hospitals report fewer patients requiring critical care than in past winter waves.
In San Francisco, there have been 114 people hospitalized with COVID as of Dec. 12, a 115% increase from a month earlier,
in response to city data.
In California, the variety of hospitalizations is at lower than one-third the height of last winter’s omicron-driven surge, though it’s still higher than it was presently last 12 months.
COVID patients make up 10% to 12% of all Kaiser Permenante hospital admissions, in response to Dr. Stephen Parodi, executive vice chairman of external affairs, who also practices as an infectious diseases physician.
“In case you take into consideration that (10% to 12% figure), three years ago, the disease didn’t exist. In order that’s a big contributor still to what we’re taking good care of in our healthcare system,” Dr. Parodi said.
Starting in November, COVID admissions began “creeping up,” more so in John Muir Health’s “much older” Walnut Creek population than amongst 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 folks 50 to 64 years old often have underlying medical conditions that put them at greater risk, Parodi said.
Like at John Muir Health, most patients usually are not landing within the ICU, and in the event that 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 amongst a wider age range than before, in response to chief medical officer Dr. Adrienne Green. She thinks it might be since the omicron subvariant is infecting “larger swaths of the population.”
Also unlike past surges, UCSF is seeing each vaccinated and unvaccinated patients, one other sign of how infectious the present strains are, though severe illness is more pronounced amongst those that haven’t gotten their shots, Dr. Green said.
Some increase in COVID transmission is anticipated: “Any winter season, we at all times anticipate an uptick in respiratory viruses,” said Dr. Nona Mei, medical director of critical care at Saint Francis Memorial, all of the more so with holiday travel picking up and waning vaccine efficacy.
Complicating matters, the COVID subvariants currently in circulation are more able to getting around immunity developed from vaccines or past infections than earlier strains of the virus. That is resulting in an increase in infections, even amongst cautious people similar to 81-year-old Areta Fleming, who was admitted to John Muir for COVID on Monday after waking up feeling unwell.
Anxious concerning 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 good care of presents before being hospitalized. “It’s type of a lonely thing,” Fleming said about getting COVID right before Christmas.
Fleming said she has a nasty cough, not much appetite and feels weak and exhausted. She last got vaccinated six months ago and can have had a light-weight COVID case prior to now — “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, in response to Green.
Even when COVID isn’t the first reason someone is within the hospital, it may make their other health issues worse, requiring special isolation protocols and affecting when and where patients they could 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 medicine prescribed to those that’ve had transplants, Dr. Bernett and Dr. Green said. This is particularly tricky now that
more COVID patients depend on Paxlovid:
Monoclonal antibodies, a key treatment for immunocompromised patients, aren’t any longer authorized for usage because they’re ineffective against the most recent subvariants.
Together with COVID, hospitals are seeing an increase in cases of RSV and the flu. Some 13 out of 21 Kaiser hospitals have opened up tents, “because literally, the hospital itself is totally full,” Dr. Parodi said.
The overall 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 a problem as people quit the healthcare career after a grueling three years, leaving hospitals much more stretched. “I almost feel like day-after-day, one among 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 beneficial testing before large gatherings over the vacations, and Dr. Bernett
beneficial masking, particularly for the elderly and immunocompromised.
“We don’t see the plain masking, the disruptions in our personal lives anymore. I believe for lots of people, we expect the pandemic is over. And it really is just not,” Dr. Bernett said.
Claire Hao is a San Francisco Chronicle staff author. Email: claire.hao@sfchronicle.com Twitter: @clairehao_
