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ERs stressed as COVID-19 cases increase in San Diego County

As flu cases show signs of peaking in San Diego County, coronavirus continues to surge, according to the latest weekly update from the county health department.

Influenza is still producing plenty of cases, but the numbers show that case rates are no longer increasing nearly as quickly as they were one month ago. Still, 10 percent of local emergency department visits exhibited flu symptoms last week, down a single percentage point from the week before.

Simultaneously, confirmed coronavirus cases jumped from 3,211 two weeks ago to 5,489 last week. And those numbers definitely understate the true situation given the current prevalence of home testing that is often not reported to public health departments.

By all accounts, they’re feeling it on the front lines.

Dr. James Elia, an emergency medicine specialist at Sharp Grossmont Hospital in La Mesa, said that even though they are using tents in parking lots to handle the most minor cases, patients are waiting longer in the emergency department, especially when many need to be admitted for overnight stays.

“We’re having longer length of stays in our emergency room because we’re at that time of year where we’re also having a lot of staff that are calling in sick, and staffing has been an issue all throughout the county,” Elia said.

It is not clear just how stressed the region’s emergency medical system has been recently. The county’s emergency services department, which monitors ambulance offload times and other critical factors across all hospitals, has not responded to repeated requests for more current information.

The most recent data posted on the county’s EMS “Transfer of Care” website indicates that some facilities saw as much as 19 percent of their ambulance offloads take longer than 60 minutes in October, the most recent month for which information is available.

Impact on hospitals goes beyond emergency departments. State records show that confirmed and suspected COVID-19 hospitalizations in San Diego County reached 359 Wednesday, up from 306 one week earlier.

Dr. Christopher Longhurst, chief medical officer at UC San Diego Health, said in an email Thursday that university hospitals had 40 active COVID-19 patients, the largest number since July, but still significantly fewer than the peak of 150 during last winter’s surge.

So far, he said, the volume, even though it has stacked on top of patients with severe respiratory infections caused by influenza and other viruses, has not yet been severe enough to force delays of scheduled surgeries and other non-emergency procedures.

“It’s certainly something we worry about,” Longhurst said.

But it is also clear that many of those currently in the hospital with COVID-19 aren’t necessarily there because of coronavirus. Though county-level information is not available, the California Department of Public Health said that since late February 2022, primary COVID-19 cases — those where the virus is the main reason why a person has been admitted — has been between 45 percent and 50 percent.

That means that roughly half of coronavirus hospitalizations are those who are admitted for a different reason — say a knee replacement or cancer surgery — and come back positive after routine testing for all new patients.

Some have called COVID-19 hospitalization figures misleading because they make it seem as if the virus itself is responsible for every patient that ends up in a bed after testing positive.

In an email, the CDPH said that COVID-19 still takes a toll even if it is not the primary reason for admission.

“It is important to note that even though patients may not be hospitalized because they have COVID-19, they still influence hospital workload and burden due to special infection-control precautions and placement for any patient with COVID-19 infection,” the statement said.

There has been some hope that the impact on emergency room demand for care might be somewhat lessened this season due to the widespread availability of home testing. Last season, these tests were in very short supply, causing many with minor symptoms to show up at emergency departments looking to rule out coronavirus, even though their symptoms were relatively minor.

Elia said that, so far, he’s still seeing far too many emergency patients who aren’t testing at home before they decide to go to the emergency department.

Embracing home testing, he said, would be a great Christmas present for worn-out health care workers. Those who do test positive at home, he added, should not feel compelled to make an emergency visit.

“If they’re having flu-like symptoms and they home test positive for COVID, really, they just need to quarantine,” Elia said. “They don’t need to go see a doctor unless they’re really feeling unwell such has having shortness of breath or chest pains.”

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