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San Diego hospitals starting to see more patients with COVID-19

As December arrives, coronavirus-related hospitalizations are on the rise in San Diego County, mimicking trends at the state and national level.

The rise is to be expected given the overall uptick in the amount of the virus detected in local wastewater in recent weeks. While it will take some time to determine whether or not COVID-related death rates will similarly increase, experts say there are reasons to believe that new tools not available last winter may further stave off the most grim outcomes as the world’s coronavirus pandemic closes out its third year.

In terms of numbers, San Diego County sits right about where it did this time last year.

Newly arrived descendants of the Omicron variant that began to spread in the late fall of 2021 are responsible for an increase in overall activity. According to the California Department of Public Health, there were 306 confirmed and suspected coronavirus hospitalizations in San Diego County Wednesday, one more than was the case on the same day one year ago.

Intensive care bed use, however, shows the true difference. Last year, according to state records, the region’s hospitals collectively had 84 intensive care beds holding COVID-19 patients compared to just 26 on Wednesday.

Chris Van Gorder, chief executive officer of Scripps Health, said in an email earlier this week that his organization’s network of hospitals had 81 hospitalized COVID-19 patients Monday, in the same ballpark as one year earlier, but significantly fewer than during the winter of 2020 and 2021.

The question of the moment is: How bad will this new surge get? Last season topped out with 1,348 people in hospital beds with COVID-19 on Jan. 22. While 211 were sick enough to need critical care, the true pain was felt in emergency departments with so many people flooding in for care that facilities often had to divert ambulances to other hospitals.

The crush in the ERs became so intense that the county’s emergency services department warned in early January that local emergency capacity was exhausted. Some hospitals briefly declared internal emergencies due to crowded emergency departments.

This time around, the health care community has a new weapon to fight back.

Paxlovid, an anti-viral drug that can significantly reduce the chances of hospitalization if taken within five days of symptom onset, was in limited supply last winter. But it’s fully stocked today.

Home testing was also very limited last year, but is commonplace as 2023 approaches.

These two tools combined, said Dr. Brian Clay, associate chief medical officer of inpatient care at UC San Diego Health, are working together to keep some people out of the ERs. Last year, much of the demand at emergency departments was for testing as lines at testing centers stretched around city blocks in late December 2021.

“This year we have a whole segment of our patient population that, when they feel ill, they can test themselves at home, then they can call their clinic physician, get a prescription to Paxlovid and pick it up at their pharmacy,” Clay said.

Handling the basics at home, Clay said, can go a long way toward preserving hospital capacity for those who need it most.

“In the last couple of winters, hospitals have had to delay some kinds of non-COVID-19 care when it got really busy with COVID-19 patients, and we want to avoid that kind of thing if we can,” Clay said.

As of Thursday, he added, UC San Diego’s two hospitals in La Jolla and Hillcrest had 49 hospitalized patients who tested positive for coronavirus infection. He said about half of those who get hospitalized these days are struggling with the symptoms of their infection — usually difficulty breathing and low oxygen saturation levels. The other half test positive incidentally after arriving for some other kind of care.

Back in January 2021, he said, about 80 percent had a primarily severe COVID-19 symptoms.

While some are still ending up on ventilators, that situation is now rare.

“The median patient in the hospital with COVID in November of 2022 is only mildly to moderately ill, is at a medical and surgical level of care, and is expected to stay, you know, no more than a few days,” Clay said.

Overall, the region’s weekly respiratory virus report showed continued increases in both flu and coronavirus activity. There were nearly 2,700 total confirmed influenza cases detected last week, up slightly from the nearly 24,000 detected two weeks ago. The percentage of patients in ERs with flu-like symptoms increased from 10 percent to 11 percent.

Confirmed coronavirus cases increased from nearly 3,000 two weeks ago to about 3,100 last week. Home testing, however, makes those numbers somewhat incomplete.

Wastewater, considered to be a better broad reflection of coronavirus prevalence in the community, estimated to be 4.3 million coronaviruses per liter on Nov. 22, the most recent day for which data is available. That’s about four times higher than it was on Nov. 6, but still far lower than the estimated 47 million per liter at the height of last winter’s surge on Jan. 9.

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