After months of decline, the number of COVID-19 patients in Orange County has spiked. As of the third week of August, Orange County has recorded approximately 650 new positive COVID cases each day for two weeks in a row. Rates are nowhere near where they were last winter, however. At that time the County saw nearly 3,000 new cases per day causing ICUs to overflow and St. Jude to open its abandoned wing and tented outdoor areas to accommodate both COVID and other patients, even as the bodies of COVID victims collected in local morgues. Still, the 650 daily average is more than twenty times as many as the 30 cases per day the County was experiencing just a few months ago.

Countywide, the number of patients hospitalized with COVID-19 as of August 18 was 568, the highest it has been since February, and the number of those in intensive care units has nearly doubled since the first of August from 68 to 125; that ICU number had held steady in the single digits to low teens for much of May and June.

Source: OC Health Orange County COVID-19 Dashboard.

Last winter’s surge pushed those with elective and semi-elective surgeries out of hospitals as hospitals cleared the decks for the flood of COVID patients at their doors. So far this month, OC hospitals, have been able to avoid a repeat of that experience. However, at a forum that the Voice of OC hosted on Monday August 9,  Dr. Jim Keany, the co-director of the emergency department at Providence Mission hospital in Mission Viejo, said that people in the Providence ER are already waiting for beds.

During the same forum, UC Irvine biostatistician Vladimir Minin noted that the coastal cities have so far been leading the current surge, with Huntington Beach cracking the 10% positivity rate for tests that, under the State’s previous tiering system, would have put the city in the most restrictive “purple” tier. Other current COVID hot spots with rates approaching that 10% mark in the second week of August included Costa Mesa, Dana Point, San Clemente, and Mission Viejo. However, Minin did make a few encouraging observations: the number of new cases in Newport and Laguna was plateauing rather than continuing to rise; and in northern OC, the surge was “markedly more gradual.”

Dr. Chinsio-Kwong concurred, citing Santa Ana and Anaheim, which suffered from high infection rates last winter but which have not seen as sharp an increase this August.

Safe to Return to School?

The steep rise in COVID-19 cases in Orange County has alarmed parents who have sent their children back to Fullerton’s public schools, which opened this week. The COVID-19 vaccine has not yet been approved for children under 12, and local schools’ return to full-time, in-person instruction for all students means that classrooms are too crowded to maintain the physical distancing that helped to slow the spread of COVID last school year.

Many parents find comfort in the fact that severe illness in children with COVID remains rare, even with the current surge: as of August 9, only six children were hospitalized in Orange County with confirmed COVID, and another four with suspected COVID.  As reported in an August 16 LA Times article, “What are the risks of kids getting COVID-19 in schools?” these low County numbers are consistent with California’s low rate of pediatric COVID-19 hospitalizations as a whole: the overall hospitalization rate for children in California is only 10% that of adults in their 30s. Furthermore, at .21 new hospitalizations per 100,000 children, California children are being hospitalized for COVID-19 at just more than half the national average of .37 per 100,000, and well below the rates in current hotspots like Florida and Texas.

Nonetheless, Vladimir Minin, is concerned that the County is unprepared for how Delta will affect Orange County’s schoolchildren: “We have zero experience dealing with Delta in schools,” he warned. “We don’t know how it’s going to play out because we are dealing with a highly transmissible variant that has not circulated during the school year before.” Minin urges the public to “be open minded and be prepared to be unpleasantly surprised.”

Delta Variant Drives Current Surge

In late May, the Delta variant began showing up in the County in substantial numbers, and within two weeks it had overtaken the Gamma and Alpha strains as the dominant form of infection. Today, it accounts for over 90% of new cases in the County.

Sanghyuk Shin, a UC Irvine epidemiologist and public health expert, reports that those infected with the Delta strain of COVID can expect to infect 6 or 7 other unvaccinated people, while those suffering from last winter’s strains would typically have infected only 2 or 3 others. Shin also noted that the contact time needed to spread Delta is lower, with infections occurring after less than 15 minutes of contact indoors. As explained by Dr. Fauci in an August 12 press briefing, evidence suggests this is because there is 1000 times more of the Delta virus present in the nasal passages of those infected with the Delta than the Alpha variant.

Thus, even as Orange County public health officials are urging students to return to schools to enjoy the benefits of in-person instruction, they are advocating for increased vigilance. In a media briefing call on Friday, August 13, Dr. Clayton Chau, OC Health Care Agency (HCA) Director and County Health Officer, said, “Anyone who takes the virus seriously knows that the virus doesn’t spare children.” He is urging parents to share responsibility for enforcing other measures that help slow the spread of COVID: indoor masking, hand washing, and avoiding physical contact.

Still, members of the media are voicing concern that County and State officials are sending mixed messages by keeping the economy and public gatherings open in the midst of this latest Delta surge. And public health experts like Shin are urging our leaders to take a look at investing in more costly means of addressing COVID, like improved classroom ventilation, and providing the more effective KN95 masks to schoolchildren, as Utah has done.

COVID Impacts

Melissa Dawn Pinto, a nursing professor at UC Irvine, noted during the Voice of OC forum that younger people, though less likely to be hospitalized for serious COVID symptoms, can still suffer from long-haul COVID.

Pinto shared the alarming symptoms of long-term COVID: chest pain, rashes, bruises, inability to think, brain fog, problems with cognition, and more. Over 200 more symptoms have been reported by patients who suffer from the disease. “These are relatively healthy people who have been put down because of long haul,” Pinto said. “We don’t know how long it lasts. Some people were put down in December of 2019, and some still have unresolved symptoms. It does affect the rest of your life. There are people who cannot work with long haul. It is a disability.”

Dr. Jim Keany said that, long-haul or otherwise, people misunderstand COVID if they see it merely as a respiratory illness. Keany explained that COVID is a vascular disease: it affects your blood vessels, which means that it affects every organ in the body, including the kidney, liver, and brain, in which some patients have experienced blood clots.

Vaccination

Hoping to avoid a repeat of last winter’s surge of deaths and hospitalizations, Orange County health officials are pushing hard for adults and teens to take the single most important step they can to avoid contracting COVID and spreading it to the vulnerable: vaccination.

Source: OC Health Orange County COVID-19 Dashboard.

The numbers on the vaccine’s effectiveness speak for themselves: 91% of COVID patients in the hospitals countywide have not received the vaccine, a trend that holds across California and the nation as a whole. Those who haven’t been vaccinated are six times more likely to contract COVID than those who have, and are much more likely to be hospitalized once they do fall ill.

Providence hospital’s Dr. Jim Keany urged those who have not been vaccinated to reconsider their choices before they end up in emergency rooms like his, which are filling up once more. “You may say your risk is small, you may say I’m willing to take the risk,” Keany said. “But what you’re doing is putting yourself in a position to need our help when we may not be able to give it.”

Keany also asked those who have chosen not to get the vaccine to think about the impact of their choice on the community. “You’re not creating the barriers to spread, and so rather than it stopping with you, or maybe just spreading to one or two close contacts because you’ve been vaccinated, you are continuing to spread it, especially with this Delta virus, which is highly contagious and is just running through communities.”

Even as the state of California has taken a more hands-off approach to its public health mandates for private businesses, it has tightened up vaccine requirements for workers. County Health Officer Dr. Clayton Chau recounted these moves: On Aug 5, the State ordered that workers in health care must be fully vaccinated by September 30. And on August 11, it ordered that all educators, with the exception of home school childcare centers, and higher education, must verify vaccine status.

Most of the public has already chosen to protect itself against the disease with vaccination. As of August 19, 1,963,035 people in Orange County had been fully vaccinated. Over 75% of the eligible population, those aged 12 and over, have received at least one shot, while just over 67% are fully vaccinated.

However, not everyone is getting vaccinated at the same rate. Chau reported that 91% of the eligible over age 65 have been fully vaccinated, but County numbers showed that only 56% of residents aged 12 to 17 and 66% of those aged 18 to 24 had done the same as of August 9. Chau noted that African Americans, especially senior citizens, are doing well, which Chau credits to Black church leaders stepping up in cooperation with the County. But he also said that Latino youth, who make up a far higher percentage of the County’s population, are not coming in for the vaccine in equal numbers.

Even among different communities in Fullerton, vaccination rates vary widely, as can be seen on ABC 7’s vaccine map, which pulls from California public health data. In 92831, only 58% of those over the age of 12 have been fully vaccinated. In 92832 that number is 63%, in 92833 it’s 69%. And 92835 is the only zip code to surpass the County averages, with a vaccination rate at 75%.

These numbers make a difference in how the Delta variant of the Coronavirus is spreading through our communities. Orange County deputy health officer Dr. Regina Chinsio-Kwong said that residents of Anaheim and Santa Ana, which are not seeing dramatic increases in new infections right now, have been getting vaccinated at higher rates than people in the coastal cities that are the hot spots in this latest surge.

The number of those getting vaccinated has increased in the last few weeks, a welcome sign to leaders like Chau that people are taking the virus seriously. And Chau and others in Orange County health continue to take steps to increase that number, like sending mobile vaccination units into communities and funding the Vaccine Equity Engagement Program in which nonprofits can “earn a coordination fee of $20 for every individual who receives either the first or second dose of the COVID-19 vaccine.”

Yet there remain many residents who are reluctant to take the vaccines. To them, Dr. Chau is sounding the alarm: “There is no way of getting out of this pandemic without the majority of people getting the vaccine. No way. No how.”