Imagine you're driving down an unfamiliar country highway at night, the kind lined with forests and hillsides and without cell service, as you notice your fuel gauge ticking down. Do you wait until the "get fuel" light ticks on before deciding to pull off at the next gas station? Better to gas up at the next opportunity, right? Better to avoid being left on the side of the road, walking to next station or waiting for help that may never come, right?
We ask because that's the terrain through which Northern California is speeding, watching COVID-19 caseloads climb while eyeing our cumulative available hospital intensive care capacity fluctuate, needle bobbing toward the red, knowing the moment it dips below 15 percent it will trigger a state stay-at-home order and a host of new restrictions designed to keep intensive care units from becoming overrun. It's an arbitrary metric, to be sure, and one that isn't proving terribly effective in the Southern California and San Joaquin regions, which dipped below the 15-percent threshold weeks ago and now sit at 0 capacity, with hospitals and ambulance services discussing when and how, not if, to begin rationing care. Statewide, cumulative available intensive care unit capacity has dipped to a razor-thin 1.4 percent.
But, as so many are quick to point out, Humboldt County isn't Los Angeles or San Diego, right? So let's look at how this is all likely to play out closer to home.
The Northern California region, in which Humboldt is one of 11 rural counties, has a total of about 120 ICU beds, including Humboldt's 28, which is obviously a lot different than the 1,300 in the Bay Area. That's 120 beds to treat heart attacks, strokes, trauma victims and COVID-19 in 11 counties. Fifteen percent of 120 is 18. Are we really going to wait until there are just 18 intensive care unit beds left to be shared among 11 counties before deciding we need to do something different? How is that likely to end?
After all, it's not like we don't know where this road leads. About 12 percent of COVID-19 patients require hospitalization at some point within 14 days of their diagnosis, and a subset of those — studies indicate about 20 percent — will require intensive care. In Humboldt County — with our 28 intensive care beds — we saw 486 new COVID-19 cases confirmed in the 14 days before this edition of the Journal went to press, which the numbers suggest will result in 58 hospitalizations and 12 ICU stays.
And let's not forget local healthcare workers telling the Journal that Humboldt County's largest emergency room — St. Joseph Hospital — is already crowded with more critically ill (non-COVID-19) patients than they've ever seen. And increasingly, available beds are being filled up by patients indefinitely awaiting delayed transfers to other California hospitals that are now overflowing with COVID-19 patients.
That sobering reality should also drive home the fact that our local healthcare workforce is likely to be the ultimate limiting factor in all this. Hospitals can and will move to surge capacity protocols to meet demand, but that will require nurses, technicians and doctors working in grueling conditions and asked to provide a level of care they simply weren't trained for in a scenario one local health official referred to as "wartime medicine."
And while officials once talked hopefully of the possibility the county could bring in skilled healthcare workers from other areas should we face a local surge, that hope is now all but lost.
Mark Futernick, an emergency room doctor in Los Angeles, was blunt when asked about this by the Associated Press, saying California's surge will be worse than New York's in the spring. Then, Futernick noted, healthcare providers flew in from all corners of the country to help but now, he warned, every place is inundated without healthcare workers to spare.
"There's no cavalry coming," he said.
And if it's not coming to Los Angeles, it's definitely not coming to Humboldt. Instead, we'll once again need to handle a crisis on our own. We have to find the off-ramp and the time is now.
As we've said repeatedly, we will all need to do our part by not gathering with people outside our households, wearing masks when outside our homes, washing hands and staying home as much as possible. It's also past time for our local government to do more.
Earlier this month, when Gov. Gavin Newsom announced the stay-at-home order and the 15-percent ICU capacity trigger, six Bay Area health officials acted proactively. Even though their region still had 24.1 percent cumulative ICU capacity, they implemented new stay-at-home orders and promised to enforce them vigorously. Humboldt should do the same.
Now we don't say this lightly, knowing new restrictions could be devastating to our local small business community and the local workforce, which have already lost so much. And we all must advocate for meaningful state and federal relief packages in the months to come. But the time for action is now as allowing our healthcare system to be overrun — and the restrictions that will ensue — will only prolong the pain being experienced by those businesses, their owners, employees and customers.
If we wait for Newsom and the state to tell us it's time to try something different, it will simply be too late. There will be widespread suffering. Our healthcare workforce will face unspeakable challenges and our children will spend another semester at home. People will die, including some who could have been saved.
It's time for leaders to lead and take the exit because there will be no help for miles.
Jennifer Fumiko Cahill (she/her) is the Journal’s arts and features editor. Reach her at 442-1400, extension 320, or Jennifer@northcoastjournal.com. Follow her on Twitter @JFumikoCahill.
Thadeus Greenson (he/him) is the Journal’s news editor. Reach him at 442-1400, extension 321, or firstname.lastname@example.org. Follow him on Twitter