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Experts warn of another coronavirus surge as Southern California cases decline

With far fewer people going to the hospital and vaccine getting into many people’s arms, the outlook is brighter than at any time during the coronavirus pandemic.

But, as shutdown-weary Southern Californians welcome the reopening of schools, gyms and movie theaters and the return of indoor dining, experts say there is a strong chance the region will see yet another spike in hospitalizations and deaths.

And they say it is crucial for people to stay vigilant — wearing face coverings, maintaining a safe distance from others and avoiding crowds — and to make plans to get coronavirus shots.

“We’re getting there,” said Dr. Russell Buhr, a pulmonary and critical care doctor who cares for patients at Ronald Reagan UCLA Medical Center and other hospitals. “We’re making good progress.”

Close to 3 million doses of vaccine have been administered in Los Angeles County and  more than 1 million shots have been given in Orange County. In the Inland Empire, more than 700,000 doses have been given to Riverside County residents and more than 500,000 to San Bernardino County residents.

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But until roughly 70% to 80% of the population is immune to the virus, either as a result of getting a shot or having recovered from COVID-19, the threat of another surge will persist, Buhr said.

And millions more will need to get vaccinated before the region reaches that point, he said in a Thursday, March 18, interview.

Dr. Troy Pennington, an emergency room physician at the San Berrnardino County-run Arrowhead Regional Medical Center in Colton, said the region essentially is in “a race between the variants and the vaccines.”

In short, it’s not time to celebrate.

“We shouldn’t be doing an end-zone dance,” said Andrew Noymer, an epidemiologist at UC Irvine’s Program in Public Health.

Fewer hospital patients seen

Hospitalizations peaked in early January.

L.A. County’s worst day was Jan 5, when there were 8,098 people hospitalized with confirmed virus cases. Orange County peaked on Jan. 7 with 2,259 and San Bernardino County on Jan. 5 with 1,785. Riverside County reported a maximum of 1,671 COVID-19 patients Jan. 8 and 10.

Then things finally turned around and the number of patients being treated started falling. By the end of February, the region’s hospitals were reporting about 30% fewer patients each day than they had one week prior.

The numbers are still dropping. But since the beginning of March, the pace has slowed down quite a bit. On Thursday, the most recent day for which numbers were available, there were about 17% fewer patients in hospitals than there were a week before that.

As far as hospitalizations have plunged — down about 90% from the January peak — they’re still not back to the lowest levels seen during the fall. On Thursday, there were 1,380 people with confirmed cases hospitalized in the four counties. That’s 225 more — or 23% more — than at the lowest point in September.

By county, the totals were 827 in Los Angeles, 206 in Orange, 175 in Riverside and 172 in San Bernardino.

Public health experts across the region echo concerns expressed recently by Dr. Anthony Fauci, chief medical advisor to President Biden, that at some point the numbers will stop improving and begin to plateau.

“Hospitalizations are falling, and we remain cautiously optimistic,” wrote Bruce Weng, infectious disease specialist at Riverside University Health System Medical Center, in an email. “But there is concern that we will likely level off and potentially go up again. The next few weeks will be critical given we expect to see a rise in variants in the community.”

Weng, whose hospital is run by Riverside County, called it “very concerning” that Europe is experiencing a major surge.

He anticipates another wave to hit the United States as well.

“The question is, how big will it be?” he said.

Will there be another virus wave?

Buhr, the UCLA pulmonary and critical care doctor, said he also believes the situation will get worse again.

“There are probably going to be a few fits and starts over the next few months, rather than smooth sailing,” Buhr said.

And because the region has a long way to go to vaccinate working people under 65, Jakub Hlavka, a research professor in health policy at USC, said he worries a surge would disproportionately harm minorities and low-income people. That’s a huge concern given that, Latinos, for example, have been dying at a higher rate than others, he said.

Still, Pennington, the Arrowhead emergency room doctor, said he doesn’t believe another wave would be as devastating as the one that hammered the region during the holidays because fewer people are vulnerable to the virus.

“I don’t think it is going to be anything like what we saw in the third wave,” Pennington said

It helps, he said, that vaccines have proven highly effective at preventing death, he said.

“The vaccines, in that sense, have been a home run,” he said.

Buhr said vaccines also are preventing serious illness in those who become infected after getting shots.

“If it takes a life-threatening disease to a cold, that’s a win,” he said.

With the improving outlook, experts generally support the California guidelines that cleared Los Angeles, Orange, San Bernardino and Riverside counties this week to move to the less restrictive red tier, after being stuck in the most restrictive purple tier for months.

People are weary, Noymer said. They have been making sacrifices for a year. And the situation has improved to the point where it is time to loosen restrictions, he said.

“If you expect people to trust the public health system, you have to keep your promises,” Noymer said.

Closing again would be difficult

However, Noymer said it is crucial to follow details in the guidelines, such as limiting the number of people to 10% of capacity in gyms and 25% in restaurants.

“What we’re doing makes a lot more sense than what the state of Texas has done,” Noymer said. “They threw everything open all at once.”

Still, there is a risk involved in reopening — an acceptable one, but a risk nonetheless, he said.

Hlavka said it will be crucial to move forward cautiously to avoid a relapse.

“Closing again would be so much more difficult,” he said.

While experts generally believe California is on the right track toward reopening, they don’t suggest rushing to engage in every available activity.

Hlavka and Noymer recommend people not dine indoors or work out in a gym unless they have been fully vaccinated.

Unless one has been vaccinated, Noymer said, “I wouldn’t go anywhere near a gym right now” because of the labored breathing involved in exercising.

Gyms taking precautions

Gyms and fitness centers have argued that they take measures to protect people who work out.

For example, Rikki Hubbard, owner of a small fitness center in Riverside for women called t3 Fitness, said she upgraded her ventilation system and constantly cleans equipment.

Full-body-workout classes have been shortened from an hour to 45 minutes, Hubbard said, to allow time to clean before the next session.

After each class, women place dumbbells used in workouts into a bin labeled “dirty,” and each weight is disinfected before the next class, she said.

Face coverings are required upon entering and leaving, and in high-traffic areas, Hubbard said. When clients are settled in marked, designated areas spaced up to 8 feet apart for classes, they are permitted to remove masks, she said.

Hubbard said class sizes have been reduced and participants must register in advance; no walk-ins are taken. Clients are asked to clean their hands before entering the studio, she added.

Hubbard’s center continues to offer outdoor classes, and give customers the option of participating in exercises remotely via Zoom.

Hlavka called going to a gym “a very personal choice.”

He said he went to a gym for the first time in a year on Monday, March 15, in Santa Monica, adding he has been vaccinated. The gym appeared to be taking adequate precautions, he said.

“They were not even at 10% (capacity),” he said.

Much progress made, but safeguards still needed

In any event, now is not the time to relax, experts say.

Weng said people need to continue doing the basics: maintaining a safe distance from others, avoiding gathering with people outside their households, wearing face coverings and washing their hands frequently.

He recommended fully vaccinated people follow U.S. Centers for Disease Control and Prevention guidelines, which permit indoor visits with other people who have received shots without masks or social distancing. The guidelines also permit unmasked, indoor visits with people from a single household who haven’t been vaccinated, if they are at low risk.

Weng said precautions still should be taken around people at risk of becoming seriously ill.

“For example, if you’re vaccinated and you wanted to visit your elderly grandmother who had cancer, but she isn’t vaccinated — I would still mask in this situation,” he wrote. “Do you really want to risk infecting her?”

While urging people not to let their guard down, experts suggest people take comfort in the progress that has been made.

“To go from not even understanding what the coronavirus was in November 2019 to where we are today, it’s a light-year away from where we started,” Buhr said, “And that gets lost in the shuffle, sometimes. We’ve really come a long way.”


Source: Orange County Register

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