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L.A. County facing a full-blown coronavirus surge as cases double, deaths rise

A woman in a mask crosses the street in downtown Los Angeles.
If coronavirus rates continue to rise, Los Angeles could see a return to indoor mask mandates.
(Irfan Khan / Los Angeles Times)
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Los Angeles County appears in the midst of another full-blown coronavirus surge, with cases doubling since Thanksgiving.

The spike — which partially captures but likely does not fully reflect exposures over the Thanksgiving holiday — is prompting increasingly urgent calls for residents to get up to date on their vaccines and consider taking other preventive steps to stymie viral transmission and severe illness.

Also on the rise is the number of coronavirus-positive patients being cared for in hospitals, sparking concerns about renewed stress on the region’s healthcare system and raising the specter of an indoor public mask mandate if the trends continue, possibly shortly after New Year’s Day.

The surge in viral transmission comes as many people have stopped paying attention to COVID-19. But it’s not too late to intervene, officials say.

“We are seeing a rapid acceleration again,” L.A. County Public Health Director Barbara Ferrer said in an interview Tuesday. “We’ve got to get more people boosted [and] everybody should go ahead and put those masks on when they’re indoors.”

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And critically, more doctors should be prescribing antiviral drugs like Paxlovid, which can reduce illness severity, Ferrer said.

Health officials warn that continued spikes in COVID-19 could bring a return to an indoor mask mandate.

Though many officials expect a third pandemic winter wave could be moderated due to vaccines and better drug treatments, it’s still a potent threat as the region also contends with an early onslaught of flu, RSV and other respiratory viruses.

“Taken separately, these infections are manageable. But when all come together, the difficulty posed to the system is pretty extreme, and we’re seeing that now,” said California Health and Human Services Secretary Dr. Mark Ghaly.

L.A. County reported an average of 3,829 coronavirus cases a day over the seven-day period ending Tuesday, up from 2,301 the prior week. The latest case rate is triple the rate recorded in early November. Recent week-over-week increases in the case rate have ranged as high as 81%.

The per capita rate — 265 cases a week for every 100,000 residents — hasn’t been this high since early August, when the summer surge began to fade. A rate of 100 or more is considered high.

“If you have alarming numbers of cases and lots and lots of transmission, you’re going to end up with more people in the hospital,” Ferrer said. “And tragically, our hospitals also have to deal with other respiratory viruses ... and deal with the corresponding staffing shortages that happen when you have lots of illnesses.”

The latest maps and charts on the spread of COVID-19 in Los Angeles County, including cases, deaths, closures and restrictions.

Of the state’s 25 most populous counties, L.A. has the highest case rate, followed by San Diego, Solano, Merced, San Bernardino, Fresno, Santa Clara and San Francisco, according to The Times’ coronavirus tracker.

Official case counts are likely artificially low due to the widespread use of at-home tests, the results of which are often not reported to public health departments.

For the week ending Sunday, L.A. County recorded 1,459 new hospital admissions of coronavirus-positive patients. That’s 14.5 new admissions for every 100,000 residents, up 34% from the prior week, according to data from the U.S. Centers for Disease Control and Prevention.

An admission rate of 10 or greater is one of two criteria county officials have set for potentially instituting a new public indoor mask order. The second is the percentage of staffed hospital beds occupied by coronavirus-positive patients.

As of Sunday, 6.6% of hospital beds in L.A. County were being used by such patients, up from 2% at the start of November. Should that share reach 10%, it would trigger a countdown — likely a couple of weeks — to a new mask order, which would be the first for L.A. County since early March.

Hospitalizations among those 70 and older have surpassed the summer peak. Coronavirus cases for all age groups are up nearly 50% in just one week.

If current trends persist, Ferrer estimates we could hit the second trigger days before Christmas, potentially putting the county on track to implement a new mask mandate in early January. However, that timeline could shorten or stretch out depending on how things play out this month.

L.A. County was on the brink of issuing new masking rules during the summer Omicron surge, but narrowly avoided doing so when cases and hospitalizations dipped just before the new order would’ve gone into effect.

While not currently contemplating a California-wide mandate, officials at the state level continue to tout masking as an effective way to help thwart viral transmission.

“Given the trajectory and the trends that we see now, we’re hopeful that we’ll be able to use masks on top of other tools to keep numbers manageable enough, although health systems certainly have been strained,” Ghaly said Tuesday.

Southern California is presently bearing the brunt of increased coronavirus spread, with a case rate 35% higher than the state’s second-hardest-hit region, the San Francisco Bay Area.

But as has always been the case throughout the pandemic, Southern California doesn’t exist in a vacuum. The latest modeling from the California Department of Public Health estimates the spread of COVID-19 is likely increasing in both the San Francisco Bay Area and San Joaquin Valley, as well.

Officials in Santa Clara County, Northern California’s most populous county, said they have detected a sharp increase in coronavirus levels over the last month.

“The current rise in COVID-19 within the county should serve as a stark reminder for everyone eligible to get the bivalent Omicron booster as soon as possible, especially in advance of the holidays,” Dr. Sara Cody, the county public health director, said in a statement.

With coronavirus cases and hospitalizations rising in Los Angeles County, officials are voicing new confidence in the effectiveness of the updated COVID-19 booster shot.

COVID-19 deaths have also started to increase. L.A. County recorded 77 COVID-19 deaths for the week that ended Tuesday, up from 55 reported in the prior week. Fatality rates are highest among those who either haven’t been vaccinated or are not up to date on their booster shot, officials say.

A post-Thanksgiving rebound in coronavirus activity is a repeat of the pattern seen in the last two autumns. Exactly one year ago, on Dec. 6, 2021, L.A. County recorded a 94% week-over-week increase in coronavirus cases, a prelude to the first Omicron surge that was one of the deadliest of the pandemic.

But there remains optimism that a surge this autumn and winter won’t be as bad as last year, given the plethora of tools: plentiful rapid tests, an updated booster shot that is a good match for circulating coronavirus strains, and an awareness that masking remains a helpful tool to limit transmission.

Still, officials remain deeply concerned about disappointing uptake of the updated booster shot, which became available in early September. Just 35% of vaccinated California seniors age 65 and older have received the updated booster, as have just 21% of those age 50 to 64, state data show.

The findings, published by the U.S. Centers for Disease Control and Prevention, show that COVID-19 can still cause severe and fatal outcomes in children too young to be vaccinated.

Coronavirus-positive hospitalization levels have risen significantly for all age groups in California. As of Friday, the coronavirus-positive hospitalization rate for seniors age 70 and older exceeded that of the summer Omicron surge — the only age group to do so.

While a certain percentage of people in the hospital with a coronavirus infection aren’t being treated specifically for COVID-19 illness, that share can change depending on whether you’re in a surge.

For instance, during last winter’s Omicron peak, 60% of L.A. County patients hospitalized with a coronavirus infection were being treated for COVID-19 illness, meaning the other 40% tested positive incidentally after being treated for some other reason.

Since February, between 37% to 45% of coronavirus-positive hospitalizations were due to COVID-19 illness in L.A. County, Ferrer said. For the week that ended Nov. 7, the figure was 43%.

“We’re currently towards the upper end of that range, and we know that this proportion usually increases during the surges,” she said. “It is possible that with increasing COVID cases this winter, we’ll see an increasing proportion of COVID hospitalizations that are due to COVID-associated illness.”

As of Monday, 4,208 coronavirus-positive patients were hospitalized statewide. That census has ballooned 62% over the last two weeks, reaching a level not seen since early August.

However, it remains well shy of the heights seen during either the 2020-21 or 2021-22 winter surges — when hospitals were at times caring for upward of 21,000 and 15,000 coronavirus-positive patients, respectively.

On Friday, the CDC’s color-coded map showed California and nearly a dozen other states shaded purple, the worst of the three shades in the very high flu level.

But COVID-19 isn’t the only game in town this year. Hospitals are already busy dealing with an influx of patients sick with flu and RSV, or respiratory syncytial virus. The confluence of this viral trio — a so-called “tripledemic” — could greatly stress healthcare systems, even if overall COVID-19 numbers are not what they were the last two winters.

“People forget that in the last couple of years, even though it’s been very difficult, we have been spared multiple threats at the same time,” Ghaly said.

He estimated Tuesday that combined, about 6,100 people are hospitalized with COVID-19 and the flu in California. That figure could reach somewhere around 10,000 by late December or early January, he said.

“When we look back at Omicron or the surge the year before, you see pretty low flu numbers, pretty low RSV numbers, pretty low other circulating viruses ... and things could have been a lot harder had we seen the circulation of those other viruses,” he said.

The rough start to the flu season, combined with spread of COVID-19 and RSV, is “a perfect storm for a terrible holiday season,” according to Dr. Sandra Fryhofer, board chair of the American Medical Assn.

That is why it’s so important to get vaccinated not just for COVID-19 but flu as well, she told reporters Monday.

“I know everyone’s tired of getting shots. We all have booster fatigue. But understand, you could get really, really sick this year and ruin your holiday celebrations if you don’t get vaccinated,” Fryhofer said.

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