Editor’s note, Dec. 16 at 2:30 p.m.: The Greater Sacramento Region is at 14.1% ICU availability as of today. The original article contained information about the Dec. 15 availability (14.9%). That change has been reflected below.
Clarification 5 p.m.: We originally placed the line “notable exceptions for skiing, snowboarding, and sledding” under the stay-at-home order after lodging reservations, seemingly implying that lodging is permissible for those looking to recreate at resorts. That was not the intention, and we’ve since relocated the line to after non-essential travel across the state.
Though the battle against the novel coronavirus continues and the number of positive cases soars, reinforcements have appeared on a local level.
As vaccines trickle throughout the United States into the hands — and arms — of healthcare workers, Tahoe Forest Hospital is days away from receiving its own batch. Paige Thomason, director of marketing and communications with the hospital, told Moonshine Ink in an email that staff expects an arrival this week. In addition to the top prioritized frontline workers for the vaccination are residents of TFH’s skilled nursing facility.
Increased testing capacity and re-established lockdowns have also emerged to curb the spread of COVID-19, though the stark reality remains: Statewide, ICUs are near capacity; local counties are in a lockdown; and holidays revolving around family gatherings (and thus potential spreader events) are coming right up.
We’re not out of the tunnel yet.
A numbers game
Nevada County’s eastern portion, which includes Truckee, topped 722 all-time COVID cases yesterday , a leap of nearly 250 since Dec. 1 alone. County-wide, 24.9% of total cases (2,123 since March) are active.
On Tahoe’s North Shore, also as of Dec. 15, Placer County documents 94 cases for Tahoe City; 213 for Kings Beach; 30 for Tahoe Vista; and 31 for Carnelian Bay; plus 31 in Olympic Valley, and 49 for the county’s Truckee reaches.
Reno as a whole notes over 13,000 active cases (and the regional hospital system has expanded care to its parking garage), but yesterday Incline Village had 68 active cases. Any Incline residents or visitors in need of acute hospital care end up at TFH in Truckee rather than Renown Health in downtown Reno.
But these numbers aren’t the be-all, end-all. A report released over the summer cited by the Centers for Disease Control estimates six to 24 times more infections than what’s being reported.
Applying the more conservative six-times estimate, the current high of 722 Truckee COVID-positive cases could in reality be over 4,300 — people might just not be symptomatic enough to need testing or therapeutics.
Covid19-projections.com, which utilizes data from The Atlantic’s The COVID Tracking Project, aims to project true COVID infection rates, and suggests that in California as a whole, on Nov. 30 one in 40 residents had the coronavirus.
State mandates, however, rely on not only each county’s actual positive testing rate (as opposed to the estimated true rate), but also the capability of handling potential surges.
Lake Tahoe’s surrounding California counties, El Dorado, Nevada, and Placer, are all part of the Greater Sacramento region, paired with Yolo, Sacramento, and Plumas, among others. At the end of last week, the region sat at an average 9.9% ICU availability; yesterday, it rose to 14.9% — one-tenth of a percentage point below the state’s 15% threshold. Today regional ICU availability dropped to 14.1%.
With below 15% of intensive care units available, the Greater Sacramento region is under a stay-at-home order, which requires the closure of bars, wineries, personal services, and hair salons, establishes a ban on non-essential travel across the state (with notable exceptions for skiing, snowboarding, and sledding), and prohibits lodging reservations for non-critical infrastructure support.
Beginning last Friday, Dec. 11, this order is in effect for three weeks and can end only if, at the end of those three weeks, the region’s ICU capacity is projected to be at or over 15% for four weeks. At that point, each county would rely on state-assigned tier placements based on COVID positivity rates.
On Tuesday of this week, TFH cared for one ICU patient and nine inpatients who were either COVID-positive or rule-out (meaning COVID symptoms are apparent, but a test result hasn’t yet confirmed an infection). Nearly a week earlier, it’s worth noting, five out of six TFH ICU beds were full. The December month-to-date average percentage of occupancy in the hospital’s ICU is 85%.
Numbers aside, Harry Weis, CEO of Tahoe Forest Health System, has noted multiple silver linings — the first being that most folks who’ve tested positive for the disease are recovering at home with over-the-phone physician guidance, which can include taking antibody cocktails. This care approach minimizes the number of people in need of inpatient services or an emergency room trip.
Meanwhile, those admitted into the hospital with COVID-19 aren’t relying on ventilators as much as they once did — it’s become quite rare, Weis said. “I’m not saying it never happens,” he added, “but it only happens probably [for] a minority of our patients. Then we use high-flow oxygen delivery devices far more than ventilators.” These provide additional oxygen while patients continue to breathe in and out on their own (as opposed to a ventilator, which works a the lungs in addition to providing oxygen).
Positive number three comes, oddly enough, hand-in-hand with the rise of positive COVID-19 cases.
“As the volume of lab tests has probably grown six to 10 times [since the middle of November],” Weis explained, “… The good news is that with all the care and coordination … we’ve not seen a six- to tenfold increase in inpatients.”
There are opportunities for an expansion of services if needed — the silver slivers of good news not hampering reality. The six ICU spots are part of 19 standard inpatient care beds, but TFH has the capabilities to increase total beds to 32, which includes an additional three ICU beds, and even beyond that, if needed.
Local testing opportunities, on the other hand, already have expanded in recent weeks. Last Monday, the state-staffed Optum Serve testing site on Donner Pass Road in Truckee opened with nearly double the space it’d had previously after hospital staff were relocated to accommodate the need. On that first day, according to Weis, staff performed over 300 tests.
The turnaround to receive COVID-19 test results in Truckee were averaging seven days just a few weeks ago. With the recent expansion, and additional labs in Southern California that can confirm virus positivity or lack thereof, the wait time has decreased. Moonshine confirmed with a testing site representative that the DPR site states two to six days for testing results, though anecdotally, three to four days is the sweet spot for returns.
Sarah Lowis, Tahoe City resident and staff nurse at Renown Health in Reno, went to the Truckee site to get a test last Thursday, first thing in the morning. Lowis has sought local tests multiple times in recent months with the goal of keeping her results in her home county. She was delayed by days at every turn.
“I have heard from others in the community around Tahoe City that they have had difficulty getting tested after having found they were exposed,” Lowis wrote in an email from mid-November. “Most recently, a local business owner, whom I will not name for sake of privacy, had an employee exposed, so he closed his business for a two-week precaution as per guidelines. Meanwhile, he had hoped to get a test for himself and his kids, but there was nowhere that could give him any relatively quick results.”
The recently expanded services have improved options. Lowis explained that she was able to walk in last week and receive a test right away: “[They] have increased their staffing at the site to accommodate more tests [per] day, so that is good. I was able to get an appointment without delay, which is also an improvement. However, what remains lagging is that results still take anywhere from four to six days!”
As of Dec. 15, five days later, Lowis said she hadn’t received her test results.
The trail of tests
Placer County’s public health officer, Dr. Rob Oldham spoke to Lowis’s concern about her out-of-county testing results not feeding her place of residence. When asked about a North Shore resident choosing to get tested in Reno, and whether results (positive or negative) would be attributed to Placer, Oldham offered a fuzzy answer.
“For Reno, it should,” he said. “… If they came to another site in California, for sure that’s getting to us. I was getting reports from Reno. I want to say the answer is yes, but it might be a little bit more complicated, it might be more delayed.”
It depends on the type of test, he continued. PCR tests, which detect the virus’s genetic material, “eventually get back to” Placer, Oldham said. Antigen tests, though, which are rapid tests that look for certain virus proteins, aren’t always reported — “especially the negatives don’t get reported to public health routinely. So that’s something we’re hoping to have a more robust system for reporting on those tests.”
While local counties are stymied by the Great Sacramento region’s ICU availability, Weis said the TFHS isn’t yet overburdened. He hopes it can stay that way if people wear masks, physically distance, and wash their hands.
“We’ve been around 71 years and we’re well suited to care for our 40,000 regular, full-time residents, and we’ve been well suited for the surges that come throughout the year where there are plus 70,000 or plus up to 100,000 individuals,” he said. “… However — if you overlay a pandemic on top of that, where many individuals are becoming sick, we do have to share that we still have limited resources here. We’re hopeful we have enough, but based on people limitations, staff limitations, space, and equipment limitations, we don’t have an infinite supply of services here.”
Looking ahead, Weis is keeping an eye on upcoming holidays and their impact on case counts as people choose (or don’t choose) to celebrate, with or without others. As vaccinations begin to be administered to healthcare workers, he says he remains anxious about keeping his team members on staff.
“The bigger thing that we’re concerned about is, can you get enough personnel to treat high census surges?” Weis said. “That’s really the concern of most health systems in the better California or other locations. Can you do that? We’ve been proactive in trying to hire up additional per-diem or part-time individuals to help with that, but there’s still a limited supply of personnel.”
The U.S. Department of Health and Human Services is releasing COVID-19 data for individual hospitals across the country on a week-by-week basis. The hospital-provided information includes the number of inpatients (including those in the ICU and on ventilators), beds available, and staff on-site to attend to the patients.
To download the latest set, visit healthdata.gov/dataset/covid-19-reported-patient-impact-and-hospital-capacity-facility