Los Angeles County appears in the midst of another full-blown coronavirus surge, with cases rising by 75% over the last week.
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 preventative 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, possible within weeks.
“While there still is uncertainty about what the impact of COVID-19 will be this winter, there is mounting evidence that we are entering another COVID-19 surge,” said L.A. County Public Health Director Barbara Ferrer.
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 and RSV.
“There is a common line of thinking that the pandemic is over, that COVID-19 is no longer of concern,” Ferrer said. “But given both the increases in hospitalizations and the lack of certainty in the winter trajectory for COVID-19, it’s important to continue common-sense mitigation strategies that we know work.”
L.A. County reported an average of 3,721 coronavirus cases a day over the seven-day period ending Monday, up from 2,128 the prior week. The latest case rate is double what it was just before Thanksgiving, and triple the rate recorded the first week of November.
The per capita rate — 258 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.
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 that ended Saturday, L.A. County recorded 1,211 new hospital admissions of coronavirus-positive patients. That’s 12.1 new admissions for every 100,000 residents, 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 Saturday, 6.4% of hospital beds in L.A. County were being used by such patients, up from 4.8% the prior week. 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.
Ferrer estimated last week that could happen in late December, should trends persist. That means the earliest a mask mandate would likely go into effect would be early January.
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.
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.
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.
COVID-19 deaths have also started to increase. L.A. County recorded 76 COVID-19 deaths for the week that ended Monday, up from 53 deaths 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. 5, 2021, L.A. County recorded a 91% 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.
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 go up that peak.
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.”
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.
“This year’s flu season is off to a rough start,” said Dr. Sandra Fryhofer, board chair of the American Medical Assn. “Flu’s here. It started early. And with COVID and RSV also circulating, it’s a perfect storm for a terrible holiday season.”
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.