California Has Lost Control

The Golden State was in better shape than most of the country. Now the outbreak there is going from bad to worse.

Registered nurse Carmen Verano wipes her CAPR helmet after attending a Covid-19 patient in the Intensive Care Unit (ICU) at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, California on December 18, 2020.
Apu Gomes / AFP / Getty
Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.

California is on the verge of breaking a pandemic record from the darkest days of the spring: With 17,750 COVID-19 patients hospitalized yesterday, the state is closing in on New York’s single-day high of 18,825, set on April 13. It’s a shocking turn of events for California, a huge state that, not long ago, had better control of—or luck with—the virus than much of the country.

In October, as the pandemic’s winter surge was beginning to take shape across the U.S., California’s public-health researchers and officials expressed measured optimism that the nation’s most populous state could avoid a disastrous rise in cases. During a press conference on October 19, Governor Gavin Newsom pointed to declining hospitalization rates as a sign of the state’s success, but also warned that the decline was slowing. “We’re beginning to flatten out, plateau, as relates to hospitalizations,” he said.

For a moment, such a plateau seemed like the most likely outcome. A week after Newsom’s press conference, the state had 2,991 people hospitalized with COVID-19, its lowest number since April 10. But the trend quickly reversed, and by November 23, the state’s hospitalizations had doubled to more than 6,000.

What’s happened since is a worst-case scenario. While California’s per capita hospitalization rate is nowhere near New York at its worst—with 39.5 million people, the Golden State is about twice as populous as New York—the sheer number of patients in the hospital is still a sign of how badly California is doing right now.

Worse yet is how quickly the state reached nearly 18,000 hospitalizations during its current surge. When New York reached its record, it represented a 12 percent increase over the week prior. In California, by contrast, hospitalizations are up 27 percent over last week. With cases in California continuing to rise, more hospitalizations will follow.

Things are much worse in some parts of the state than others. Southern and Central California are driving the current surge: 34 percent of the state’s hospitalized patients are in Los Angeles County, the nation’s most populous by far. Yesterday, 620 people per million were hospitalized with confirmed COVID-19 there, the fifth-highest rate among California counties.

Plus, Los Angeles County contains only a portion of the sprawling metro area. San Bernardino County, Los Angeles County’s neighbor to the east, has an even higher rate of hospitalizations, with 766 per million. Orange County, just south of Los Angeles County, with 561 per million, and Riverside County, east of Orange County, with 540 per million, are also among the 10 California counties with the highest COVID-19 hospitalization rates. Together, these four counties account for more than 11,000 of the state’s 17,750 hospitalized patients.

Just one other California county with more than 500,000 residents has a higher rate than Los Angeles County—Stanislaus, a food-production center in the Central Valley east of San Francisco with a large population of essential workers, many of whom live in cramped conditions and are unable to stop working during an economic downturn.

The Bay Area is doing better than Southern California, but this surge is still the region’s worst to date. Santa Clara, the Bay Area’s largest county, has the highest rate, with a concerning 323 people hospitalized per million—like Los Angeles County, that’s about three times higher than Santa Clara’s previous high this summer. San Francisco County, home to fewer than 900,000 people, has just 175 hospitalized right now, with a rate one-third that of Los Angeles County. A more expansive definition of the Bay Area might include San Joaquin County, which borders Stanislaus and has a hospitalization rate of 445 per million; the Central Valley region, including Fresno and the San Joaquin Valley, has been approaching its limited intensive-care-unit capacity in recent weeks.

Northern California, as defined by the state for its regional stay-at-home orders, is still better off: 28.7 percent of its ICU beds are available, so it’s not under the state stay-at-home orders that are triggered when ICU capacity falls below 15 percent in a particular area. For comparison, the Bay Area is at 13.7 percent. Greater Sacramento is at 16.2 percent. Meanwhile, the San Joaquin Valley and Southern California are essentially full. California has very little room for error; on December 3, The New York Times reported that only two states had fewer ICU beds in total per capita. By comparison, Poland has nearly the same population and three times as many hospital beds.

Why California—a state that had been an example of a reasonably effective response—and why now? Some officials have pointed to lockdown fatigue. Thanksgiving alone is not the culprit, as cases were clearly rising in early November. The state’s reversal of fortunes is so sharp and sudden that the reasons remain unclear, but its time as a big and relatively bright spot in a dark winter has definitively come to an end.