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An aerial photograph of El Centro Regional Medical Center shows the tent-based expansion of the hospital in winter 2020-2021 at the height of the second surge of COVID cases. Although no tents can be seen today, ECRMC and Pioneers Memorial Hospital are preparing for a substantial increase in local cases as the Valley enters a "third wave" and the country a "fourth wave," ECRMC CEO Dr. Adolphe Edward said this week. | COURTESY PHOTO

COVID’s Latest Surge to Stick Around till 2022

ECRMC’s CEO Says Imperial County’s “Third Wave” Will Only Get Worse; Area Has “Gotten Lucky” So Far

The taxman is coming to collect on Imperial County, said Dr. Adolphe Edward, even though this area has not seen the alarming spread in COVID cases experienced throughout most of the United States in the past month.

That is largely owed to high vaccination rates and widespread previous infections, El Centro Regional Medical Center’s chief executive officer said during an interview with this newspaper on Thursday, July 29.

Yet health officials have started their preparations for a more substantial local increase, as they realize the 439 percent rise in cases the collective United States has experienced since June cannot be avoided in the Imperial Valley altogether.

Dr. Adolphe Edward, chief executive officer of El Centro Regional Medical Center, gets ready to take the first vaccine given during a press conference at the hospital campus on Dec. 21, 2020, to mark the first wave of COVID-19 immunizations among ECRMC front-line staff. | FILE PHOTO

“The epidemiologists that we work with throughout the state are predicting a rise in September that will continue getting to a very high number in October. We don’t know what that number looks like, and it will continue through November and December, getting us to lower numbers again around the new year,” Edward said midday Thursday as his own hospital was experiencing a relative calm before the storm.

Hospitalization rates have stayed remarkably low and stable in Imperial County so far. ECRMC on Thursday had 68 total in-patients with just four of those patients COVID-positive. Two COVID patients were in the intensive-care unit.

Overall, those numbers were down from a high of nine COVID-positive patients the previous week, he said.

It’s much the same at Pioneers Memorial Hospital in Brawley.

“Pioneers only has a few patients admitted for COVID at any point in time. Today (Thursday), we only have one COVID patient out of 56 total patients. This is compared to New Year’s Eve last year, (when) we had approximately 75 COVID patients in the hospital,” Pioneers Chief Executive Officer Larry Lewis said in an email. “The COVID patient census we are currently experiencing is as low as it’s ever been since we began tracking in early May 2020.”

Edward is not trying to be an alarmist, but the numbers and the variants are increasing in all other areas of the country too fast for Imperial County to act like it’s on an island, and just this week the hospitals, Imperial County Public Health Department officials and others who need to be present resumed their weekly huddles with the California Department of Public Health for updates and game planning.

Edward said don’t expect a tent city to reappear at the El Centro hospital campus immediately, but the ability to mobilize quickly is there and would only happen as fast as the state provides support.

“Even though the national cases are up 439 percent, and there has been several trends that we’re seeing in terms of high levels of community transmission because of the rapid rise in COVID cases in some regions … Our community have gotten lucky,” he said.   

“It’s kind of strange to say it this way, because the fact is that one out of five to seven patients or people have had the virus,” Edward added.

What’s Working in Imperial County

That Imperial County is above the California average for both fully vaccinated rates and rates of those with at least one dose of the vaccine has been well documented and celebrated by Imperial County Public Health, but Edward said there is a second piece to this comparably slower proliferation of the more transmissible variants of concern seen circulating the nation: widespread prior community infections.

“I think (Imperial County) Public Health and others would support that proposition. If not, just come talk to any of our physicians in the ER and they’ll tell you, that’s what we’re telling folks,” Edward said.

The data bears this out, as well. Some 28,821 positive cases have been recorded in Imperial County through July 29. With an estimated population of 180,600, that’s a shade under 15 percent of the population, or one in every seven people who have been infected with COVID.

Vaccine hesitancy is very much an ongoing phenomena, yet there are reports coming in from all areas of the country that the nation’s “fourth wave” of COVID (this is being considered Imperial Valley’s “third wave,” according to Edward) has placed a newfound urgency and willingness to put aside mistrust and politics.

For Imperial County, outreach efforts by the health department, the hospitals, private healthcare providers and health justice groups like Salud Sin Fronteras, and others, have put the pressure on to inoculate the public.

“I would celebrate the fact that we do have a high vaccine rates. I’m very thankful that the community stood by us as we went out to vaccinate people. And it was a good thing that we were yelling at the state to make sure that we got our vaccines down here and put vaccines in arms,” Edward said.

“We’re actually among the top-12 performers when it comes to vaccination in California. So, the Imperial County community has responded very well to the vaccination,” Public Health’s Angulo said on July 27.

Some 83.1 percent of Imperial County residents ages 12 and older who are eligible for vaccination had at least one doses of vaccination as of Monday, July 26. That data point accounts for the single-dose Johnson & Johnson and one of the two doses of Pfizer-BioNTech or Moderna, Angulo has explained previously.

Some 66.9 percent of the eligible population was considered fully vaccinated, she added, both percentages of which are above the California average.

Where Imperial County continues to struggle is partial vaccinations, or those who have failed to return for their second dose of the Pfizer or Moderna, at 16.2 percent, she said.

This was early in the week when the data was for 216,431 total doses administered in Imperial County. The number of doses was up to 218,120 as of Thursday.

(The above data is available through the Imperial County Public Health COVID pages.)

Concerns with Variants of Concern

Despite all the good news over vaccination rates in Imperial County and in California overall, there is a harsh reality surfacing that can play into the hands of the vaccine-adverse, and that is that the vaccinated are still getting sick.

It’s not a fact that Imperial County Public Health is hiding from, either.

Of the variants of concern that have been identified and documented in Imperial County as of Tuesday afternoon’s update, which was 178 found through genomic sequencing of Public Health samples, 12 percent came from persons were already vaccinated, 43 percent from the unvaccinated, and in 45 percent of the cases vaccination status was not known.

That is happening in all areas of the world among all vaccinated populations — collectively referred to as “breakthrough infections” — and it speaks to the ability of COVID to learn and modify and adapt than it does to any failure of the science.

“The vaccines are working, there’s been a lot of confusion about that. The bottom line is, these vaccines are very effective, especially at keeping people from getting really sick, and getting hospitalized or ending up on a ventilator or dying,” Imperial County Health Officer, Dr. Stephen Munday, said this week.

“However, they’re not perfect. And because of the sheer number of infections that are taking place, and the sheer number of people that have been vaccinated, because a small percentage of them don’t work, maybe because somebody’s immune system isn’t strong enough or for whatever reason along those lines, we’re going to continue to have cases.”

The Delta variant is still not presenting itself in Imperial County the way it is elsewhere in the country, but it’s just a matter of time, Munday said.

As of the most recent report for week ending July 27, no new Delta (B.1.617.2) cases have been found beyond the two detected almost a month ago at this point.

The overwhelming numbers of the total of 178 variants of concern found in Imperial County since December have been the Gamma (P.1) variant, or what has also been referred to as the Japan/Brazil variant, detected some 103 times and the Alpha (B.1.1.7) variant, or what is widely referred to as the U.K. strain, which has been seen in 69 cases.

Munday explained gene sequencing lags behind several weeks.

“Sequencing is quite a labor intensive, robust lab process, so unlike just the regular testing, in which you can get the turnaround done in some cases within an hour or so … the whole genome sequencing really isn’t amenable to that,” he said.

“The point that I’m making is that although it doesn’t look yet like we have much Delta, I do expect that that will change. And we are sequencing essentially everything that comes into the health department,” Munday added.  

Local Place in National Picture

The U.S. Centers for Disease Control and Prevention’s own color-coded “heat map” provides a snapshot into how Imperial County has simmered at a certain level of transmission as the rest of the nation has come to a boil around it.

For more than month, Imperial County has been an “orange” county, for “substantial transmission,” where surrounding counties on June 28 were “yellow” for moderate transmission (San Diego and Yuma counties) and even “blue” for low transmission (Riverside County).

Just four weeks later, as of July 28, Imperial and Yuma counties have stayed the same while Riverside and San Diego, as well as Los Angeles County have rocketed to red, and where much of California was yellow, it’s now awash in orange.

That might be confusing for some, considering the end to color coding was supposed to be on June 15, but that was a state system attached to the opening of business and public sectors.

“If you do happen to hear about a color-coded system, CDC is using a color-coded system,” Imperial County Public Health Director Janette Angulo explained earlier this week for anyone still a bit stumped.

“They’re labeling us, as you know, substantial spread. They have it in orange. We’ve been in that tier or that color for quite some time now,” Angulo said on Tuesday, July 27. “For CDC, it’s the total new cases per 100,000 persons in the past seven days. That’s how they’re calculating and determining the spread or the transmission rate.”

Orange spread is considered 50 to “99.99” total new cases per 100,000 persons in the past seven days (82.22 for Imperial) and positivity percentage rate of 8 percent to 9.99 percent.

Imperial County’s state data, adjusted to remove state inmate populations and out-of-county and out-of-country cases that are detected locally, showed 9.6 new cases per 100,000 residents per day for the week of July 11-July 17 and a positivity rate of 5.6 percent for the same period.

This was a steady increase over the past four weeks, when a low of 2.3 new cases per day per 100,000 residents were recorded for the week of June 13-19 and a low positivity rate of 2.6 percent was recorded June 24-30, according to Imperial County Public Health.

On Thursday morning, there were 174 active cases.

Angulo explained this week that a single day high for new cases was 35 on July 19.

Where Do We Go from Here?

Masking and vaccinations are very much on public health officials minds at the moment. As children get ready to go back to school, there is a requirement now in place for all students, teachers, and staff to use masks in indoor settings regardless of vaccination status, and on Monday, July 26, a new state health order required proof of vaccination for healthcare staff members in acute care facilities, other clinic settings, and in congregate living conditions like skilled nursing homes and prisons and jails, as well as rules on mandatory masking in such settings and when respirators would be required of staff.

That former does not sit well with many in the public and the latter is still in the formulation stages as far as how it will be enforced.

Frontline Health Workers
An unidentified El Centro Regional Medical Center emergency department staff member examines an unidentified patient in the triage area of the hospital in March 2020. The female staff member is wearing a Powered Air-Purifying Respirator, or PAPR, that protects nurses, doctors and other ER staff from coming in contact with COVID-19 infection. | PHOTO COURTESY OF ECRMC

“Really, this is an attempt to keep the healthcare system as safe as possible protect the workers on both the vaccinated and the unvaccinated and also prevent them not only from contracting COVID, but of course, being able to spread it to others,” Munday said of this week’s new health officer order.

As far as variants of the SARS-CoV-2 virus that causes COVID, ECRMC’s Dr. Edward prefers to not even speak of the Greek system of Deltas and Alphas, et al.

“I know everybody’s concentrating on Delta, but there are other variants. I don’t want to get into the details of all the variants, but there’s other variants that are surfacing, and thee labs are all monitoring … so I don’t want to mislead you by telling you that it is one (that is worse than another),” he said. “It’s multiple variants.

“We collectively, as a society, have let our guard down just a bit. So that’s why you see counties like L.A. issue the indoor mask mandate again,” he said. “Other good news that I think you probably need to include somewhere is the fact that we know that about 97 percent of hospitalized COVID patients aren’t vaccinated. And that’s why we’re begging people to go get vaccinations.”