COVID-19 surge builds in San Diego County

San Diego County has pushed past 2,000 new coronavirus cases per day to start the week, as the expected post-holiday surge begins to show itself across the region.

On Monday, the county health department was notified of 2,367 new cases preceded by 2,690 on Sunday. Totals for Dec. 25 and Dec. 24 were predictably lower, both coming in under the 2,000 mark, likely due to many testing operations shutting down for the holiday. But last Thursday, the daily figure was 2,690, a number high enough that it has not been surpassed since Jan. 22, according to county records.

The question of the moment remains: How will the current increase in infections affect local hospitals?

Early research indicates that hospitalization rates caused by the new Omicron variant could be substantially lower than for Delta and other types that came before it. It’s not clear exactly how much lower the hospitalization rates will be, making it difficult to know for sure just what hospitals are likely to face in the next few weeks.

This winter, though, there is an additional tool coming available that could further protect hospitals from filling up to a level that crowds out others who urgently need medical attention not connected to COVID-19.

Last week, the county health department said that it expects the first doses of Pfizer’s Paxlovid, an antiviral medication that trials have shown can dramatically reduce the chance of hospitalization, will soon be available by prescription across the region.

The county, though, has been reluctant to say exactly where the new drug will be available, indicating that only a few dozen local pharmacies chosen by the state health department will be able to fill prescriptions. A subsequently-released set of instructions to local doctors indicates that Paxlovid is expected to start appearing at certain CVS and Rite Aid pharmacies starting next week.

While continuing to keep the specific locations private, the California Department of Public Health said in an email that the locations have been chosen with an eye toward health equity, meaning that places with higher rates of infection and lower levels of access to high quality health care are most likely to score an early supply.

But specific locations are being kept on the down low, meaning that many doctors may not know whether their patients will be able to fill a Paxlovid prescription.

Most, at least in the very early going, won’t have much of a chance.

Dr. Cameron Kaiser, a deputy public health officer for San Diego County, said that the region is expected to receive enough Paxlovid for about 600 patients next week and, after that, enough of a second antiviral called molnupiravir to serve about 2,800.

Keeping the specific list of receiving pharmacies vague, he added, is an intentional attempt to make sure the drug gets to the patients who are most in need.

“Sure, folks can call around, but I don’t want to facilitate a situation where folks are homing in on doses and pharmacies in neighborhoods that really need them,” Kaiser said. “I think we did the best we could to pre-position medications in the neighborhoods where it’s going to do the most good.”

As to the situations that individual doctors will face when trying to decide whether or not to write a prescription that may or may not get filled, Kaiser, formerly the public health officer in Riverside County, said that physicians should not feel shy about using their medical judgment and acting accordingly.

“We’ve looked at the list of pharmacies, and I’m confident that it’s going where it needs to be,” Kaiser said. “If you happen to serve one of those places, your patients are more likely to get it, and I think that’s, at least in the short term, as it should be until we can get more.”

Paxlovid comes in pill form and is taken orally twice per day for five days. The treatment course should be started as soon as possible after diagnosis. Prescriptions are reserved for those with medical conditions such as cancer, diabetes and obesity, that put them at risk of severe COVID-19 consequences.

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