This is what the COVID-19 pandemic looks like in the part of California where the surge in the Delta variant is not abating.
In Fresno County, understaffed hospitals are so congested that emergency services have stopped moving people unless they have a life-threatening emergency.
In Tulare County, a Visalia hospital – which has treated more COVID-19 patients in the past few days than any other medical facility in the state – declared last week on a day when 51 patients waited in the emergency room for a bed to be opened became high, an internal disaster.
And this week, sparsely populated Kings County, which has one of the lowest vaccination rates in California, had one of the highest Covid-19 hospitalization rates per capita in the state.
RN Melanie Albor prepares to vaccinate resident Peggy Arnold (left) in an affordable shared apartment in Tracy, California in February 2021.
(Brian van der Brug / Los Angeles Times)
For the past year and a half, the rural, agricultural San Joaquin Valley has been a constant focal point for the virus – the land of the eternal COVID-19 surge.
Case numbers and hospital admissions fell sharply across California, including Los Angeles and the San Francisco Bay Area, after the height of summer. But not in the San Joaquin Valley.
“We felt kind of like the forgotten part of California reading that things were getting better all over the state,” Gary Herbst, executive director of Kaweah Health Medical Center in Visalia, told the Times. “It’s like we’re almost in another country, even though we’re in the middle of the state.”
The San Joaquin Valley has the highest COVID-19 hospitalization rate in the state this week. For every 100,000 inhabitants in the region, there were 24 people who were hospitalized with COVID-19. This compares with eight out of every 100,000 residents in southern California who were hospitalized with the virus. The San Francisco Bay Area had four.
In Fresno County, the area’s most populous county, the vast majority of patients currently hospitalized with COVID-19 are unvaccinated. They are mostly people in their 30s, 40s, and 50s and are often the primary financial service providers for their families.
There are many reasons the region is under constant siege, but the main culprit is low vaccination rates, according to health officials and hospital administrations.
Kings County has the third highest vaccination rate in the state, with only 39% of its 150,000 residents being fully vaccinated, compared to 63% of all Californians.
Albor vaccinates another resident of an affordable shared apartment.
(Brian van der Brug / Los Angeles Times)
On Tuesday, the county had the highest per capita Covid-19 hospitalization rate in the state, with 34 patients per 100,000 residents. By comparison, Los Angeles County, which has 64% of its 10 million population fully vaccinated, had 6.5 patients per 100,000 population.
There is also politics. The San Joaquin Valley is largely conservative, and across the country, rural residents and Republicans are among the least likely to be vaccinated against COVID-19, surveys show.
Fresno City Councilor Garry Bredefeld – who has tweeted “Let’s go Brandon,” the code for “F – Joe Biden” several times in the past few days – said he and his constituents believe the government is pushing boundaries with business bans, school and church closings as well as mask and vaccination regulations.
Bredefeld said he was vaccinated and that he is encouraging people to get vaccinated if they wish. But he called it “experimental” and said no one should be forced to get it by the government or their employers.
“This is still America, the land of the free, and that means the freedom to make your own choices for yourself, your children and your family,” he said.
The valley’s key agricultural and food processing workers – who are mostly Latinos, often live in overcrowded apartments and have never been able to work remotely – have been hard hit by the virus.
The San Joaquin Valley is plagued by a chronic medical shortage and large rural areas have fewer hospitals and pharmacies.
And the region shows a high level of poverty. Associated with this, medical officials say, are high levels of chronic health conditions that make residents more susceptible to COVID-19 hospitalizations and deaths: diabetes, congestive heart failure, asthma, and obesity.
“We are dealing with decades of health inequalities and we try to resolve everything during an emergency response and the results are not there, to be honest,” Rais Vohra, Fresno County’s interim health officer, told reporters last week.
Last month health officials were optimistic that trends were going in the right direction after the delta surge peaked in August.
In Fresno County, some public health workers were planning vacation for November in hopes of a brief respite before an expected winter surge.
As the stress on emergency rooms appeared to be easing early last month, public health officials relaxed a policy restricting ambulance trips to seriously ill or injured patients.
But COVID-19 hospital stays ticked off again immediately.
Just three weeks after the ambulance policy was relaxed, it was reinstated last week because the emergency rooms were so crowded that it often took two to four hours to discharge patients, according to the Fresno County Department of Health.
Paramedics who respond to emergency calls now assess patients and, if they are not critical enough for the transport, refer them to their general practitioner, emergency services or telemedicine.
Despite extensive coverage, the vaccination rate remains persistently low in Fresno County, in part due to widespread misinformation about the vaccine, Vohra said.
“We just don’t have productive conversations about how to keep people safe, how to plan your vacation, how to talk about boosters and risk levels,” he said.
A worrying sign for the coming weeks is that the demand for booster shots is low.
“We have in a way hardened ourselves against the reality that we are facing a hard winter. There is an exhaustion that I haven’t really seen in my entire career with the medical staff and my colleagues. ”
Gurvinder Kaur, the Central Valley medical officer for Adventist Health – which includes four small community hospitals in Kings, Tulare and Fresno counties – said staff problems that existed before the pandemic were made worse by the flood of COVID-19 Patient.
Recruiting has long been a challenge in rural areas in the San Joaquin Valley and beyond, she said. And now, during the pandemic, attracting travel nurses to the Central Valley because they prefer to work in places like Los Angeles or San Francisco is even a challenge.
“We can have a bed, but if you don’t have a nurse to look after the patient, this bed is no use,” said Kaur.
As of Thursday, Kaur said there were 51 COVID-positive patients at Adventist Health Hanford, an acute medical center with 173 beds that is the largest of the Adventist hospitals in the region.
For comparison, the 600-bed Los Angeles County + USC Medical Center had an average of 21 COVID-19 patients in the past week.
In Tulare County, where only 47% of residents are fully vaccinated, the 435-bed Kaweah Health Medical Center in Visalia has treated an average of 111 COVID-19 patients in the past week – more than any other hospital in the state.
The hospital declared an internal disaster called code triage for two days last week before the state sent additional nurses to help the overburdened staff.
During the delta surge, some patients waited days in the emergency room for beds to open, Herbst said. Some were treated in the waiting room for a day or two.
Even before the pandemic, many people in the region were hospitalized for chronic illnesses, Herbst added. The weeks of around 100 COVID-19 patients marginalized staff, he said.
Exhausted health care workers have quit in droves in recent months, and the hospital relies heavily on travel nurses.
The Kaweah Health system employs 5,100 people – and currently has 700 vacancies, Herbst said. It only has 80 applicants.
“There is a sign in front of practically every department in our company that says ‘Help wanted’,” said Herbst.
About 80% of Kaweah’s employees are vaccinated, Herbst said. Ailing medical staff are struggling with burnout and compassion fatigue, he added. Almost all COVID-19 patients in the hospital are unvaccinated, he said.
San Joaquin Valley, he said, was “largely conservative in political and religious beliefs,” and many residents do not trust the government or the vaccine.
Fresno city councilor Bredefeld said government embassies were too focused on vaccination and not enough emphasis on treatments like monoclonal antibodies.
“You will not be vaccinated,” said Bredefeld.
However, Hernan Hernandez, executive director of the California Farmworker Foundation based in Delano, argued that more employee mandates are needed in the San Joaquin Valley, especially among farm workers and Latinos, who are disproportionately affected.
“Farm workers are no different from teachers and nurses,” he said. “You are human. They will not change jobs after they have worked for 15 or 20 years and are comfortable there. You will get the vaccine. ”
The impact of the virus on rural Latinos in the region is devastating, Hernandez said. Today, every farm worker he speaks to has a story about someone in his family who dies or becomes sick.
He was frustrated with what he believes is the clear reason the region continues to see coronavirus surges even as other areas improve.
“At this point, it’s the vaccination rate,” he said. “There are no other explanations.”
The Times authors, Rong-Gong Lin II, Luke Money, and Sean Greene contributed to this report.