Ahead of the Thanksgiving holidays, California officials are raising the alarm about a winter Covid surge as hospitals in some parts of the state remain overwhelmed with patients, despite overall progress.

California’s coronavirus infection rate is one of the lowest in the country but the burden of infection remains unevenly distributed. In central California, a region that struggled with resistance to masks and vaccines throughout the pandemic, the strained public health system has been pushed to the brink. Hospitals this week are over-capacity and officials are seeking to transfer more patients out of the region for treatment in Los Angeles.

“We’re just running around like crazy,” said Rachel Spray, a nurse at the Kaiser hospital in Fresno. “Call lights are going off, alarms are going off. We just don’t have the resources.” The hospital’s emergency room, intensive care unit, coronavirus overflow zones, and tent are not enough to accommodate the surge of sick patients, she said. “It’s not slowing down.”

In Fresno county, hospitals are “consistently above 100% of capacity”, Dale Dotson, the region’s EMS operations coordinator, said at a news conference on Friday. As a result, ambulances are stuck idling outside emergency departments and patients have been left waiting for hours or even days for a bed.

The public health system in Fresno and the rest of California’s agricultural Central Valley has been pushed to the brink during the pandemic, even as other parts of the state saw the crisis ease this summer and autumn. Only 55% of Fresno residents are fully vaccinated, compared with 63% statewide.

While visiting a vaccination clinic in San Francisco, California’s Governor Gavin Newsom urged residents to get their coronavirus vaccinations ahead of the holiday weekend, urging caution despite an overall drop in transmission across the state. “States are struggling because people are taking down their guard or claiming ‘mission accomplished’,” he said. “I don’t want to see that happen here in California.”

California is not the only western state seeing troubling outbreaks ahead of the holidays. In Colorado, pockets of resistance to vaccinations and masking have helped fuel a surge that has pushed hospitals to crisis levels. Although that state has a similar vaccination rate to California’s its community transmission rate is one of the highest in the country, and 95% of ICU beds are in use. Denver and other parts of the state have reissued indoor mask requirements that were lifted over the summer.

In central California, resistance to public health measures including masks has run high throughout the pandemic and the region experienced the highest support for recalling Newsom over his pandemic-era restrictions.

Meanwhile agricultural workers in California’s Central Valley – many of whom lack legal status and easy access to medical care – remain the most vulnerable. The rate of Covid-19 positivity among California farm workers was four times that of the rest of the country, according to a report published in the journal Jama Network Open earlier this year. “The area we live in, that’s a higher-poverty area. There’s a lack of access to medical care. People have more co-morbidities,” said Spray. “And that leads to a higher chance of people getting sicker.”

Staffing shortages and burnout among health workers have further strained the region’s medical system. At Doctors Hospital of Manteca, nurses have been assigned up to nine patients at a time, “which normally is just unheard of”, said Brittany Smith, a surgical nurse at the center. The state’s guidelines recommend one nurse for every two ICU patients and every five surgical patients. “We’re essentially in a state of crisis,” Smith said. “And we’re being forced to work in conditions that are completely unsafe.”

“Due to labor challenges impacting other local hospitals, we are accepting additional patients to ensure our community receives safe, uninterrupted care,” said Krista Deans, a hospital spokesperson. “To support our care teams, we have been exercising all options available to us.”

Nurses at the hospital unionized in September.

Spray said that medical staff are burned out and “morally distressed”.

“We want to give the very best care to every patient. And we can’t,” she said. Ahead of Thanksgiving and the holiday shopping season, she added, she is bracing for the worst and pleading with patients to wear masks indoors and get vaccinated.

“Between now and next year, we may be in for a very challenging winter,” said Rais Vohra, the Fresno county interim health officer, at a press conference. “Bone up on your turkey and your gravy but also don’t forget to fill up on your mental and spiritual resilience.”



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