Respiratory illnesses continue to impact local hospitals

Area hospitals report a higher volume of patients as multiple respiratory illnesses further spread throughout Tulare, Fresno County

(Rigo Moran)
(Rigo Moran)
Serena Bettis
Published January 5, 2024  • 
11:00 am

VISALIA – Amid the peak of flu season, respiratory illnesses continue to spread in Tulare County, resulting in an increased impact on hospitals as health officials advise residents to take extra precautions. 

Visalia-based Kaweah Health issued a statement on Dec. 29, 2023, reporting a higher demand for services in urgent care clinics, emergency departments and primary care physician’s offices. This follows a trend also seen in Fresno County as cold and flu season spreads respiratory viruses among the community.

“This is our expected surge season, so we aren’t necessarily surprised by the volume,” Keri Noeski, Kaweah Health chief nursing officer, said. “This is the standard time of year where we see influxes of patients specifically because of respiratory illnesses.” 

Noeski said this demand is being driven by increased instances of all respiratory illnesses, including Influenza, RSV (respiratory syncytial virus), COVID-19 and upper respiratory infections. While Kaweah Health patients may experience longer wait times, the increase in patients is not overwhelming the Visalia hospital to a point of concern, Noeski said. 

Health care systems hold up under patient increases 

From October to December, Noeski said that there were about 1,000 more patients who sought out care in the emergency department in December than in the previous two months. This kind of increase was also mirrored in urgent care clinics, some of which may see more impact on patient capacity due to more limited hours of operation. 

Kaweah Health is not the only health care system in the Central Valley that is experiencing this influx. 

At the Sierra View Medical Center in Porterville, the influx of respiratory illnesses has increased emergency department volumes by 10-20% daily, said Jeffery Hudson-Covolo, vice president of patient care services, in a statement to the Mid Valley Times. 

In mid-December 2023, the Fresno County Department of Public Health (FCDPH) also notified the public about its Fresno-area hospitals being overwhelmed with patients, citing both an increase in respiratory illnesses and patients seeking out emergency services for non-emergent health concerns. 

Similar to FCDPH, the Tulare County Health and Human Services Agency (HHSA) has observed that hospitals are seeing more cases that could be treated by a primary care physician instead of in the emergency department. 

As a result, health officials are encouraging residents to make appointments at urgent care clinics or their physician’s offices as soon as their symptoms begin so that they do not reach a point where they need to seek emergency services.

Noeski stressed that residents should be washing their hands regularly — including before and after eating and after sneezing or coughing — and taking care of themselves by resting when sick and drinking plenty of water. If someone is not feeling well, one of the best ways they can prevent the spread of an illness is by staying home until they are better.

Noeski went on to explain that this level of patient care demand is not atypical for this time of year, and higher volumes of patients seeking care is likely to continue through January and February. This is because, in the fall and winter months, more cases of respiratory illnesses occur due to colder weather and increased indoor contact between individuals, especially during the holiday season. 

Although Kaweah Health cannot definitively say that one specific respiratory illness is causing these demand increases, Noeski said that the health complaints of patients seeking care in the emergency department point to this increased demand being tied to respiratory illnesses as a whole. 

For example, Noeski said the top three diagnoses for patients seeking care in the emergency department are high blood pressure, abdominal pain and chest pain, and those volumes remained the same between October and December.

When looking at the complaints that are generally associated with respiratory illness, including symptoms such as cough, shortness of breath, fever and headaches, “those all increased from October to December, which is why you hear people saying ‘yes, this influx in patient care demand is reflected in respiratory illness,’ but it’s not necessarily just one illness,” Noeski said.

Where does COVID-19 fit in?

In a Mid Valley Times article published on Dec. 19, Mato Parker, Emergency Medical Services coordinator for the Central California Emergency Medical Services Agency (CCEMSA), said the increased volume of patients seeking care was the most the county had ever seen, even compared to the peaks of the COVID-19 pandemic. 

Without comparing exact month-to-month numbers between October to December 2023 and previous years, Noeski said that she has seen a similar occurrence within Kaweah Health, where the volumes of patients seeking care are higher currently than during pandemic times.

“The difference with COVID was the severity of the illness,” Noeski said. “While we have patients coming in with respiratory illnesses now — and even being admitted — the demand for the resources isn’t the same and the illness isn’t as acute. … The volume all at once that we saw, and the continuous volume throughout the whole year for several years, is the difference now.” 

This is also why COVID-19 numbers gathered by the Centers for Disease Control and Prevention (CDC) do not reflect such a major increase in hospital capacity. 

From Hudson-Covolo’s perspective, he said the current flu season is not comparable to times during the pandemic because the volume of patients is not overwhelming the entirety of the health care system.

The CDC’s dashboard on COVID-19 hospitalizations per county puts Tulare and Fresno County, along with all but a handful of other counties in California, in the “low” category, meaning there are fewer than 10 COVID-19-related hospital admissions per 100,000 people. 

That’s not to say that people are not experiencing severe cases of COVID-19 and other respiratory illnesses, Noeski said, but the comparison between volume and severity helps explain why local health care systems are stressing the increase in respiratory illness without only focusing on COVID-19. 

“We aren’t as daily out there with COVID information anymore, so then people worry that it’s happening and nobody’s saying anything, but we really are … still very low,” Noeski said.

For Tulare County, CDC data through Dec. 23, 2023, showed that there were 35 new COVID-19-related hospital admissions in the seven days before then, up 52% from the week before; the rate of hospital admissions per 100,000 was 7.5, keeping the county in the low category. 

The hospitalization rate then decreased the next week, according to a data update on Jan. 5 that showed cases for the week of Dec. 24-30, 2023. Tulare County reported 22 new COVID-19-related hospital admissions in that week, a 45% decrease with a rate per 100,000 population of 4.7.

For Fresno County, data through Dec. 23, 2023, showed that there were 92 new hospital admissions in the previous seven days, up 4.5% of the week before; the rate per 100,000 was 7. 

Cases in the next week continued to increase, with 100 new hospital admissions reported through Dec. 30, 2023, up by 8.7% with a rate per 100,000 of 7.6.

Respiratory illness by the numbers

Data from the California Department of Public Health (CDPH) last updated on Jan. 5 categorizes most of the state into a “moderate” level of recent influenza activity, meaning an area has recorded a 10-20% positivity rate from administered flu tests. 

Overall, the CDPH report highlighted that, between Dec. 24-30, 2023, flu and RSV test positivity decreased slightly while outpatient Influenza-like illness activity and flu hospital admissions increased. Health officials have noted that numbers may rise in the next few weeks following large holiday gatherings.

According to the CDPH report, the test positivity data comes from laboratory-confirmed virus detections reported on a weekly basis by clinical sentinel labs and public health labs that are a part of the state’s Respiratory Laboratory Network. 

There were 28,815 specimens tested during the week of Dec. 24-30, 2023, that yielded 4,830 Influenza-positive cases for a rate of 16.8%. Positive cases recorded the previous week had a rate of 18.8%, which was the highest rate recorded so far for the 2023-24 flu season that began in October 2023. 

Hospitalizations, severe cases and deaths resulting from flu diagnoses have most impacted adults 65 years old and older. The full breakdown of how CDPH assesses flu-related deaths is available in the report, although — as with the COVID-19 pandemic — recorded deaths in this category are considered to be an underestimate of all flu-associated deaths. 

Statewide RSV rates have continued to decline since a peak of a 10-15% positivity rate was recorded near the end of November 2023. According to the CDPH report, the overall rate of RSV detection in clinical sentient labs during the last week of 2023 was 8.6%, down from 9.1% the previous week.

The rate of detections of SARS-CoV-2, the virus that causes COVID-19, recorded by CDPH increased by 2.1% from the previous week, as labs reported 11% of tests came back positive for the virus the week of Dec. 24-30, 2023.

When looking more broadly at the occurrence of Influenza-like illness activity — a way of monitoring outpatient visits for respiratory illnesses that present with both a fever and cough or sore throat, but are not laboratory confirmed as Influenza — the state of California as a whole is categorized by the CDC as having a “very high” level of activity.

However, the CDC notes that its mapping of activity comes from preliminary data and does not “measure the extent of geographic spread of flu within a state,” meaning that high activity in a highly populated area could impact the results shown for the entire state. 

Serena Bettis
General Assignment Reporter