A brief thread on an item in California's COVID-19 regional shutdowns that has lingered out there, unanswered, for the better part of a week: what process are state health officials using to "standardize" ICU capacity in each region, the metric by which a shutdown is required?

When the regional shutdown plan was announced, the attention largely focused on a state-generated percentage of ICU beds left in each of the 5 regions. But less discussed was how the numbers were being calibrated, which is an important piece of government transparency.

A email distributed by the CA Dept. of Public Health to some local officials earlier this week laid out a metric by which an adjustment is made to the ICU capacity projection when more than 30% of the region's ICU beds are filled by COVID-19 patients.

When more than 30% of a region's ICU beds are filled by COVID-19 patients, state officials reduce by 0.5% the stated capacity for each 1% over the 30% threshold.

That sounds confusing, but the example they cited in the email helps make sense of it...

Per CDPH email to stakeholders:

"For example, if a region had 20% ICU capacity and 34% of its ICU beds were currently being used for COVID-19 positive patients-then the calculated metric would be 20 - (0.5 x 4) = 18%."

This calibration happens before the number is made public.

So how did state health officials choose 30% of ICU beds filled by COVID-19 patients as the standard?

On Thursday night, they said the number generally represents what ICUs saw during the summertime surge in COVID-19 cases.

The reason for the calibration is understandable.

Per CDPH: "This is done to preserve the capacity of the ICU to also treat non-COVID-19 conditions," citing how beds for ailments like cancer and heart attacks need to be taken out of the number considered avail for COVID-19.

While some may quibble with the threshold chosen or even the idea that the numbers are standardized, the simplest takeaway is that this information wasn't readily available.

Some local officials, sources said, did not know about this calibration until this week.

There are a lot of stakeholders to brief in this process, to be sure. From my vantage point, the ones that need to also be considered are everyday Californians. The more we know, the more we can understand why the shutdowns are being ordered.

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