Is San Diego ignoring its own COVID warning system?
Despite many signals being in the red, there are no hints of change.
SAN DIEGO — In June 2020, San Diego County’s public health department adopted a set of 13 “triggers” designed to signal that the COVID-19 pandemic was worsening and that additional measures were necessary to bring viral transmission under control.
Eighteen months later, six of those indicators are in the red, enough to prompt modification of existing health orders. But there are no signs that anyone in the county government intends to make changes, even as the region posts record numbers of cases and emergency rooms are flooded with coronavirus-positive patients.
Why hasn’t the region’s public health authority made any changes as its own triggers have flipped?
Neither Dr. Wilma Wooten, the San Diego County public health officer, nor her deputies responded to the question last week. The county’s communications office said in a memo, not attributed to anyone in particular, that the county “constantly monitors and uses the trigger metric to inform local decision-making” but that “decisions are made based on the totality of the information,” including knowledge gleaned long after the triggers were devised 18 months ago.
Rather than modify the trigger list, local public health authorities have generally taken direction from the state when it comes to pandemic policy.
County supervisors did not respond when asked through their communications officers to comment on the situation.
The pandemic landscape has changed dramatically with the advent of effective vaccines. That appears to be a significant factor in the health department’s reluctance to make changes — such as reinstituting business restrictions — as its warning system has sent up red flags.
“San Diego County has since become one of the most highly vaccinated populations in the state and hospitalization numbers are far less than 12 months ago, along with the rollout of emerging treatments for those most at risk,” the county’s statement said.
Other California metropolitan areas have been more forceful in recent months. Los Angeles and San Francisco, having maintained indoor masking rules that this summer fell away in most communities across the state, have instituted proof-of-vaccination requirements for bars, gyms, restaurants and other areas accessible to the public, though anecdotal reports of spotty enforcement have raised questions about their effectiveness.
The latest numbers don’t seem to indicate that San Diego has suffered because of its more open approach. As of Saturday, the state’s coronavirus website listed Los Angeles with a case rate of 76 per 100,000 residents, San Francisco with 69 and San Diego with 64.
California’s pandemic stance is far less restrictive than it was in late 2020 and early 2021; a wide range of businesses and venues have remained open as cases have surged. But momentum is building in academia toward a more aggressive approach, especially amid reports of overwhelmed hospitals across the nation.
Two weeks ago, a pair of Harvard professors, in a letter later shared online, urged Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, to consider short-term shutdowns, “with the narrow goal of avoiding catastrophic hospital overload and the avoidable deaths and suffering that would otherwise ensue.”
Often called “circuit breaker” shutdowns, the idea is generating discussion in the United Kingdom, with one group of researchers modeling the effects of a two-week pause of most activity in places where case rates are growing quickly. The researchers found that such a shutdown — if a large enough segment of the population were to comply — could function as a “temporal reset,” breaking chains of person-to-person transmission for long enough that the number of infections, hospitalizations and deaths could be significantly reduced.
So far, though, there has been little response to the call for any type of shutdown in the United States.
In San Diego County, the path is more visible than in most cities because of the formalized trigger system, which states that the “Health Officer Order will be modified” when certain parameters get out of line.
Just last week, an indicator that shows how quickly local hospital beds are filling turned red. The metric is deemed to be normal as long as the percentage of locally hospitalized COVID-19 patients is increasing at a rate less than 10%, a figure calculated by comparing subsequent three-day averages of hospitalization across all non-military medical centers in the region.
Two weeks ago, the growth rate was listed at negative 4.5, meaning that the number of hospital patients with confirmed cases of COVID-19 was shrinking. Last week, the number shot up, hitting 19.7%. The jump coincided with a crush of residents arriving in local emergency rooms, forcing many facilities to temporarily divert ambulance traffic, even though most patients were said to have mild illness, and some appeared to be trying to cut long lines at testing centers.
Other triggers — such as the local case rate, number of local community outbreaks, number of people with COVID-19 or flu-like symptoms and percentage of new cases being investigated in a timely manner by the health department — were all in the red.