San Francisco Chronicle - (Sunday)
Reality: COVID may be with us forever
Unvaccinated fill hospital beds, to officials’ dismay
For several days in late spring, San Francisco General Hospital had no COVID19 patients, and the staff rejoiced.
From the intensive care floors no longer nearoverflowing with patients to the emergency department where doctors and nurses had worried for more than a year that anyone who showed up could be infected, the relief was palpable, said Dr. Robert Rodriguez, an emergency physician at San Francisco General and a professor at UCSF.
Then California reopened and dropped almost all pandemic safeguards, and the highly contagious delta variant arrived. Few had believed the pandemic was over, of course. But it’s discouraging to be bracing for yet another surge, Rodriguez said, and living again under a cloud of anxious anticipation of just how bad things will get.
“Cases definitely are increasing, and there is a sort of — I would call it a triggering,” Rodriguez said of a staff that’s already exhausted and traumatized from the long pandemic.
As of Friday, eight people were hospitalized with COVID at San Francisco General, including three in intensive care; all were not vaccinated.
And Rodriguez can’t help wondering, “Is this going to accelerate? Is this going to fade? Or are we just going to continue at this rate, this smoldering rate, indefinitely?”
Those are questions that extend far beyond San Francisco General’s emergency room. Across a region with some of the highest vaccination rates in the world, there’s a collective sense of dread, confusion, frustration and despondency. And people are asking: How can this be happening again?
The Bay Area appears to be hurtling into a fourth surge, with cases spiking in every county and hospitalizations rising quickly, too. But this wave is unlikely to mimic the past — at least that’s the assumption of health experts.
It’s fueled largely by the unvaccinated, who tend to be young and healthy and not at high risk of serious illness or death. So far, vaccinated people who get infected almost always have mild illness or no symptoms at all. That means this wave should be less devastating than earlier ones.
Even so, the numbers contain a stark warning: Until the world conquers COVID — until global vaccination stomps out any opportunity for the coronavirus to mutate into something more dangerous and harder to contain — even the Bay Area will remain at risk. Eliminating the virus is probably not possible. This summer surge may simply be a bump on the rough path toward learning to coexist with COVID.
“We’re going to have to live with this for a while,” said Dr. Yvonne Maldonado, an infectious disease expert at Stanford. “And we are reaching the point where people have to just settle into that. We have to get back to some kind of a normal life. We can’t keep living like this. But normal life now may be different.”
This current surge in many ways feels distressingly familiar to the three previous waves the Bay Area has endured. New cases are doubling every week or two, and are now roughly in line with the early stages of the summer and winter surges. Two weeks ago, Dr. Erica Pan, the state epidemiologist, said California could be facing a wave onehalf to twothirds the size of last summer’s.
But cases are not as useful a marker of this pandemic as they once were. Those who are vaccinated may still become infected, therefore contributing to the case counts, and they may be able to transmit the virus to others. But very few of them will become seriously ill or die. Even if large numbers of unvaccinated people also get infected — which is exactly what’s happening — and end up with severe illness, there probably won’t be enough of them to overwhelm hospitals.
COVID hospitalizations, though, always lag a few weeks behind cases, and deaths a few weeks after that. And hospitalization numbers already are creeping up — they climbed 30% in just five days in the Bay Area last week. Deaths remain at or near their lowest points in the pandemic.
“We are very concerned about the rise in cases, and the rise in hospitalizations also,” said Dr. Chris Farnitano, the Contra Costa County health officer, at a news briefing last week. “It’s going up as rapidly as we saw it last summer and last winter.”
Bay Area health officials said they don’t anticipate any major new lockdowns in response to this surge, and the response so far has been more nuanced and diffuse. Instead of mandates, health officials are issuing recommendations and hoping people understand enough about the virus to abide by them. Meanwhile many businesses are requiring that staff get vaccinated, or they’re demanding everyone wear masks. Some Bay Area restaurants and bars have become vaccinationonly establishments.
Los Angeles is the only county in California to issue a widereaching new mandate in response to climbing case rates, now requiring everyone, vaccinated or not, to wear masks in public indoor spaces. Eight of the nine Bay Area counties have recommended a return to masking for all residents but are not — yet — requiring them.
The Bay Area holdout is Solano County, where the health officer said he doesn’t think a mask recommendation, or even a mandate, will help. Cases in Solano County are climbing as rapidly as anywhere in the region, but they’re mostly due to social gatherings, especially from the Fourth of July, said Dr. Bela Matyas, “and the masking mandates do not apply to your backyard barbecues.”
Matyas, a frequent contrarian among his Bay Area public health colleagues, said he understands why people are feeling anxious over this latest uptick in cases. In many ways the region has experienced a shared trauma, and every setback can seem ominous.
“Now we are at a time when we pretty much have to face facts: This disease will be with us chronically. There’s nothing about it that indicates it’s going away any time soon,” Matyas said. As long as hospitalizations and deaths don’t spike again, “the fact that a lot of people are getting sick from a disease we can’t get rid of, that’s normal. In fact, this (reopening) has been an enormous success.”
That success can be hard for some people to embrace as the pandemic continues to smolder. But public health and infectious disease experts say people should remain confident in the vaccines, and that this phase of the pandemic, though at times disheartening, is part of the long road toward recovery.
“In many ways this isn’t unexpected, what’s happening now,” said Dr. Maria Garcia, a UCSF professor of medicine who focuses on health disparities. “It’s disappointing. It may feel like we’re moving backwards. But we are still moving forwards.”
The situation the Bay Area now faces is a huge turnabout from June 15, when California reopened. The region, with relatively high vaccination rates and low case rates, seemed like a safe place for unvaccinated as well as vaccinated people.
“What we’ve learned in the last 18 months is this thing just has curveball after curveball,” said Dr. Robert Wachter, chief of the Department of Medicine at UCSF. Though the delta variant — perhaps twice as infectious as the original strain of the virus — was causing chaos in other parts of the world by the time California reopened, many experts still underestimated it.
“You think you can project the future because it’s mostly math. And mostly things looked great (before June 15). We felt like we had a pretty good handle on what the summer would look like,” Wachter said. “And we were wrong, because the virus got smarter.”
What may be most challenging about this stage of the pandemic is the familiar, unsettling sense of uncertainty over what comes next. In the fall schools will reopen. Influenza may come back. The winter will drive people indoors for holiday gatherings.
The Bay Area will almost certainly never experience anything like the calamity of last winter’s surge. But beyond that, it’s hard to know what to expect, said Dr. Jahan Fahimi, an emergency room physician at UCSF.
“There’s really only one thing that in my mind we can say with certainty,” he said. “You need to get vaccinated if you’re not vaccinated.”