Virus watch list keeps tabs on lagging counties
A new state watch list meant to closely monitor counties that are struggling to contain local COVID19 outbreaks underscores the varied complications health officers are running up against as they lift shelterinplace restrictions and try to jumpstart economies.
On Monday, 11 counties were on the list, which state officials quietly unveiled last week. Contra Costa County is the only Bay Area county to to fall under scrutiny so far, though it
was removed from the list after just three days when its hospitalization numbers improved.
The monitoring program involves tracking hospitalizations and testing and case rates, along with a few other metrics, and raising a red flag if counties falter in meeting state benchmarks. Redflag counties go on the watch list and work closely with the state public health department to address specific trouble spots.
If metrics don’t improve after two weeks, county health officers may decide to halt their reopening, or even take a step back and introduce restrictions again. The state may take its own action if counties still aren’t meeting goals.
“We will continue to update this list on a daily basis and share it with you every Monday, so you can track with us those areas where we are concerned,” said Mark Ghaly, secretary of the California Health and Human Services Agency, in a news briefing Monday.
The watch list was launched as California case counts are climbing and the state continues to push forward with reopening its economy. California reported more than 6,000 new cases on Monday, a disappointing record for the state.
Southern California counties are driving the state’s outbreak. Bay Area case counts have climbed somewhat over the past few weeks, but the number of people hospitalized with COVID19 is falling. More than 20,000 cases have been reported in the Bay Area.
Data metrics are key tools for determining how widely the virus is spreading in a community and whether it’s safe to lift shelterinplace restrictions. Six Bay Area counties — Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara — identified a shared list of indicators to track their progress as they reopen. The state has a similar but separate list of benchmarks counties must meet to continue reopening.
The state monitoring program is run by the California Department of Public Health. A table of the counties’ performances and the list of counties that are being watched closely are available online at the department’s COVID19 website at bit.ly/countywatchlist.
The monitoring program involves tracking the number of tests and cases per 100,000 people in a county; the percentage of people testing positive; fluctuations in hospital occupancy; and the percentage of intensive care beds and ventilators available.
Counties are added to the list if they are unable to meet a metric for three consecutive days. They can drop off the list only after they can show improvement in that metric for three consecutive days.
As of Monday afternoon, all nine Bay Area counties were meeting state benchmarks. Contra Costa County briefly made it on the list Thursday because of a concerning rise in COVID19 hospitalizations. The county failed to meet one metric set by the state: keeping hospitalization increases below 10% over a threeday average.
Contra Costa County was removed from the list over the weekend, after meeting the hospitalization goal for three days. The county continues to report large increases in case counts, including 81 new cases on Monday, but it’s currently meeting all of the state benchmarks.
The metrics are meant to flag when disease transmission may be surging in a community, and trigger a quick response to address that increase before it spirals too far and leads to a largescale outbreak that puts pressure on local health care systems.
“It’s a scoreboard: We’ve got a detailed scoreboard now that’s going to give us good information on our counties,” said Stephen Shortell, former dean of the UC Berkeley School of Public Health. “We’re letting the counties do their own thing, and then the state is there as backup.”
Putting all of the counties on one scoreboard also applies a sort of peer pressure, Shortell said. It also gives both health officers and the general public an opportunity to understand how their community is faring compared to others, based on metrics that can be fairly applied instead of just raw numbers.
According to situation summaries for counties on the watch list, a wide variety of factors have led to evidence of distress. In several counties, specific large outbreaks are driving case counts. Five counties cite prison outbreaks as sources of spikes in case counts and hospitalizations. Nine counties blame large clusters at skilled nursing facilities for driving up metrics.
Cases in Riverside County are up due to nursing home and prison clusters, health officials said, but also from protests in the area and from people socializing more. Several counties name social gatherings and workplace transmission — both likely tied to reopening the local economy — as a cause of case and hospital surges.
“The bottom line is, as we move forward, we have to be sober about the reality that we are still in the first wave of this pandemic,” Gov. Gavin Newsom said at a news briefing Monday, in discussing the county monitoring program.
John Swartzberg, an infectious disease expert with UC Berkeley, said he appreciated that the county monitoring program was being made public and providing some details about the source of local outbreaks. Throughout the pandemic, it’s often been challenging for the public to understand why case counts, hospitalization numbers and other metrics are increasing.
He and other public health experts said simply identifying which metrics to follow is complicated — it’s dependent on what data is available, how reliable that data is, and how the virus itself behaves. For example, case counts alone aren’t a great determinant of a local outbreak because they vary depending on how many tests are being done and who is being tested.
“This is all brand new to us. We’re figuring it out as we go along,” Swartzberg said. “I’d like the population to recognize that this is a work in progress.”
He appreciated that the state has developed a chart to compare all of the counties at once in addition to the watch list to get a more nuanced look at what’s happening in counties that are struggling.
Another advantage of the monitoring program is that it takes some of the burden of reopening counties off of local health officers’ shoulders, said UCSF infectious disease expert George Rutherford. Increasingly, county public health officers are coming under intense pressure from communities to lift restrictions and let people return to work and social lives.
If health officers can point to state metrics as a reason for slowing down, that may relieve some stress, he said.
“Obviously there’s a lot of political pressure on local health department to go along, go along,” Rutherford said. “The state is a lot more bulletproof about this stuff. Right now I think that’s the right move, to have published criteria that people can judge themselves against.”