State’s COVID-19 case rate explodes

Reasons include pandemic fatigue, less compliance and indoor holiday gatherings

It wasn’t long ago that COVID-19 infections in California were coming at half the rate of the nation, per capita. But in just the past few days, the explosion in California’s case counts has wiped out its advantage.

Wednesday marked the state’s third consecutive day of more than 30,000 cases, after never before hitting that threshold. And now, California’s infection rate has pulled even with the national average for the first time in more than three months.

The Golden State has logged about 62.8 daily cases per 100,000 residents over the past week, a rounding error away from the national rate of 63.1 over that time. Its death rate remains relatively low, and there are still 33 states with higher infection rates. But California is closing the gap — its infection growth rate is outpacing the country as a whole, up 77% week-over-week versus 28% nationally. What happened? “I think that the reality is that it reflects a variety of forces at work,” said Dr. Arthur Reingold, an infectious diseases expert and the chair of epidemiology at UC Berkeley.

Nine months in and facing new shutdowns, Californians are suffering from pandemic fatigue and are less compliant with public health measures, Reingold said. Colder weather also pushed more people indoors, where the virus spreads much more easily. Add on Thanksgiving gatherings, and you’ve got a situation “pretty much what any reasonable infectious disease epidemiologist could predict,” Reingold said.

Case numbers don’t tell the whole story, though.

More people in California are getting tested for the virus than ever before. Over the past week, California has tested an average of nearly 250,000 people per day, a 25% increase from the previous week. More of those tests are also coming back positive: 10.1% of

all tests in the past week, the state’s highest positivity rate since testing became widely available.

A lthoug h Ca lifor nia ranks 17th in testing per capita, with about 630 daily tests per 100,000 residents, it is well ahead of the nation in its efforts to expand testing. While the U.S. is testing about 15% more than it was three weeks ago, California has increased its testing capacity by 45% in that time.

“Testing capacity has gone through the roof,” said Dr. George Rutherford, an infectious diseases expert at UC San Francisco. “I think some of it is just increased case finding. But, you know, at the end of the day, there’s just a s—load of cases.”

Rutherford echoed Reingold in his on-the-ground observations about pandemic fatigue: In recent weeks, more people have been crowding city sidewalks and enjoying alfresco meals.

If those prove to be vectors of transmission, Gov. Gavin Newsom’s new stay-at-home order, which forces restaurants to close their patios in affected regions, could make an impact. State health officials have urged Californians to avoid gathering with people outside their household altogether.

But there’s been pushback over the new order’s restrictions on outdoor ac

tivities. Several restaurants in the Southern California region declared plans to remain open to outdoor dining, in defiance of the new order.

And, after protests from parents and lawmakers, state officials Wednesday quietly dropped the order’s closure of outdoor playgrounds. Health experts said there’s no evidence those outdoor activities are fueling virus spread.

But spread it has. On Wednesday, the Greater Sacramento region joined the Southern California and San Joaquin Valley regions in falling under the new stay-at-home order due to low intensive care capacity in its hospitals. Monterey County said it would impose the new order Sunday, joining Santa Clara, Alameda, Contra Costa, San Francisco

and Marin in the Bay Area region.

And while California just days ago had been ahead of New York in new cases per capita, about even with Texas and lower than Florida among the country’s most populous urban states, it is now ahead of all three.

So far, California has avoided the mass casualties seen early on in the pandemic and now again in the Midwest — its death rate, per capita, is still about half the national average. But health officials worry about a rapid increase in deaths as well, warning that the quality of care can slip quickly when hospital workers are overwhelmed by patients requiring serious attention.

In the past 72 hours, California has reported more than 100,000 new cases of the virus. By state health officials’ estimates — that about 12% of cases require hospitalization and 20%30% of those end up in the ICU — that alone could mean an additional 12,000 hospitalizations and more than 2,500 new patients in ICUs in the coming weeks.

“I think that’s an intelligent and rational way of understanding things,” Reingold said. “Presumably (the stay-at-home orders) are not going to prevent further strain on the ICU and hospital beds in the next two to three weeks because they’re going to be reflecting infections that already occurred. But the hope is we’ll see the impact of them a couple weeks after that.”