San Francisco Chronicle - (Sunday)
State struggles to combat sharp rise in infections
Walking along the sunny streets of the Bay Area last week, one might think the coronavirus had finally retreated.
Restaurants and cafes, from San Francisco to Sonoma, resumed business on newly fashioned sidewalk patios. Retailers welcomed customers back inside. Even some breweries offered cold beer and crowds in place of solitary shelter.
It all appeared normal and safe. But if you looked past the increasingly busy streets and unmasked faces, if you examined the public health data, you’d find a region with a quickly growing number of coronavirus cases. A state recording sharp increases on a daily basis, many in communities already grappling with longstanding health disparities. And a
nation wrestling with a worsening pandemic.
The disconnect between streetlevel reality and rising coronavirus cases raises more questions than answers. What options do public health officials have to stop a wave of infection that’s swelling? What levers can politicians pull? And what should the general public think when seeing restrictions lifted amid rising case counts?
Some have called for the state and counties to more closely examine the pace of reopening, pointing to inadequate testing and contact tracing and a lack of support — both financial and medical — for some of the most vulnerable residents. San Francisco and Marin County have already delayed plans to further peel back restrictions after a rash of new cases was reported during the week.
But many health officers are determined to push forward, while promising to continuously monitor the situation and move deliberately.
“At this point there’s little appetite for reimposing more difficult restrictions because of the effect on people and the economy,” said Dr. Arthur Reingold, an epidemiologist at UC Berkeley’s School of Public Health. “We either need to collectively act more responsibly or accept the fact that we’ll continue to see more infections, more people hospitalized and overcrowded intensive care units.”
Surge in cases: On a warm Friday afternoon, outdoor tables in Walnut Creek were filled with people excited to be eating out after months of the shutdown. Most weren’t wearing masks — which is allowed while enjoying a meal outside — but said they were trying to socially distance, even though sheltering in place has left them worn out.
“I guess it’s going up again, and maybe it’s from the protests or group gatherings, I don’t know,” Michael Bellotti, 28, said as he stopped to get a salad at the restaurant Lettuce. “I think people were just locked up too long, and I have to say, out of the 100 people I stay in contact with, no one has gotten the coronavirus.”
Over the hills in Oakland, businesses were less busy and people seemed more committed to wearing face coverings. Still, Josh Assink, operations manager for the Urban Village Farmers Market Association, said the strictures were being loosened too quickly.
“This is absolutely not a good thing, it’s completely inappropriate to reopen this much,” he said. While most people follow guidelines at the farmers’ markets he works at, there needs to be a vigorous effort to have people everywhere adhere to safety guidelines “because our livelihoods are at stake.”
As residents try to make sense of the seemingly contradictory messages — businesses are reopening while cases are spiking — health officials say it’s important to know how widely the virus is spreading and remain vigilant about safety precautions.
The rate of infection in most of the Bay Area is still relatively low compared to parts of the San Joaquin Valley and Southern California, and the proportion of tests that come back positive is below the state average in most counties.
The number of deaths per day from COVID19 also dropped in the Bay Area by nearly 5.5% from May to June. Statewide, average daily deaths fell by the same amount.
Still, as people emerged from months at home, the number of confirmed coronavirus cases hit record highs in every Bay Area county except for San Francisco between June 18 and June 24, according to a Chronicle analysis of public health data. And in San Francisco, a wave of new cases — more than 100 new reported on Friday — caused the city to postpone plans to reopen some businesses.
Experts fear the spike could have tragic results in the coming weeks, as more of the newly infected people flow into hospitals or die from the disease.
A spiraling outbreak at San Quentin State Prison, along with a surge at a local waste management company, pushed the daily average of cases reported in Marin County last week to 96 — more than four times higher than the next worst week of the pandemic. Average daily cases in Santa Clara County more than doubled from week to week, and San Mateo County experienced a 66% increase. Alameda County has been dealing with an escalating spread of the virus in mostly lowincome and predominantly Black and Latino communities. Last week, two ZIP codes in East Oakland, which house just 5% of the county population, made up 15% of the newly confirmed cases, The Chronicle found.
The glaring disparity has pushed community leaders to ask for more support and services in the hardesthit neighborhoods, which will likely continue to feel an outsize impact as restrictions are lifted.
“Alameda County appears to be on the verge of reopening its places of commerce, leisure and worship even though the best available data indicates that the spread of COVID19 is quickening and expanding in several of the counties most vulnerable neighborhoods,” a group of health centers and community leaders wrote in a recent letter to the Board of Supervisors that called for more transparency in how officials are handling the pandemic.
Meanwhile, the number of patients in California hospitals steadily rose last week, as the state hit a recordhigh number of COVID19 patients for nine consecutive days. Parts of Southern California and the San Joaquin Valley have seen dramatic growths in hospital counts.
The number of patients sick with the disease was relatively flat in some parts of the Bay Area in recent weeks, but it increased in Marin, Napa, Contra Costa, Santa Clara and Solano counties.
This week, both Contra Costa and Santa Clara counties were added to a list of more than a dozen counties being monitored by the state because
of concerning metrics, including rising hospitalizations — which experts consider a good measure of the spread of the virus since it’s not as dependent on the availability of tests.
Even as the number of patients in Bay Area hospitals goes up, there are still open beds and intensive care units have not yet filled — though some worry that the current rise in cases could lead to more hospital admissions and deaths in the coming weeks.
“Those that suggest we’re out of the woods, those that suggest this somehow is going to disappear, these numbers tell a very, very different and sobering story,” Gov. Gavin Newsom said.
Why now? Public health leaders are trying to figure out what’s driving the spike in confirmed coronavirus cases. They’ve pointed to several factors: Expanded testing in places where the virus is known to be widespread; the reopening of industries and businesses; and increased social interactions between people tired of staying isolated at home.
Some local health officials told KQED there’s little indication so far that ongoing protests against police violence significantly contributed to the spike. Experts, however, credit a different brand of protest — against the use of face masks — for unnecessary infections.
“We always knew that as the economy opened up there would be some transmission, and to an extent, that’s what we’re seeing,” said Dr. George Rutherford, a UCSF infectious disease specialist. “The way to prevent that is wearing masks, staying home if you’re sick, socially distance and avoiding crowded indoor environments. The more lax we are in following guidelines, the more people are going to die. It’s a simple calculus.”
Crowded facilities like nursing homes, jails and prisons have also continued to be hot spots for the virus, with major outbreaks spreading rapidly among residents and staff and threatening to overwhelm local hospitals. It’s hard to know how much these highrisk settings are contributing to the spike, Rutherford said.
Bay Area health officials said they’re closely monitoring the case and hospitalization data as they continue to pull back restrictions.
Contra Costa Health Services officials told The Chronicle that their “current timeline is a safe, deliberate approach,” but the recent increase in COVID19 cases and hospital admissions could delay future plans to loosen the rules if it continues.
Alameda County health officials said that while case rates rose over the past week, hospitalizations have been flat, and they pledged to “continue to move at a pace that balances risk, safety and socioeconomic needs of our communities.”
But Marin County, like San Francisco, announced Friday that it will delay reopening some businesses following a swell in positive coronavirus cases. These include hotels, gyms, nail salons and tattoo parlors.
Certain states, experiencing more concerning spikes in hospital admissions, have begun to reimpose restrictions or delay future openings. Texas announced plans to close bars and limit restaurant occupancy Friday, while Florida made similar changes. The Bay Area is not yet in as dire of a place, and at a news conference Friday, Newsom said he would leave it to local leaders to reverse course as needed.
A key metric being monitored is whether hospitals are becoming strained. Currently, they’re operating at about 8% of the surge capacity statewide and 30% of ICU beds are in use.
Dr. John Swartzberg, a UC Berkeley infectious disease expert, said he would support the state and certain counties pausing reopening plans while they assess the data.
“I would not have been at all opposed for him to say, ‘We’re going in the wrong direction, we need to reverse course, we need to contract a little bit,’ ” Swartzberg said, referring to Newsom’s comments this week. “What no one understood, including myself, was how difficult it would be to take that step back.”