State strug­gles to com­bat sharp rise in in­fec­tions

San Francisco Chronicle - Late Edition (Sunday) - - FRONT PAGE - By Joaquin Palomino, Kevin Fa­gan and Al Sarace­vic

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.”

Noah Berger / Spe­cial to The Chron­i­cle

Cus­tomers line up for take­out or­ders at Ariz­mendi Bak­ery in Oak­land, where cases are spik­ing in Black and Latino ar­eas.

Stephen Lam / Spe­cial to The Chron­i­cle

A health worker from Chi­nese Hospi­tal in San Fran­cisco holds a face shield for a col­league dur­ing test­ing in Chi­na­town.

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