Safeguards cited as state hits U.S. low in case rates
California hit the lowest coronavirus case rate in the nation Friday — thanks not only to high vaccination and masking, but also to a state culture that generally embraces public health precautions, experts said.
Despite the highly contagious delta variant, which accounts for essentially all COVID cases in California, coronavirus infections are plummeting in the state, with a 32% drop in average weekly cases as of Thursday compared to a month earlier — 25 per 100,000 people, down from 33 per 100,000.
In much of the country outside the Northeast, case rates are at least double, or even five times higher, the Centers for Disease Control and Prevention reports.
California’s ability to reduce the spread of the virus lies partly in vaccinations. Among residents 18 and older, 69% are fully vaccinated, according to the New York Times vaccination tracker.
That’s good, but nowhere near good enough, said Stephen Shortell, dean emeritus at UC
Berkeley’s School of Public Health, who said it may take a 90% vaccination rate to achieve herd immunity because of the delta variant.
California is the 19th state by vaccination percentage.
“We are not the most vaccinated state,” said Dr. Kirsten Bibbins-Domingo, chair of UCSF’s Department of Epidemiology and Biostatistics. “But we are also a state that has not completely abandoned the other mitigation methods.”
California requires mask wearing at schools, on public transportation, and in hospitals, nursing homes and prisons. Masks in other indoor settings are recommended.
The Bay Area has been far more aggressive than the state. In eight of the nine counties, masks are required in nearly all indoor public settings — restaurants and bars being the main exceptions, though San Francisco, Berkeley and Contra Costa County require people to be vaccinated to enter those venues. Case rates in the region have plunged faster in recent weeks than those statewide.
Experts say many residents go beyond the rules.
“I think in California, there is a social norm around masking,” said Arnab Mukherjea, chair of Cal State East Bay’s public health department. “If you go outside, 75% of people are wearing masks.”
The state had the lowest COVID rates in the country on Friday, with 114 weekly cases for every 100,000 residents, according to the CDC’s tracker map.
Wyoming has one of the highest state rates, with a weekly figure of 659 cases per 100,000 residents. Only half of its residents 18 and older are fully vaccinated — trailing every state except West Virginia. Wyoming’s governor lifted the state’s mask mandate in March.
“In a way, the idea of American independent thinking is working against us in the pandemic,” said Dr. Robert Siegel, an immunology expert at in Stanford University,
who is teaching a course called the “Vaccine Revolution” this semester.
Connecticut and Vermont have the highest vaccination rates in the nation, with 79% of adults having gotten their shots in each state.
Not coincidentally, Connecticut’s seven-day case rate was nearly as low as California’s on Friday, and Vermont’s was only slightly higher than Connecticut’s.
Dr. Tim Lahey, infectious disease expert at the University of Vermont Medical Center, credited not just his state’s high vaccination rate, but its science-based leadership for its comparatively low weekly COVID rate of 151 cases per
100,000 residents.
Lahey also referred to his state’s “ethos of neighborliness” as critical to its success.
“If the small inconvenience of wearing a mask could protect my neighbor, I wear one with a smile,” he said. “Similarly, if the science, my own self-interest and the protection of my neighbors all are promoted by getting a vaccine, I’m happy to join my neighbors in line.”
California has not quite cultivated a Vermont-like reputation for neighborliness. But a similar approach has evolved over decades that set the stage for California’s pandemic-era health actions, experts said.
In 1995, after California became the first state to ban smoking in workplaces — influencing about half the states, including Vermont and Connecticut — “we made it socially acceptable” to broadly adopt public health practices, said Mukherjea of Cal State East Bay.
But the state’s commitment to public health alliances among key groups goes back to the 1980s, said Dr. John Swartzberg, an infectious disease expert at UC Berkeley.
Early on, those most at risk for getting sick and dying from AIDS clashed with public health officials. But “we really ironed it out,” Swartzberg said. “We realized we were all on the same team, and we did a spectacular job.”
Up and down the state, he said, “we made a cultural shift that positioned us really well for tackling the pandemic in ways that other states didn’t have in place.”
Swartzberg hastened to say that public health systems in many other states also work well with their communities.
Even so, he added, “I do think that, even if we are not unique, then at least culturally we were prepared for these times.”