Virus watch list keeps tabs on lag­ging coun­ties

San Francisco Chronicle - - FRONT PAGE - By Erin All­day and Cather­ine Ho

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 on 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 5,000 new cases on Mon­day, a dis­ap­point­ing new record for the state.

South­ern Cal­i­for­nia coun­ties are driv­ing the state out­break. Bay Area case counts have climbed some­what over the past few weeks, but the num­ber of peo­ple hos­pi­tal­ized with COVID­19 is fall­ing. Nearly 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 at the de­part­ment’s COVID­19 web­site at­ty­watch list.

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 last 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.”

Pho­tos by Jes­sica Chris­tian / The Chronicle

Chil­dren prac­tice ten­nis skills at a day camp in Wal­nut Creek. Con­tra Costa County was briefly on the state’s virus watch list.

An­thony Beck­ley of San Fran­cisco (left) and Into Ale­gre of Phoenix dine at Tele­feric Barcelona in Wal­nut Creek.

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