Is state flattening the curve?

As surge continues, Newsom declines to give a target for loosening restrictions

For all the talk about “flattening the curve,” new coronavirus cases and deaths continue to surge in California, suggesting a return to normalcy remains far off for anxious residents who have now spent almost six weeks under an unprecedented shelter-in-place order.

This week, the state reported 11,877 new cases for a total of 41,235 as of Friday, as compared to 8,012 new cases the prior week, according to data compiled by this news organization. Meanwhile, deaths ticked up by 562, compared with 456 new deaths last week,

for a total of 1,612. The deadliest day since the onset of the outbreak came Wednesday, with 118 deaths, followed by 95 on Thursday and 83 Friday.

So how much has California really accomplished — and where are all the new cases coming from?

“Those should be sobering and cautionary statistics as it relates to the desire we all have to get back to some semblance of normalcy,” said Gov. Gavin Newsom in his daily news briefing Friday, adding, “We’re not by any stretch of the imagination in a position to say … that any new lights are yet green.”

Newsom hasn’t given a specific target, but federal guidelines suggest new cases should be on a “downward trajectory” for 14 days before social distancing measures ease — and California seems far from that goal.

Geographically, Los Angeles County remains the state’s coronavirus epicenter and suffered by far its worst week so far in terms of new cases: On Monday, it reported more than twice as many

new cases as on any previous day. In the Bay Area, increases are more modest, but Santa Clara County became the first in the region and the fourth county in the state Friday to soar past 2,000 total cases.

While social distancing has helped to stem the spread of disease in the general population, epidemiologists are tracking the new cases to “congregate facilities” — namely skilled nursing and assisted living facilities, households with myriad family members and homeless shelters, said UC San Francisco epidemiologist Dr. George Rutherford.

“There’s basically an ongoing outbreak in large ‘households’ of sorts,” Rutherford said of such facilities. “That’s where we think most of these cases are coming from.”

Across California, more than 5,400 residents and health care workers at longterm care facilities have contracted the virus — and at least 539 of them have died, according to information released by the state this week.

The large outbreaks in the Bay Area include an assisted living facility in Redwood City, Gordon Manor, which announced Friday that at least 10 residents have died of COVID-19 and 27 people have tested positive. Gateway Care and Rehabilitation Center in Hayward has the largest outbreak among skilled nursing facilities in the Bay Area, with at least 13 patients dead and more than 100 patients and workers positive for the virus, according to previously released data from the state and county.

Jail facilities also have

been hard hit, with the Bay Area’s largest outbreak at Santa Rita Jail in Alameda County. The facility reported 33 inmates infected with the virus as of Thursday, 24 of whom have recovered. Although the jail can house up to 3,500 inmates, it’s only about half full to limit the spread of disease.

And COVID-19 tore through San Francisco’s largest homeless shelter this month, infecting 106 people at MSC-South — including 10 staff members — in one of the largest outbreaks the Bay Area has seen so far. Another 22 residents and two staff members have tested positive at Casa Quezada, a permanent supportive housing facility for formerly homeless residents in San Francisco’s Mission District.

All facilities where residents live in close quarters — homeless shelters, nursing homes, jails or prisons — are problematic during a pandemic, Dr. Margot Kushel, director of the UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, said earlier this week.

“Congregate settings are just incredibly challenging places to keep people safe,” she said.

A small note of encouragement came from statewide hospitalization numbers, which remained stable Friday at 3,344, according to the California Department of Public Health. The number of patients requiring care in intensive care unit beds increased by about 1% to 1,216.

The steadying hospitalizations show that California’s social distancing measures have smoothed the curve, at least somewhat, Rutherford said.

“At least for this first wave, I would say we’re on the

downslope,” Rutherford said.

Some of the increase in case counts, he added, can be attributed to an increase in statewide testing availability, where California has typically lagged. With a population of nearly 40 million, the largest state in the nation has tested about 465,000 of its residents. A recent analysis found only Texas, Kansas and Virginia were testing its residents at a lower rate, but the state has gained ground since and is now close to the middle of the pack.

The state said it has reduced its backlog, which once reached 64,000 pending tests and numbered 7,400 as recently as Monday. Daily test counts also have skyrocketed: While the state averaged about 2,000 tests per day through the end of March, it’s now surpassed about 16,000 daily, Newsom said Friday.

Some Bay Area officials have been more restrained in proclaiming a flattened curve even as case counts in the region level off more than the state as a whole. Santa Clara County Executive Jeff Smith said Friday the county will loosen some of its shelter-inplace rules only when it has “strong testing and case tracing.”

Smith declined to give countywide testing and tracing targets necessary to lift the order. Based on the governor’s goal of ultimately conducting 60,000 tests a day, the Bay Area should aim for around 15,000 tests a day, Smith said — plus it needs millions of masks for frontline workers and a “legion of tracers” that can spend two to three hours tracing each new case.

Other local jurisdictions would be wise to start planning for their own unique circumstances, said Dr. Arthur

Reingold, division head of epidemiology and biostatistics at UC Berkeley. While death and case counts have risen statewide, judging California’s progress as a whole “collapses” information from places with divergent experiences, he said.

“I would argue that the state should increasingly give counties flexibility to make

locally appropriate decisions, as opposed to saying everyone needs to do it exactly the same way,” Reingold said.

Newsom stopped short of promising counties autonomy Friday, but he hinted at the same message during his address.

“I recognize that despite (California) being a state, it is many parts,” Newsom said.

“And that means we recognize the incredible imperative and importance of recognizing regionalism and how local conditions are distinctive from one another.”