It’s troubling, though unsurprising, to see covid-19 cases spiking across the American South and Southwest, where public officials delayed lockdowns, rushed to reopen organizations, or refused to require people to wear masks.
But what’s the matter with California? The nation’s most populous state was the first to enact statewide shelter-in-place rules, took decisive steps to build up the recommended testing and case tracing capacity, and has hammered the public health message on social distancing and masks.
Yet new cases are rising sharply in pockets throughout the sprawling state, even as they’re flat or falling across much of the East Coast. Positive tests over the last seven-day period have risen 45%, regularly topping 5,000 a day, Governor Gavin Newsom said within a press conference on Monday. Hospitalizations and intensive care unit admissions are both up around 40% over the past few weeks aswell, threatening to overwhelm health-care systems.
In turn, Newsom has pressed Imperial County—the southernmost element of the state, where skyrocketing case loads have forced officials to move countless patients to hospitals in neighboring areas—to fully reinstate stay-at-home orders. He’s also recommended or necessary that more than a dozen counties turn off their bars or keep them closed, including Los Angeles and Santa Clara, the home of Silicon Valley. Meanwhile, San Francisco’s mayor halted the city’s reopening anticipate Friday.
So what’s driving the outbreaks in a state that supposedly did things right? Why weren’t its ambitious testing and contact tracing programs sufficient to prevent the recent surge in cases?
“It’s not one thing, but four or five,” says George Rutherford, an epidemiologist at University of California, San Francisco, who is leading the university’s training program for the state’s contact tracing task force. “The state is so big—the population of California is larger than Canada—and there’s a lot of different things going on in different places.”
Health officials believe the state’s efforts to boost testing and rapidly track down infections is helping. California’s amount of cases per capita—567 per 100,000—is well below the rates for states like Alabama, Arizona, or Florida. And Rutherford says about 85% of the people known to have interacted with positive patients are returning calls or answering questions from the state’s contact tracers, who are tasked with tracking down possible infections and encouraging people to quarantine or isolate themselves.
But plainly not enough people are strictly following these recommendations, among others, from public health officials—sometimes due to carelessness, and sometimes as a result of financial strains and other constraints.
Here are a few of the main drivers at the job:
Throughout the state, Latinos make-up by far the largest share of cases (56%) and deaths (42%), according to data from the California Department of Public Health. While Latinos make up 39% of the population, whites are a close 2nd at 37% but represent only 17% of covid-19 cases.
These infections appear to be concentrated within low-income communities, where people are often crucial workers who can’t do their jobs from home, can’t afford to call in sick and may are now living in crowded housing conditions, according to information from contact tracing programs as well as other research and reporting. Language, immigration status and financial dilemmas can complicate efforts to successfully reach infected patients or their close contacts in these communities, and convince them to isolate themselves for extended periods.
Early results from the covid-19 screening project in San Francisco’s heavily Hispanic Mission neighbor hood found that 95% of those who tested positive were “Hispanic or Latinx” (the big difference is explained here). And 90% of infected patients said they couldn’t home based.
People are becoming cavalier
Another major factor is that individuals are ignoring safety techniques, according to a state break down of counties experiencing rising cases. As regions relax stay-at-home rules, families, friends, and strangers are increasingly gathering in domiciles, bars, restaurants, and other venues. Too often, they’re maybe not wearing masks or staying far enough away from one another, said Mark Ghaly, secretary of California’s Health and Human Services Agency, throughout the Monday press conference.
Los Angeles County has become the nation’s largest epicenter of the illness, with not exactly 98,000 confirmed cases, according to Johns Hopkins University’s coronavirus tracking map.
The Los Angeles County Department of Public Health announced on Sunday that it might heed Newsom’s directive to shut down bars, noting that the region’s sharp upsurge in cases and hospitalizations directly coincides with the reopening of organizations a few weeks earlier in the day. Those include breweries, pubs, wineries, as well as other venues “where people remove their face covering to drink while they may be socializing with people not in their households,” the statement read.
“I implore that our residents and businesses follow the public health directives that will keep us healthy, safe, and on the pathway to recovery,” said Barbara Ferrer, the county’s director of public health. “Otherwise, we are quickly moving toward overwhelming our health-care system and seeing even more devastating illness and death.”
Explosions in prison cases
More than 2,500 state and federal prison inmates throughout California are infected with the coronavirus. More than 1,000 prisoners and workers tested positive in San Quentin State Prison alone during the last couple of weeks, in an outbreak linked to the transfer of inmates from the California Institution for Men in Chino, where there are significantly more than 500 active cases.
The spillover of patients into local hospitals has forced Marin County, where San Quentin is based, to pause its plans to reopen gyms, hotels, as well as other businesses.
An influx of cases from elsewhere
A selection of other facets are driving higher case counts, including increasingly widespread testing across the state (which totaled nearly 106,000 on Sunday), continuing outbreaks in nursing homes in many counties, and patients from outside California crowding in to counties with better testing and treatment.
Part of what’s driving the soaring case loads in Imperial County is the influx of positive patients from Mexico. State officials say they’re primarily Us residents, hundreds of thousands of whom are now living in neighboring Baja, crossing in search of superior healthcare.
The county has by far the state’s highest case numbers on a per capita basis, 3,414 per 100,000, as well as a positivity rate for tests that’s more than four times the state average.
The different drivers demand different interventions, health experts say. Officials need to make extra efforts to keep in touch with low-income Latino patients and supply money, food, housing, or other services to help them isolate while they’re infectious. (San Francisco has some programs like this set up, but plainly more are needed through the duration of the state.) Prison systems need to keep infected inmates isolated, and ensure that they’re no longer spreading the illness across facilities. And nursing facilities should test patients and workers more regularly, and part of more rapidly at the earliest signs of an outbreak.
But pretty much this has been known from the start. Californians need to observe that the dangers haven’t passed, even as regions relax certain rules. Everyone still has to maintain their distance from the others, vigorously wash their hands, and adhere to the one public health decree that can help the most.
“Wear masks,” UCSF’s Rutherford says.