Bay Area projected to reach threshold in “mid-late December”
twitter.com/KQED – Governor Newsom announced the details of a sweeping new stay-at-home-order that will come into effect for three weeks in certain California regions when their intensive care unit capacities drop below 15%. The Bay Area is projected to reach that point in “mid-late December.”
Newsom to impose new stay-at-home orders in California’s hardest-hit areas
SACRAMENTO — Vast swaths of California will fall under new shutdown orders in the coming weeks after Gov. Gavin Newsom announced additional restrictions Thursday to try to slow the surging number of coronavirus cases in areas where intensive care unit capacity is dwindling.
Newsom said he was “pulling the emergency brake” to help California through a third surge of the pandemic this winter, one he hoped would be a final ordeal before a coronavirus vaccine becomes widely available.
“The bottom line is if we don’t act now, our hospital system will be overwhelmed. If we don’t act now, we’ll continue to see a death rate climb, more lives lost,” Newsom said during a news briefing. But, he added, “There is light at the end of this tunnel. We are not in a permanent state.”
The regional orders will close personal care services such as hair and nail salons, playgrounds, bars and wineries, movie theaters, museums and zoos in places where ICU capacity has dropped below 15%.
Retailers, grocery stores and other businesses in those regions that are allowed to remain open will have to operate at 20% capacity, and restaurants will be able to offer only takeout or delivery. No outdoor or indoor dining will be allowed. Schools that have received a waiver to reopen can continue to offer in-person classes.
[Solano County’s COVID age group data doesn’t mesh with age group data given in this report. But I can report that 10% of Solano cases are youth under 18, significantly higher than in April. And although the 18-49 age group is 41% of the County population, it represents over 61% of total cases, by far the highest percentage of all age groups. More Solano data here. – R.S.]
Troubling trend in pandemic: More young people infected, ill
As the coronavirus enters its eighth month, a troubling trend has emerged in the Bay Area and around the nation: More young people are getting sick, in numbers so large that in some regions they now make up the largest and fastest-growing demographic contracting the virus.
It marks a dramatic shift from the narrative that dominated the early weeks of the pandemic, when health experts emphasized that older adults, in part due to the higher likelihood of chronic health conditions, were most at risk of falling ill.
“We are seeing increased rates of infection among young adults,” Santa Clara County public health officer Dr. Sara Cody said at a July county board of supervisors meeting. “It’s where the epidemic is spreading the most quickly. … This is disproportionately accelerating among young adults.”
In six Bay Area counties, people in their 30s or younger make up the largest proportion of cases. In San Francisco, for instance, 18-to-40-year-olds represent 48% of all cases; in Santa Clara County, 20-39year-olds represent 39% of all cases. Anecdotally, the region’s medical clinics are reporting a major uptick in younger people coming in with COVID-19 symptoms like shortness of breath, fever and cough.
Statewide, the number of cases among people ages 18 to 34 shot up 1358% between May 1 and Aug. 1, from 12,373 to 180,354 — representing an increase from 24% of all cases to 35% of all cases, according to the California Department of Public Health. During the same period, the number of cases among people 65 and older grew more slowly, 387%, from 11,547 to 56,206 — representing a drop from 22% of all cases to 11% of all cases.
At the Stanford coronavirus outpatient clinic, the proportion of patients under age 40 has more than doubled since April, from about 25% to 55%, said Dr. Maja Artandi, the clinic’s medical director.
In the South Bay, Kaiser is seeing more patients under age 30 getting hospitalized with COVID-19, which was unusual during the first surge in March. And more patients in their 20s are also seeking medical care for the virus from their primary care doctors.
“It’s worrisome,” said Dr. Charu Ramaprasad, an infectious disease physician in Kaiser’s San Jose Medical Center, who has been leading much of the health system’s coronavirus response.
Health officials and physicians have not pinpointed exactly why younger adults appear to be driving the latest surge in infections. But many believe it is likely because young people have been going out more — either for jobs that require them to interact with the public frequently, or in social settings — and are being more lax about social distancing and wearing masks.
And younger people may experience less severe symptoms, which may lead them to think it’s OK to gather with friends if they have just a minor cough or a scratchy throat, said Dr. Aisha Mays, medical director of the Dream Youth Clinic at Roots Community Health Center in Oakland.
“We have seen our young folks have a false sense of security that make them more susceptible to contracting COVID,” Mays said. “In the beginning, we were really concerned about our elderly population because they are so much more susceptible to the negative effects of COVID, including death. At the same time, it might have sent an unintended message to our young people that they were more immune to contracting COVID.
“We know that’s not true. We know young people can still contract COVID as easily as anyone else.”
People in their 20s and 30s are less likely to be hospitalized or die from the coronavirus than people in their 60s and 70s. Eight out of 10 coronavirus-related deaths in the United States have been among adults 65 or older, according to the U.S. Centers for Disease Control and Prevention. And hospitalization rates for people between 18 to 29 years old are 56 per 100,000, compared to 281 per 100,000 for people between 65 and 74 years old.
Still, many young people have symptoms severe enough to send them to the emergency room or intensive care. And even if they have mild symptoms, they still risk exposing older family members or friends who may get much sicker from the virus.
One of them is Tyler Lopez, 27, who in June began experiencing fatigue and chest congestion and lost his sense of smell. Lopez tested positive for the coronavirus, quarantined for 10 days and felt like he had recovered — but was soon hit with a second and much more severe wave of symptoms.
His heart rate repeatedly shot up to above 120, at times going as high as 140, even when he was sitting or lying down, and he had a fever and chest pain so bad it felt like the inside of his chest was inflamed, he said.
Lopez, who lives in Riverside, was admitted to a hospital twice. Doctors ran tests and concluded the COVID-19 infection likely caused inflammation in the tissue surrounding the heart, and that he could’ve gone into cardiac arrest if the medication he received at the hospital had not reduced the inflammation fast enough, he said.
“It’s just crazy what COVID can do,” said Lopez, who was released from the hospital last week and is recovering at home. He plans to go back to his doctor next week to see if he can get cleared to return to work — nearly two months after he first noticed symptoms. “The past couple months, it totally changed my life.”
Before he got sick, Lopez said, he did not take the virus seriously and continued going to the gym and meeting up with friends.
“I was like, ‘It’s not that big of a deal, whatever, if I get it, I get it,’ ” he said. “I was just living life without taking that extra precaution.”
He now wishes he had been more careful.
“It jacked me up,” he said. “I wouldn’t wish this on my worst enemy.”
Local health officials recently launched initiatives to urge people in their teens and 20s to practice social distancing, wear masks and limit activities to the outdoors like biking or hiking. Contra Costa County beginning Aug. 10 will start training hundreds of youth ambassadors to help get the message out to their peers.
A regional effort led by seven Bay Area public health departments, Crushing the Curve, has a similar aim.
Brandi House, 19, will participate in both programs as a youth leader. She said many of her acquaintances and coworkers have been going to parties during the pandemic, not believing the virus is serious or that they will get sick. She hopes to help dispel such attitudes.
“The message I’d like to put out for young people is to know this is real,” said House, of Richmond. “I know a lot of people not believing COVID is real. I know people that are still going to parties and stuff. I’m like, ‘Why are you going to parties during this time?’
“There’s a lot of people that have been getting sick and passing from it. That’s one message I want to get out.”
Contact tracing — finding and notifying everyone who has had close contact with a person infected with the coronavirus — is key to stemming the pandemic. Once people learn they’ve spent time near someone who had the virus, they can get tested themselves and quarantine so they don’t infect others.
Bay Area county health departments ramped up in April and May to handle the laborious process, most of it armchair detective work by phone and email, not the high-tech surveillance some in Silicon Valley originally envisioned. But the recent surge in cases has made the task much harder, because there are more people to contact and because it takes longer to be tested and then get the results.
Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara counties all fall short of their goal of doing case investigations for 90% of the people who test positive, and then reaching out to 90% of the folks those people had close contact with while they were infectious.
Napa, Sonoma and Solano counties did not respond to requests for information.
When it comes to reaching contacts of the people who tested positive, the counties range from 70% to 80%, except for Contra Costa, which reaches only 26% of those who had contact with infected people, and Marin, which reached only 46% (its numbers are older). Still, those numbers are far better than those in New York and some other states.
“Obviously we want as many as possible because that’s where you get the most bang for your buck,” said Dr. George Rutherford, an infectious diseases expert at UCSF who spearheaded San Francisco’s contact-tracing program. But modeling shows that even reaching 43% of infected people’s contacts provides some disease suppression. “I think the spread would be worse without” contact tracing, even though it hasn’t reached its potential, he said.
Contra Costa County could not say why it is so far below the Bay Area norm, especially since it is closer than Alameda and San Mateo counties to meeting its contact tracing staff goal.
“We’ve been grappling with it,” said Erika Jenssen, deputy director of Contra Costa Health Services. “To do effective contact tracing, we need timely lab results for tests, adequate staffing and to partner with the community.”
She pointed to delayed test results as a major obstacle. While the median turnaround time in the county is four days, many results come in as late as 10 days after testing — by which time a person may not longer be infectious.
The case investigations — interviews with newly diagnosed people — shed light on how the virus has spread since shelter-in-place orders were eased.
“We are seeing more people who were at some kind of gathering; that’s a common source of exposure,” Jenssen said. Contra Costa County investigators found that 18% of those who tested positive had attended large gatherings in the previous 15 days, while 17% had been to in-person workplaces. About 20% had visited restaurants, supermarkets and other stores.
Even counties that have maintained fairly high contact tracing numbers say they struggle with the surge.
[BenIndy editor: The Chronicle’s 7-day test rate numbers match the daily 7-day average numbers recently released by Solano County through July 12. More recent numbers are available: Solano first released test numbers to the public on July 13, at 5.3%, increasing on July 14 to 6.7% and on July 15 to 7.3%. The Benicia Independent and others repeatedly requested Solano Public Health to release positive test rate information, and it took weeks for the County to finally add the 7-day average to its daily dashboard report. – R.S.]
Charts show how coronavirus positive test rates have roller-coastered in Bay Area counties
As California reverses course this week and shutters many reopened businesses in the counties on its coronavirus watch list, one crucial metric guiding health officials’ decisions is the positive test rate.
That figure, which officials refer to as the “positivity rate,” is the percentage of tests conducted that come back positive for coronavirus. The state threshold for counties to reopen faster is 8% over a seven-day period. California’s current positive test rate sits at 7.1%, and the latest 7-day moving average for the U.S. is 8.7%.
Lee Riley, an infectious disease expert at UC Berkeley, said the positive test rate is one of several ways to assess the trajectory of the epidemic, along with hospitalizations and deaths.
“The public should care because if any of these parameters are increasing, they need to know why,” he said. “They need to know who is not wearing masks and what social gathering settings are contributing to the increased spread. Then, these behaviors can be targeted for correction.”
But what does the positive test rate look like across different regions of the Bay Area, where seven counties — Alameda, Contra Costa, Marin, Napa, Santa Clara, Solano and Sonoma — are on the watch list?
We examined what the average positive test rate was over the past two weeks for each county, and compared that to the historical trendline to see how things have changed over time. For a number of counties, the changes are quite stark.
Top of the list: Marin, Solano, Contra Costa
Marin County tops the list right now with an average rate of 12.9%, the third highest in the state over the past 14 days as of Tuesday afternoon. That number includes the outbreak at San Quentin State Prison, which now has more than 1,300 active cases. The prison had zero coronavirus cases through May until the transfer of prisoners from Chino to Marin County on May 30, which led to the rapid spread.
Marin County doesn’t include the prison statistics in its reporting, and instead listed a 14-day average positive test rate of 7.1% as of July 10. But the state and The Chronicle’s Coronavirus Tracker include the San Quentin cases, which are putting a strain on local hospitals and contributing to community spread, since prison workers have also become infected.
Both of those numbers are considerably higher than what Marin was averaging at the end of May, about 3.7%, before the outbreak at the prison. And the county’s rate was just 2% in early May. Marin County has seen outbreaks in skilled nursing facilities, growing cases among essential workers and within the county’s Latino population.
Solano County currently has the next highest positive test rate in the Bay Area, at 6.3% for the 14-day period. The state points to outbreaks among farmworkers who live in Solano County but work at Napa and Sonoma vineyards. Like many other places that are reopening, county officials have tied many cases to more in-person gatherings among individuals who don’t live in the same household.
Contra Costa County is third highest at 5.1% over the past 14 days. The state reports a rise in hospitalizations paralleling the increasing infections. The 7-day average was last reported at 7.8% on July 12, and in May, it never went higher than 3.8%. The county recently implemented a stricter face mask order requiring individuals dining on restaurant patios to keep face coverings on at all times except when actively eating or drinking.
Posting the lowest rates: San Francisco, Santa Clara
San Francisco has the lowest positive test rate of any Bay Area county at 2.1% for the 14-day period. The lowest average rate it has posted on a weekly basis was 1.1% in mid-June, and the highest was 4.3% in early May.
San Francisco has been cautious about reopening, waiting until June 12 to allow outdoor dining and indoor retail. Further expansions planned for late June and early July, including hair salons and indoor dining, have been postponed indefinitely.
“San Francisco was the first county to implement the lockdowns, so it had low rates to begin with,” Riley said. “I think they’ve been able to maintain these low rates also because people have accepted social distancing practices seriously.”
Santa Clara County is the second lowest at 2.5% for the past 14 days. While Santa Clara’s positive rate has remained well below the state threshold and the average rate hasn’t peaked above 3.3%, the county has seen an increase in hospitalizations, which prompted the state to place it on the watch list.
“Many of the cases identified in Santa Clara County are from long-term care facilities, who are more likely to develop severe disease requiring hospitalization,” Riley said. “The overall number of cases is not very high, but the proportion of people developing severe disease may be higher in this county than some of the other counties.”
San Mateo County’s positive test rate is 3.3% for the 14-day period ending Tuesday. The county has progressed far into reopening, with less risky businesses resuming in May, indoor dining OKd in mid-June, and most other businesses allowed to open by June 19. It was the only Bay Area county still allowing indoor dining as of Monday, when Gov. Gavin Newsom’s statewide order revoked that privilege; others either suspended operations earlier or hadn’t allowed them to reopen yet.
Napa County, with a 3.7% positive test rate over the 14-day period, was the earliest Bay Area county to reopen outdoor and indoor dining, on May 20. For most of June, Napa’s weekly positive test rate was steady at 1.7%, and in late May it was as low as 0.4%. But the state reports social gatherings, an increase in transmission, especially among the Latino community, and the impact on agricultural workers contributed to a recent rise in the rate, which reached 4.7% on July 5.
Alameda County, at 4% for the 14-day period, has been among the slowest in the Bay Area to reopen. But increased social interactions and a spike in cases among essential workers and in nursing facilities prompted the state to place it on the watch list on Wednesday. The county had allowed outdoor dining to resume on June 19, but had to reverse course last weekend because of a state restriction. As of Wednesday, restaurants can reopen for patio dining again. Alameda posted its lowest weekly rate in mid-June at 3.6%. Throughout May it hovered around 5%.
Sonoma County follows with a 4.2% positive test rate over the 14-day period, and saw its highest daily case count since the start of the pandemic on July 12, when 116 infections were reported. Health officials have blamed the rise on more social gatherings, and workplace outbreaks including at skilled nursing facilities. Outbreaks have also occurred among workers at wineries. Past positive test rates are not recorded on the county website, so we were unable to chart the historical trend.
Here is the complete list of positive test rates for all 58 California counties over the 14-day period ending at 4 p.m. Tuesday:
Marin (includes San Quentin cases): 12.9
San Joaquin: 12.6
San Bernardino: 11.2
San Diego: 10.2
Santa Barbara : 8.4
San Benito: 6.8
Los Angeles: 6.5
Sacramento: 6.4 Solano: 6.3
Contra Costa: 5.1
San Luis Obispo: 4.8
San Mateo: 3.3
Santa Cruz: 3.2
El Dorado: 3.1
Del Norte: 2.9