There are 9 counties in the Bay Area. In 7 counties, covid-19 cases per 100K are declining. In Contra Costa, the case rate has increased by 4%. In Solano, the case rate has increased by 41%. Our case rate is 59 per 100K. The next highest in the Bay Area is 35.
As far as covid-19 hospitalizations, 4 counties are flat or declining. Solano is among the 5 counties seeing hospitalizations increasing. We now have 30 people hospitalized per 100K. The next highest county is 27. Most Bay Area counties are much lower.
The mortality rate in Solano County is 32% higher than the next highest county.
As far as vaccinations, 53% of our population is fully vaccinated. The other 8 counties range between 65% and 76%.
It has been said by some that we are not like the other 8 Bay Area counties. I have to say I don’t understand that statement. As far as our covid-19 metrics, it is clearly true. But I feel Solano County should be able to counter this virus as well as our neighbors in the bay. There is no reason for us to concede that we are, for some reason, incapable of protecting ourselves as well as our peers to the south and the west.
Solano Public Health Director opposes mask mandates
By Richard Fleming, MD, September 2, 2021
[BenIndy Editor: Dr. Fleming slightly modified his analysis here from the piece that appeared in today’s Vallejo Times-Herald. This updated version is published here with permission. – R.S.]
The Vallejo Times-Herald carried an interview with County Public Health Director Bela Matyas on August 29. In it, he explained why he opposes a county mask mandate for indoor public settings and why he feels the recent decision by the Benicia City Council to establish a mask mandate was “unnecessary.”
Dr. Matyas indicated he was looking at three factors – politics, community consensus, and science. He stated there is no consensus on masking in the county so, “My decision is purely based on science.” Yet in that interview, Dr. Matyas offered no scientific data.
These comments echo comments he made before the Benicia City Council on August 24. At that meeting, Matyas said there is no evidence mask mandates work. According to him, if they did, then the disease curve in Solano County would look different than in the eight other Bay Area counties, all of which have recently re-established mask mandates. He said the curves are the same in all the Bay Area counties.
However, the curves are not the same. On every measure of the covid-19 pandemic, case rates, hospitalization rates, and mortality rates, Solano County is far higher than our peer Bay Area counties. Not only that, the rate of increase for Solano is significantly higher than for the rest of the Bay Area.
When Mayor Steve Young pointed these facts out to Matyas, the health director pivoted and said that Solano County is not like the rest of the Bay Area, that we are in between the Bay Area and the Central Valley. Yet if one looks at the pandemic numbers in the Central Valley counties, there are quite a few doing better than we are.
There are also studies from various parts of the country showing the effectiveness of masks. A very informative one from Kansas was published in June 2021 in JAMA Network Open. It compared 15 counties which imposed mask mandates to 68 counties that did not. After ten months, the counties with mandates were doing far better on every measure. There are also excellent studies looking at school districts where teachers were mandated to wear masks, and the spread of the virus in those districts was much less than in districts without such mandates.
At the Benicia City Council meeting, Matyas said that in Solano County, “Our data clearly shows that indoor public spaces are not where the disease spreads.” He said spread results from private gatherings, so a mask mandate would not help. When I heard him say this, what came to mind is, “Where’s the beef?” He did not present any evidence publicly to support his statement.
There is no doubt that private gatherings are a big problem. But the odds are high that the virus behaves similarly in our county as elsewhere. There is no infectious disease expert in the country who says that indoor public gatherings are insignificant and can be ignored as a source of viral spread.
Solano County is a great place to live, but that does not mean covid-19 spreads differently here than in the rest of the U.S. During my 30 years practicing internal medicine in Solano County, I was never advised to treat infectious diseases here differently than the way doctors treat them in Kansas, Florida, or New York.
Matyas said he is relying on science to decide against mask mandates. Yet science confirms that mask mandates work. Of course other factors help as well, especially vaccinations. Sadly, our county has the lowest vaccination rate in the Bay Area. And lower than some Central Valley counties.
Matyas says mask mandates can backfire, because people will wonder why they got vaccinated if masks are still needed. He suggests that people in the northern parts of our county are not disposed towards masking. These are valid concerns. And there are two ways our county’s top health officer can address them.
He can say, “I understand why you feel that way, so I won’t rock your boats.”
Or he can say, “I understand why you feel that way, but I want you to understand some things. Vaccinated people are very protected against serious illness, but can still spread the virus. That’s why you still need to wear a mask. And there is very good evidence that wearing masks in indoor public settings will protect our community’s health and help our economy.”
Bela Matyas has chosen the first option. He appears to feel we are somehow incapable of performing as well as our peers in the rest of the Bay Area.
In times of crisis, leaders need to step up and lead. Every other Bay Area county public health director has followed the second option, and the data shows clearly we are falling behind. Thankfully, the city leadership of both Benicia and Vallejo decided we should rise to this challenge, follow the science, and try to protect our communities. They are not willing to say we have to settle for less than our neighbors in Contra Costa, or Napa, or Marin.
But we still have a lot to do to improve our vaccination rate.
The Centers for Disease Control and Prevention (CDC) revised its masking guidance Tuesday to advise that all individuals — including vaccinated ones — wear masks indoors in areas with “high” and “substantial” COVID-19 transmission.
According to the CDC’s map, four Bay Area counties — San Francisco, Alameda, Contra Costa and Solano — are classified as areas of “high” transmission and the other five — Santa Clara, San Mateo, Marin, Sonoma, Napa — are classified as areas of “substantial” transmission. Masking is currently recommended but not required in every Bay Area county except Solano.
Given how Bay Area counties have previously handled the pandemic, it seems highly likely the region will turn their recommendations into mandates following the updated CDC guidance. A mask mandate is currently in effect in Los Angeles County.
Across California, most counties fall into the “high” or “substantial” categories.
California Gov. Gavin Newsom said Tuesday the state would issue updated statewide guidance sometime after the CDC guidance was released.
The CDC said the change in guidance is based on new evidence showing that while fully vaccinated individuals are protected against severe disease from the delta variant, they can transmit it to unvaccinated individuals more easily than other strains of the virus.
CDC Director Dr. Rochelle Walensky said that when earlier strains of the virus were dominant, infected vaccinated people were found to have low levels of virus in their nose and throats and were deemed unlikely to spread the virus. That has changed with the delta variant, where Walensky said the level of virus in infected vaccinated people is “indistinguishable” from the level of virus in infected unvaccinated people.
If the Golden State was still using its four-color reopening blueprint for ranking counties by infection rates, at least a dozen, including Los Angeles, Alameda, Contra Costa and Solano now would be in the most-restrictive purple tier, and many businesses would not be fully open.
And that’s using new metrics introduced in March that made it easier for counties with higher case rates to move into lower-restriction tiers once the state reached what it considered equitable vaccination rates. Using the state’s original tier definitions, 29 counties, including San Francisco, now would be purple, which meant that the virus was widespread, a Bay Area News Group analysis found.
The dire picture comes a little over a month since California authorities on June 15 dropped the reopening blueprint and its color-coded restrictions on gatherings and business activities and eased requirements for face masks in public to slow the virus’ spread. Since then, sports venues, bars and amusement parks have fully reopened, and people throughout the state gathered for July Fourth barbecues and parties.
“We’ve all forgotten about the tier system because we wanted to,” said Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley’s school of public health. “We’re not in a very good place compared to where we were a month ago.”
California was one of the slowest states to reopen its economy during the pandemic and has one of the highest vaccination rates, especially among large states, with almost 52% of its population fully inoculated against the virus compared with 56% in New York, nearly 48% in Florida and 43% in Texas.
But like much of the United States, California is seeing rapid spread of COVID-19 driven by the highly infectious Delta variant, nearly all of it among those who haven’t been vaccinated.
On Monday, Napa, Santa Cruz, San Benito and Monterey counties became the latest to urge people who are both vaccinated and unvaccinated to wear masks while indoors in public places to slow the virus’ spread, joining most other Bay Area counties as well as Sacramento, Fresno and Yolo. Los Angeles made that an order Saturday.
According to the California Department of Public Health, the virus is spreading statewide at a 7-day average daily rate of 6.3 cases per 100,000 people among the unvaccinated, but at a rate of 1.1 per 100,000 people among the vaccinated. The department did not have those figures by county.
“Vaccines remain the best protection against COVID-19, including the highly infectious Delta variant,” the CDPH said in a statement Friday. “As we continue to see the real and aggressive impact of the Delta variant in rising case rates, we cannot stress enough how critical it is for eligible individuals to get vaccinated.”
California introduced its color-coded reopening blueprint last August amid a summer surge in cases after the state eased its March 2020 stay-home order to curb the coronavirus.
Under the original blueprint, counties in which the 7-day average of daily COVID-19 cases was 7 per 100,000 people or more were assigned the most restrictive purple tier.
At those rates, middle and high schools, and at some levels even elementary schools, couldn’t begin opening campuses to students. Bars were closed, and restaurants, theaters and gyms could only operate outdoors, where the virus doesn’t easily spread.
The blueprint allowed for progressively more gatherings and activities once counties’ case rates fell, putting them into the “substantial” red, “moderate” orange and “minimal” yellow tiers.
At the January peak of California’s deadly winter COVID-19 case spike, all but four rural counties were in the purple tier.
In March, as vaccines became more widely available and more people were getting the shots, state officials revised the tier metrics to account for the protection offered by immunization, making it easier for counties with high vaccination rates to move out of the restrictive tiers and reopen more businesses. Under the revised rules, the purple tier applied to counties with 7-day average daily case rates of 10 per 100,000 people or more.
On June 15, when the state ended its tier system, no California counties remained in the purple tier, and just one was in the red, while 29 were in the yellow tier.
The breathtaking pace of the virus’ resurgence already has led many local health authorities to at least recommend measures such as wearing masks indoors in public for all, vaccinated or not. But state officials for now have not changed their guidance, including allowing the vaccinated to go without masks inside.
Swartzberg noted that given how low infections had fallen since the spring, the sharp rise in new case rates still involves relatively small numbers. Statewide, the 7-day average daily case rate as of Sunday was 7 per 100,000 people, up significantly from 2 per 100,000 in early June but far lower than the 109.3 per 100,000 Jan. 9. And hospitalizations and deaths, which tend to lag new cases by a few weeks, remain on a downward slope. The 7-day average daily death rate as of Sunday was 0.01 per 100,000, down from 1.7 per 100,000 Jan. 9.
But given the Delta variant’s high transmissibility and rapid spread, even in the highly vaccinated Bay Area where many people continue wearing masks, new restrictions may be in order.
“The Delta variant’s transmissibility is so much greater than anything we’ve encountered,” Swartzberg said. “I think the Bay Area was wise in recommending masks indoors for everyone. If things continue on the trajectory we’re seeing, the Bay Area will probably have to mandate it and hope it’s sufficient to flatten the curve.”