“These are all trade-offs, these decisions,” said Dr. Michael A. Rodriguez, a professor at the UCLA Fielding School of Public Health. “Many people will be upset about having to wear masks again. At the same time, will many people be saved? There is no doubt about it.”

California was among the first states to issue an indoor mask mandate, require proof of vaccination for large events, place capacity limits on private gatherings, issue vaccine requirements for schools, and impose many other rules. Masking and vaccination are all the more urgent, California officials say, as the highly contagious omicron variant gains traction.

Some recent headlines have pointed out that California’s daily case rates are now higher than those of Florida and Texas, Republican-led states that have frequently blocked pandemic control measures such as indoor masking and vaccination requirements.

As of Wednesday, the seven-day average of daily cases per 100,000 people in California reached 113, while Texas reported 102 cases and Florida 78, according to data collected by the US Centers for Disease Control and Prevention.

But that is a snapshot in time — and while states’ case rates have fluctuated throughout the pandemic, California’s overall case rate is still below that of the other large states. As of Dec. 11, California’s overall COVID-19 case rate was about 13,000 per 100,000 residents; Texas’ was 15,000, and Florida’s was 17,300.

But with vaccinations protecting residents against serious disease, most experts also say case rates aren’t the only important metric when determining the pandemic’s impact.

“A lot of people are focused on the case numbers and those numbers can be overwhelming,” said Rodriguez. “But it’s those cases that require hospitalization and those who end up dying that are the most significant metrics used to get a sense of the impact of the pandemic — and what we ultimately want to bend the arc away from.”

By that measure, California’s diligent policies have helped the state avert a larger disaster.

Data collected by The Chronicle showed California with 74,685 cumulative deaths on Wednesday. It’s the most in the nation, but that is hardly surprising because California is the most populous state. On a per-capita basis, the death rate in California is 189 per 100,000 people, versus 252 for Texas and 288 for Florida.

California also has a smaller proportion of deaths after controlling for age. When comparing death rates for the 50-to-64-year-old age group in each state, California’s death rate for that cohort is 235 per 100,000 residents, compared with 257 for Texas and 274 for Florida.

While some might expect California’s numbers to be even lower relative to other states given the vast difference in policies, public health experts note that there are many factors in play in a state of nearly 40 million residents.

“California has an extremely diverse population, such as Latinos and African Americans, that may not have equal access to public health or health care facilities,” said Rodriguez. “When you you look at things in a more granular level, depending on the different areas of California, you will see differing levels of protection.”

Another indicator that pandemic measures are working is California’s relatively high vaccination rates, experts say.

Widespread uptake of vaccines and masking — most likely the result of a variety of state rules — helped the state stem a summer surge as the delta variant spread across the United States over the summer, preventing California’s health care systems from becoming overwhelmed.

Nearly 65% of Californians are fully vaccinated, state data shows. Florida is not far behind, with 62% of its residents fully vaccinated. In Texas the figure is about 56%.

“I think with all of these behaviors, however hard it is, it did make an impact,” said Dr. Peter Chin-Hong, an infectious disease expert at UCSF.

He added that these smaller measures have prevented California from reaching the point where it had to lock down again, setting off a chain of business closures, social distancing rules and capacity restrictions.

But some argue that statewide measures are an overreach and erode trust in public health systems when they are levied seemingly at random. A regional approach that fits California’s geographic diversity would feel less punitive, said Dr. Monica Gandhi, an infectious disease expert with UCSF.

“I think masks and ventilation made a huge difference in counties and states that imposed them before vaccination,” Gandhi said. But after vaccines became available, she said, “mask mandates didn’t seem to make a difference during the delta surge.”

Solano County Health Officer Bela Matyas said public mask requirements might help some people feel safer but that they aren’t that effective in limiting transmission. People are far more likely to transmit the virus at home or in private social gatherings, he said.

“In those situations, people don’t wear a mask,” Matyas said. “If that’s where the disease is spreading, imposing a mask requirement in a public setting isn’t going to change the spread of the disease.”

Assemblyman James Gallagher, D-Yuba City (Sutter County), criticized the Newsom administration’s one-size-fits-all approach to the pandemic given the state’s diversity. He, too, said California didn’t provide compelling evidence to show a mask mandate would be effective.

“Ultimately I think we’re at a point now, and I think we’ve been there a long time, where localities have been able to manage this virus risk on their own,” Gallagher said.

State officials appear to be listening, at least to regions that have already taken aggressive stances on masks.

After issuing the broad statewide indoor mask mandate on Monday, the California Department of Public Health said on Tuesday it would recognize the efforts that places like San Francisco, Marin, Alameda and Contra Costa counties have taken throughout the pandemic to control spread and allow them to exempt offices and gyms where everyone is fully vaccinated.

Some experts said measures like masking help enforce good behavior, even if not everyone follows them.

“It’s a statement by our public health and political leaders that, ‘We care about you,’” Chin-Hong said. “Nobody gets a kick out of telling people to wear masks. They do it because they feel like it’s the right thing for their people, and they are worried about resources like hospital systems.”

Rodriguez said he believes states that put the pandemic on the backburner and ignore virus mitigation strategies do it at their peril, especially with omicron looming.

The state reported 48 cases of the variant on Wednesday, up from 39 the day before.

Chin-Hong noted that there is a mental health toll that comes with living with restrictions for the past 21 months. Ongoing mandates drive up feelings of isolation and fatigue, especially among adolescents and young adults.

But the trade-off, he said, is those who live in more restrictive states are less prone to live in fear of illness.

“Even if you’re free from masks in Florida, you have people who are sick around you,” he said.

Chronicle staff writer Julie Johnson contributed to this story.
Aidin Vaziri and Susie Neilson are San Francisco Chronicle staff writers.