New actions include pulling an emergency brake in the Blueprint for a Safer Economy and strengthening face covering mandate Vast majority of counties in the most restrictive tier starting tomorrow
SACRAMENTO – As COVID-19 cases sharply increase across the country and California, Governor Gavin Newsom and state public health officials announced immediate actions today to slow the spread of the virus. The state is pulling an emergency brake in the Blueprint for a Safer Economy resulting in 94.1 percent of California’s population in the most restrictive tier. This change is effective tomorrow. The state will reassess data continuously and move more counties back if necessary. California is also strengthening its face covering guidance to require individuals to wear a mask whenever outside their home, with limited exceptions.
“We are sounding the alarm,” said Governor Newsom. “California is experiencing the fastest increase in cases we have seen yet –faster than what we experienced at the outset of the pandemic or even this summer. The spread of COVID-19, if left unchecked, could quickly overwhelm our health care system and lead to catastrophic outcomes. That is why we are pulling an emergency brake in the Blueprint for a Safer Economy. Now is the time to do all we can – government at all levels and Californians across the state – to flatten the curve again as we have done before.”
The rate of growth in confirmed COVID-19 cases is faster than it was in July, which led to a significant peak in cases. This requires a swift public health response and action from all Californians to slow the spread of the virus. Immediate action will help protect individuals at higher risk of severe illness or death from COVID-19 and will help keep the state’s health care delivery system from becoming overwhelmed.
“The data we are seeing is very concerning. We are in the midst of a surge, and time is of the essence. Every day matters and every decision matters,” said California Health and Human Services Secretary Dr. Mark Ghaly. “Personal decisions are critical, and I am I imploring every Californian to stay home if they can, wear a mask whenever they leave their homes, limit mixing, practice physical distancing and wash their hands.”
The 28 counties moving back into Tier 1 (Purple / Widespread) include:
Alameda
Napa
Santa Cruz
Butte
Nevada
Siskiyou
Contra Costa
Orange
Solano
El Dorado
Placer
Sutter
Fresno
San Benito
Trinity
Glenn
San Joaquin
Tuolumne
Kern
San Luis Obispo
Ventura
Kings
Santa Barbara
Yolo
Mendocino
Santa Clara
Yuba
Merced
The nine counties moving back into Tier 2 (Red / Substantial) include:
Colusa
Marin
Plumas
Del Norte
Modoc
San Francisco
Humboldt
Mono
San Mateo
The two counties moving back into Tier 3 (Orange / Moderate) include:
Calaveras
Sierra
Today’s action will remain in effect until the State Public Health Officer determines it is appropriate to make modifications based on public health conditions and data.
California has taken steps to prepare the state for an increase in COVID-19 cases. The state has developed additional testing capacity to allow cases to be quickly identified, recently opening a new laboratory in Valencia that is already processing thousands of tests a day. The state is averaging 164,345 tests over the last seven days.
The state has been working in partnership with hospitals, clinics and physicians on the COVID-19 response. To support California’s health care delivery system, the state has an additional 1,872 beds available at alternate care sites outside of the system that can be made available quickly if needed to respond to a surge in cases.
California will continue to update the Blueprint for a Safer Economy based on the best available public health data and science. For more information about the Blueprint and what Californians can do to prevent the spread of COVID-19, visit covid19.ca.gov.
State will assemble a “review board” of leading scientists
FILE – In this July 27, 2020, file photo, Nurse Kathe Olmstead, right, gives volunteer Melissa Harting, of Harpersville, N.Y., an injection as a study of a possible COVID-19 vaccine, developed by the National Institutes of Health and Moderna Inc., gets underway in Binghamton, N.Y. A letter from federal health officials instructing states to be ready to begin distributing a vaccine by Nov. 1 — two days before the election — has met, not with exhilaration, but with suspicion among public health experts and others. (AP Photo/Hans Pennink, File)Vallejo Times-Herald, By Lisa Krieger, September 26, 2020
California will conduct its own independent review of potential COVID-19 vaccines, signaling its distrust of the Trump administration’s accelerated “Operation Warp Speed” initiative.
To vet a vaccine before distribution to state residents, California Health and Human Services Secretary Dr. Mark Ghaly said Friday that the state will assemble a “review board” of leading scientists at academic institutions to assess the safety and effectiveness of any vaccine candidate.
“We think it is an appropriate approach to take, especially because things are moving so quickly,” Ghaly said. “We want to make sure — despite the urge and interest in having a useful vaccine — that we do it with the utmost safety of Californians in mind.”
The announcement came at a press conference in which Ghaly also expressed concern that California’s coronavirus numbers are beginning to move in the wrong direction after weeks of declines. Based on current trends, he projected an 89% increase in COVID-19 hospitalizations over the next month. That would still be far below hospital capacity and the worst rates in other states.
On the vaccine testing issue, several other states, including New York, have signaled that they’ll also take the unusual step that Ghaly outlined.
“Frankly, I’m not going to trust the federal government’s opinion, and I wouldn’t recommend to New Yorkers, based on the federal government’s opinion,” New York Gov. Andrew M. Cuomo announced at a Thursday news briefing, according to the New York Times.
President Trump has insisted a vaccine will be ready as early as next month, an assertion that other federal authorities say is unlikely.
California is already building a rollout plan for distribution of the vaccine, including whom to prioritize in the process, said Ghaly.
Led by the state’s Department of Public Health, members of a new Vaccine Task Force include other state agencies, as well as academic experts, community groups and individuals.
Once the state confirms the safety of the vaccine, this task force will advise distribution “in an equitable and smart way, to serve all the needs of Californians,” said Ghaly. “That absolutely is our plan.”
Conflicting information about the timing of the vaccine and whether it will be safe and adequately tested has created growing concern that people are hesitant to take it, despite its importance in stopping the pandemic.
The share of Americans who say they would get vaccinated for the coronavirus has declined sharply since earlier this year, according to a survey conducted this month by the Pew Research Center. About half of U.S. adults (51%) now say they would definitely or probably get a vaccine to prevent COVID-19 if it were available today, down from 72% in May.
Only about 21% said they would definitely get a coronavirus vaccine, half as many as in May.
While it is the federal government’s role to approve a vaccine, states have authority for actual distribution — and could, in theory, reject a vaccine they think is unsafe.
“Each state, indeed, has that sort of responsibility,” said Vanderbilt University’s Dr. William Schaffner, an internist and infectious disease specialist who formerly worked for the U.S. Public Health Service and the Centers for Disease Control and Prevention, at a Sept. 24 National Press Foundation program. “Some may be more ready to independently evaluate the data than others.”
An FDA committee — called the Vaccines and Related Biological Products Advisory Committee comprising 15 authorities selected by the FDA commissioner — reviews the safety and effectiveness data at a public meeting. The FDA commissioner usually follows the committee’s recommendation, but not always.
Typically, states follow the decision of the Advisory Committee on Immunization Practices, or ACIP, an independent committee that assesses data on FDA-approved vaccines and makes recommendations to the CDC.
But there is growing worry that the federal regulators may feel pressure from the White House to activate “Emergency Use Authorization” of an unlicensed vaccine, which would not require completion of a full “Phase 3” trial, during which efficacy is tested in thousands of people.
Two other COVID-19 products — hydroxychloroquine and convalescent plasma — received emergency use authorization, and have been touted by President Trump, despite little or no evidence of effectiveness.
This week, the FDA said it would enact new guidelines to toughen the process for approving a coronavirus vaccine. But President Trump said on Wednesday that the White House “may or may not” approve the plan, saying it “sounds like a political move.”
Saying they were “alarmed by political interference in science amid the pandemic,” the presidents of the prestigious National Academy of Sciences and National Academy of Medicine issued a statement on Thursday warning that “our nation is at a critical time in the course of the COVID-19 pandemic with important decisions ahead of us, especially concerning the efficacy and safety of vaccines.”
According to the Capitol Hill-based Roll Call, seven jurisdictions have indicated they would analyze the data independently: California, Colorado, the District of Columbia, Michigan, New York, Oregon and West Virginia. Another two — Montana and Wyoming — said they’d only administer a vaccine that completed clinical trials and an outside committee’s review.
“States are nervous. We’re talking about this now,” Marcus Plescia of the Association of State and Territorial Health Officials told Roll Call. “I think that a lot of public health officials in the states are concerned, given the rhetoric from the administration indicating they want a vaccine as quickly as possible.
But a state-by-state approach — for instance, if one state allows a vaccine, but another state does not — could complicate the pandemic response, which already varies greatly among states, said one expert.
While trust and confidence in the federal agencies has been shaken recently, “that is not the way to get control of this virus,” said Dr. Howard Koh, professor at the Harvard T.H. Chan School of Public Health, in a Sept. 16 media briefing. “Whenever a vaccine approval occurs, that needs to be accepted by the country, across the country, with implementation as a country.”
As to California’s numbers, Ghaly said Friday that the state is seeing upticks in case rates and hospitalization rates in some counties. They are small now but enough that the state is forecasting that 4,864 people will be hospitalized with COVID-19 by Oct. 25, an increase of roughly 89% from Wednesday, when there were 2,578 patients.
Dr. Mark Ghaly flagged “early signs” that state’s progress has shifted slightly: hospitalizations could rise from 2,578 patients now to 4,864 by late October
Dr. Mark Ghaly, Secretary of California’s Health and Human Services Department, addressed the state’s COVID-19 response in a Zoom broadcast Tuesday. (YouTube. July 21, 2020)
California could see an 89% increase in COVID-19 hospitalizations by the next month if coronavirus infections continue apace, a top state health official warned Friday.
Short-term forecasts indicate that hospitalizations could skyrocket from the 2,578 patients now hospitalized to 4,864 by this time in October, said California Health and Human Services Secretary Dr. Mark Ghaly during a Friday press briefing — a signal that Californians should stay vigilant as more parts of the economy open up.
“As we see these trend lines, which have been coming down and flattening, look like they’re coming up … we want to sound that bell for all of you,” Ghaly said. “We want to see us respond as a state to those slight increases.”
Although Ghaly praised the state’s “significant progress” in infection and hospitalization rates since mid-July — when a peak 7,170 COVID-19 patients were hospitalized — he flagged early signs that the state’s progress has begun to shift. Starting in mid-September, Ghaly said, infection rates have risen slightly across the state, while coronavirus-related emergency room visits have also climbed.
Although overall lower case rates have allowed many counties to reopen businesses within Gov. Gavin Newsom’s reopening system, the virus’ reproduction number has surpassed 1.0 in some regions, Ghaly said. Twenty-five of California’s 58 counties remain in the red or “widespread” tier, with another 19, including most of the Bay Area, in the purple or “substantial” tier, allowing for movie theaters and restaurants to welcome customers indoors at limited capacity.
Keeping case rates low means that the virus’ reproductive value has less of a dramatic effect on potential hospitalizations, Ghaly said — especially with the double whammy of flu season looming. But with more cases overall, “you can see how quickly case rates go up and how quickly that creates additional pressure on our hospitals,” he added.
Statewide, however, there was little change in the seven-day average of new infections and fatalities reported as of Friday. Both figures remained lower than where they were two weeks ago and significantly below their respective peaks. The 3,274 new cases and 85 deaths reported by county health departments Thursday kept each seven-day average about even — just over 3,500 cases and just below 84 deaths per day over the past week, according to data compiled by this news organization.
Ghaly’s hospitalization projection, meanwhile, would put the state on par with its Aug. 19 hospitalizations, when 4,890 people were hospitalized with COVID-19 — more than 2,000 people fewer than the state’s peak a month earlier.
“As Californians we’ve done a good job to avoid those situations, and we want to keep our guard up,” Ghaly said.
New York versus California: A tale of two pandemics
San Francisco Chronicle, by Erin Allday, July 27, 2020
People practice social distancing in white circles in Domino Park New York in May. Photo: Noam Galai / Getty Images
Their journeys began at about the same time, but California and New York immediately diverged down two very different paths during the coronavirus pandemic.
California started in January, with travelers from China carrying a new virus into the Bay Area. New York was probably only a few weeks behind, its virus arriving from Europe.
From there, California’s trajectory was a gentle upward bend in case counts, a long plateau, and then — the surge. New York’s was the classic curve: a sharp climb in cases followed by a long and bumpy descent.
Last week, six months into this pandemic, their paths crossed. California passed New York with the most coronavirus cases in the United States.
That grim convergence occurred as the nation reached its own dark milestone: 4 million reported cases. California, as of Sunday, has about 452,000 cases, to New York’s 412,000. Florida passed New York over the weekend and now has about 425,000 cases.
California and New York have gone through a role reversal of sorts, now that New York’s terrifying outbreak from the spring appears to be over, while California’s summer surge is still swelling. In March and April, New York consistently reported 10 times as many cases a day as California. By the end of June, California was outpacing New York by about the same rate. Last week, California reported about 65,000 new cases to New York’s 4,900.
But the numbers are more complicated than case counts. California has twice the population of New York, and its infection rate is half that of the Empire State — about 1,100 cases per 100,000 residents compared to 2,100 per 100,000. And New York has more than three times as many deaths — 32,600 to California’s 8,400, an indicator of how hard-hit the East Coast’s hospitals were early in the outbreak and how many more people died as a result.
The numbers are even more nuanced when California and New York are parsed into regions. The Bay Area, for example, has experienced a different epidemic, and is in far better shape, than Southern California. Some rural northern parts of the state have barely been touched by the virus. In New York, it has been Manhattan, along with the other four boroughs and their suburbs, that make up the vast majority of the cases statewide.
The two states ended up in roughly the same place — 400,000 known infections — at this moment in time. How they got there says as much about the nature of this new virus as it does about the culture of the East and West coast states and how they responded to the threat.
“The relationship between behavior and virus spread is mathematical, and we see it in those curves,” said Steven Goodman, a Stanford epidemiologist.
In the beginning. The initial trajectory of their curves are fairly well understood. California, the first state in the U.S. to enact widespread shelter-in-place orders in mid-March, shut down ahead of its outbreak. New York acted a little too late.
By the time New York shut down, a large portion of the population in New York City was already infected, public health experts now believe. In the two weeks after Gov. Andrew Cuomo’s statewide shelter-in-place order, confirmed cases doubled every three or four days, and the hospitals were overwhelmed. When the outbreak peaked in the second week of April, more than 10,000 cases were being reported a day and about 1,000 people were dying.
California successfully quashed its burgeoning outbreak. After a gentle uptick in March, daily cases seemed to settle at about 1,000 to 1,500 for a while. They climbed a bit more in May, hitting more like 2,000 cases a day, but still looked stable.
The hospitals were never overrun. The state generally saw fewer than 100 deaths a day. Residents celebrated their “California miracle.” Early, aggressive action had saved the state from the fate of New York and countries like Italy that experienced disastrous outbreaks.
“New York never had the chance to be data-driven and to build up their health care infrastructure and at least mitigate mortality,” said Shannon Bennett, chief of science with the California Academy of Sciences. “Even though we’ve flip-flopped in terms of the endpoint and daily new cases, it’s very different here. We were hearing in New York reports of bodies piling up, the social fabric was kind of crumbling. And I haven’t seen that here in California.
“We’re way better off than New York because we kind of saw it coming,” she added. “But wouldn’t it have been nice if seeing it coming could have prevented where we are now?”
New York: the bell curve. An advantage of having a sharp trajectory up is it’s fairly clear when the peak has arrived. In New York, it was in mid April, when the state reported 11,434 cases on what would have been Tax Day. California saw 1,197 cases that day.
From there, the cases fell far and fast in New York. The state reported a daily average of 7,600 cases in April, and 2,100 in May. The average dropped to about 750 cases a day in June and 700 this month.
New York’s curve, now six months into this pandemic, is an elegant bell with a well-defined peak and a long, steady tail.
There’s no one reason why New York’s case count fell so dramatically, but infectious disease experts point to a few most likely explanations. There were probably very few gaps in New York’s shutdown, which primarily affected New York City, the driver of infections. Residents were scared — a few weeks into the outbreak almost everyone knew someone who’d been infected — and therefore obediently quarantined.
Another possible explanation for the drop-off is immunity. By the end of May, one-fifth to one-quarter of people in New York City are believe to have been infected, according to antibody studies. That’s not enough for herd immunity, in which a large enough portion of the population is immune that a virus can no longer find traction to spread.
But if groups of people prone to infection had higher rates of immunity, that could have dampened the outbreak, infectious disease experts said.
“That may have produced some blunting,” said George Rutherford, an infectious disease expert with UCSF. “And they may have just learned their lessons better than the rest of the country.”
California: flattening the curve. California has never come close to that level of community disease. In the Bay Area, only about 1% of people were infected by the end of April, according to a recent Centers for Disease Control and Prevention study. That was the result of flattening the curve.
The state averaged about 600 cases a day in March, then 1,400 in April and 2,000 in May. That’s an obvious increase with the benefit of hindsight, but at the time the numbers appeared flat, day after day. They were even steadier in the Bay Area. There is no doubt, public health experts said, that sheltering in place prevented the massive spike that New York had experienced.
But when it looked like the numbers had plateaued, and as the rest of the country began to reopen the economy, Californians grew complacent and impatient. People in many parts of the state begged for a loosening of stay-at-home restrictions. They also began to socialize again — visiting friends and family they hadn’t seen since March.
Cases began a notable uptick around Memorial Day, and then picked up speed. Californians thought they’d peaked in April, like New York — but it turned out the worst was still to come. The state reported an average of 4,000 cases a day in June — twice as many as May. And 8,500 a day so far in July.
“We never really allowed the epidemic to reach a peak,” said Lee Riley, an infectious disease expert at UC Berkeley. “When they started seeing a slight flattening of the curve and what they thought was the peak, that’s when they reopened. And then it kept going up. In New York, they waited well after the peak period of the epidemic to begin to reopen.”
But California’s curve is deceptive, infectious disease experts say, because it’s taken different shapes in different regions. Los Angeles’s trajectory, which has been driving the state curve in recent weeks, was on a slow but steady ascent before a sudden spike in June. In the Bay Area, the curve was notably flat for a long stretch in April and May before trending up.
New York’s pandemic may have been deadlier and more destructive, but it was also more easily contained because it was centralized, Rutherford said. “When you talk about New York State, what you’re really talking about is New York City and the suburbs,” he said. “That makes it simpler.”
California held down its initial outbreak with a blanket shutdown on all 58 counties, but that wasn’t going to be appropriate for the entire state in the long haul, public health experts said. The reopening was blundered, in part, because there was no one approach. “Here, it’s like herding cats,” said Riley.
Both states can learn lessons from the other, infectious disease experts said. California looked to New York’s spike in March and April and knew to bulk up its hospital capacity while its case counts stayed manageable. That knowledge is paying off now as hospitalizations climb to new records.
“Certainly we have learned from the New York situation how bad the pandemic can get and how rapidly it can get bad,” said Grant Colfax, director of San Francisco public health, in a news briefing last week.
And New York, perhaps, looked to California’s reopening and saw that a more conservative approach would be best.
“The lessons that Gov. Cuomo talks about are the lessons of Memorial Day weekend,” Rutherford said. “That’s when it got away. And you don’t want that to happen to New York.”
Forecasting this pandemic has been notoriously difficult, so no one can yet say where the New York and California trajectories will go from here. The hope, of course, is that New York stays its course, and California manages to tamp down its current surge and wrestle back some control of its outbreak.
These curves represent only the first chapter of what’s bound to be a very long story, infectious disease experts say. These months may end up being the worst of the United States’ epidemic, or simply the first rise in a dizzying roller coaster with many more swells to come.
“We happen to be crossing these milestones, but we’re still very much in the early phases of this pandemic,” said Nicholas Jewell, a biostatistician with UC Berkeley. “This is a long haul. Let’s try to be strategic, and learn what works and what doesn’t. We need to be in better shape to live with this virus while we wait for a vaccine.”
San Francisco Chronicle staff writer Mike Massa contributed to this report. Erin Allday is a San Francisco Chronicle staff writer.
You must be logged in to post a comment.