Locked-down California runs out of reasons for surprising surge

Locked-down California runs out of reasons for surprising surgeDecember 24, 2020

OAKLAND, Calif. — California has had some of the toughest restrictions in the country to combat the coronavirus, from a complete ban on restaurant dining to travel quarantines and indoor gym closures.

It hasn’t been enough.

America’s most populous state has become one of the nation’s worst epicenters for the disease, setting new records for cases, hospitalizations and deaths almost every day. Things are so bad in Southern California that some patients are being treated in hospital tents, while doctors have begun discussing whether they need to ration care.

The turnabout has confounded leaders and health experts. They can point to any number of reasons that contributed to California’s surge over the past several weeks. But it is hard to pinpoint one single factor — and equally hard to find a silver bullet.

It couldn’t come at a worse time, given that the Christmas and New Year’s holidays have arrived, and officials fear that residents are even more likely to travel and congregate than during the Thanksgiving period that propelled the current trends.

“We are facing a very, very difficult and very dangerous time in our county, in our region and in our state. All of our numbers are going in the wrong direction, and our reality is rather grim at the moment,” Santa Clara County public health officer Sara Cody said Wednesday.

“If we have a surge on top of a surge,” she added, “we will definitely break.”

At more than 100 new daily cases per 100,000 residents, California’s case rate is second only to that in Tennessee, according to the nonprofit tracking site Covid Act Now — though it’s a state that does not mandate mask wearing and allows indoor gatherings of up to 10 people. The website Covid Exit Strategy shows a 97 percent rise in Covid throughout California, which has gone in the opposite direction from its West Coast counterparts, Oregon and Washington.

In Los Angeles, officials have said all along that people were gathering too often. They blamed celebrations and postseason viewing parties when the Dodgers and Lakers won championships this fall.

Some have blamed the strict rules themselves, saying that cooped-up Californians couldn’t take it any longer and decided they need to live their lives. Others have said congregant settings remain a severe concern in a housing-constrained state, especially in low-income communities where residents live in tight quarters and must continue to work in-person to survive.

The state hasn’t employed strict enforcement and has relied on its regulatory agencies to cite the worst-offending establishments in spot cases. But it has no real hammer against people gathering or engaging in everyday social activities, and many local law enforcement agencies have made a point of declaring they will not become the stay-at-home police.

“It’s a big state. We get big numbers when things go wrong,” said George Rutherford, professor of epidemiology and statistics at the University of California, San Francisco.

California has begun providing its initial vaccine allotments to health care workers, but immunizations are not expected to have a dramatic impact on infection spread for months, until broader distribution takes place.

In the meantime, the state is running out of levers to control the spread, leaving public health officers little choice but to implore residents to adhere to the rules.

Gov. Gavin Newsom has said all along that the state has to rely on social pressure to keep people apart. The state, with help from private donors, has spent tens of millions of dollars on billboards and advertisements urging responsible behavior. But Newsom himself erred in November when he attended a lavish dinner party with lobbyists — a faux pas that fueled resentment and resistance from residents already beleaguered by months of prohibitions.

California, with nearly 40 million residents, is nearing 2 million cases and more than 22,000 deaths. By any calculation, California’s outbreak numbers are stunning. With rapid, logarithmic growth, the virus has become so prevalent it’s simply become easier to spread.

In the biggest shopping month of the year, parking lots at malls and retail centers are packed. Such stores are among the few indoor operations allowed to stay open with stated capacity limits. Mobility data from Google suggests that Newsom’s December stay-home orders have barely made a dent in keeping people home compared to previous months, though the baseline doesn’t say whether it may have tamped down traffic compared to last December.

Rutherford doesn’t think the general population fully grasps the seriousness of the current surge. “People think they can negotiate with the virus,” he said. “Here’s a hint: They can’t.”

Critics have questioned the science behind the regional lockdown orders. Public and industry pressure has already convinced state health officials to reopen playgrounds and relax limits on grocery store capacity. A Los Angeles trial court judge also said the county’s prohibition on outdoor dining was “arbitrary” and that there was insufficient evidence showing it was a source of virus spread.

“Nationally, there has been a kaleidoscopic application of every imaginable type of lockdown order with California being the most restrictive and inflicting the most devastation on small businesses and the most economically vulnerable service workers. And still, we are none the better as far as COVID is concerned,” California Restaurant Association President and CEO Jot Condie said in a statement. “In fact in L.A. where indoor and outdoor dining are completely shut down, with indoor dining [closed] since July, the virus rages on.”

Assemblymember Jordan Cunningham (R-Templeton) argued that the state’s attempt to “shut down types of human interaction without seeing if that’s effective” was creating a backlash of sorts — “driving people to higher-risk activity” like gathering indoors at home, rather than places like restaurants.

“The public health officials have lost credibility with a huge section of the populace. They’re just tuning them out now,” Cunningham said. “The goalposts are moving all the time. … People are fed up with it and they don’t think it makes any sense, and they’re not wrong.”

There are small countervailing signs, however, that California can turn things around.

New case numbers stopped increasing dramatically this week, plateauing to less than 40,000 a day. It also remains debatable to what extent California’s wider test access is contributing to higher per capita numbers than elsewhere; the 12 percent positivity rate here, for instance, remains lower than many of the hardest-hit states. Meanwhile, only 16 states have a lower Covid-19 death rate, according to the Centers for Disease Control and Prevention.

Most of the transmission is being driven by the Central Valley and Southern California regions — areas more populous than many U.S. states — and some health experts argue that California’s surge should be viewed as a multitude of separate outbreaks with unique causes. Most of Northern California still has ICU capacity above 10 percent, while the southern part of the state, by comparison, has shifted to its surge phase.

Still, even residents in the San Francisco Bay Area, which has had many of the strictest rules all year, have let down their guard to some degree and have seen numbers shoot upward. For some, the decision to ignore the orders may come down to the survival of their businesses and the ability to put food on the table. Many essential workers and people living in disadvantaged areas throughout the state have had few options but to continue working.

Andrew Noymer, a University of California, Irvine associate professor of population health and disease prevention, said people often look to California’s status as a deep blue state to suggest that left-leaning residents uniformly agree with lockdown protocols and believe in staying home. But that ignores a large share of residents who feel otherwise, even if they aren’t a majority.

“In politics, 40 percent doesn’t carry the day, but 40 percent can drive the epidemic,” Noymer said. “California is deep blue, but … from the virus’s perspective, we’re a lot more purple than people give us credit for.”

California on Wednesday reported a record 361 Covid-related deaths from the day earlier, but the seven-day statewide positivity rate has declined slightly in recent days. San Francisco health officials this week noted that the virus’s reproductive rate is starting to trend downwards — dipping to 1.24 as of Dec. 20 from 1.45 on Dec. 5 — a sign that the stay-at-home orders may have started to work in the city.

But Noymer takes a more pessimistic view. Considering that December has been the worst month of the pandemic even before the holidays, January could be worse, he said.

“We’re not through this crisis,” he said. “It’s too early for a postmortem analysis of what worked and what didn’t.”

Jeremy B. White contributed to this report.

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