Coronavirus on the Rise—Again

On March 16, a day when there were only 133 confirmed cases of coronavirus infection in California, six Bay Area counties—San Francisco, Santa Clara, San Mateo, Marin, Contra Costa and Alameda—imposed the United States' first “stay at home” orders on their combined 6.7 million residents. Three days later, Los Angeles County, with another 10 million residents, did the same. Governor Gavin Newsom, also on March 19, signed an executive order extending the shutdown conditions to the entire state of California.

With the early, decisive actions of its public officials, California set an example for the country, bringing the pandemic largely under control in the state. California was America’s coronavirus success story—until it wasn’t. Because sometime in late June, something began to go terribly wrong.

On July 13, as case counts climbed in 30 of the state’s 58 counties, Newsom slammed on the brakes. Just as the state was moving into the third phase of its reopening process, after movie theaters, hair salons, gyms, and even restaurants had been allowed to resume business with certain health restrictions in place, the governor announced in a post on his official Twitter that he was ordering those businesses to shut down again, at least with regard to their indoor operations. On July 20, however, Newsom “clarified” his order, allowing hair salons to continue operations—as long as they did their hairstyling outdoors, according to a report by Taryn Luna of the L.A. Times.

“It was our intention to provide for barbershops and the like to be able to do their work outdoors,” Newsom said in his July 20 announcement. “It turned out that was more challenging than it may have appeared.”

Newsom ordered bars to cease all business, entirely. And that did not change.

Even with the new closures, according to Dr. Mark Ghaly, California's health and human services secretary, the state may not see any improvement in case nuimbers, or death and hospitalization rates, for as long as five weeks.

“We’ve learned that a two-to-three week period may not be long enough,” Ghaly said on July 21, as quoted by Mercury News reporter Wes Goldberg. “It may take up to three, four, even five weeks to feel the full impact of some of those changes.”

California hit a total of 413,576 total COVID-19 cases on July 21, the L.A. Times reported, putting the state past New York, the early epicenter of the pandemic, as the national leader in COVID-19 cases. New York has since brought its coronavirus outbreak under some measure of control.

New York saw 823 new cases on July 21, per Worldometers data, compared to a new record of 12,137 in California, which also reported 156 deaths on the same day—more than 10 times New York’s total of 15.

“It’s just another proof point of how deadly this disease continues to be,” Newsom said, as quoted in an L.A. Times report.

The numbers continued to prove him right as the week went on. The state set new records for loss of life, with 157 COVID-19 deaths on July 23, and another new high, 159, the following day.

Also on July 13, Los Angeles Unified Superintendent Austin Beutner announced that the United States’ second-largest school district would remain closed for in-person classes for the foreseeable future, according to a report by Howard Blume of the L.A. Times. The first day of school was scheduled for August 18. The L.A. Unified district serves about 500,000 students in grades K-12, and employs approximately 75,000 people. San Diego School District also announced Monday, in a statement reported by Kristen Taketa of the San Diego Union-Tribune, that it would remain closed past its opening date of Aug. 31, saying that school officials there would reassess the pandemic situation on Aug. 10 to decide if schools will stay closed for more than one week.

On July 8, California’s seven-day average of new coronavirus cases hit 8,060, the highest daily number of the four-month pandemic, according to Worldometers statistics. COVID-19 hospitalizations soared 77 percent in three weeks, as 6,357 Californians were in the hospital with confirmed cases as of July 13, according to a Mercury News report by Elliot Almond.

Newsom’s new orders mark a shocking reversal of the state’s once-optimistic reopening policies. By early May, some parts of the Bay Area had started relaxing restrictions, allowing certain supposedly low-risk businesses to get back to work. By mid-June, the state was moving into Stage 3, which allowed in-person religious services, movie theaters, hair and nail salons and other, higher-risk business activities to get back under way.

And then daily case counts surged upward, topping 5,500 on June 25. That was a one-day record for the state, according to Worldometers stats. That record toppled the very next day, when California recorded more than 6,500 cases. On July 2, the state confirmed a staggering 9,439 cases. The number stayed mostly upwards of 7,000 or 8,000 over the subsequent week.

In the first week of July, Newsom issued orders to “pause” the reopening process in 19 counties that were placed on a watch list for potentially disastrous outbreaks of the virus. Restaurants, bars, wine tasting rooms, and other indoor businesses that attract closely packed gatherings of people were all ordered closed after having been given the green light to open, at least on a limited basis, just a week earlier.

By the second week of July, 26 counties of the state’s 58 were under orders to put their reopening on hold. Over the previous two weeks, according to figures published by the Mercury News, California saw a 30.8 percent jump in cases. Napa County alone absorbed a 44 percent increase.

Unlike other states experiencing severe coronavirus case spikes—notably Florida, Arizona, and Texas—California had strict lockdown orders that appeared to do their job, and did not seem to be rushing recklessly into reopening. And yet, California’s rate of positive coronavirus tests reached 7.6 percent for the week leading up to July 10, according to Johns Hopkins University data. That’s well over the 5 percent positivity rate set by the World Health Organization as the highest safe number for reopening.

What happened? 

So far, epidemiologists and other experts aren’t really sure. The usual suspects—nursing homes, restaurants, in-person workplaces and similar facilities—accounted for only between 15 and 20 percent of the increase, according to tracking data cited by the Guardian. Health experts last month warned that the mass street protests against racial injustice and police brutality, while necessary, could lead to new outbreaks of the virus.

But health experts who have studied the resurgent outbreaks in California say that they can’t make a direct connection to the protests, according to a report by KQED radio. In fact, reopening the state’s businesses and economic activities was a likelier culprit for the case increases than the protests, said University of California-San Francisco epidemiologist Kirsten Bibbons-Domingo, quoted by KQED.

Lee Riley, an epidemiologist at U.C. Berkeley, told the Guardian that he suspects “individual households” have been the most important vectors for the disease, and that people between the ages of 18 and 50, who are least likely to suffer serious cases of COVID-19, may be the main spreaders.

“Maybe they feel invincible, so they go out to bars, they gather in big groups,” Riley told the Guardian. “But then they can spread the virus to their grandmas and grandpas, their parents, their buddies with asthma or diabetes, who are more vulnerable.”

Californians in that supposedly less vulnerable age-range account for about 60 percent of cases statewide, and have been the driving force behind the breakdown in California’s once-solid coronavirus response.

The sad truth appears to be that California’s younger population just got careless, or complacent. As the state and local governments loosened the bonds of health restrictions,  too many Californians took that as a green light to pretend that the pandemic was no longer a threat.

“The story of California is the story of why we all have to do more,” Bibbons-Domingo said in an interview with Vox.com. “I don’t think we can easily point to a totally outrageous government policy or a totally outrageous citizen action or a totally outrageous anything. It really is that all of these things together matter.”

But there were some outrageous citizen actions, unfortunately. Despite data and multiple studies showing that wearing facial masks is the most effective tool for slowing the viral spread, according to Nina Bai of UC San Francisco, too many Califorians simply refused to put one on. 

Particularly in politically conservative Orange County, residents have made a performative show over their resistance to wearing masks. The county has the third highest number of coronavirus cases and fourth-highest death toll in the state, according to a Los Angeles Times report by Hannah Fry. But in early June, the county’s chief health officer, Dr. Nichole Quick, quit after protests and even at least one serious death threat over the masking order she had imposed, the Times reported. At one county supervisors meeting, some attendees from the public showed up with Quick’s picture defaced with Nazi swastikas and a Hitler-style mustache.

The county’s sheriff said that he would not enforce the masking order, which was promptly reversed following Quick’s resignation. Now, as of July 6, Orange County had a test positivity rate of 14.2 percent, and 222 cases per 100,000 residents. State guidelines to allow reopening call for just 25 cases per 100,000, according to Fry’s report.

“People began to fixate on individual liberties without understanding that one of the most fundamental civil liberties in the U.S. is the right to health,” Riley told the Guardian. “The right to stay alive.”

The bizarre resistance to mask wearing is at least in part a political statement by supporters of Donald Trump. Though he could have set an early example by encouraging mask-wearing, and donning one himself, he refused. Not until July 10, after “pleading” from his aides, according to a CNN report, did he agree to allow himself to be photographed wearing a protective mask.

The way forward for California remains unclear. With 23 counties reversing their reopening process, Newsom has yet to impose a new, statewide stay-at-home order, and has given few indications that he is willing to take that step. But he now finds himself under pressure to take more drastic steps, to bring the pandemic in California back to at least a level that could be manageable with a comprehensive program of testing and contact tracing.

"I'm frantic. Everybody is frantic. The public health officer is frantic,” Santa Clara County CEO Jeffrey Smith told the San Francisco Chronicle, as he called on Newsom to order a statewide ban on indoor activities. “There is no leadership from the top and we are not going to be able to control this regionally or locally. ... There is no way that we can utilize testing and tracing with such high numbers to test everyone."