The coronavirus curve is flat, the hospitals have plenty of beds, and in one week, the Bay Area’s shelter-in-place orders are due to expire — so understandably, millions of residents are asking when they can go back to some kind of normal life outside their homes.
It’s going to be a while longer.
The governor and state public health officials will decide when to reopen California, and nothing is imminent, they say. They won’t pin down even a rough estimate of when California may relax some of its shelter-in-place restrictions.
San Francisco Mayor London Breed said Friday that she expects the Bay Area stay-home order, which is set to expire on May 3, to extend a few more weeks, at least. On Friday, the Solano County health officer extended his shelter-in-place directive to May 17.
But some California counties are pushing back, noting that the economic fallout of sheltering in place is becoming unbearable, especially in areas that have seen few cases of COVID-19. Though Bay Area health officers are not among those pleading to peel back restrictions at a faster pace, they acknowledge that they may be ready to reopen earlier than some other parts of the state that have fared worse in the outbreak.
“The reality is that this epidemic is experienced at the regional level. There are a wide range of experiences across the state,” said Dr. Matt Willis, the Marin County health officer. “It’s challenging for the governor to have a one-size-fits-all approach.”
Gov. Gavin Newsom has promised a “bottom-up approach” to reopening that is responsive to regional differences across a vast state, but he has provided cities and counties with little flexibility so far. During his daily briefings last week, the governor repeatedly cautioned local elected officials about “taking the parachute off before we land,” and said Thursday that he would be able to loosen the stay-at-home order sooner if “all of us are checking off the same list.”
A Chronicle analysis of statewide coronavirus data shows dramatic variance in its impact across counties. Though the Bay Area was hit first in the state and carried a significant burden of the earliest cases, it’s also had more success from sheltering in place than Southern California.
The state outbreak has been slowing down over the past few weeks, but there are obvious signs that the virus is still a threat. Of special concern: Last week was the deadliest in California, with more than 400 deaths recorded — including a one-day high of 115 on Wednesday. Most of the cases and deaths have been in Los Angeles County.
Last week, the Bay Area case count rose 2% to 4% each day; in Los Angeles, the case count climbed 6% to 12% a day. Hospitalizations — a key indicator of how the disease is affecting a community — have been largely unchanged across the Bay Area for much of April. But in Southern California, they increased during most of the month.
In general, urban areas in California have been hardest hit, and many rural regions have been spared. But the stay-home orders put in place by Newsom on March 19 cast a blanket over the whole state. That made sense, public health and civic leaders said; to prevent almost-certain disaster, drastic statewide action was needed.
But reopening should be a regional affair, many say, with decisions based on coronavirus data points such as case counts and hospitalizations, along with how well prepared counties are to handle possible increases. The Bay Area, after all, did its own thing announcing shelter-in-place orders three days before the rest of the state. And the region may emerge from those orders at its own pace, too.
“The challenge for us here in California is how big we are — the 40 million people, the geography and so on,” said Stephen Shortell, a health policy professor at UC Berkeley and former dean of the School of Public Health. “Gov. Newsom needs to work very closely with our counties — and they need to be grouped into regions — and we’ll reopen in geographic regions based on the data. It would be a mistake to have a rollout statewide on a certain date.”
Preparing for the future: It’s not just metrics of the current outbreak that will decide when a region is ready to reopen, but how well prepared it is to handle a potential reemergence of the virus. Especially in the Bay Area, where case counts are relatively stable and hospitals are not overrun with patients, public health leaders have now turned to preparing for the next phase of the pandemic: what to expect when they reopen the economy and the community is again vulnerable to the coronavirus.
Several health leaders have started discussing those issues with the public over the past week, in virtual meetings and video announcements. On Tuesday, the Santa Clara County Board of Supervisors grilled Health Officer Sara Cody on how prepared the county is to reopen, now that its case counts are slowing down.
“We’ve flattened the curve, but we are far, far, far from done,” Cody said. “We anticipate this won’t be the only surge — we’ll have other surges to come if we let up too much. We have to be extraordinarily careful. We need to go a little slow and make sure we have the energy and the resources to manage this in the long term.”
Counties will need enough testing to ensure that everyone who needs to be tested can be, and that results are returned within a day or two, if not faster, public health officials said. They will need armies of workers who can do labor-intensive contact tracing meant to identify new cases and quarantine anyone who may have been exposed to the virus.
They need to make sure that hospitals have enough protective equipment for staff if cases start to rise again, and that they have plans for extra beds and ventilators if there is a surge in demand. They’re even thinking as far ahead as next fall, when counties may be contending with the flu and COVID-19 at the same time.
Public health authorities also need to develop tools to keep an eye on the virus in their community. Willis, the Marin County health officer, said they will need “triggers” to alert them right away if coronavirus cases climb again and they need to enforce more social distancing, or even go back to sheltering in place.
Those triggers may vary from county to county, even in a relatively homogeneous region like the Bay Area, he said.
“We are a single human ecosystem, and in a lot of ways it makes sense to have a unified approach,” Willis said Monday during a virtual town hall meeting. “At the same time, we know different counties will have different burdens. Based on indicators — how well we’re doing in a community — one community could move forward more quickly.”
“It’s a friendly competition between counties to see how well we can do with our figures,” he said.
First steps: Some counties in the Bay Area and nearby already are opening parks and outdoor venues like golf courses and swimming pools, and Willis said he and other health officers are keeping a close eye to see how those tentative steps toward normal play out.
Santa Cruz County has reopened beaches and parks — but not parking lots for those areas — after closing them for a week around Easter. Last week, some beaches were crammed with visitors, and on Friday public health authorities issued a reminder to obey social distancing practices, and warned that people gathering in large groups face fines of up to $1,000.
Napa County updated its shelter-in-place orders Wednesday with an open-ended extension past May 3, but also with some looser restrictions, such as allowing construction and real estate showings to resume. On Monday, politicians in San Luis Obispo County sent a letter to Newsom asking for permission to begin a phased reopening of the region, where they said the infection rate has been dropping for the past three weeks.
“Now we need to move to the next phase, which is economic recovery,” they wrote. “We must take steps now to cut down on the risk of prolonged recession and the resulting catastrophic public health issues that will inevitably follow from an economic downturn of that magnitude.”
In Placerville, northeast of Sacramento, the City Council voted last week to make a similar request. The effort was led by Vice Mayor Dennis Thomas, the owner of a downtown pharmacy, who argued that local businesses are struggling with Newsom’s nebulous timeline for loosening his statewide stay-at-home order.
Rural areas, which have been hit less hard by the coronavirus, are beginning to chafe against a strategy that could continue to hold them in limbo because outbreaks in distant cities are not yet contained.
The mayors of seven Stanislaus County cities sent a letter to the governor on Monday “requesting that you pursue an aggressive strategy for reopening our county for business.” They proposed a first phase where churches, hair salons, dog grooming shops, restaurants, golf courses, automated car washes and city parks could operate with appropriate social distancing measures, and gatherings of up to 50 people could resume.
“A reopening process that may fit, and make sense, for the Los Angeles and our neighboring Bay Area regions does not work for our County,” the mayors wrote. “Stanislaus County is nothing like the regions of San Francisco or Los Angeles.”
But Newsom has publicly batted away that notion, pointing to the scarcity of resources in rural parts of the state that could make outbreaks there even more dangerous to residents. He reiterated Thursday that his decision to lift restrictions would be driven only by indications that the virus is coming under control.
Kristin Olsen, chairwoman of the Stanislaus County Board of Supervisors, said now that more data have been collected about the spread of the virus, local officials should be given the authority to determine what is best for their own communities. She compared it to the flexibility that governors sought from the federal government on early responses to the outbreak.
“We should be trusted to make responsible decisions,” she said.
San Francisco Chronicle staff writer Joaquin Palomino contributed to this report.
Erin Allday and Alexei Koseff are San Francisco Chronicle staff writers. Email: eallday@sfchronicle.com, alexei.koseff@sfchronicle.com Twitter: @erinallday, @akoseff
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As coronavirus curve flattens, some California counties consider reopening - San Francisco Chronicle
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