This week marked one year since Gov. Gavin Newsom issued the stay-at-home order, the measure that made California the first U.S. state to effectively close its economy in an attempt to limit spread of the coronavirus.
A year later, closures aren’t as tight but COVID-19 restrictions and modifications remain in place for businesses, schools and other activities across the state and its capital region.
Reopening rules were relaxed this week for the first time in four months for Sacramento, Placer and Sutter. All three counties were promoted into the “red tier” of the state health department’s reopening framework, allowing indoor restaurant dining and establishments including gyms and movie theaters to resume indoor business, as their virus numbers improved.
Nearby El Dorado and Yolo counties also joined the red tier in recent weeks. Yolo could advance again as early as next week, into the looser orange tier, allowing higher capacity limits and a few more types of indoor entertainment businesses to open.
All the while, the state and U.S. are a little more than three months into a mass vaccination campaign.
All three vaccines currently authorized are said by experts to be safe and highly effective in preventing severe illness and death from COVID-19. The California Department of Public Health now reports that more than 20% of the state’s population is at least partially vaccinated.
Concern remains high, though, because genetic variants have emerged that studies have shown to be far more infectious and potentially more dangerous.
At this key moment, a year into the pandemic and in the first reopening effort that is supported by vaccines, The Sacramento Bee spoke by phone or Zoom with all five local health officers in the six-county capital region.
Here is what they said about the current state of the COVID-19 crisis, and their expectations for the coming weeks and months.
Sacramento: Normalcy by late summer could be ‘reasonable’
Sacramento County health officer Dr. Olivia Kasirye is optimistic. She said she believes the region is “definitely past the peak” of COVID-19 spread.
The move into the red tier coincides with many school districts in Sacramento County formalizing plans to return to on-campus instruction on at least a hybrid schedule. Elk Grove Unified, which has the most students of any district in Northern California and was the first in the Sacramento area to close last March, returned to campus this week.
“I think it’s great that we’re at the point where schools are able to reopen, and I think that will help to show that we can do it safely and then be able to move on to other venues as well,” Kasirye said.
She also said a “good portion” of educators in Sacramento County are now vaccinated.
Kasirye said two factors are important at the policy level in preventing another major surge: keeping the reopening progress gradual, and continuing to monitor the numbers and make decisions based on the data.
At the individual level, Kasirye said people should keep their guard up and remember the basics on masks, social distancing and avoiding gatherings, especially indoors.
“I think that we learned a lot from the last (surge),” she said. “The surge started because of gatherings.”
More than 700 of the county’s 1,559 COVID-19 deaths confirmed to date happened in December and January, in the wake of the devastating statewide winter surge, according to the local health office’s online data dashboard.
Kasirye said she does believe, consistent with recent guidance from the Centers for Disease Control and Prevention, that small gatherings among people who are fully vaccinated are safe without needing masks or distancing.
Kasirye said that whether Sacramento will be able to offer vaccine eligibility to the general adult population by May 1, in line with a timeline President Joe Biden set last week, “is very dependent on the number of doses we get.”
“If that increases, that’s doable,” she said.
Looking further ahead, Kasirye said that in terms of when the capital region might return to what the average person might consider to be mostly normal: “End of summer or beginning of the fall seems to be a reasonable target.”
Yolo: Leading region in testing, reopening progress
County public health officer Dr. Aimee Sisson expressed excitement at the possibility that Yolo could advance to the orange tier next week.
She’s also confident K-12 schools can safely resume in-person instruction on hybrid schedules, as long as established safety protocols are followed. Sisson said that after giving about 100 doses at a clinic later this week, the county will essentially be done vaccinating most teachers and education workers who want a dose.
But Sisson also spoke critically of how the state has handled economic reopening and the vaccine campaign. She disagrees with the state’s decision to loosen the tier thresholds based on vaccination milestones being reached.
“I worry when I see the state changing the rules of the blueprint midstream when we have something that’s working … When we get impatient with COVID is when we get into trouble,” she said. “I’ve encouraged the state to stay the course with the existing blueprint.”
She noted that California’s two major surges, last summer and winter, followed periods of reopening in spring and autumn.
Sisson said there is “political pressure on our governor right now” — referencing the recall effort against Newsom — and “decisions might be being made based on both politics and (public health).”
More than a month ago, Sisson testified before state lawmakers saying CDPH data tracking was under counting how many doses were being administered in Yolo and other counties, and said she was concerned that this inaccurate reporting could unfairly penalize local health offices by impacting their weekly vaccine allocations.
“I don’t know that the accuracy has improved” since those remarks at a Feb. 10 hearing, Sisson told The Bee this week. “I think that there’s a plan in place for the accuracy to improve, and that’s a big part of why California is turning to the MyTurn (system).”
While Sisson said the transition to MyTurn should help accuracy and uniformity of data reporting across the state’s counties, she called the additional implementation of handling appointment sign-ups and clinic management through MyTurn “a bit of overkill for the problem we had.”
“You create new problems when you’re solving problems that don’t exist,” she said.
Yolo faced devastation early in the pandemic, with deadly outbreaks last spring and summer in senior living homes, which account for about a third of the county’s 190 confirmed virus deaths reported throughout the pandemic as of Tuesday.
The county of about 225,000 people is faring much better lately by all available measures.
This week’s tier update from the California Department of Public Health showed the county with a weekly test positivity rate of 0.7% — best among all California counties with at least 40,000 residents, edging out San Francisco.
State data show the number of confirmed COVID-19 cases in Yolo County hospital beds has decreased from a late January peak of 33 to just two as of this Monday.
The improvement comes as Yolo now leads all 58 counties in diagnostic testing by a wide margin. CDPH reports Yolo conducted about 1,270 tests per 100,000 residents during the most recent data survey week — almost 500 more than the next closest county, San Mateo, and nearly quadruple the statewide median of 320.
Sisson credits successful virus surveillance largely to the county’s partnership with UC Davis.
“They’ve been a wonderful partner throughout COVID, and have really put Yolo County in the place that we are,” she said.
It was the Davis Genome Center lab at UC Davis that conducted the genotyping that identified the Sacramento region’s first confirmed case of B.1.1.7, a concerning variant of COVID-19, last month in a Yolo resident.
Sisson said it almost certainly wasn’t the first case in the region, but “just happened to be the first case detected because UC Davis has that technology.”
Sisson said it feels as if “there’s always this other shoe hanging in the air that can drop any time.” At the moment, that comes in the form of genetic variants, particularly those that have proven more infectious or show potential to resist vaccines.
The other big issue statewide is scarcity of vaccine supply, but Sisson said she expects “a pretty abrupt transition” in the next few weeks. If supply ramps up as expected in April, the state could quickly move from a position of scarcity into sufficient supply and then perhaps even into excess, she said.
At that point, the problem would flip from having not enough doses to not enough providers to inject them.
“That’s going to be on the backs of Blue Shield as the third-party administrator,” Sisson said. “They need to be ready soon for that surge of doses. I’m a little concerned with what I’ve seen so far.”
Placer: Vaccine success story
Placer County has had great success early in the vaccination campaign, ranking consistently at the top of the Sacramento region and near the top statewide in terms of doses administered per capita.
“I’m really proud of what we’ve done in our county-run clinics, but it’s been a team effort … with our community partners, so our hospitals and our pharmacies,” county health services director and interim health officer Dr. Robert Oldham said.
The Placer health office in a detailed report on its COVID-19 response in February said it retained about half of the 78,370 doses it was allocated that month, and transferred the remaining half to other providers.
Oldham said his view is that providers like pharmacies and hospital systems should ultimately do the bulk of vaccination while county-run clinics help “fill in the gaps” and assist in achieving equity for underserved communities.
That said, The Grounds clinic at the Placer County fairgrounds site in Roseville has administered more than 50,000 doses, and Oldham said it has been a smooth operation that benefits from its location in the most densely populated part of the county.
Placer is also partnered with 18 pharmacies. Oldham says his county was the first in Northern California to partner with Safeway pharmacies, teaming up with seven stores at the outset.
“That actually caused us to be a little bit slower in getting our county clinic going, but that helped us with the geographic distribution,” Oldham said.
Placer has no ZIP codes in the bottom HPI quartile, and its weekly allocations from the state have essentially held flat rather than increase or decrease, according to Oldham.
Oldham said that while he can’t predict specifically what local case rates will look like weeks or months into the future, he called it reasonable to believe the “worst is behind us.” He said it seems unlikely that Placer spikes back above 50 daily cases per 100,000 residents or faces a similar hospital surge to what it saw in December and January.
Placer’s health office as of Tuesday reported its daily case rate at about eight per 100,000 for the past week.
With three vaccines now available, Oldham spoke to the need to reduce skepticism and encourage those who might be hesitant to get vaccinated.
“I do anticipate in the future, there will be more freedom given to people who’ve been vaccinated, certainly a peace of mind. But the big (motivation) is around protecting your family.”
Oldham said Placer is retooling its “Mask up” public messaging campaign to include a “Sleeves up” campaign to help with potential vaccine hesitancy.
El Dorado: School openings go well. Time to end hybrid learning?
Compared to other Sacramento region counties, El Dorado County over the course of the pandemic has seen lower infection numbers and, before rolling back with most others due to the winter surge, had some of the loosest restrictions for the longest period of time last fall.
Health officer Dr. Nancy Williams said this window gave El Dorado an advantage when it came to K-12 campuses reopening.
“We’re certainly more open than the average county’s schools,” she said. “We’ve been pretty successful with it. I think we were lucky that our numbers were low (last fall).”
Williams said there have not been any major outbreaks linked to schools, and that most students and teachers who have tested positive had those cases traced back to exposure elsewhere in the community.
Some districts on the western side of the county, in the Placerville and El Dorado Hills areas, are nearly ready to start launching into “full in-person learning” — five days a week rather than a hybrid schedule, according to Williams. Rescue Union and Buckeye Union Elementary, both K-8 districts, have already done so.
South Lake Tahoe High is the lone public school in the county that hasn’t resumed any in-person learning, she said.
Williams is confident in the most recent round of business reopenings because health experts and the general public have more knowledge about the virus now.
“I think the science behind the precautions has grown stronger and stronger. We’ve learned more about how well masking works. We’ve learned more about how much less risky it is to be outdoors than indoors, in enclosed spaces. We’ve also learned that schools don’t tend to be risky places.”
Like Placer, El Dorado County has no ZIP codes in the bottom quartile of the state’s Healthy Places Index.
“My understanding is that we’re receiving somewhat less vaccine because of that,” Williams said.
Williams said it’s impossible to predict when — if ever — we’ll return to pre-pandemic “normal,” but said on the current trajectory of vaccinations, she foresees “a much more comfortable life” by late summer.
“I don’t think the state’s going to be very quick on dropping a mask mandate,” she predicted, adding that many people will continue mask-wearing “as a habit anyway, in places that they deem risky.”
Yuba-Sutter: Equity focus increases vaccine supply
Dr. Phuong Luu, health officer for Sutter and Yuba counties, said the region is benefiting greatly from the state’s focus on reducing vaccine distribution inequities, which included a commitment earlier this month to double supply totals for communities considered disadvantaged according to California’s HPI index.
More than half of the ZIP codes in the Yuba-Sutter bi-county area rank in the bottom quartile of the state’s HPI index, according to Luu. As a result, the health office’s supply allocations increased substantially in early March compared to January and February.
Yuba has one of the lowest rates of vaccine doses administered per capita among all 58 counties in California. As of Wednesday’s update from CDPH, Yuba had injected about 17,000 doses per 100,000 residents. That’s only a little over half of the statewide rate of about 32,500 per 100,000, and well below Sutter’s rate of about 24,500.
Luu says the discrepancy between the two sister counties is largely because Sutter has more long-term care homes — four compared to one in Yuba — and also more health care facilities than Yuba.
Because residents and staff at long-term care facilities, along with health workers, were first in line for the vaccine, making up Phase 1A of distribution, Yuba County saw a smaller share of the earliest shots injected.
Notably, Sutter advanced into the red tier in this week’s update while Yuba’s case rate grew too high, meaning it won’t be eligible to leave the purple stage until at least March 30.
Similar to Sisson, Luu said that while demand is far outstripping available supply of the vaccine right now, health officials are already considering the possibility that the problem could flip in the coming weeks.
“We are afraid that the pendulum will swing to the point where in, say, May as President Biden noted that available vaccines will be plentiful (that) we will actually have to chase around asking people, ‘Please get the vaccine.’”
Luu said that while there have been confirmed cases involving students and education workers, there has been “nothing that is extremely concerning” with regard to schools reopenings. K-6 campuses have opened but middle and high schools in the two counties have stayed closed since last spring.
“I do agree that this is now the time” to gradually reopen businesses and schools, Luu said. “Because it’s not feasible to continue to say, ‘Avoid everything, just stay at home all the time.’
“We’re in the one-year mark, and we are seeing great strides with vaccination, so a prudent, gradual approach is key.”
Continuing social distancing and mask protocols, and keeping reopenings gradual, are especially important due to the ongoing concern of genetic variants, Luu notes.
Luu says Yuba-Sutter must request state assistance to test for genetic variants like B.1.1.7 and has tried “a few times” to do so, but “the clinical criteria was not fully met” and so those requests were denied.
“We’ll continue to keep a really close eye on that situation.”