Coronavirus: California can still prevent a 'third wave'

A sign at outdoor shopping center says Notice: Facial covering required

Nov. 8, 2020 Updated 2:52 PM PT

SAN FRANCISCO — Although California has started to see a rise in coronavirus cases, the pace of increase is slower than that seen in the rest of the United States, and experts said there is still time to prevent a third wave.

There are clear warning signs, including a troubling increase in daily cases in Los Angeles County. But statewide, the uptick — for the moment — is proceeding at a pace considered relatively slow, and health officials say there’s no conclusive sign of the kind of surge that roiled California this summer.

“We are fortunate in the sense that we have a much more muted uptick that’s beginning to occur,” said Dr. Robert Kim-Farley, epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health. “And I think it’s because we are still adhering, for the most part, to this tiered approach of gradual opening of the economy and schools.”

California’s slow reopening process has prompted criticism from some businesses, including executives of the state’s largest theme parks, which remain ordered shut. Indoor bars that don’t offer meals remain largely closed statewide. And in the hardest-hit counties, including Los Angeles, Riverside and San Bernardino, indoor dining rooms are ordered closed, as are indoor gyms and houses of worship.

Although the slow-moving reopening strategy may be frustrating to some, health experts and officials are crediting the framework with keeping California’s hospitals from being overwhelmed by a surge of new COVID-19 cases.

California’s first attempt at reopening the economy in late spring ended in disaster, with state officials, under political pressure, agreeing to speed up the pace without meeting their own previously established criteria. That led to a summertime surge in cases that brought California’s deadliest season of the pandemic.

Chart shows daily new coronavirus cases in California vs. the rest of the U.S., with three major peaks

The milder situation currently in California, Kim-Farley said, could be considered “somewhat of a modest success story compared to the rest of the nation.”

Although California’s cumulative COVID-19 death toll of more than 17,900 is far worse than that of some countries — Japan, for example, has recorded only 1,800 deaths — the Golden State has about half the total deaths of New York, the hardest-hit state, with nearly 34,000.

The number of weekly coronavirus cases California has recorded recently is far below its peak. For the seven-day period that ended Thursday, California recorded nearly 34,000 cases, about half as many as the state’s worst week, July 17–23, when 66,341 cases were diagnosed.

By contrast, the nation recorded more than 662,000 cases in the last week — the second consecutive weekly record.

“Part of California’s success is because we have gone really slow with our reopening — that we’ve allowed ourselves time to see how our reopening efforts impact our healthcare delivery system,” said Dr. Mark Ghaly, the California Health and Human Services Agency secretary.

Ghaly said he believed California has been helped in places that have high compliance with the state’s mandatory mask order, which he called “one of the most valuable tools at play to reduce transmission.”

By contrast, some of the states seeing the worst per capita case rates have residents who largely are not wearing masks.

Across the nation, newly diagnosed coronavirus cases for the first time exceeded more than 100,000 daily in recent days. Since the pandemic began, the U.S. has recorded the most coronavirus cases and fatalities of any country worldwide, with more than 9.9 million people infected and more than 237,000 deaths.

The pandemic is rapidly worsening in most states, with the exception of the West Coast, Hawaii, New York, Louisiana and parts of New England, Dr. George Rutherford, an epidemiologist and infectious diseases expert at UC San Francisco, said Friday.

On a per capita basis, coronavirus cases have been highest over the last week in the Midwest, where there has been plenty of controversy over managing the pandemic. In Wisconsin, the Democratic governor and the Republican-dominated Legislature and conservative Supreme Court have sparred over control measures.

Texas on Halloween surpassed California as the state with the most coronavirus cases. By Sunday, more than 985,000 cumulative cases were reported in the Lone Star State; the Golden State stands at more than 973,000.

Texas has seen more than 19,000 COVID-19 deaths and in mid-September surpassed California as the state with the second-highest number, after New York.

Over the last week, Texas, Illinois and Wisconsin tallied more new coronavirus cases than California, Rutherford said.

It’s remarkable how much density of infection there is in Illinois, Iowa, Minnesota and scattered across metro areas in the Mountain West, Rutherford said. By contrast, the West Coast has been “relatively spared,” he said, and “here in California, we continue to be somewhat fortunate.”

A woman, wearing a mask, votes at a polling station, with her two mask-wearing children looking on.

Rutherford said he was worried that an uptick in cases in California that began roughly two weeks ago was the start of a significant surge, in which the state would be recording 8,000 new cases a day, up from about 3,200 earlier in October. But the dire scenario hasn’t happened. Over the last week, there has been an average of 5,050 cases a day.

“Just because we’ve seen other parts of the country experience a surge, it’s not a foregone conclusion that we’ll just see it down the road,” Ghaly said. “Our choices matter a great deal.”

Like California as a whole, Los Angeles County has started to see an uptick in cases in recent weeks, but it’s not at the point where it’s a surge that is expected to imminently stress local hospitals.

“There’s definitely surges happening across the country. We’re not seeing that yet here in L.A. County,” said Dr. Paul Simon, chief science officer for the L.A. County Department of Public Health. For the seven-day period that ended Thursday, 10,490 cases were reported, slightly down from the previous week’s tally of 10,987 but still higher than the count three weeks ago, which was 7,921.

These numbers are still below the county’s worst week, July 10-16, when more than 22,000 cases were reported.

“We’re pretty convinced at this point that these smaller gatherings — where people feel pretty safe because they’re with friends and extended family — are in fact fueling a lot of the increase,” said Barbara Ferrer, L.A. County’s director of public health. “They’re just not as safe as we would like to believe.”

Seemingly wholesome gatherings, where people are inside eating and drinking, can easily spread the virus.

“Please don’t bring people inside your house who aren’t a part of your household, because it just keeps accelerating this increase in the number of cases,” Ferrer said. “We, like everybody else, do not want to be at the place where we feel like the only steps open to us are very dramatic sorts of reclosings.”

Social gatherings are also a problem in the Bay Area. In Solano County, almost all the cases from a recent surge “came from family and social gatherings,” Dr. Bela Matyas, the county’s public health officer, said at a public meeting.

“And some of those that were reported were clearly in violation of common sense: We had a funeral with 300 people, and nobody wearing masks. We had a wedding in a person’s home with 40 individuals — nobody wearing masks,” Matyas said.

In Southern California, other counties are reporting week-over-week increases in cases, but at levels still below the summertime surge. For the seven-day period that ended Thursday, San Diego County reported 2,738 cases, up from 2,400 the previous week but below the mid-summer high of 3,753.

The five-county region of L.A., Orange, Riverside, San Bernardino and Ventura reported 18,558 cases in the last week, up from 17,704 the previous week. The numbers are half of what was seen in the summer, when nearly 39,000 cases were reported in one week in mid-July.

The increase in cases is still a sign of concern, and Kim-Farley suspected an uptick reported Thursday and Friday may be related to gatherings around Halloween. If a jump in cases tied to Halloween did occur, it would put the region in a worse position heading into Thanksgiving, Christmas and other winter holidays.

“We are in a critical time where we have many established cultural familial traditions of getting together and celebrating,” Kim-Farley said. “That just really cannot be the same as it was last year.”

The state generally bans large gatherings and has set up requirements for how small gatherings can occur: outdoors, for no more than two hours, with members of no more than three households who stay six feet apart and wear masks when not eating or drinking, and with food and drink in single-serve disposable containers.

“This is not the year to party in large crowds, particularly inside,” said Dr. Grant Colfax, the San Francisco director of public health. “We want to be here for the next holiday season. We want all of us to be here.”

Much of the concern nationwide is that major transmission occurs in small groups of friends and families. Health experts are urging people to not host or attend large gatherings and say it’s safest to celebrate in person only with members of your household.

“With the exception of some large rallies, it seems to be smaller groups of people who are clustering together where most of the transmission is going on,” Rutherford said. “And so the concern is that Thanksgiving, in and of itself — because it is a time when people cluster together with their masks off so they can eat and drink — will be a major amplifier.”

L.A. County officials are also monitoring a deepening of the disparity in coronavirus cases among Latino residents compared with other racial and ethnic groups. The disparity improved in August and early September but began to worsen again in October.

Lin reported from San Francisco, Lee from Los Angeles and Greene from Thousand Oaks.