- Experts say increased testing is only a partial explanation for the surge this week in COVID-19 cases and hospitalizations in California.
- They say the reopening of businesses and the lax enforcement of restrictions such as face mask wearing are major factors.
- They also note that the new coronavirus is spreading in multifamily dwellings, especially in Southern California.
California, which seemed to have COVID-19 reasonably under control just a few weeks ago, is now facing a major spike in new cases.
The Golden State reported its largest one-day total of new confirmed cases on Wednesday, June 24 with more than 7,000 recorded.
Hospitalizations for COVID-19 have also risen nearly 30 percent in the state in the past 2 weeks.
So what went wrong?
More testing has played a role in the increase in cases, according to the California Department of Public Health.
Officials note that the state of 40 million people has tested about 3.5 million residents for COVID-19 since the outbreak began.
However, as various governments around California have eased stay-at-home orders and other restrictions on movement and gatherings, COVID-19 cases have risen.
“While some of the increases are due to test reporting issues, it is clear that much of the increase represents more community transmission,” said Barbara Ferrer, PhD, director of the Los Angeles County Department of Public Health.
“In particular, we are seeing higher cases among younger Californians, and we are concerned for them and concerned they could spread it to medically fragile and older Californians,” according to a statement from the California Department of Public Health. “In addition, some large hospital systems are testing more people as they resume scheduled surgeries and, in some cases, these individuals are asymptomatic but nevertheless contribute to the increasing positive case counts.”
“Increased testing will continue to detect more cases, but this only serves as evidence that COVID-19 is in our communities,” Dr. Sonia Y. Angell, MPH, director of the California Department of Public Health and the state’s public health officer, told Healthline. “As we move more, we are at greater risk.”
California health officials say they expect to see a high level of COVID-19 cases and hospitalizations continue into the summer and beyond.
“Viruses don’t take summer breaks,” the state health department noted.
“I suspect the rise of COVID cases was related to widespread lifting of restrictions causing more COVID exposures,” Dr. Sunny Jha, an anesthesiologist at the University of Southern California who helped launch the Los Angeles Surge Hospital, told Healthline.
“Enhanced testing, complacency with COVID, a desire to get out and about, poor adherence to social distancing/handwashing/face masks, an acceptance and willingness to get the disease, widespread protests, and a growing distrust or belief in health systems [or] the disease being real have all likely contributed,” he said.
“Fortunately, it does not appear as if the cases are as severe even though there are a lot of infections,” added Jha.
“I don’t suspect it’s because we’re better at treating the disease, but perhaps the people who are getting the virus are healthier at baseline, thus requiring less hospitalizations,” he said. “Previously, we had a lot of exposures [at] nursing homes where many high-risk patients resided.”
Dr. Robert Goldberg, a pulmonologist at Mission Hospital in Mission Viejo, California, told Healthline that many of the COVID-19 cases now being documented are among people living in multifamily dwellings, who often bring the disease home after going to work.
A recent outbreak in migrant worker communities in Chula Vista in San Diego County also “shows that when people are in close quarters they are going to expose each other and the virus is going to spread quickly,” said Goldberg.
California is a vast and diverse state, experts point out, making it difficult to generalize about the spread of COVID-19 or the reasons behind the recent increase in cases.
“Some parts of the state are doing better than others,” Dr. Art Reingold, head of the epidemiology and biostatistics division at the School of Public Health at the University of California Berkeley, told Healthline.
“Los Angeles is struggling while San Francisco is doing really well,” he said. “There are many parts of the state that have been very little affected so far. We have a hodgepodge of epidemiological situations.”
Local political, geographic, economic, and social dynamics play a big role.
Low-income people living in densely populated Los Angeles, for example, may be at higher risk of contracting the virus than those who live in the more sparsely populated Central Valley, said Dr. Solomon Kuah, an emergency medicine physician and team leader at International Medical Corps, which has set up COVID-19 surge facilities at hospitals across California.
“These little ebbs and waves for California is kind of what we expected,” Kuah told Healthline.
He added that while observers are quick to blame protesters or exuberant beach goers for the increase in COVID-19 cases, “oftentimes it’s something that you see the least,” such as the spread of the novel coronavirus in nursing homes and in low-income communities.
The state of California has scrambled to set up a contact tracing program that can respond to COVID-19 cases and trace the spread of illness.
Companies such as Manifest Medex and Skedulo are working with healthcare organizations to overcome California’s fragmented health system and collect data on people who test positive for the virus, contact them, and determine who they’ve been in contact with.
However, Reingold said it may already be too late to use contact tracing to contain the spread of the virus.
“The fact is that even under optimal circumstances, this would be an incredibly difficult virus to contain — and we’re not doing a very good job in some parts of California or in the U.S., frankly,” said Reingold.
He said other jurisdictions could learn a lesson from the six Bay Area counties that took early action to shut down as COVID-19 arrived, and have joined together to communicate clear and accurate information since.
“San Francisco has been very thoughtful and organized, and worked between political leaders and the healthcare community to formulate as good a response as any city in the world,” said Reingold.
Kuah, who has worked in war zones as well as pandemic-riddled areas in other parts of the world, said that while every disease presents unique challenges, the approach to ending the COVID-19 epidemic is tried and true.
It’s a combination of clinical interventions, epidemiology, and community mobilization behind preventive steps such as wearing masks, maintaining physical distancing, and handwashing.
Without a big increase in testing, tracing, and public adoption of proven preventive measures, Kuah and others warn that California’s COVID-19 crisis won’t end any time soon.
“The notion that this virus would disappear with the warm weather was not believable and the analogy to influenza was flawed,” said Reingold. “Most people believe that come fall most of the population will still be susceptible to the virus.”
Reingold said it’s unknown at this point whether people can be co-infected with COVID-19 and the flu, which usually arrives in the fall in the United States and persists through February.
He’s also skeptical about the odds of a COVID-19 vaccine being developed and ready for widespread distribution anytime in 2020.
“It could be a really bad winter,” he said.