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Weekend Covid-19 update: New guidance, mandates abound as surge rages back to winter levels

This week has seen some of the highest rates of Covid-19 cases, hospitalizations and deaths here at home and nationwide since February, which, in a rare show of united response, has also inspired some of the boldest vaccination and mask policies out of both public and private sectors. The shift in messaging has been both rapid and remarkable.

While health outcomes are of obvious concern, the threat of another economic and social life shutdown is proving to be a powerful motivator. Companies like Google, Disney and Walmart have jumped aboard the serious train over the last week in rolling out vaccination or regular test requirements for many employees.

Still, not all people are willing to comply with sweeping new rules and guidance, and, if past is prologue, it stands to reason that tension will increase and disparity will widen between the ‘wills’ and the ‘will nots.’ In a data-driven editorial analysis published Monday, we found the line between the two groups is largely drawn by political rhetoric and choice in media consumption — we won’t revisit that here, but the impact cannot be understated. 

Let’s take a look at how the latest Covid-19 surge is impacting the nation, the state and here at home in the Bay Area. 

U.S. 

  • Confirmed Cases: 34,974,823
  • Deaths: 613,133
  • Fully Vaccinated: 58%
  • Partially Vaccinated: 67.3%
  • Unvaccinated: 32.7%

Source: John Hopkins University Coronavirus Resource Center COVID-19 global tracking tool and the U.S. Centers for Disease Control and Prevention as of 6:21 p.m. Saturday, July 31.

In response to rising cases and hospitalizations, the CDC issued another iteration of mask guidance Tuesday. They now suggest people of all vaccination status in areas with “substantial or high” virus transmission go back to wearing masks in indoor public spaces and in large crowds. On a local note, all but two of the nine Bay Area counties are determined to have high community transmission, and the remaining two are designated as having substantial transmission. 

The CDC now also recommends universal indoor masking on all school campuses.

The agency has been widely criticized for confusing messaging and back-and-forth guidelines throughout the pandemic — the latest guidance only added to that general frustration. While some people are outright irate about needing to wear masks again, others would rather the CDC apply a more broad and clear mandate until the virus is under control.

Dr. Anthony Fauci claims the CDC and the science haven’t changed, but the delta variant is changing the nature of the beast.

“The War Has Changed”

Fauci’s sentiments were reiterated Thursday in leaked CDC slides obtained by the Washington Post. The slides imply the delta variant is “likely more severe” than previous strains and is as contagious as chickenpox, which all public school children are required to be vaccinated against, and various other viruses like the flu, common cold, SARS and Ebola.

CDC Internal CDC slide graph reflecting that unvaccinated people have an 8-fold chance of infection and 25-fold chance of hospitalization and death from Covid-19 compared to vaccinated people. Calculations were based on data through July 24, 2021.

The leaked CDC slide deck urges the Biden administration to communicate clearly and firmly with the American people that vaccinations are the best line of defense and drastically reduce the chance of severe illness and death. However, they also find vaccinated people with breakthrough infections can carry the same viral load as the unvaccinated. In light of the recent discovery, the agency also revised its guidance on testing, now recommending fully vaccinated people who have been exposed be tested regardless of symptomatic show. 

Think of it like wearing a helmet: The helmet itself doesn’t stop you from crashing on your own or into others, but it helps prevent major head injury in the event you do fall. And, if you crash into someone not wearing a helmet, they are substantially less protected than you are in that scenario. 

Noting that vaccination rates are far from desired herd immunity in the U.S., the CDC said:

“Given higher transmissibility and current vaccine coverage, universal masking is essential to reduce transmission of the Delta variant.”

Federal, state and local governments, as well as educational institutions, the entertainment sector and private industry, are scrambling to respond to the rapid case and hospitalization surge with nearly hourly updates on employee vaccination mandates and mask requirements. 

Congress recessed Friday for six weeks without extending federal eviction protection that expires at midnight Saturday. Some states, like California, and individual counties have superseding moratoria in place, while others do not. In short, August could prove a particularly harsh month for people who still owe pandemic-related back rent and especially if the employment rate takes a hit as a result of the latest surge and subsequent regulations. 

Several Bay Area counties are slowly making up for devastating job loss in 2020, however, some were already going in the wrong direction prior to the latest case rate anxiety. Santa Clara County’s famed Silicon Valley actually saw the unemployment rate increase from 4.6 percent in May to 5.1 in June.    

California 

  • Total Confirmed Cases: 3,960,410
  • Cumulative case increase since June 15: 7.1%
  • Covid-19 hospitalizations: 4,374/915 
  • Total Deaths: 64,423
  • Deaths added to cumulative total since June 15: 1,908  
  • Fully Vaccinated: 62.7%
  • Partially Vaccinated: 72.2%
  • Unvaccinated: 27.8%

Source: John Hopkins University Coronavirus Resource Center and California Department of Public Health with data pulled Saturday, July 31, 2021. 

The number of hospitalized COVID-19 patients statewide has grown by nearly 50 percent over the last seven-day period; resulting ICU admissions are up more than 42 percent in that same time. 

Many counties over the past week have reintroduced mask mandates for all people entering municipal facilities, regardless of vaccination status, and several have adopted county employee vaccination or regular testing requirements similar to what was announced for California’s health care and state employees last week. 

While the federal eviction moratorium fades away, California residents impacted by the pandemic are still protected through Sept. 30.

Alameda County

  • CDC transmission level: High
  • Total confirmed cases: 95,826
  • Cumulative case increase since June 15: 7.1% 
  • Covid-19 hospitalizations/ICU: 168/42  
  • Total deaths: 1,282
  • Deaths added to cumulative total since June 15: 11
  • Fully vaccinated: 71.5%
  • Partially vaccinated: 84.4%
  • Unvaccinated: 15.6%

Source: Alameda County Public Health Department and California Department of Public Health with data pulled Saturday, July 31, 2021. 

The county is reflecting a 5.2 percent test positivity rate as the current rolling seven-day average. Covid-19 hospitalizations are up more than eight-fold since the lowest point in June, marking the Bay Area’s most substantial increase.  

Oakland continues to carry the predominant share of total cases and while the city has vaccinated more residents than any other in Alameda County, it’s worth noting it’s also the most populated city in the area and vaccination rates there are falling behind neighboring cities like Berkeley, Alameda and Piedmont. 

Alameda County Public Health Department Alameda County zip code vaccination rate heat map indicates Oakland, Calif. is falling behind neighboring cities as of Saturday, July 31, 2021. (Map graphic courtesy of Alameda County Public Health Department)

Some local businesses are stepping up with patron restrictions based on vaccination status, including the Palmetto steakhouse and tapas-themed Kon-Tiki.  

Contra Costa County

  • CDC transmission level: High 
  • Total Confirmed Cases: 77,271
  • Cumulative case increase since June 15: 9.8%  
  • Hospitalizations/ICU: 130/31
  • Total Deaths: 834
  • Deaths added to cumulative total since June 15: 26 
  • Fully Vaccinated: 74.5%
  • Partially Vaccinated: 80.2%
  • Unvaccinated: 19.8%

Source: Contra Costa Health Services and California Department of Public Health with data pulled Saturday, July 31, 2021.

County health officials said Saturday that active Covid-19 cases have increased by 37 percent over the past two weeks, while the hospitalization rate in that time reflects an alarming growth of more than 60 percent. The county has so far recorded 11 deaths in the month of July, all of whom were from the general population. For comparison purposes, four deaths were reported in all of June. 

As of Saturday, nearly a fifth of the county’s vaccine-eligible population aged 12 and older remain unvaccinated. 

Marin County*

  • CDC transmission level: High
  • Total Confirmed Cases: 14,874
  • Cumulative case increase since June 15: 4.9% 
  • Hospitalizations/ICU: 8/1
  • Total Deaths: 214
  • Deaths added to cumulative total since June 15: 2  
  • Fully Vaccinated: 86.2%
  • Partially Vaccinated: 93.3%
  • Unvaccinated: 6.7%

Source: Marin Health and Human Services and California Department of Public Health with data pulled Saturday, July 31, 2021. 

The county is seeing a seven-day average case rate of 27.8 percent among its unvaccinated population, compared to 8.8 percent among vaccinated people. The moving seven-day average positivity rate was sitting at 3.6 percent as of Tuesday, marking a 620 percent increase since the state reopened on June 15.

Although San Quentin staff cases are recorded within their residence county, it’s worth noting that six prison staff members have tested positive in the past two weeks, with five cases still active. According to the California Department of Corrections Saturday, there have been no new inmate cases over the past 14 days.  

*San Quentin State Prison, the site of a major Covid-19 outbreak in July 2020, reported cases and deaths separately from Marin County. The facility confirmed a total of 2,241 cases and reported a resulting 28 deaths among the prison population, which we are including in our county totals. Another 471 prison staff members have also tested positive since the pandemic began, with six in the past two weeks — staff cases and deaths were recorded within their county of residence. Source: CDCR data as of Saturday, July 31.

Napa County

  • CDC transmission level: High
  • Total Confirmed Cases: 10,442
  • Cumulative case increase since June 15: 4.5%  
  • Hospitalizations/ICU: 12/4
  • Total Deaths: 84
  • Deaths added to cumulative total since June 15: 2 
  • Fully Vaccinated: 74%
  • Partially Vaccinated: 79%
  • Unvaccinated: 21%

Source: Department of Health and Human Services and California Department of Public Health with data pulled Saturday, July 31, 2021.  

In an update issued Friday, the county health department said the case count has increased for five consecutive weeks, with the period between July 23 and Thursday reflecting a 65 percent increase over the prior week. As of July 18, unvaccinated people represented nearly three quarters of all new cases.  

Bottlerock was canceled last year due to the ongoing pandemic, and though this year’s three-day music festival is still scheduled to kick off on September 3, organizers are faced with the reality of a fourth case surge nobody really expected at this point. In response to the growing delta transmission, it was announced Friday that attendees will be required to provide proof of full vaccination or a negative test within 72 hours of each ticketed festival day. Organizers remind people who are not yet vaccinated that they only have until this Friday to get their first shot in a two-dose series or until Aug. 20 for the one-dose Johnson & Johnson to be considered fully vaccinated and allowed entry.  

For additional precaution, touchless wristbands, cashless transactions and more than 350 hand sanitizing stations will be available. It’s recommended guests wear masks, but they are not, yet, required. Further details can be found on the Bottlerock website.

San Francisco

  • CDC transmission level: High
  • Total Confirmed Cases: 40,285
  • Cumulative case increase since June 15: 9.2% 
  • Hospitalizations/ICU: 78/22
  • Total Deaths: 563
  • Deaths added to cumulative total since June 15: 13  
  • Fully Vaccinated: 77%
  • Partially Vaccinated: 84%
  • Unvaccinated: 16%

Source: San Francisco Department of Public Health and California Department of Public Health with data pulled Saturday, July 31, 2021. 

It was discovered Friday that more than 230 mostly vaccinated staff members at UCSF and Zuckerberg San Francisco General Hospital are currently infected with Covid-19. Dr. Lukejohn Day, the Chief Medical Officer of San Francisco General Hospital attributes staff cases to “easing of restrictions,” adding:

“We are seeing it among physicians, nurses, ancillary staff, we sort of are seeing that across the board.”

According to Dr. Day, most cases are attributed to community spread and SFGH has yet to identify patient-to-staff or staff-to -patient transmission. 

SFGOV A health care worker receives one of the first doses of the Covid-19 vaccine at Zuckerberg San Francisco General Hospital in San Francisco, Calif., on Tuesday, December 15, 2020.

However, Day said: 

“But we still have some active investigations that are going on.”

As of Thursday, hundreds of San Francisco bars showed a united front in requiring patrons to prove vaccination status or a negative Covid-19 test prior to entry. 

City and county employees have been subject to a vaccination mandate since Wednesday.

San Mateo County

  • CDC transmission level: Substantial
  • Total Confirmed Cases: 44,430
  • Cumulative case increase since June 15: 5.1% 
  • Hospitalizations/ICU: 28/9
  • Total Deaths: 588
  • Deaths added to cumulative total since June 15: 7 
  • Fully Vaccinated: 79.6%
  • Partially Vaccinated: 89.3%
  • Unvaccinated: 10.7%

Source: San Mateo County Health Department and California Department of Public Health with data pulled Saturday, July 31, 2021. 

In a county that now requires all people wear masks inside government buildings, one supervisor has had just about enough, bluntly laying blame for surging cases at the feet of those who refuse vaccination. Noting that cases have nearly doubled in San Mateo County over the past two weeks, Supervisor David Canepa said: 

“To those who are unvaccinated, shame on you! Shame on you! We’re in a life and death situation and the decision that you’re making is affecting my residents. And you’re affecting residents who live in the state of California.”

Canepa said that city and county leaders will be closely monitoring the situation over the course of the next several weeks to determine if more or less restrictions are appropriate.  

Santa Clara County

  • CDC transmission level: Substantial
  • Total Confirmed Cases: 123,404
  • Cumulative case increase since June 15: 3.2% 
  • Hospitalizations/ICU: 93/27
  • Total Deaths: 1,709
  • *Deaths added to cumulative total since June 15: – 
  • Fully Vaccinated: 78%
  • Partially Vaccinated: 84%
  • Unvaccinated: 16%

Source: Santa Clara County Public Health Department and California Department of Public Health with data pulled Saturday, July 31, 2021. Santa Clara County criteria for Covid-19 death reporting in early July, which lowered the prior county by about 22 percent.   

Nearly 30 percent of the county currently hospitalized Covid-19 patients are being treated in ICU beds.

San Jose Unified School District teachers and staff will be subject to twice-weekly Covid-19 testing unless they provide proof of full vaccination, the district announced Tuesday. They were the first and remain the only large Bay Area school district to adopt such a clear and regimented policy, but it’s expected other districts will soon follow.

Going above and beyond the latest CDC guidance, all district staff and students will be required to mask up indoors and outdoors unless eating or drinking, engaged in physical education activity or are alone.

The county seems poised to introduce vaccination requirements beyond what state law dictates. Santa Clara County counsel James Williams said Friday it increasingly looks like county employees will be required to get vaccinated unless they have valid medical exemptions, and jobs will be on the line if they refuse.

Solano County

  • CDC transmission level: High
  • Total Confirmed Cases: 36,004
  • Cumulative case increase since June 15: 7% 
  • Hospitalizations/ICU: 67/14
  • Total Deaths: 249
  • Deaths added to cumulative total since June 15: 5 
  • Fully Vaccinated: 58%
  • Partially Vaccinated: 70%
  • Unvaccinated: 30%

Source: Solano Public Health and California Department of Public Health with data pulled Saturday, July 31, 2021. 

Solano County, which stubbornly remains the least vaccinated throughout the Bay Area, is also stubbornly avoiding changes to health guidelines that may help. Despite cases doubling last week over the prior seven-day period, Dr. Bela Matyas, Solano County’s health officer, claims the CDC’s recommendation for indoor masking is misguided. He attributes the transmission surge to private and outdoor social settings that the indoor mask recommendation won’t impact.

As of Friday, just 26 percent of the county’s total ICU beds remained available. The average test positivity rate was more than 19 percent over the last seven-day period, which hasn’t been seen in the county since the end of January. 

Solano County Public Health Test positivity rate graph for Solano County, Calif. showing a more than 19 percent positivity on July 28, 2021, which is similar to rates seen at the end of January. (Graphic image courtesy of Solano County Public Health)

Sonoma County

  • CDC transmission level: High
  • Total Confirmed Cases: 32,880
  • Cumulative case increase since June 15: 7.1% 
  • Hospitalizations/ICU: 59/14 
  • Total Deaths: 330
  • Deaths added to cumulative total since June 15: 14  
  • Fully Vaccinated: 70%
  • Partially Vaccinated: 78%
  • Unvaccinated: 22%

Source: County of Sonoma and California Department of Public Health with data pulled Saturday, July 31, 2021. 

Dr. Sundari Mase, the county health officer, said county residents and businesses will likely see stronger health measures roll out next week, adding:

“When you have a variant that is 60% more transmissible, this is the outcome.”

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