CDC may have misjudged California Covid-19 risk with old data

The CDC said half of Californians live in high-risk counties. But the agency apparently relied on outdated numbers of COVID infections and patients. Newer data indicates only 19 counties are in the CDC’s riskiest category, where universal masking is advised.

Federal health officials who reported that nearly half of Californians live in “high-risk” counties for Covid-19 were relying on old data, and only a small number of counties now fall into that category, according to local officials.

At stake is whether counties considered high risk should keep indoor masking requirements under new guidance from the U.S. Centers for Disease Control and Prevention or follow the state’s lead in removing nearly all mask requirements.

Kamlesh Kaur, a spokesperson for the Stanislaus County Department of Public Health, said the county was surprised to be designated high risk by the CDC. The most recent Covid-19 case rate for Stanislaus County is about 13 times lower than what the CDC reported on Friday, she said.

The CDC’s estimates appear to be outdated by more than a month.

She said:

“I’m not sure when (the CDC) received their data. They are showing a little over 200 cases per 100,000 residents. Right now our cases are at 18.2 per 100,000 residents.” 

The CDC’s new guidance for measures that counties should take to protect residents is based on three criteria: the percent of hospital beds occupied by a Covid-19 patient, the seven-day case rate per 100,000 residents and the seven-day hospital admission rate.

The federal agency on Friday released a map showing that more than half of California’s 58 counties, and 49 percent of its residents, fell into the high-risk category using those three metrics.

But a CalMatters analysis of state data detailing the first two criteria suggests only 19 counties, home to 5.8 million people or 14 percent of the population, should be considered high risk under the CDC’s thresholds and therefore are advised to keep indoor mask mandates. (The California Department of Public Health only reports total hospital admissions — not new ones.)

The 19 high-risk counties include Kings, Fresno and Imperial along with a handful of other, less-populated Central Valley and far north counties.

Kaur said Stanislaus County’s current data places it in the mid-tier group, where the CDC deems indoor masking for vaccinated and unvaccinated people unnecessary. The county follows state guidelines and will not be issuing stricter guidance, Kaur said, although public health officials still are strongly recommending masks.

The CDC did not respond to questions about the sources of its data. The agency is expected to update the tool weekly, starting Thursday.

Los Angeles County, which has implemented some of the strictest Covid-19 mitigation measures in the state, indicated it would align its policies with the CDC’s new guidance for counties.

The CDC placed Los Angeles County in the highest risk tier, but the county’s numbers suggest otherwise.

The state’s most populous county has a weekly average of 10 new cases and 7.4 hospital admissions per 100,000 residents, and about 6 percent of all hospital beds are occupied by Covid-19 patients. These numbers put the county well below the thresholds CDC set for low-risk counties.

Los Angeles County Public Health Director Barbara Ferrer said she expects the county to fall into a less-stringent tier this week.

In a Tuesday meeting with the Los Angeles County Board of Supervisors, Ferrer said:

“You can see that even last (week) we were on the cusp of moving to lower thresholds, and we are pretty clear that when CDC updates their dashboard we will move to low risk.”  

Ferrer added:

“On Friday, when we move into low or medium risk, just about all of these (masking) requirements will become strong recommendations.”

Los Angeles County still requires vaccinated and unvaccinated people to wear masks indoors, but it plans to relax those rules as soon as Friday, once the county is moved out of the CDC’s high-risk category.

California’s indoor mask mandate for vaccinated persons expired on Feb. 15. Then the state dropped its mask requirement for unvaccinated people on Tuesday, and for schools starting March 12.

The CDC’s use of the outdated data and the widespread confusion over the disparate state and federal guidelines call into question just how effective or useful the CDC’s masking recommendations will be. In California, most counties other than Los Angeles appear to be following the state’s masking guidance, not the new federal guidelines.

Dr. Norma Perez, a pediatrician at AltaMed in Los Angeles, said the varying guidelines — at the national, state and local levels — are confusing to the public.

She said:

“We practice in Los Angeles and Orange County, and just between those two counties we sometimes see different levels of masking being recommended.”  

While providers try to keep up with the changing rules, their message for patients is that masking is highly recommended, especially if they’re at higher risk for severe illness, Perez said.

Loosening of state and federal mask rules has come under fire from scientists and community advocates for not including vaccination rates or accounting for disparities among hard-hit communities.

Throughout most of the pandemic, California’s statewide protections — and those implemented by some counties — have been more cautious and often more strict than those issued by federal health officials. California was the first to order residents to shelter in place; it’s guidelines for school reopenings were more rigorous than the CDC’s; and more recently, during the omicron surge, state guidelines for allowing infected people back to work required a negative test, while the CDC only asked for five days of isolation.

But in recent months, masking orders have become increasingly divisive in communities and among legislators.

Last month, nearly 100 Sonoma County health workers and community advocates sent a letter urging the county health department to delay joining the state in ending masking for vaccinated individuals. Regardless, Sonoma and 11 other Bay Area counties, with the exception of Santa Clara, lifted masking restrictions in accordance with state guidelines.

Dr. Jennifer Fish, a physician who signed the letter, said the Latino community continues to be disproportionately harmed by COVID hospitalizations and deaths. While Latinos make up less than 24 percent of the local population in Sonoma County, they account for 50 percent of cases, 40 percent of hospitalizations and 31 percent of deaths.

Fish said:

“It’s important to understand that the impact goes beyond those metrics. Those are community members that are at higher risk of losing their jobs, losing their homes, and food insecurity.” 

African American and Pacific Islanders across the state are also dying at disproportionate rates, despite efforts to increase vaccinations and testing.

The group of Sonoma County health workers and advocates hopes the county will reconsider removing mask requirements from schools, where a third of student cases have occurred among the most disadvantaged students.

Fish said:

“Even if the risk is less than it was during the peak of the surge, the risk is still higher among vulnerable communities. We want policy that prioritizes our most impacted students.” 

Santa Clara County is one of the few counties to set its own thresholds for unmasking, including vaccination. On Tuesday, Dr. Sara Cody, the county’s health officer, announced that those metrics had been met.

Cody said the county can drop its masking requirement starting today because hospitalizations are low and stable and the moving average number of daily new cases has been under 550 for seven days. Nearly 85 percent of the county’s population is vaccinated.

Cody said while the mask requirement is no longer in effect, residents are still encouraged to wear a mask indoors, especially to protect those at higher risk of illness.

Cody said:

“Preventing infection is still a worthy goal. … And we know that masks are effective at preventing infection; they are still a very important layer of protection for an airborne viral respiratory disease.”

Sen. Richard Pan, a Sacramento Democrat, and chair of the Senate health committee, said in a statement that while case rates are decreasing, “they remain high and too many Californians remain vulnerable.” A pediatrician, he encouraged residents to keep masking indoors, including schools.

Meanwhile, Sen. Melissa Melendez, a Republican from Lake Elsinore and the vice chair of the same health committee, has spoken against prolonging mask mandates in schools.

In a statement following the state’s mask update, Melendez said:

“It’s not the science that has changed, it’s the political science that has changed. It’s clear the mounting political pressure from parents and Californians are driving these decisions.”

This story was originally published by CalMatters. 

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