Coronavirus roundup: Mask directive is step toward loosening shelter order; COVID-19 a leading cause

APRIL 20 — Marin and California public-health officials signaled last week the coronavirus shelter-in-place order will extend beyond the Bay Area’s May 3 end date, but with modifications that will allow for looser restrictions. In preparation for such a shift, the county became the second in the Bay Area last week to order the mandatory use of face coverings in certain situations beginning noon today, April 22.

“We need to make sure we can interact more safely in public before we consider any changes to the shelter-in-place order,” Dr. Matt Willis, Marin’s public health officer, said in a press statement.

Meanwhile, the number of global cases surpassed 2 million, the number of global deaths passed 150,000, and coronavirus has become a leading cause of death in the U.S., pacing heart disease. The number of deaths in California and the U.S. have also now exceeded last year’s flu season.

Marin: 199 confirmed cases, 10 deaths, per the Marin Department of Health and Human Services as of 4 p.m. April 20. Up from 164 cases, 10 death the previous week.

California: 30,333 confirmed cases, 1,166 deaths, per the California Department of Public Health as of 4 p.m. April 18. Up from 21,794 cases, 651 deaths the previous week.

U.S.: 746,625 cases, 39,083 deaths, per the U.S. Centers for Disease Control and Prevention as of 4 p.m. April 20. Up from 554,849 cases and 21,942 deaths the previous week.

World: 2,314,621 cases and 157,847 deaths, per the World Health Organization as of 1 a.m. April 20. Up from 1,773,084 cases and 111,652 deaths the previous week.

Marin face-covering requirements

A directive issued by Marin public-health officials on April 17 requires the use of face coverings in certain settings beginning today, a five-day rollout that attempted to give residents time to procure or create their own masks.

Sonoma County on April 13 became the Bay Area’s first to issue a face-covering requirement; its rule went into effect at noon April 17. Hours after Marin’s order, San Francisco followed with a similar rule that went into effect April 18.

As outlined in the Marin order, face coverings are not required by the general public when interacting with household members inside or outside the home. However, coverings will be required in essential settings when physical distancing isn’t possible, including:

• When inside public spaces or waiting in line to enter public spaces.

• When seeking health care.

• When waiting for or riding on mass transit or other shared transportation.

• In common areas of buildings, such as hallways, stairways, elevators and parking facilities.

• By workers at businesses physically open and in areas where the public is present, likely to be present or at any time when others are nearby.

• By workers in any space where food is being prepared and/or packaged for sale.

• By drivers and operators of public transit.

“Covering our faces is something we do to protect all of us,” said Willis, who returned to work last week after being diagnosed with COVID-19 and recovering. “The decision to cover your face is a decision to support our well-being as a community. If we can really do this, if we can get this down, it will help eventually give us more freedom to travel and interact more within our community. Facial covering will be an important part of the new normal.”

Children ages 12 and younger are exempt, as are those exercising or otherwise recreating outdoors — though officials say people “should carry (a face covering) with them and must continue to practice physical distancing.”

Places of business may also refuse service or admission to those who refuse to comply.

Under the order, a face covering may be “made of cloth, fabric or other soft or permeable material, without holes, that covers only the nose and mouth and surrounding areas of the lower face,” with examples including “a scarf or bandana; a neck gaiter; a homemade covering made from a T-shirt, sweatshirt or towel, held on with rubber bands or otherwise; or a mask, which need not be medical-grade.”

Rather, officials request that the general public not purchase medical-grade masks, such as surgical masks and N95 respirators, due to limited supplies that are needed for health-care providers, first responders and other front-line essential workers.

‘You will not return to normal this year’

“Normalizing” face coverings is the Bay Area’s first step toward easing the shelter-in-place order — a mandate that could spread statewide or even across the West Coast as public-health officials coordinate their responses.

On April 13, Gov. Gavin Newsom and Marin’s deputy public health official, Dr. Lisa Santora, gave separate briefings that hinted at a timeline for easing restrictions but never quite landed on one.

Newsom said the statewide timeline will depend on a series of public-health benchmarks, including the state’s ability to track the virus through testing, the capacity of hospitals, how well the vulnerable are protected and whether businesses and schools can demonstrate they can accommodate physical-distancing guidelines.

He said the measures would likely include the continued use of face coverings, a ban on large gatherings through summer, that restaurants may need fewer tables with diners’ temperatures checked at the door, and that if kids are able to return to school in the fall, class times may need to be staggered to prevent crowding.

Those rules could remain in place until a vaccine is developed and a significant enough portion of the population is inoculated, which likely would be well into 2021.

Newsom also announced a “western states pact” with Oregon and Washington to collaborate on public-health strategies that will allow the coastal states to reopen their economies, noting “COVID-19 doesn’t follow state or national boundaries.”

While the state’s shelter order is indefinite, Marin’s order is set to expire May 3. However, Santora said the county is planning an extension “to buy time for tools … to both treat this disease and to prevent it through vaccination.”

“You will not return to normal this year. I do not anticipate us returning to normal next year,” she said.

Santora said the three conditions that must be in place to ease restrictions in Marin include preparing hospitals for a potential surge in cases, which includes the number of beds, staff and protective equipment; “optimized testing” that ensures “residents have access to rapid antibody testing to see if they have developed immunity to exposure of COVID-19”; and, finally, a strong public-health-policy infrastructure to conduct contact tracing and identify patients for isolation and quarantine.

“We know that when we loosen (restrictions) … that will result in increased cases of COVID-19, will result in increased cases of hospitalizations and increased deaths in our community,” she said.

Strawberry Safeway worker diagnosed

A worker at the Strawberry Village Shopping Center Safeway has contracted COVID-19, according to a report by the Marin Independent Journal.

Safeway officials told the IJ the employee last worked March 27 and has since received medical treatment, but they did not provide any additional details on the worker’s role in the store or whether other employees were known to be exposed.

Safeway did not return an Ark request for comment by press deadline, and the county would not release any additional patient information, such as infections among grocery and other essential workers, beyond age and gender.

Bolinas offers free testing to community

Two Bolinas businessmen raised about $300,000 and partnered with the University of California at San Francisco to offer free drive-through COVID-19 testing to all residents ages 4 and older April 20-23.

ABC7 news reported the broad testing in rural Bolinas will be part of a UCSF study that also includes an urban setting, San Francisco’s Mission District.

“This study stands to benefit people at three levels — individuals, who will get to learn their disease status; the community, for the opportunity to isolate and eradicate the virus; and worldwide, through improved ability to understand how this virus spreads,” Bolinas resident Dr. Aenor Sawyer a UCSF orthopedic surgeon who acted as a liason and the project’s medical director, told ABC7.

Meanwhile, Carbon Health is planning to open Marin’s first mobile testing site at the Novato Fair Shopping Center from 9 a.m. to 6 p.m. April 27-28. Tests there are available to those with symptoms and those with high risk of exposure, such as essential workers.

Willis, the county’s public-health official, says that, broadly, capacity is still limited and that those without symptoms are not yet recommended for testing. He also notes that, until accurate antibody testing is more common, the current tests only indicate whether you’re sick at the date of testing.

COVID kills more than seasonal flu

WHO chief Tedros Adhanom Ghebreyesus said last week that COVID-19 is 10 times deadlier than swine flu, H1N1, which caused a global pandemic in 2009.

At the same time, the virus has now killed more Californians and more Americans than last year’s seasonal influenza.

In California, some 615 people died of influenza in 2018-2019, compared with 1,166 of COVID-19 to date, according to California Department of Public Health statistics. For the U.S., about 34,000 people died of the flu last year versus more than 39,000 of COVID-19 to date, according to CDC data.

The coronavirus is also on pace to become the nation’s leading cause of death.

It was the second leading cause of death in the U.S. the first two weeks of April, killing more Americans than any other single factor except heart disease for a comparable time frame, the Washington Post reports. Daily coronavirus deaths have increased in that time and were on pace to eclipse heart disease as the leading factor.

Other developments

• County and Marin Community Foundation officials are seeking to double the foundation’s COVID-19 Fund of MCF to $2 million after “it quickly became evident that the greatest need was in the area of immediate rental assistance,” officials said April 17.

The fund, created last month, was initially seeded with $500,000 each from the county and foundation, and on April 21, after The Ark’s press deadline, the Marin Board of Supervisors was to be presented with a proposal to contribute an additional $500,000 to be matched by the foundation.

Officials said the fund quickly received some 1,475 requests for rental assistance, with nearly $800,000 allocated to 487 low-income residents for April rent.

To contribute to the fund, visit arkn.ws/MCFCOVIDfund.

• Marin officials on April 15 announced the cancellation of the 2020 Marin County Fair, which had been set for July 1-5 and draws more than 100,000 people a year. The fair is tentatively scheduled to return on the same dates in 2021.

• The Golden Gate Bridge, Highway and Transportation District announced April 15 that Golden Gate Transit is limiting passenger counts to eight on its 40-foot buses and 10 on its 45-foot buses, while Golden Gate Ferry is limiting the number of passengers based on vessel site. The district operates the Route 8 weekday commuter bus from downtown Tiburon to San Francisco’s Financial District and the weekday commuter ferry between Tiburon and the San Francisco Ferry Building.

• The Metropolitan Transportation Commission announced April 16 that the Golden Gate district is in line to get more than $30 million and Marin Transit $5.4 million under the federal Coronavirus Aid, Relief and Economic Security Act. The commission is set to receive a $781 million distribution of the $1.3 billion for which it is eligible in support of Bay Area transit agencies.

“These funds will help save a lot of jobs for the bus drivers, train operators, mechanics, dispatchers, cleaners and others who are making it possible for other essential workers to get to and from their jobs all around the Bay Area; and will help our transit agencies recover their footing when this public health emergency finally is behind us,” officials said.

• California has become the first state in the nation to offer coronavirus relief for undocumented workers. The state on April 15 announced a $75 million relief fund to issue $500 per adult with a $1,000 household cap to some 150,000 undocumented workers who are otherwise ineligible for unemployment insurance benefits or disaster relief. Individuals will be able to apply next month.

In addition, the state pointed to the Grantmakers Concerned with Immigrants and Refugees network of nonprofits, which is raising $50 million to help families of undocumented workers. To donate, visit immigrantfundCA.org.

• New York state’s Department of Health reports that more than 86 percent of its COVID-19 deaths include at least one comorbidity — or the presence of another chronic condition in a patient. In order, the state’s top 10 comorbidities are hypertension; diabetes; high cholesterol; coronary artery disease; dementia; atrial fibrillation, a heart condition; chronic obstructive pulmonary disease, a respiratory disease; renal disease; cancer; and congestive heart failure.

• After four consecutive days of U.S. deaths surpassing 1,900 in a single day — reaching 1,931 on April 10, according to the WHO — the daily toll fell to roughly 1,500 April 13-14.

The peak and subsequent decline appeared to be in line with the predictions of the influential model by the Institute for Health Metrics and Evaluation at the University of Washington, until it wasn’t. On April 15, some 2,395 people died, making it the virus’s deadliest single day in the U.S.; the figure held, at 2,350, the following day and had not fallen below 2,000 deaths per day by The Ark’s press deadline.

Kevin Hessel is The Ark’s executive editor. Reach him at 415-435-2652, on Twitter at @thearknewspaper and on Facebook at fb.me/thearknewspaper.