Marin's coronavirus stay-home order is extended

Marin County is now under an indefinite extension of the state’s coronavirus stay-at-home order as regional intensive-care-unit bed availability dropped to a low of 0.7 percent on Jan. 11.

California implemented the stay-home order for the Bay Area — the traditional nine counties plus Monterey and Santa Cruz — effective Dec. 17, when regional bed availability dropped below the 15-percent trigger. The order was to last at least three weeks, or through Jan. 8, but won’t be lifted until the California Department of Public Health projects availability to meet or exceed 15 percent again. Those projections are based on actual available beds, community transmission and regional case rates, and the proportion of cases being admitted to the ICU.

California confirmed the indefinite extension for the Bay Area on Jan. 9. Marin had previously joined four other Bay Area counties to issue a pre-emptive stay-home order effective Dec. 8, which shut down indoor and outdoor dining, hotels, campgrounds, museums, zoos, hair salons and other personal-care services. Retail stores are allowed to stay open at 20-percent capacity, grocery stores at 35 percent and essential businesses can continue operations. Both indoor and outdoor gatherings with members of other households are prohibited.

Phasing in the vaccine

The latest stay-home extension comes as more than 14,000 doses of COVID-19 vaccine have been administered to Marin residents and workers, with the county slated to begin the third and final tier of Phase 1A in its distribution model. Marin’s Phase 1A rollout of the two-dose Pfizer vaccine began Dec. 16, its Moderna counterpart days later. The phase focuses primarily on high-risk health-care workers, first responders and older adults in congregate-living facilities.

The working model is based on criteria developed by the Centers for Disease Control and Prevention, its Advisory Committee on Immunization Practices and by the California Department of Public Health, with Marin officials saying they have little wiggle room to make local adjustments.

Phase 1B is expected to start later this month or in early February, starting with residents 75 and older and high-risk essential workers such as educators and those in food and agriculture. It will then move to residents 65-74, broaden to more moderate-risk critical workers and include others in congregate settings, such as those in prisons, jails and the homeless.

“We are greatly following the state’s directive as closely as possible, and we’re keeping equity at the forefront of what we want to accomplish here in Marin to make sure that our communities, especially the ones most hardest hit by COVID-19, get the opportunity to get the vaccine as soon as possible,” said Dr. Benita McLarin, the director of Marin Health and Human Services.

Phase 1C is expected to start in late February or early March for those ages 50-64, as well as anyone 16-64 with an underlying health condition, alongside another expansion to lower-risk essential workers. Phases 2 and 3 will begin in late spring and summer, respectively, and be targeted at the general population, though full guidance is not yet complete.

Marin’s public-health officer, Dr. Matt Willis, said it will take about six months to get through all three phases and their tiers, with “open season,” where anyone who wants a vaccine can have one, in three to four months.

“There’s no list — you don’t need to worry that you need to get on a list to be notified,” he said. “Everyone in the county has the right to be vaccinated. It’s free for everyone. … As we get doses we’ll get the word out.”

He said he expects “normal life” to return in late summer or fall, once there’s about a 70-80 percent vaccination rate.

“For those who have to wait a few weeks for their turn, recognize it’s probably because others are at higher risk,” Willis said. “By protecting those who are most vulnerable, we protect all of us. Our vaccination plan is a chance to recognize the difference between privilege and vulnerability and to make room for everyone.”

ICU availability dictates lockdown

In the meantime, Marin remains under the state-mandated stay-home order that’s affecting four of five regions. As of The Ark’s press deadline Jan. 11, the Bay Area had 0.7 percent bed availability; the Greater Sacramento region has 9.7-percent availability; and the Southern California and San Joaquin Valley regions each report no availability. Northern California, the only region that has not been subject to the order, has 35 percent availability.

Marin County on Dec. 20 quietly stopped publicly reporting its own total ICU capacity and bed-availability count and percentages following weeks of scrutiny about the accuracy and transparency of its data.

The county had been using a unique internal calculation that differed from the method used by the state, reporting only its “functional” capacity — the 29 ICU beds that were already staffed or could be within four hours. That figure did not include at least 10 other existing physical ICU beds or dozens of potential surge ICU beds that could be staffed with travel nurses, overtime, cross-training and -staffing or by canceling non-essential procedures, among other potential staffing solutions.

As a result, when the county on Dec. 14 reported it had 0-percent bed availability, local health officials were forced to issue a press release on Dec. 16 stating that local hospitals still, in fact, were able to accept new ICU patients and that the reported bed availability instead represented a transition from normal to surge operations.

In a footnote of its emailed Dec. 20 coronavirus status update, the county said “the method for recording and reporting Marin County ICU capacity is being revised by Marin Public Health, local hospitals and the California Department of Public Health to ensure accurate reporting.”

Marin public-information officer Laine Hendricks and public-health officials have not responded to The Ark’s repeated requests for comment on when the revision will be complete and whether the county will provide more data publicly.

California has been no more transparent with its data, offering a mishmash of figures such as county-level bed-count availability and regional percent availability, but no counts of total county or regional beds.

Marin on Jan. 11 reported eight coronavirus patients in county ICU beds, with the state of California reporting the county has 13 available staffed beds.

However, according to a weekly report by the U.S. Department of Health and Human Services, the county on Jan. 10 had a seven-day average of 33.1 staffed ICU beds, 18.8 used by both COVID-19 and non-coronavirus patients — a weekly average of 14.3 available beds, suggesting roughly 43 percent availability.

Other metrics show community transmission is still spreading. According to the California COVID Assessment Tool, an ensemble estimate based on six independent models suggests Marin’s effective reproduction rate is 1.14 as of its last update Jan. 9, meaning each person with a confirmed infection is transmitting the virus to at least one other person.

When the ICU-based stay-home order is lifted, each county will again be individually reassigned to one of the four color-coded tiers under the state’s blueprint to reopen the economy based on per-capita case rates and test positivity.

The California health department shows Marin’s seven-day-average adjusted case rate of new infections is 15.2 per 100,000, more than double the seven per 100,000 required to qualify for the state’s most-restrictive purple tier for widespread transmission. The seven-day average test positivity rate is 3.7 percent, which taken alone would qualify the county for the third tier, orange, for moderate risk.

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.