APRIL 27 — Marin public-health officials say they will announce an extension and any changes to the Bay Area’s coronavirus shelter-in-place order this week, as the regional order is set to expire May 3 and Gov. Gavin Newsom told Californians last week “we are not prepared” to reopen large sectors of society.
“Our biggest challenges are ahead of us as we try to balance the needs for opening our economy while preventing surges in disease, knowing that the virus is part of our environment, and that so many of us remain susceptible to COVID-19,” Marin’s public-health officer, Dr. Matt Willis, said April 22 after Newsom’s announcement.
Meanwhile, at least half of Marin’s deaths have come from senior-care facilities; California and the U.S. had new peaks of 151 and 2,471 deaths, respectively, on April 22, while total California and U.S. deaths surpassed 1,500 and 50,000, respectively, last week; Newsom eased restrictions on elective procedures; the emptied-out Paycheck Protection Program got a $310 billion cash infusion; new data from Santa Clara County shows the first confirmed U.S. death was weeks earlier than previously thought; two pet cats have tested positive for SARS-CoV-2, the virus that causes COVID-19; and California has announced a series of new initiatives for volunteers, seniors and those with student loan debt.
Marin: 224 confirmed cases, 12 deaths, per the Marin Department of Health and Human Services as of 6 p.m. April 26. Up from 199 cases, 10 death the previous week.
California: 43,464 confirmed cases, 1,755 deaths, per the California Department of Public Health as of 4 p.m. April 26. Up from 30,333 cases, 1,166 deaths the previous week.
U.S.: 957,875 cases, 53,922 deaths, per the U.S. Centers for Disease Control and Prevention as of 1 p.m. April 26. Up from 746,625 cases and 39,083 deaths the previous week.
World: 2,878,196 cases and 198,668 deaths, per the World Health Organization as of 1 a.m. April 27. Up from 2,314,621 cases and 157,847 deaths the previous week.
In a joint press statement April 27, Marin and other Bay Area public-health officials said they will extend the regional shelter-in-place order through the end of May, with “limited easing of specific restrictions.”
The announcement said specifics would be coming later this week.
The extension was expected. On April 22, the same day Marin’s new face-covering order went into effect, Newsom announced the statewide shelter-in-place directive will remain open-ended — though, in coordination with Washington and Oregon, he lifted a hold on elective surgeries and procedures, effective immediately.
Those include preventive-care services like colonoscopies, mammograms and vaccinations, as well more pressing non-emergency procedures like tumor removal and heart-valve replacements.
Purely cosmetic surgeries are still banned.
Newsom says the state still needs to expand testing sites and test capacity. In March, he said, about 2,000 tests were being performed a day, a figure that has increased to 16,000 per day but one he says needs to scale to 60,000-80,000 per day.
Willis, Marin’s health officer, says with about 2,500 nasal-swab tests on hand to detect active infections, the county has the capacity to test everyone who qualifies — namely those with symptoms. Willis says testing asymptomatic people is impractical, as they’re a point-in-time test with a roughly 20-percent false-negative rate.
In a livestreamed April 21 public forum, Willis said he’s been working with health officers across the Bay Area to design a “common agenda” for extending the regional order.
“There’s a clear recognition that it’s difficult for all of us to maintain this level of shutdown, societally, however necessary it has been to control this first phase of the epidemic — and those are the challenges to balance as we consider reopening,” he said.
In a video update the following day, he added that “the reality is, this is only the first state of a much larger and longer mission.”
According to a survey of 1,015 Californians conducted by Ipsos for the California Health Care Foundation, some 75 percent of respondents favor the stay-at-home order and say it should remain in effect “for as long as needed,” while 11 percent say the order should end immediately to restart the economy, even if it means increasing the spread of the virus.
Nationally, Dr. Deborah Birx, the White House’s coronavirus task-force coordinator, said April 26 that some form of physical distancing will last through summer, appearing to push back on Vice President Mike Pence’s suggestion that the worst will be over by Memorial Day, stating the U.S. will need a “breakthrough” in testing for antibodies to move toward normalcy.
Willis says that one of the key components to relaxing the rules will be accurate antibody tests. Unlike the nasal-swab tests, antibody tests can show who has been previously infected with the virus and recovered, which may help determine who is immune and who is susceptible.
“Right now, we estimate that at least 95 percent of our community is still susceptible, which is why we need to be so cautious as we lift any shelter-in-place elements,” he said.
More than 100 antibody tests have flooded the market under the U.S. Food and Drug Administration’s relaxed rules that don’t require verification or FDA approval. All have different and even unknown levels of accuracy.
“Getting faulty results is a problem and can be worse than getting no results, because we don’t want to assume someone is immune if they’re not, or vice versa,” he said.
He warned “it will take at least a month to better understand from a huge range of options what tests are most reliable to hang our hat on.”
Even then, he said, scientists still don’t know what level of immunity the detection of antibodies indicates.
The WHO is warning that those who have recovered from COVID-19 are not necessarily immune, issuing a brief last week that there is “currently no evidence” that people who have recovered have enough antibodies to protect them from a second infection.
“At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’ or ‘risk-free certificate,’” WHO said, throwing a wrench in suggestions that those who have recovered may be able to re-enter the workforce and help kickstart the economy.
Willis said last week that one of the county’s top priorities is controlling the spread of the virus at skilled-nursing facilities and other congregate living facilities, where staff and patients representing 47 of the county’s 224 total cases — roughly 20 percent — are spread across 10 sites.
Willis said about half of all county deaths have come from such facilities, though a Marin Independent Journal report suggests that figure is higher.
While the county does not release the names of the facilities, the IJ was able to identify several, mostly in San Rafael. The IJ reported April 24 that two people each have died at Three Home Village in San Rafael, Windchime of Marin in Kentfield and Atria Tamalpais Creek in Novato, with one death at Drake Terrace in San Rafael. Three Home Village reportedly has about two dozen confirmed cases among residents and staff.
While the paper was able to identify and contact five of the 10 total facilities, those five accounted for seven of the county’s 12 coronavirus-related deaths, or nearly 60 percent.
“We know that we need to be really very aggressive in terms of preventing outbreaks and then early detection of any activity and on-site mitigation, so that we can limit spread within those facilities,” Willis said. “They have a high risk for outbreaks because people are gathered closely together, especially when it’s challenging to control people’s behaviors — if it’s a memory ward or there may be people that have behavioral issues or dementia, which are common in those settings.”
First U.S. death weeks earlier than thought
The Santa Clara County Medical Examiner-Coroner’s Office announced it has new data indicating deaths on Feb. 6, Feb. 17 and March 6 were linked to COVID-19 — the earliest death being nearly a month before two Feb. 26 Seattle-area deaths that had been considered the first in the U.S.
The county had previously announced its first death was March 9.
According to a press release from the county of Santa Clara, the CDC confirmed April 21 that tissue samples from autopsies conducted on the individuals, who died in their homes, had tested positive for SARS-CoV-2, the virus that causes COVID-19.
Officials said they died during a time when testing was limited and only approved for people with a known travel history and who sought care for specific symptoms.
The individuals did not have a known travel history to China, suggesting they had all contracted the coronavirus through community spread as early as January.
The first confirmed case the U.S. was Jan. 20 in Snohomish County, Wash. — a man who had returned to the U.S. Jan. 15 after visiting family in Wuhan, China.
Marin property-tax penalty waivers
The Marin Board of Supervisors voted unanimously April 21 to give the director of finance the ability to waive property-tax penalties for reasons related to the coronavirus pandemic.
More than 87,000 Marin taxpayers met the April 10 deadline, which could not be extended under state rules in part because the scheduled revenue was required to fund critical county services and local financial obligations, including for schools, fire agencies, public health and safety, water and sanitation. As of April 21, some 95 percent of the taxes had been collected and distributed to local agencies.
However, nearly 4,500 taxpayers were delinquent, representing some $30 million, with more than 500 applicants seeking relief of more than $600,000 in penalties.
Under Marin’s new allowance, taxpayers will now have until June 10 to pay without penalty but need to file an application for the penalty waiver by May 15 at marincounty.org/penaltywaiver.
Stepped up testing for Marin City
A multiagency volunteer task force in Marin City is working to raise $50,000 to establish a drive-through testing site that seeks to screen every resident, an effort similar to the community campaign that offered free testing to all Bolinas residents.
According to the Marin IJ, the task force includes the Marin City Community Services District, Cronkite Development, Shore Up Marin City, the Sausalito Women’s Club and Showing Up for Racial Justice of Marin.
Marin City has a predominantly black population, a group that nationwide and in California is disproportionately affected by COVID-19. In California, some 12 percent of those who have died of the coronavirus are black versus roughly 6 percent of the population.
Infectious-disease and public-policy experts point to socioeconomic conditions that lead to higher-density populations and health disparities as contributing factors.
In Marin, roughly 2 percent of the population is black, but none of the 12 deaths and just one of the 43 hospitalized have been black, according to county data and Dr. Matt Willis, Marin’s public health officer.
“We’re not seeing the same trends that we are seeing nationally,” said Dr. Lisa Santora, Marin’s deputy public-health officer. “We have seen parity in how we are testing across our community, so our testing reflects the demographic profile of Marin County.”
For information on how to donate, contact organizers Alena Maunder at email@example.com or Paul Austin at firstname.lastname@example.org.
Two pet cats test positive in U.S.
The CDC on April 22 confirmed the first two cases of pet cats in the U.S. testing positive for SARS-CoV-2 in separate areas of New York.
Both cats had mild respiratory illness and are expected to survive.
In the first case, no members of the household were confirmed to be ill with COVID-19, and officials suspect the pet may have become infected from a mildly ill or asymptomatic household member or someone outside the home.
The second cat’s owner had already tested positive for COVID-19, though another cat in the home had no signs of illness.
Early studies from China published in Science magazine suggest cats and ferrets — which are illegal in California and Hawaii — are susceptible to the coronavirus, but that the virus replicates poorly in dogs.
The CDC is not recommending the routine testing of animals, but it recommends owners do not let other people or animals interact with their pets outside the home; to generally keep cats indoors; keep dogs on a leash and within the 6-foot physical-distancing guidelines from other people; and to avoid dog parks or other places where people and dogs gather.
Pet owners who have been diagnosed with COVID-19 should have another household member care for their pets and avoid contact, including petting and sharing bedding and food. If you must care for your pet, wear a mask and wash hands before and after touching your pet, the CDC says.
State volunteering initiative
Citing a loss of 70 percent of volunteers at food banks across the state, Gov. Gavin Newsom on April 21 announced the Californians For All service initiative to connect residents with volunteering opportunities, including options for those physically unable to volunteer, while also ensuring shelter orders and physical-distancing rules are met.
Roles include sewing masks, delivering meals, working in shelters, creating neighborhood chalk-art competitions, assembling hygiene kits and tutoring.
For more information, visit californiansforall.ca.gov.
Assistance for California seniors
California on April 24 announced a first-in-the nation meal-delivery program as well as a partnership to make wellness check-in calls and the expansion of Friendship Line California to help combat social isolation in effort to serve some 1.2 million residents ages 65 and older who live alone.
The Restaurants Deliver: Home Meals for Seniors program will seek to enlist community restaurants to prepare and deliver meals while providing support for restaurant owners and workers who have lost business.
The program will provide $66 per day for seniors — $16 for breakfast, $17 for lunch and $28 for dinner, plus $5 for incidentals. It will be up to counties to set up and administer the programs and be reimbursed by the state and Federal Emergency Management Agency. For more information, call 211.
The Social Bridging Project will enlist more than 1,000 people to call seniors isolating at home, with Listos California partnering with the California Department of Aging, United Airlines, Community Emergency Response Teams and Sacramento State University to check on seniors’ well-being and connect them to resources.
Finally, Friendship Line California will help provide emotional support to seniors facing loneliness, isolation and anxiety, an expansion of the state’s previously announced “Stay Home. Save Lives. Check in.” campaign to combat social isolation. Seniors may call 888-670-1360.
Under an initiative announced April 23 in California and other states, residents with privately held student loans may be eligible for financial relief, including three months of forbearance, the waiver of late-payment fees and enrollment in other assistance programs.
The federal CARES Act offered similar assistance for those with loans owned by the U.S. government, but the program offered by California now includes about 1.1 million people with privately held loans.
• President Donald Trump on April 24 signed a new $484 billion coronavirus-relief package that includes $310 billion for the Paycheck Protection Program, which provides small-business loans that can be forgiven if used for wages, benefits rent and utilities. The initial $350 billion for that program was all allotted the week prior. The new bill also provides $60 billion for Small Business Administration disaster-assistance loans and grants; $75 billion in grants to hospitals; and $25 billion to increase testing.
• Some 4.4 million Americans filed for unemployment the week ending April 18, the latest figure available from U.S. Department of Labor, bringing the five-week total beginning the week ending March 21 to 26.5 million jobs lost. California’s five-week total is about 3.35 million jobs lost.
According to “In Harm’s Way,” a report by the nonprofit Economic Roundtable, some 43 percent of all California workers have a high risk of unemployment. Among counties, Marin has the second-lowest percentage of workers at high-risk of unemployment in the state, at 35 percent; broken down by community, North Marin’s risk was 37 percent and Southern Marin’s risk was 33 percent. Some 10 percent of Southern Marin workers are considered essential, and 48 percent of all workers have the flexibility to work from home.
Marin as a whole was tied with Santa Clara County; San Francisco County was lowest-risk county, at 33 percent.
• CDC Director Robert Redfield said last week the outbreak could emerge this winter in conjunction with next flu season. He cited the need for a preventive campaign on the importance of flu shots to reduce flu hospitalizations.
• The U.S. Food and Drug Administration on April 21 approved the first test that allows people to self-swab at home. The LabCorp test will first be made available to health-care workers and first responders under a doctor’s order, but home kits will be made available to patients who take an online questionnaire. If approved for the test, the $119 kit will be shipped to the person’s home for the nasal swab, then returned back to LabCorp’s labs for analysis.
• The U.S. Department of Agriculture announced an emergency increase of $2 billion for its Supplemental Nutrition Assistance Program, representing a roughly 40-percent increase in benefits. The money will allow the average five-person household, of two adults and three kids, to receive $240 in additional benefits, which would raise them the $768 maximum-benefit level.
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.