While California’s guidelines amid the coronavirus pandemic now say counties can allow retail book, music, clothing, flower, toy and sporting-goods shops to reopen for curbside pickup and delivery, Marin and the rest of the Bay Area won’t be relaxing their stricter, unified regional stay-at-home order until May 18.
“Working in concert with regional health officers, Marin County Public Health recognizes that to take this step safely will require time to prepare,” county health officials said in a press statement last week.
Gov. Gavin Newsom on May 7 announced the retail guidelines that would go into effect the following day, May 8, but Dr. Matt Willis, the county’s public-health officer, said the county needed more time to ensure child care was available for the newly mobilized workforce and that cities and towns would be able to coordinate and accommodate traffic from curbside pickup and delivery services.
The region’s public-health officials said May 6 they will announce the details of the local changes sometime this week.
Meanwhile, another extension to the Bay Area shelter-in-place order is expected by next week, as the current regional order is set to expire May 31.
Gradually relaxed iterations of the localized shelter orders are expected to continue for a year or longer, as Marin last week announced its own three-phase plan to reopen the county’s economy.
That plan will include the efforts of the county’s new Marin Recovers working groups, in which representatives from more than a dozen sectors will develop industry-specific protocols.
But, just like California’s four-stage plan, Marin’s final phase will require herd immunity — either through broad infection or a vaccine that experts say is still 12-18 months away.
Marin: 261 confirmed cases, 14 deaths, per the Marin Department of Health and Human Services as of May 10. Up from 240 cases, 13 death the previous week.
California: 67,939 confirmed cases, 2,770 deaths, per the California Department of Public Health as of May 10. Up from 54,937 cases, 2,254 deaths the previous week.
U.S.: 1,324,488 cases, 79,756 deaths, per the U.S. Centers for Disease Control and Prevention as of 1 p.m. May 10. Up from 1,152,372 cases and 67,456 deaths the previous week.
World: 4,006,257 cases and 278,892 deaths, per the World Health Organization as of 1 a.m. May 11. Up from 3,435,894 cases and 239,604 deaths the previous week.
Phased reopening of California, Marin
Marin has been working with five other Bay Area counties and the city of Berkeley in issuing largely unified regional orders. The latest order, which was announced April 29 and took effect May 4, was to last the rest of the month. It allows the restart of all construction, gardening and landscaping while letting some outdoor businesses like plant nurseries to reopen.
Just as that order went into effect, however, Newsom announced California achieved some critical public-health metrics necessary to further relaxing the statewide guidelines, giving the counties permission to individually allow some retail curbside pickup starting May 8.
Under Newsom’s four-stage plan to end the state’s open-ended stay-at-home order, California has now exited Stage 1, in which it built up coronavirus testing and contact tracing while preparing for a potential surge in COVID-19-related hospitalizations.
Having met those baseline goals, the state is now in Stage 2, which focuses on opening lower-risk workplaces in multiple phases. The first phase, which is underway elsewhere in the state, allows retail to reopen with delivery curbside pickup, along with manufacturing and more offices where telework isn’t possible, while child-care and educational programs may resume in small groups. Newsom on May 12, after The Ark’s press deadline, was expected to announce guidelines so counties may begin reopening dine-in restaurants, shopping malls and outdoor museums.
Stage 3 will include higher-risk spaces like hair and nail salons, gyms, movie theaters, houses of worship and sporting events without live audiences.
“(Stage 3) is not six months away. It’s not even three months away. It may not even be more than a month away,” Newsom said May 8.
Stage 4 will require a vaccine — which could be a year and half away — and will end the state stay-at-home order by allowing the largest-risk events, such as concerts, conventions and sports with live audiences.
Under Stage 2, retailers are being asked to develop contactless payment systems, have hand sanitizer available for workers and customers, ensure employees have protective gear and to deliver goods directly to customers’ vehicles when possible. Break rooms are to be closed and replaced with outdoor break areas with loosely spaced seating, where possible.
Marin is expected to announce its version of these rules this week, to take effect beginning May 18.
Marin and other counties will have the ability to reopen more swiftly than the state within Stage 2 if local public-health officials can prove they meet several criteria, including no more than one new case per 10,000 residents and no COVID-19-related deaths in the prior 14 days, at least 1.5 tests per 1,000 residents and 15 contact tracers per 100,000 residents, as well as the ability to handle a hospital surge and provide essential-worker and nursing-facility access to protective equipment, among others.
The Bay Area, however, has had consistently stricter policies than California’s base guidelines since the initial shelter-in-place orders were issued nearly two months ago and will likely remain a week or two behind the state in implementing updates.
Willis says that because SARS-CoV-2, the virus that causes COVID-19, has up to a two-week incubation period for symptoms to present, the region will need at least that long after every set of rule changes to see whether those changes cause a spike in infections. If that happens, officials could roll back the eased restrictions to contain the spread of the virus. If it doesn’t, officials can consider relaxing further restrictions.
Even if Marin were to break away from the unified Bay Area order to attempt to move more swiftly, the county would fail several of the state’s metrics — including deaths and new cases — and would not yet be able to reopen more quickly than the rest of the state.
However, Marin has established its own three-phase approach to reopening, with the county still in the first phase.
Phase 1, to slow the spread of the virus, has six metrics — half of which have been achieved. Health officials say the county has successfully stabilized cases and hospitalization rates, prepared medical facilities to handle a potential surge in cases and established an accurate monitoring system to get timely data from hospitals and labs.
However, before Marin can fully move into Phase 2, sequential reopening under a continued stay-at-home order, and on to Phase 3, the end of the shelter order with widespread immunity, public-health officials require:
• Adequate testing capacity, or the ability to test at least 500 residents per day, up from about 280 per day currently.
• Improved contact tracing, isolation and quarantine, with the ability to reach and isolate 90 percent of positive COVID-19 cases and then quarantine their contacts within 24 hours of diagnosis.
• Safety criteria to reopen all sectors, including businesses, schools and transportation.
For the latter requirement, the county has formed the Marin Recovers task force, an effort to bring together leaders from across more than a dozen sectors with members of government and public-health officials to develop the standards to safely get back to work.
Marin Recovers launches
Under Marin Recovers, the county administrator’s office has selected leaders to create small work groups of five to eight industry advisers each, representing restaurants, retail, real estate, construction, parks and outdoor activities, religious activities, general office space, schools, summer camp and youth opportunities, transportation, the arts, hospitality and personnel services.
Each work group will advise on developing the guidelines for a “safe, economically sound and socially sensitive recovery and reopening plan” for each industry, sector or business in Marin, then Willis will have the authority to roll out those reopenings in intervals of about every two weeks as his office monitors for any spikes in coronavirus cases.
Marin Recovers is seeking feedback from the public and business leaders, including from those who would like to take part in the work groups. The deadline to submit the form, which can be found via arkn.ws/marinrecoversinput, is May 15.
The Marin Recovers website, which went online last week at marinrecovers.com, is more of a catch-all guide for the county’s coronavirus response, offering the outline for the phased approach to reopening; links to daily updates, frequently asked questions and COVID-19 surveillance data; guidelines for physical-distancing and hygiene; and links to resources for businesses, schools, housing, transit, parks and open spaces and public safety, as well as how residents can help or get help.
FDA crackdown on antibody tests; patients offer plasma in Marin
The U.S. Food and Drug Administration announced last week it is cracking down on coronavirus antibody tests — which are designed to identify those previously exposed to the virus — after its own relaxed rules caused a flood in the market of more than 250 tests with varying degrees of accuracy.
On March 16, the FDA had issued a policy that allowed manufacturers to self-report the accuracy of their tests, with no evidence provided to the FDA of their effectiveness, and then market those tests under a promise they’d eventually be submitted for emergency-use authorization. The policy was intended to apply to certified labs under a presumption of proper validation.
The hope was to put tests on the market as quickly as possible, but some manufacturers were falsely claiming their tests were FDA-approved or FDA-authorized, and many tests were unreliable, giving false-positive results that could lead people to believe they had previously been infected and are now immune.
The new rules, issued May 4, now require commercial manufacturers to submit their requests — plus validation submitted to the FDA for the results of their antibody tests — within 10 business days. Those tests now must also meet minimum performance guidelines.
The rules are retroactive to tests currently on the market.
Only about a dozen tests have been authorized by the FDA, with about 200 more in pre-authorization or authorization-review stages, the FDA said last week.
“These tests may be important for guiding our next steps in the fight against this pandemic, such as by providing information on disease prevalence and the frequency of asymptomatic infection, and also by identifying potential donors of ‘convalescent plasma,’ an approach in which blood plasma containing antibodies from a recovered individual serves as a therapy for an infected patient with severe or immediately life-threatening disease,” FDA representatives said last week.
In Marin, Willis has said the county’s contact investigators are asking those who have recovered from COVID-19 if they are willing to donate plasma, and most of the more than 200 patients have said yes, according to the Marin Independent Journal.
The county’s pool of potential donors comes only from those previously diagnosed with an active infection using the nasal-swab test, and plasma from each donor could be used to help treat as many as four patients.
It remains unclear whether or how long those with antibodies will have enough effective antibodies to fight off reinfection, and the WHO and other agencies, including the Marin health department, continue to warn that there is not enough evidence of test accuracy or antibody-mediated immunity to dictate public-health policies or to guide individual behavior, which would include so-called “immunity passports” that may allow those with positive antibody tests to return to normal life.
• Marin County will be required to send vote-by-mail ballots to all registered voters for the Nov. 3 general election under a statewide executive order issued May 8. Such ballots usually are sent only to registered voters who have opted in to permanent mail-in voting.
“No Californian should be forced to risk their health in order to exercise their right to vote,” Newsom said.
• Officials for the California Department of Motor Vehicles say they hope to begin reopening field offices as early as this month, which may include the office in Corte Madera. Offices would open for in-person visits by appointment. The DMV closed field offices March 27 and extended driver-license expiration dates for residents younger than 70 until May 31, with 120-day extensions for those older than 70, as they are at higher risk of complications from COVID-19. Services available online, at dmv.ca.gov, include vehicle-registration renewals, title transfers, lost driver’s-license replacements and temporary license extensions.
• Health officials in the Bay Area and across the U.S. and Europe are reporting dozens of cases of what’s being called pediatric inflammatory multisystem syndrome, or PIMS, in which children who have tested positive for COVID-19 or antibodies against it have inflammation of the blood vessels, heart, skin and eyes. The symptoms are similar to the rare disorder Kawasaki disease and can cause aneurysms if left untreated.
• Three members of the White House Coronavirus Task Force — National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci, CDC Director Dr. Robert Redfield and FDA Commissioner Dr. Stephen Hahn — are self-quarantining for two weeks after reportedly coming into contact with someone with COVID-19. They’re being tested daily. The news, announced May 9, came a day after Vice President Mike Pence’s press secretary tested positive, though it was not made clear to whom the task force members had been exposed.
• An internal White House model prepared by the Federal Emergency Management Agency is reportedly predicting as many as 3,000 COVID-19-related deaths per day in the U.S. by June 1, according to the New York Times. The Times reports the average daily deaths are about 1,750 under its own models, and the WHO reported the U.S. peak to date at 2,909 deaths on April 30.
Meanwhile, a popularly cited public model by the Institute for Health Metrics and Evaluation at the University of Washington has doubled its predicted total U.S. deaths to roughly 137,000 by Aug. 4 as states begin to reopen. Its mid-April projection was roughly 61,500 total U.S. deaths by Aug. 4, a figure already surpassed.
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.