JUNE 9 — Worship and cultural ceremonies, peaceful protests and use of swimming pools are among the outdoor activities that can resume on the Tiburon Peninsula and across Marin under a surprise announcement from the county last week, which came even as Marin has the highest coronavirus new-case rate in the Bay Area, infections surpassed 500 countywide and Marin recorded three new deaths, the first in nearly a month.
Dr. Matt Willis, Marin’s public-health officer, said the acceleration in cases is driven mostly within the county’s low-income communities, where about 85 percent of new cases over the past two weeks were among Latinos, largely those living in San Rafael’s Canal district.
In a powerful message posted to YouTube last week, Willis discussed the nationwide protests surrounding the death of George Floyd at the hands of a Minneapolis police officer and pointed to Marin’s health-care gap and structural, institutionalized conditions that have left some populations vulnerable.
“The protests are about change and shine light on how the structures and institutions we’ve built hurt the health of certain groups,” he said. “The reasons are mainly structural, in the way poverty leads to conditions that spread COVID-19.”
Driven within Marin’s low-income and Hispanic populations, the county had some 62.5 new cases per 100,000 residents over the past two weeks, where only 25 are allowed by the state of California for a county to reopen the economy more swiftly than the state allows, ranking Marin among the worst 10 of California’s 58 counties. By comparison to bordering counties, Sonoma’s new-case rate is 32.2 per 100,000 residents, Contra Costa’s is 27.3 and San Francisco’s is 40.6.
“We’re still embedded in a hotbed and may enter onto (California’s) watch list if we continue to see spikes in cases,” he told the Marin Board of Supervisors last week.
“Reassuringly, we have not seen spikes in hospitalizations, and it’s a surprise that this number of cases has not yielded a proportional increase in hospitalizations,” he added, noting it may relate to the fact that infections are being found among those who are “maybe younger and healthier and are less likely to have those more severe outcomes.”
The county did report three new deaths June 1 and 2, bringing the total to 17. All are older than 65, with 15 white, one Latino and one Asian.
Also, for the first time in nearly three months, Marin’s public-health officials also publicly estimated the prevalence of infection, with Willis saying he believes some 5 percent of residents have likely been infected at some point. While roughly 600 of the county’s 260,000 residents have tested positive for COVID-19, Willis’ estimate suggests roughly 13,000 have been infected and are either current carriers or may now have antibodies. It would also mean that some 12,500 residents silently carried the disease — and that some 247,000 have no immunity at all.
At the start of the initial shelter-in-place order in mid-March, Willis and the county’s deputy public health official, Dr. Lisa Santora, had estimated roughly 1 percent of residents had been infected, or about 2,600 people.
Marin: 589 confirmed cases, 17 deaths, 52 hospitalizations per the Marin Department of Health and Human Services as of 4 p.m. June 7. Up from 501 cases, 14 deaths the previous week. The seven-day rolling average June 7 is 4.75 new cases per 100,000 residents, up from 4.25 on May 31.
California: 131,319 confirmed cases, 4,653 deaths, per the California Department of Public Health as of June 8. Up from 113,006 cases, 4,251 deaths the previous week.
U.S.: 1,938,823 cases, 110,375 deaths, per the U.S. Centers for Disease Control and Prevention as of 1 p.m. June 8. Up from 1,787,680 cases and 104,396 deaths the previous week.
World: 6,931,000 cases and 400,857 deaths, per the World Health Organization as of 1 a.m. June 8. Up from 6,057,853 cases and 371,166 deaths the previous week.
A glance at the new rules
Officials had spent much of the past two weeks saying outdoor worship and limited indoor retail were targeted to return June 15, with indoor dining and hair salons under consideration to reopen by the end of the month under two-week rollouts timed with the virus’ incubation period and the ability to monitor for any case surges from previous reopenings.
While most of those target dates are still on track, officials on June 5 issued updated guidelines for outdoor worship and three previously unaddressed sectors, which took effect June 6.
“The steps we’re taking today are at a midway point between larger stages of reopening,” Willis said. He noted all the new rules impact outdoor activities.
“I’m more concerned about future moves regarding indoor settings,” he said.
Here’s a look at some of the guidelines:
• Outdoor faith-based and cultural ceremonies: Under physical-distancing protocols that separate non-household groups by at least 6 feet, events may host up to 100 people or the maximum allowed with distancing, whichever is the least. Food and beverage are only allowed as required by faith, and items such as texts, mats and cushions can’t be shared or loaned. Chairs and microphones must be disinfected between uses, entrance and release times must be phased and social lingering isn’t allowed at the end of the event.
For the complete guidelines, visit marinrecovers.com/faith-based-organizations.
• Peaceful outdoor public protests: Protests are now allowed under a new appendix updating the county’s most recent public-health order, which was issued May 15. The update restricts attendance at outdoor protests to 25 percent of an area’s maximum occupancy and requires 6-foot physical distancing from people of different households. Face coverings are also required.
Read Appendix C-2 at arkn.ws/homeorder and the frequently asked questions guide at coronavirus.marinhhs.org/faq/136.
• Outdoor swimming pools: Under the same appendix, outdoor swimming is now allowed, but only with one swimmer per lane — more if swimmers share a household — but total swimmers can’t be more than one per 300 square feet. Locker rooms must be closed, except for use as a restroom, and gatherings aren’t allowed on the pool deck. While the county guidelines state swimming doesn’t require shared equipment, kickboards and buoys are often provided by facilities, and the county otherwise has forbidden use of shared equipment without sanitation between users.
The complete guidelines are also available as part of Appendix C-2.
• Dog parks: Also under the appendix update, all dog parks can reopen, though water fountains, benches and other high-touch areas within such parks must remain closed.
• Charter boat operators: Charter boats must be limited to a maximum of 10 people, including the captain and staff, with the ability to maintain 6-foot distancing, with face coverings worn at all times. Bathrooms must be sanitized after each use, and the boat and equipment after each trip and hand sanitizer should be placed at every rod station. Equipment and fish shouldn’t be handled my multiple people, coolers can’t be shared with people from different households and food and drink can’t be sold on board.
For the complete guidelines, visit marinrecovers.com/parks-outdoor-recreation and scroll down “Charter Boat Operators.”
Disproportionate impact in Marin
Willis said last week that his “best understanding of the experience of structural racism is through the lives of my patients,” noting that he spent four years as a physician on a Navajo reservation that now has among the highest mortality rates in the nation — and that some of his former patients have died.
Marin, he said, is the most affluent county in California and has the longest life expectancy, yet it also has the largest gap between communities: “People in Ross can expect to live an average 15 years longer than people in Marin City, just miles away. Those are the facts, the data — but it’s up to us to apply meaning and to decide if we find that acceptable.”
He said the coronavirus is taking advantage of preconditions that exist in Marin, where Latino residents are 10 times more likely to get infected. Overall, Latinos make up 16 percent of Marin’s population but account for 64 percent of all cases and 30 percent of hospitalizations since testing began.
“People with low income are more dependent on daily income and are less likely to be able to work from home. Most have been out in the workforce since the beginning of the shelter-in-place, with increased exposure while the virus has been circulating,” he said. “Second, due to rent and housing prices in Marin, people of low income share housing to pool income for rent, living in crowded conditions, increasing transmission within the household and across generations.”
Willis said such household transmission is a primary driver of new cases. In the Canal area, for example, he said the average household has six residents, and those exposed and infected when on front-line jobs in the community are bringing the virus home.
“Third, people of low income are less likely to have health insurance or regular medical providers,” Willis said. “Finally, people in this community, especially immigrants, have an understandable distrust in government, including public health, and may not have access to basic information in their own language.”
Willis said the county is seeking to address the health-opportunity disparity through several means, including education campaigns about physical distancing, face coverings, hand-washing and not going to work if ill “in the language they need to hear it.”
The county is also working to step up testing, which has included opening a facility in the Canal area but also to add more mobile testing within at-risk communities, for front-line workers of large employers such as grocery-store chains and for skilled-nursing and residential-care facilities, where infections among caregivers outpaces patients, while all 15 of Marin’s deaths are among residents older than 65.
The county has also issued health orders to ensure hotel rooms can be used by front-line workers and those who need to isolate or quarantine away from their primary residences.
In addition, on June 9, after The Ark’s press deadline, the Marin Board of Supervisors was expected to establish a COVID-19 income-replacement fund for low-income workers to help encourage them to stay home if they’re sick.
The fund would be seeded with a $50,000 grant from the Marin Community Foundation and a $50,000 match from the county.
“In order to slow the rate of community spread, it is imperative that these individuals isolate/quarantine for 14 days, (but) isolation/quarantine is a privilege that doesn’t extend to people living in communities disproportionately impacted by COVID,” Assistant County Administrator Angel Nicholson said in the staff report prepared for the board. “Low-wage earners cannot typically afford to be out of the workforce for 14 days. … In addition to providing hotel space for quarantine and food, this fund will allow the most vulnerable in our community to get well with decreased economic impact.”
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.