Despite a surge in the rate of new COVID-19 infections across Marin that’s outpacing the county’s increase in testing, health officials last week continued to reopen the economy by issuing new public-health guidelines that allow for indoor retail, automotive sales and household cleaning services.
Health officials are also looking ahead, saying they hope to restart indoor dining service and reopen hair salons, gyms and hotels in Marin by June 29 — even if it requires petitioning the state for permission to move forward.
California and 18 other states saw a rise in new cases last week as states stepped up testing, but also as economies reopened and new infections from Memorial Day weekend activities and early Black Lives Matter protests began to register in county health departments. Marin continues to have the highest rate of new infections in the Bay Area at 82.4 cases per 100,000 residents, ranking it eighth worst among California’s 58 counties, according to an Ark survey of counties. While Marin typically has about one to six hospitalizations at a given time, last week the figure bounced from three to one to 10 in a matter of days.
With the bulk of protest-related infections and the Fourth of July holiday just weeks away, new models from Johns Hopkins University, the Rand Corp. and the COVID Tracking Project also now suggest a predicted surge in cases in fall has shifted up to late July or August in California.
In a series of public forums throughout last week, Marin Public Health Officer Dr. Matt Willis, said he agrees the risk of the surge is real and that some 95 percent of Marin residents still remain susceptible to SARS-CoV-2, the coronavirus that causes COVID-19.
“The virus is still with us,” Willis said. “We’re seeing more COVID-19 now than we ever have, so we’re not opening up because it’s safe, we’re opening up because it’s impossible to just stay closed forever, and it’s going to be two years before we get a vaccine.”
Marin: 725 confirmed cases, 17 deaths, nine current hospitalizations per the Marin Department of Health and Human Services as of 4:20 p.m. June 15. Up from 589 cases, and 1 hospitalization the previous week.
California: 151.452 confirmed cases, 5,089 deaths, per the California Department of Public Health as of June 14. Up from 131,319 cases, 4,653 deaths the previous week.
U.S.: 2,085,769 cases, 115,644 deaths, per the U.S. Centers for Disease Control and Prevention as of 1 p.m. June 15. Up from 1,938,823 cases and 110,375 deaths the previous week.
World: 7,823,289 cases and 431,541 deaths, per the World Health Organization as of 1 a.m. June 15. Up from 6,931,000 cases and 400,857 deaths the previous week
Willis was careful to emphasize that the apparent policy shift since Marin joined the six-county Bay Area coalition to issue the nation’s first shelter-in-place order in mid-March was always part of the plan. The county sought preparedness under Phase 1 of its response, with a sequential reopening of the economy once it entered Phase 2.
“The economic harm and other harms as the shelter-in-place starts to eclipse the potential harms of transmission, and those are challenging decisions to make in terms of balance,” he said. “But we’ve also had a lot of time to prepare, so our hospitals are now fully prepared for surge,” while there’s now adequate testing capacity and contact-tracing to move forward.
Marin’s Phase 3 would allow for a full reopening — including concerts, sports with live audiences and conventions — once there’s a vaccine, which experts since March have said would take 12-18 months.
Willis said the number of hospitalizations remains the first indicator he checks each day, and that figure has been generally flat. If it spikes, he said, the county could slow its reopening or even roll back some rules.
He said people’s individual behavior will determine whether that happens.
“A hair salon or gym opening up doesn’t mean it’s safe to do that, it means you’re free to do that. There’s a certain amount of intrinsic risk that people need to take into account in their own decision-making,” Willis said.
He separately said residents need to continue wearing face coverings, physically distancing, washing their hands and limiting nonessential travel within the framework of the shelter-in-place.
“I feel discouraged when I look out and see people not wearing masks and interacting in ways, because I fear that the reopening decisions … are leading to a false sense of security, or a sense that the coast is clear, it must be safe.”
A look at the guidelines
The county’s Marin Recovers Industry Advisors task force last week issued several new guidelines that went into effect June 12.
• Indoor retail: Stores can only operate at 50 percent capacity or the maximum number of customers at which physical distancing is possible, whichever is fewer, and businesses can establish time limits to shopping. An employee must monitor capacity and ask overflow customers to queue at 6-foot distances at the door. Stores should continue to provide curbside pickup, where feasible, so customers don’t have to go inside to shop. Customers and employees will have to sanitize or glove their hands before handling any merchandise, and clothing cannot be tried on.
For a look at the full guidelines, visit marinrecovers.com/retail.
• Personal cleaning services: For residential properties, residents can’t be present during cleaning. For commercial properties, no employee or member of the public can be in the immediate office or space during cleaning.
Read the guidelines at marinrecovers.com/personal-services.
Absent any further surge in hospitalizations, Willis said he thinks Marin will be ready to restart indoor dining service and reopen hair salons, gyms and hotels by June 29.
But to do so, the county will be at the mercy of the state.
California frequently rolls out new sectors that are allowed to reopen. In some cases, the guidelines apply to every county statewide, and local public-health officials are then free to move forward at their own discretion, such as restarting retail, construction and day camps.
For other sectors, however, counties may only move forward if they meet a set of public-health metrics, such as testing and hospital-bed capacity, that demonstrate the county has the virus under control and can respond to a surge.
Opening indoor dining, hair salons, gyms and hotels all currently require special permission from the state — but Marin is among the seven of the state’s 58 counties that doesn’t have a variance.
Willis said last week that he hopes the county will either transition those sectors so any county can reopen them at local officials’ discretion by June 29, or Marin may seek special permission to reopen early.
The county’s new-case rate alone is a disqualifier at more than triple the 25 cases per 100,000 residents sought by the state to consider new infections to be under control. But Willis said the state has introduced an alternative method to demonstrate the county is prepared for a surge.
“We may apply for a variance if it’s the only way to move forward as a county and into elements that we feel ready for,” he said.
Antibody-testing value still uncertain
Willis said he remains wary of the value of antibody testing for now and doesn’t yet recommend people get them.
While the PCR test, which typically uses a long nasal swab, tests for active infections, the serology blood-draw test seeks to detect antibodies in recovered patients that could indicate immunity from reinfection — a key to returning to normal life.
But Willis, who beat COVID-19 himself and has twice tested positive for antibodies, said the current science has two problems.
First, he said, it remains unclear whether “my level of antibodies protect me in any meaningful way.”
“The answer to that is we don’t know,” he said.
The second problem is that touted performance characteristics of the test don’t accurately portray the predictive value of the results.
Willis notes, for example, that if a test correctly identifies 97 percent of patients who don’t have antibodies, three out of every 100 negative people will return a false-positive result. This may seem small, but when the prevalence of a disease in a population is low, it can combine to become problematic.
To scale it out, if 5 percent of Marin’s 260,000 residents have been infected, then 13,000 people should test positive and the remaining 247,000 should test negative.
But if 3 percent of residents without antibodies return a false-positive result, the test would return roughly 7,400 false positives.
Combined, of more than 20,000 total positive results, more than a third would be false.
For an individual seeking a so-called “immunity passport,” a positive test result doesn’t yet provide accurate or complete enough information to safely influence a change in behavior toward higher-risk activities.
In other developments
• Marin health officials say anyone who has participated in a public protest and was not able to maintain social distance should seek a free COVID-19 test seven days after the demonstration at lhi.care. Gov. Gavin Newsom and health experts said they fear protests throughout the state and U.S. will lead to a surge in new infections.
• Antiviral drug remdesivir is now part of the county’s treatment arsenal. With limited supplies, the county has assembled a small commission for allocating the drug and has now used it twice to help patients survive. The U.S. Food and Drug Administration granted emergency use authorization on May 1. The drug was originally developed to treat Ebola virus but was ineffective.
• Marin is now separately tracking a coronavirus outbreak in San Quentin State Prison, which until last week had been entirely spared of cases. On June 8, the California Department of Corrections and Rehabilitation confirmed that prisoners at the California Institution for Men in Chino had not been tested for weeks before nearly 200 prisoners were transferred by bus to other facilities. Chino had the deadliest prison outbreak in the state and on May 30 moved 121 prisoners to San Quentin, 14 of whom tested positive after they arrived. Some 12 more prisoners have since tested positive, and others showing symptoms have been quarantined.
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.