JULY 20 — Marin saw 106 new COVID-19 cases in a single day last week, shattering the previous one-day record of 75 as the county continues to be monitored by the state for exceeding minimum case and positivity rates. Tiburon’s total case count also grew to 26, while data for Belvedere is being reported for the first time as the city hit 14 total cases, giving it the highest per-resident concentration of infections in Southern Marin.
But Marin’s top public-health official notes that despite the increase in number and percentage of new infections, the number and proportion of hospitalizations continues to fall, with fewer hospitalizations per new case.
Meanwhile, with Marin barred from any new reopenings as long as it remains on the state’s watch list, the county on July 21 was set to establish a new non-criminal citation framework. The rules would allow jurisdictions to fine residents $25-$500 for violating public-health orders such as face-covering and physical-distancing mandates — a lesser penalty than the misdemeanor charge and $1,000 fine, jail time or both that has been on the books since April 17.
A new task force would also follow up on tips from residents about businesses violating COVID-19 health rules and potentially issue citations of up to $10,000.
Tiburon Peninsula: 26 diagnosed Tiburon cases, 14 Belvedere cases, per the Marin Department of Health and Human Services as of 4 p.m. July 20, up from 20 Tiburon cases and an unknown number of Belvedere cases the previous week. Strawberry, and previously Belvedere, had an unknown number of diagnosed cases between zero and 10, with the figure withheld by the public health department in an effort to protect patient privacy.
Marin: 2,288 diagnosed cases, 1,699 recovered, 31 deaths, 32 current hospitalizations — 24 community, eight San Quentin — per the Marin health department as of 4 p.m. July 20. Up from 1,809 cases, 1,312 recovered, 28 deaths and 26 hospitalizations the previous week.
San Quentin State Prison: 922 active cases in custody and 12 cumulative deaths per the California Department of Corrections and Rehabilitation as of 3 p.m. July 20, down from 1,437 active cases and up from 10 deaths the previous week.
California: 391,538 diagnosed cases, 7,694 deaths, per the California Department of Public Health as of July 20. Up from 320,804 cases, 7,017 deaths the previous week.
U.S.: 3,761,362 cases, 140,157 deaths, per the U.S. Centers for Disease Control and Prevention as of 1 p.m. July 20. Up from 3,296,599 cases and 134,884 deaths the previous week.
World: 14,348,858 cases and 603,691 deaths, per the World Health Organization as of 1 a.m. July 20. Up from 12,768,307 cases and 566,654 deaths the previous week.
Belvedere has Southern Marin’s highest concentration
Until last week, Belvedere has had an unknown number of diagnosed cases between zero and 10, making it difficult to gauge just how prevalent the virus was in the fairly remote city of 1,900 people, which sits at the southern tip of the peninsula and is only accessible through Tiburon or by boat.
The figure was previously withheld by the county to help protect patient privacy, according to the Marin Department of Health and Human Services, but is now reportable at 14 cumulative diagnosed cases.
That puts Belvedere’s cumulative case rate at 736 per 100,000 residents, compared with 289 per 100,000 in Tiburon, which now has 26 total cases. Neighboring Sausalito, with 30 total cases, has 428 per 100,000 residents; Mill Valley, with 19 total cases, has 136 per 100,000 residents; and Corte Madera, with 41 total cases, has 440 per 100,000 residents.
San Rafael has the highest number of diagnosed infections and the highest rate, at 1,030 total cases and 2,503 per 100,000 residents.
New enforcement options
Belvedere’s coronavirus data was revealed just days after the city formally established non-criminal fines for face-covering violations.
Seeking a middle ground between issuing ineffective warnings and leveling misdemeanor charges against people who don’t wear face coverings in public, the Belvedere City Council affirmed July 13 that anyone caught not wearing a mask or physically distancing would be subject to a $100 administrative citation, with escalating fines of $200 for a second violation and $500 for each subsequent violation.
The council vote upholds an emergency order issued by City Manager Craig Middleton July 8.
Middleton said at the council meeting that he viewed the misdemeanor penalty as too harsh, while it has also been difficult getting people — particularly young folks — to comply just by issuing warnings.
“The options are either too lenient to accomplish the enforcement task or too consequential to be used,” Middleton said.
The rest of Marin is now following suit.
At its July 21 meeting, after The Ark’s press deadline, the Marin Board of Supervisors was expected to approve an urgency ordinance that would establish an enforcement framework, which would include noncriminal fines of $25-$500 for residents violating the public-health orders, which could still be elevated to the misdemeanor penalty with larger fines and jail.
At the same time, the county is forming its own business strike teams, patterned after those created earlier this month by the state.
Marin’s team includes the Community Development Agency’s code-enforcement division, Environmental Health Services, the Sheriff’s Office and the County Counsel’s Office and will work with the county’s city and town governments to enforce the guidelines put out by the Marin Recovers Industry Advisors task force.
The July 21 urgency ordinance would establish noncriminal fines of $250 to $10,000 for business violating COVID-19 health orders. The fines would depend on the risk to public health, previous warnings and lack of a good-faith effort to comply, with consideration of a business’s increased revenue generated from not complying with the requirements.
“Cities and towns will continue to focus on education to ensure compliance with public-health orders,” Tiburon Town Manager Greg Chanis, chair of the local city and town managers association, said in a press release. “The virus doesn’t respect borders, so we need consistent and flexible tools to educate and enforce in our communities.”
In addition, on July 16 the county set up an email address, at SIPviolation@marincounty.org, for residents to report business violations of coronavirus health orders. Those emailing the tip line should include the business name and address, as much detail as possible, as well as photos and other documentation if available.
Reopenings in Marin on hold
Marin County remains among the 32 counties on the California’s COVID-19 watch list, which monitors for elevated disease transmission, increased hospitalization and limited hospital capacity.
Marin first landed on the list July 2, with a warning that three consecutive days without improvement would trigger an automatic mandate to roll back indoor activity. That mandate was activated July 5, with indoor dining forced to close down at 11:59 that night for at least three weeks, through July 27.
It’s unlikely indoor dining will be allowed to reopen by then, however, as Marin remains on the watch list with 225.5 new cases per 100,000 residents over a rolling 14-day average as of July 20, and 10.9-percent testing positivity over a rolling seven-day average. The state’s goal is to have either fewer than 100 new cases per 100,000 residents, or both fewer than 25 new cases per 100,000 residents and less than 8-percent testing positivity. Marin fails both targets.
The county won’t be allowed to reopen any new sectors until it’s off the watch list. On July 13, Gov. Gavin Newsom ordered watch-list counties to roll back other indoor activities, which in Marin included hair salons, indoor malls and general office spaces.
Positive signs despite new cases
Early in the pandemic, Marin case totals were largely driven by infections among residents 50 and older, with ages 35-49 close behind. But in late May, cases among the latter group and those 19-34 began to surge. That continued into mid-June, with case counts swelling among all age groups as those 19-49 continued to surge. About the same time, the number of infections among those 18 or younger also surpassed those 65 and older, adding to the downward shift in age for new infections.
Residents 19-34 make up 15 percent of Marin’s population but 31 percent of all cases and just 11 percent of hospitalizations; those 18 and younger make up 21 percent of the population but just 4 percent of hospitalizations and zero deaths.
“That’s been an important shift for us in Marin — and it has been also seen across the nation — and in our case reflects the fact that we are seeing more cases among our workers, essential workers, who tend to be younger, out in the workforce,” Marin Public Health Officer Dr. Matt Willis told the Marin Board of Supervisors on July 14. “It also corresponds to a decrease in the proportion of people who become ill who need to be hospitalized, because they tend to be healthier and have fewer of those comorbidities or age factors that we know correlate to more severe outcomes.”
Willis said workers in the essential workforce also overlap with the surge in cases among the county’s Latino population, who make up 16 percent of Marin residents but continue to account for about 77 percent of all coronavirus cases.
The surge is primarily centered in San Rafael’s Canal district, where the majority of residents is Hispanic and work in essential jobs in high-density, multigenerational households. Those essential workers become index cases, Willis said, bringing infections home to families.
“A high proportion of people are asymptomatic or mildly symptomatic and are diagnosed based on our contact investigation, and not diagnosed because they’re presenting to testing with active disease and symptoms, which corresponds with our decrease in hospitalizations,” Willis said.
Elderly at risk
Marin’s seniors represent about 21 percent of the population and just 12 percent of infections, but they account for 37 percent of hospitalizations and 94 percent of deaths. Some 69 percent of deaths are among those older than 80.
The primary driver of deaths in Marin remains residential-care and skilled-nursing facilities for the elderly, which account for roughly 80 percent of the county’s deaths, according to Willis — and it’s generally an asymptomatic staff member who brings the virus into the facility.
Willis said the county continues to dedicate a team to such facilities for testing, outreach and education, that a county public-health order bans visitation to prevent the spread of the disease and that another order requires facilities to test staff on a monthly basis in weekly blocks of a quarter of the staff. He said if any worker tests positive, the county attempts to respond the same day to test other residents and staff.
Across the county, 145 total patients and 148 staff have been infected since the pandemic began, and 21 facilities currently have active infections.
Tiburon’s only nursing home
Not among them is Marin Convalescent and Rehabilitation Hospital, which sits on four acres at 30 Hacienda Drive. The facility has not had a single COVID-19 infection, hospitalization or death as of July 12, according to the most recent California Department of Public Health records.
“I’m not projecting that into the future, but we have been quite fortunate,” administrator Kevin Hogan said in an interview last week.
He said the hospital, which can accommodate up to 56 patients and has about 30, implemented strict protocols early on and has remained vigilant.
“About March 10, we were not comfortable with what was happening,” he said. “We stopped all visitation (and) we limited doctor visits to what was absolutely necessary.”
Many patient appointments are now done online via Zoom, and families have been supportive and appreciative of the restrictions, he said.
Patients and staff are masked and gloved and, when appropriate, gowned. Employees have their temperatures taken when they arrive at work and when they leave for the day. The community dining and activity rooms are off-limits. New patients are put in quarantine for two weeks.
“These are measures I would hope every hospital is taking,” Hogan said.
“It’s been a serious team effort because I can’t control what happens outside this building,” he said of the facility’s staff. “I make sure they under they understand, if they are asymptomatic, they may spread it throughout the facility without knowing it. We make people understand that if they don’t follow the rules, they could cause a death.”
He acknowledged there have been a few scares.
“Some have other nursing jobs. As soon as they learn that someone where they work elsewhere has been exposed, we put them off work immediately and have them tested immediately,” he said. “Seven days after any symptoms and the test, they can come back to work.”
A staff member who had to travel to Southern California because of a death in her family was kept off work for 10 days after her return because Los Angeles is a hot spot, he said.
Matthew Hose and Deirdre McCrohan contributed to this report. Kevin Hessel is The Ark’s executive editor. Reach him at 415-435-2652.