Coronavirus roundup: July was Marin’s deadliest month; new data for care facilities, youth cases
AUGUST 3 — Marin recorded its deadliest day yet amid the coronavirus pandemic with six new deaths on July 31, capping the county’s most troublesome month since public-health officials issued the regional and statewide shelter-in-place orders in mid March. Marin saw 19 deaths in the three months between its first, on March 27, and June 30, then saw 32 in the next 31 days — a 168-percent overall increase. There were 45 new hospitalizations, bringing the total to 106, a 74-percent increase. And there were 1,610 new cases, for a total of 2,817 in Marin on July 31, a 133-percent increase.
While the number of new diagnosed cases in July mostly paced the increase in testing, that figure also comes with major caveats: In the final days of June, Marin’s testing positivity rose to state-watch-list-level highs not seen since March, then flattened and never fell off again, while the number of new cases per capita remains roughly twice what’s required to be removed from the watch list, a designation that rolled back some allowed activity and froze the local ability to reopen the economy any further.
Deaths remain driven by Marin’s oldest and most vulnerable residents. The county Public Health Department made two major changes to its available data sets last week, the first showing the total number of deaths at residential-care and skilled-nursing facilities for the first time. At 40, deaths in such facilities account for 74 percent of total COVID-19-related fatalities in Marin — 54 as of Aug. 3 — confirming previous estimates by local health officials.
The second change splits tracking of youth ages 18 and younger into two distinct groups: those ages 0-9 and those 10-18. That change comes amid a summer surge in diagnosed cases among Marin’s school-aged children as debates rage over when to restart in-class instruction.
Meanwhile, all three Tiburon Peninsula communities saw new diagnosed infections last week — with Belvedere having Southern Marin’s second-highest per-capita rate, at 789 cases per 100,000, behind Marin City — and the Marin Board of Supervisors again extended the countywide eviction ban for another month.
Tiburon Peninsula: 29 diagnosed Tiburon cases, 15 Belvedere cases, 12 Strawberry cases per the Marin Department of Health and Human Services as of 4 p.m. Aug. 3. Up from 26 in Tiburon, 14 in Belvedere and 10 in Strawberry.
Marin: 2,931 diagnosed cases, 2,496 recovered, 54 deaths, 24 current hospitalizations — 23 community, one San Quentin — per the Marin health department as of 4 p.m. Aug. 3. Up from 2,609 cases, 2,147 recovered, 40 deaths and 17 hospitalizations the previous week.
San Quentin State Prison: 145 active cases in custody and 21 cumulative deaths per the California Department of Corrections and Rehabilitation as of 4 p.m. Aug. 3, down up from 537 active cases and up from 19 deaths the previous week.
California: 514,901 diagnosed cases, 9,388 deaths, per the California Department of Public Health as of Aug. 2. Up from 460,550 cases, 8,445 deaths the previous week.
U.S.: 4,649,102 cases, 154,471 deaths, per the U.S. Centers for Disease Control and Prevention as of 1 p.m. Aug. 3. Up from 4,225,687 cases and 146,546 deaths the previous week.
World: 17,918,582 cases and 686,703 deaths, per the World Health Organization as of 1 a.m. Aug. 3. Up from 16,114,449 cases and 646,641 deaths the previous week.
County separates youth statistics
For most age groups in Marin, coronavirus cases began to climb in mid-May — about two months into the shelter-in-place order and about two weeks after the first significant reopening of the economy, which on May 5 included most outdoor businesses.
The May 18 rollout, which included outdoor recreation and curbside retail, also marked the start of weekly reopenings: Pet grooming on May 22, outdoor dining and retail June 1, outdoor worship and dog parks June 5, indoor malls and cleaning services June 12, social bubbles June 19, hair salons and indoor dining on June 29 — though indoor dining, malls and hair care were eventually rolled back in early July when Marin landed on California’s monitoring list.
For Marin’s youth, however, the steady rise in cases appears to have begun later, in mid June — about two weeks after the end of the academic year, which ended at-home instruction and kicked off social bubbles and wide enrollment in summer and sports camps.
That’s about when infections among a previously combined 0-18 age group overtook those ages 50-64 to become the third-largest group in Marin overall, behind ages 19-34 and ages 35-49.
On June 1, youth 18 and younger had combined for 68 total cases, compared with 105 among those ages 50-64. By July 1, there were 260 cases among youth compared with 232 among those 50-64. As of July 31, the rates had evened out again, at 408 and 409 cases, respectively.
The new breakdowns released by the county last week show the increase in cases among youth was largely driven by those 10-18. These older children account for about 10 percent of Marin’s population and roughly 8 percent of cases, or 237 as of July 31.
Younger kids 0-9 make up 11 percent of Marin’s population and account for 6 percent of cases, or 171 by July 31.
Older kids account for about 2 percent of hospitalizations, with no hospitalizations for younger kids and no deaths for children of any age.
The breakdowns comes as Marin public-health and school officials have said in-class instruction shouldn’t resume at least until Sept. 8, the day after Labor Day, while California says counties must be off the state watch list for at least 14 days before they can reopen classrooms. Some parents are pressing for school districts to take advantage of a waiver program to reopen classrooms, which only applies to elementary schools, amid conflicting studies about the danger of COVID-19 to young people and their ability to spread the virus.
The largest study to date, conducted by South Korean researchers, appears to confirm previous studies suggesting that younger children don’t transmit the virus as easily or have severe symptoms, but the study found that kids in middle school and older transmit the virus at least as easily as adults.
Deaths, hospitalizations, cases
On the other end of the spectrum, deaths and hospitalizations continue to disproportionately affect residents older than 65.
Of Marin’s 54 deaths, 74 percent have occurred in residential-care and skilled-nursing facilities, according to data released by the county for the first time. Marin had previously tracked only the number of cumulative and current positive patients and staff at such facilities, as well as the number of facilities in Marin with active cases, which sits at 36.
Health officials had previously estimated 75-80 percent of all deaths were in care and nursing facilities.
Some 96 percent of all deaths have been of those ages 65 and older, who comparatively make up 21 percent of the population. Further, 67 percent of all deaths have been among those 80 and older, who represent about 5 percent of the population.
Residents younger than 65 account for 79 percent of Marin’s population, but among them just two people have died: One person each in the age groups of 50-64 and 35-49 — in the latter group a man reportedly in his 40s — and no one younger.
Of 106 cumulative hospitalizations, 44 percent are among those 65 and older, more than twice the age group’s representation of the overall population. For ages 19-65, hospitalization rates roughly pace population rates.
Unlike deaths, however, hospitalizations are also disproportionately impacting residents by ethnicity.
Hispanic residents account for about 16 percent of the population but about 50 percent of hospitalizations. The case-rate disparity is even greater, with 75 percent of all diagnosed infections in Marin being among Hispanic residents.
Many of those cases are concentrated in San Rafael’s Canal area, which has a high proportion of lower-income Hispanic residents in the essential workforce who also live in high-density, multigenerational housing.
Health officials say Marin’s Hispanic population and essential workers are overlapping segments that are driving new cases, as those workers are often younger and healthier, then act as so-called index cases who infect colleagues at work and bring the virus home and infect household members.
Marin is attempting to respond to the outbreaks by targeting its testing and education at those demographic groups, offering mobile testing units in hot spots and at workplaces, offering hotels to those who must quarantine or isolate away from home and offering an income-replacement program to help essential workers who can’t otherwise afford to miss two weeks or more of work.
While Marin’s case rates have paced the increase in testing, Marin’s rolling 14-day testing-positivity rate was 8.9 percent on July 20, the last available date due to delays in lab reporting.
Testing positivity is the proportion of new cases per new test, rather than per capita, and with other data can potentially indicate changes in community spread regardless of fluctuations in testing volume.
Marin’s rate hovered around 8 percent throughout July, a rate last seen in March and up from a low of 1.8 percent in May. The state’s goal is less than 8 percent. Marin was required to be below that rate when it successfully filed a variance attestation with the state on June 17 seeking to more quickly reopen the economy than California otherwise allowed, and the figure remains one of the metrics that can land a county on the state’s watch list.
Marin has been on that watch list since July 2 and remains there for its per-capita rate, with some 175 new cases per 100,000 residents on a 14-day rolling average. California requires the figure to drop below 100 new cases per 100,000 residents.
For Marin, that would amount to about 19 new cases per day, according to Marin Public Health Official Dr. Matt Willis. Marin is averaging about twice that, and its 14 highest single-day counts were all recorded in July — the highest, 107, on July 19.
Willis has said it could take weeks to be removed from the list.
“By this point, we all know what it takes: covering your face, maintaining physical distance and limiting your activities in the community as much as possible,” he said.
As long as Marin remains on the list, indoor dining, indoor malls and indoor hair-salon operations, which had previously been allowed to reopen, must remain shut down, while the county cannot proceed with any new reopenings, such as gyms, nail salons, libraries, indoor worship or in-class school instruction.
Eviction ban extended
The Marin Board of Supervisors on July 28 voted to extend a countywide residential eviction moratorium through Sept. 30, aligning with a similar statewide order issued by Gov. Gavin Newsom.
The original county moratorium was issued March 24 and applies to unincorporated areas such as Strawberry as well as incorporated cities and towns like Tiburon and Belvedere.
Landlords cannot evict a tenant if the tenant provides written notice within 30 days of missed rent they were unable to pay due the financial impacts of the pandemic.
Renters will have 90 days to pay back any missed rent without incurring any additional fees.
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.