• Kevin Hessel

Marin misses move to yellow pandemic reopening tier


Update, April 20 — Marin's hopes to move to the yellow pandemic reopening tier were dashed by an increase in cases, which county public-health officials tied to nonessential travel during spring break.


The California Department of Public Health's assessment of county-by-county metrics takes place Mondays with formal tier assignments made Tuesdays — after The Ark's press deadline for this week's edition ("Marin likely to further reopen this week under yellow tier," April 21, pg. 1).


Marin's seven-day adjusted new-case rate for the tier assignment of April 13 was 1.7 per 100,000 residents, when fewer than two per 100,000 qualifies for the yellow tier. But for today's assignment, seven-day-average cases rose to 2.6 per 100,000 residents; that spike aligns with testing that took place as residents returned from spring break, which was April 3-11.


Because a county must qualify for the next tier for two consecutive weeks to be reassigned, Marin must now start over and cannot advance until May 4 at the earliest.


APRIL 19 — Marin is poised to advance to state’s least-restrictive pandemic reopening tier this week as rates of new COVID-19 cases see a sharp decline and as the county hit a milestone of more than half of all adults now vaccinated, with everyone 16 and older now eligible for the jab.


Separately last week, the state effective April 15 relaxed its rules on large gatherings beyond the former three-household restriction across all tiers in California’s color-coded, four-tier blueprint for reopening the economy.


Outdoor gatherings in Marin’s current orange tier-3 status may now include up to 50 people, while indoor gatherings can include up to 25 people or 25-percent capacity for the space — though indoor gatherings are still discouraged.


Other indoor and outdoor live events, such as music performances, can resume for the first time, though they’re limited to in-state attendees with advanced ticketing. Maximum outdoor capacity is 33 percent or 67 percent if the venue requires proof of a negative test result or full vaccination; maximum indoor capacity is 15 percent at small venues, 10 percent at large venues, with all able to increase to 35 percent with proof of a negative test or vaccination.


“These changes signal how our approach is shifting,” said Dr. Matt Willis, the county’s public-health officer. “We’re placing more emphasis on personal choice as we reopen. With more opportunities to gather together, we’ll rely more and more on each other to limit our risk as a community.”


However, he warns that despite fewer and fewer restrictions, the positive local news does not mean Marin is in the clear. Two weeks ago, the county identified two cases of the U.K. variant of SARS-CoV-2, the virus that causes COVID-19, for the first time, and Willis notes more-contagious variants are responsible for outbreaks elsewhere in the U.S. and globally, with many nations still restricting international travel.


Pfizer said last week that while new data shows its vaccine is effective against the South African variant, recipients of its vaccine will likely need a third dose in six to 12 months — with the possibility of annual revaccination — as protection goes down over time.


Willis notes face coverings are still required for nearly all activities outside the home, and county, state and federal officials still recommend physical distancing and limits on nonessential travel.


Willis last week said the county on April 20, after The Ark’s press deadline, would likely move to yellow tier-4 status under the state blueprint, indicating minimal spread of the virus, which would allow further reopening.


Live-event capacity would increase to 67 percent outdoors. Indoors, maximum capacity would be 25 percent at small venues and remain 10 percent at large venues, though both would be able to increase to 35 percent if the venue requires proof of a negative test result or full vaccination.


For restaurants, movie theaters, gyms, family-entertainment centers, cardrooms and breweries, wineries and distilleries that don’t serve food, indoor capacity would either remain at or increase to 50-percent capacity — but individual businesses could increase capacity to 75 percent if they require all patrons prove they’re either fully vaccinated or have had a recent negative test result.


Bars without food would be able to reopen indoors for the first time in more than a year, at 25-percent capacity or 100 total people, or at 37.5-percent capacity with proof of a negative test or full vaccination.


Gov. Gavin Newsom has said he hopes to allow all sectors to reopen without capacity restrictions by June 15, though masking and distancing requirements would remain in place, with venue-specific requirements for proof of negative tests or vaccination.


Marin has been in the orange tier for four weeks. Generally, a county must spend three weeks in a tier, and qualify for the next tier for two weeks, before it may advance. If case metrics hold, this would be the county’s second week qualifying for the yellow tier.


The state’s assessment of virus activity typically takes place on Mondays, with tier assignments announced Tuesdays, after The Ark’s press deadline. Figures for the April 19 tier assignment were therefore not available, but last week the county’s adjusted seven-day new-case rate as 1.7 per 100,000, when fewer than 2 cases per 100,000 qualify for the orange tier. Its test-positivity rate was 0.8 percent, where less than 2 percent is required, and its test-positivity rate among its highest-risk populations was 1.7 percent, where less than 2.2 percent qualifies for the yellow tier.


As of The Ark’s press deadline, more than 75 percent of all Marin adults had received at least one vaccine dose, with nearly 52 percent fully vaccinated as California opened vaccine eligibility to all residents ages 16 and older; the two-dose Pfizer vaccine is the only shot authorized for kids 16-17.


The public-health goal is to reach at least 80-percent vaccination to provide herd immunity for those who cannot be vaccinated for medical reasons. That goal could butt up against the 20-percent hesitancy rate among Americans, with 7 percent saying they would only get the vaccine if required and 13 percent saying they would definitely not get the vaccine, according to the March results of the Kaiser Family Foundation’s monthly survey.


Officials worry hesitancy could increase with the temporary suspension of the single-dose Johnson & Johnson vaccine by U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration on April 13.


The concern is based on an “extremely rare” combination of a brain blood clot with low platelet levels, which has made heparin — a blood thinner used to treat clotting — a potentially dangerous treatment that requires alternatives.


The condition was seen in just six of more than 7.1 million doses, or fewer than one in 1 million, all among women ages 18-48 six to 13 days after vaccination, one of whom died. The symptoms included severe headache, abdominal pain, leg pain and shortness of breath, with officials recommending those experiencing symptoms within three weeks of receiving the J&J vaccine contact their health-care provider.


In Marin, the J&J vaccine accounts for less than 3 percent of the cumulative vaccine allocation, and the temporary halt mainly impacted mobile operations, where the single-dose vaccine increased capacity and could better inoculate underserved and transient communities in which residents may not be as reachable for the second dose required of the Pfizer and Moderna vaccines.


The county says it will store all available supply until the FDA and CDC conclude their investigation of the product. The CDC’s Advisory Committee on Immunization Practices will meet to discuss the vaccine on April 23.


The CDC last week also released case data related to so-called “breakthrough infections,” saying that as of April 13, it has received reports of some 5,814 people nationwide testing positive for COVID-19 after being fully vaccinated, among 75 million people — or 0.008 percent. Some 396 were hospitalized, or 0.0005 percent, and 74 died, a rate of about 1 per million, or 0.0001 percent.


In Marin, there had been 21 breakthrough cases among 80,000 fully vaccinated residents as of April 2, or 0.03 percent, with no hospitalizations or deaths.


“COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control,” Marin health officials said. “No vaccine is 100-percent effective at preventing illness. …When they do occur, COVID-19 breakthrough cases are usually milder, shorter in duration and less likely to lead to hospitalization or death.”


Reach Executive Editor Kevin Hessel at 415-435-2652, on Twitter at @thearknewspaper and on Facebook at fb.me/thearknewspaper.

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