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More limits to Sonoma County businesses likely as virus cases, deaths mount

What a difference a little more than a month makes in the fight against the coronavirus. Headed into Memorial Day, many in Sonoma County were giddy. Having apparently averted a surge of the infectious disease, local officials had just cleared the way for restaurants to serve meals outdoors, and badly hurting businesses were plotting their reopenings.

Now, it appears much of the traction gained against the fierce pathogen has been lost. Six people died in the week culminating with the Independence Day holiday — boosting the death toll to 11 — the deadliest weekly stretch of the pandemic since the first case emerged in the county on March 2. About 540 local residents are confirmed to have been stricken by the virus during the past two weeks, including a single-day record of 92 on Friday, nearly double the previous high for a 24-hour period.

The past two weeks represent almost 40% of the overall cases, boosting the local case rate to a whopping 106 per 100,000 residents over 14 days.

So the region staggered into the July Fourth weekend with Health Officer Dr. Sundari Mase once again urging people to stay home. The chair of the Board of Supervisors, Susan Gorin, conceded the county might have reopened business sectors and much of public life too fast. And now the county appears likely to join the group of 22 counties statewide struggling most to contend with spikes of cases, deaths and hospitalizations related to the virus.

To be sure, Sonoma County is not yet on the state’s dreaded watchlist for counties that must reinstate severe restrictions on certain businesses. Yet it now seems inevitable, Mase and elected leaders say.

“We are tracking toward having to shut down more right now, and that sucks — what other word can I use other than it sucks,” said James Gore, a county supervisor. “But we’ve made a commitment to science and to tracking this with legitimate criteria.”

Particularly with the rapid increase in the number of fresh COVID-19 cases, which surpassed 1,350 on Friday, the county could soon land on the state’s monitoring list of locales having trouble slowing the spread of the virus. That in turn would lead to state-ordered closures of local bars and museums, and suspension of indoor dining and drinking at restaurants, brewpubs and wine tasting rooms. Those public health measures undoubtedly would cause another painful round of local job losses, as the county desperately tries to recover from April’s lofty unemployment rate, a level not seen here in nearly 80 years.

The state first made public on the California Department of Public Health’s website June 5 six benchmarks all 58 counties must meet in order to continue to keep their communities and wide swaths of business sectors open. Counties fail to achieve those targets by inadequate levels of testing, elevated transmission of the virus, increasing hospitalization, inadequate intensive care unit bed capacity at local hospitals and not enough ventilators for ICU patients.

Other factors that could put the county on the state’s monitoring list are large outbreaks in group residential settings such as skilled nursing centers and other senior living sites — where there’s been a dramatic recent jump in cases and a few of the recent deaths — or significant shortfalls of either contact tracers or personal protective equipment for local health care workers. Sonoma County now has 100 people working as contact tracers, essentially detectives tracking the spread of the virus.

Watchlist ramifications

If a county ends up on the watchlist for three or more days, it’s placed on the state’s "targeted engagement list,“ that group of 22 counties where Gov. Gavin Newsom ordered a limited number of business and public closures. As of Saturday, the group included: Fresno; Glenn; Imperial; Kern; Kings; Los Angeles; Madera; Marin; Merced; Monterey; Orange; Riverside; Sacramento; San Bernardino; San Diego; San Joaquin; Santa Barbara; Santa Clara; Solano; Stanislaus; Tulare; and Ventura counties.

Just two days before the July Fourth holiday, state health officials placed Monterey County into the troubled group due to a bulging number of confirmed coronavirus cases. That same day, Contra Costa County was taken off the list after meeting the state’s benchmarks for three consecutive days, according to state public health department data.

However, state-imposed restrictions and limitations on Contra Costa County’s residents and businesses must remain in effect for three weeks from the day they were imposed, even though the county achieved removal from state monitoring status, according to Contra Costa County health officials. That’s the way it goes for any counties that land on the watch list, no matter how slowly or quickly they progress and can leave the group.

Mase said that given the rising number of confirmed infections in the county and outbreaks in skilled nursing — as of Friday, there were 25 virus cases at such nursing centers — and residential care facilities for the elderly, it is becoming increasingly likely the county will end up on the state’s watchlist.

“This should give us all pause to know our own vulnerability here in Sonoma County,” she said Thursday, during her last public briefing before the holiday weekend, encouraging people to “stay put” and avoid travel outside the county.

Local, state benchmarks

In early May, the state established a program through which counties could petition to reopen more types of businesses and public venues than were then allowed according to the governor’s California reopening plan. At the time, health officials from many counties seeking faster resumption of business and industry submitted so-called “attestations“ that included a number of public health metrics they would use to gauge respective local efforts to stabilize the spread of the virus, or essentially to keep the curve of transmission flat.

For weeks, Mase used these local metrics she and her team compiled to measure the county’s ongoing virus containment efforts. Some of the county metrics were even more conservative than the ones now used by state health officials to identify struggling counties that go on the monitoring list.

For example, under Sonoma County’s original benchmark for cases per 100,000 residents over a 14-day period, anything over 25 confirmed cases per 100,000 people would prompt local health officials to consider implementing previous restrictions on public and workplace activity.

Meanwhile, the state set the benchmark at 100 cases per 100,000 residents for a 14-day period. Counties exceeding that 100 case rate would be flagged and ordered to again close certain businesses. On Saturday, Sonoma County’s case rate catapulted to 106 per 100,000 residents, its highest level and officially making the county out of compliance on this key state benchmark.

Counties also would be in trouble if they had a case rate greater than 25 per 100,000 residents over 14 days, plus a virus testing positivity rate greater than 8% of the population tested. Specifically, testing positivity is the average share of all COVID-19 tests reported positive over seven days.

While the case rate in Sonoma County has for more than a month been above that 25 threshold, testing positivity has stayed low at 2% to 3% for much of June and early July, with more than 51,500 people tested.

On Wednesday, the day before Contra Costa County was removed from the state monitoring list, that county logged a case rate of 74.9 per 100,000 residents, a testing positivity rate of 4.3%, a 13% decline in virus-related hospitalizations over a three-day period, ICU hospital bed availability of 53% of total ICU unit space and ventilator availability of 91%.

Monterey, which joined the state monitoring list Thursday, cited a case rate of 107.4 per 100,000 residents and a three-day hospitalization increase of 79.2%.

Local hospital, ICU beds

State requirements aside, Sonoma County is now falling short on several of its own metrics tracking suppression of the virus, including increasing hospitalizations and less availability of ICU beds for residents suffering from the sometimes deadly virus.

As of Thursday, the average daily percentage increase of confirmed COVID-19 cases over the past week was 6%, slightly more than the county’s 5% threshold. Also, only five or 7.5% of the county’s 67 ICU beds were available as of Saturday. Because the county has 82% of ventilators available at local hospitals, it’s still compliant with state requirements for hospital capacity.

However, Mase pointed out that local hospitals easily could add beds to ICU units. And with such small numbers of COVID-19 patients in hospitals, any numerical increase causes a large short-term percentage jump.

Dr. Chad Krilich, chief medical officer for St. Joseph Health Sonoma County, which operates Santa Rosa Memorial and Petaluma Valley hospitals, said there has been an increase in hospitalized COVID-19 patients. But the increase has been small and still very manageable.

Krilich said earlier in the pandemic that began in March the two hospitals would average a couple of patients suffering from the coronavirus in the hospital at any given time. Now the hospitals average about four patients.

“Overall in terms of the numbers of patients actually in the hospital, it is an increase,” he said. But Krilich noted COVID-19 patients still are only roughly 1% of the hospitals’ inpatient volume.

Overall, since mid-March, there have been no more than 13 confirmed virus-stricken patients at one time in Sonoma County’s six hospitals which have 707 total beds, according to county health department data. As of Saturday, 183 of the beds were available, while 524 were occupied.

Back in late March, when local hospitals were prepping for the first surge of sick patients afflicted by the contagion, hospital officials drafted risk management plans that would add 345 extra hospital beds, 90 of them ICU beds. That surge never materialized. Now with an eye on the rapidly escalating number of cases just since the second half of June, Mase warned it may be time for county hospital officials to refresh their plans for a potential wave of even more infections and patients needing to be hospitalized with the virus.

“I wouldn't put as much of an emphasis on things like the availability of ICU beds, because we don't even have a huge number of hospitalizations,” the health officer said just before the holiday weekend. “It's something that can turn around quickly. The hospitals have surge capacity for ICU beds.”

Anxiety mounts

What is most concerning, however, is the unmistakable rising tide of new cases that just put the county of about 500,000 people over 100 confirmed cases per 100,000 residents over a 14-day period. And that alone could land the county on the state’s watchlist, triggering pullbacks in business and public life.

Supervisor Gorin said she’s been increasingly concerned about the pace of reopening the area, given what’s occurring in many parts of California and states such as Texas and Florida where there has been a series of daily records for new cases and mounting deaths.

Gorin acknowledged the county may have prematurely reopened too widely, and she is deeply saddened by the recent virus-related deaths of local residents.

“I think the governor is going to take the appropriate action based on the data we’re seeing on the ground,” she said. “We absolutely have to take the steps necessary to safeguard the health of our community, businesses and employees.”

Jennifer Herman, a west county nurse practitioner and member of the Health Professionals for Equality and Community Empowerment advocacy group, criticized county health officials and supervisors for allowing the county to resume business and public activities too soon.

For several weeks, the county has been unable to comply with many of its own metrics measuring progress against the coronavirus, she said, citing dwindling ICU bed availability at local hospitals and too few contact tracers.

“We were advancing to stage two (of the governor’s state reopening plan) when we hadn’t met the criteria for stage one,” Herman said. “I’m afraid we’re going to learn the hard way that we’re not doing it right.”

Track coronavirus cases in Sonoma County, across California, the United States and around the world here.

For more stories about the coronavirus, go here.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.

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