California Gov. Gavin Newsom has lifted the regional stay-at-home orders for all areas of the state, and is now allowing counties to go back to the color-coded tier system for reopening.
The move comes even as hospital intensive care units in Southern California and the San Joaquin Valley remain full. Experts say loosening the restrictions now could lead to further strain on the health care system if people don’t take precautions.
Newsom said at a press conference Monday that California’s positivity rates and hospitalizations are trending down, which they expect to ultimately free up beds in hospitals’ intensive care units.
Erin Mordecai, a biologist at Stanford University who’s been tracking these trends, says the surge following the December holidays appears to be petering out.
“That’s going to mean fewer ICU admissions three weeks from now or so,” she said.
But she says more community transmission could occur once businesses reopen, depending on how closely people follow public health guidelines.
“We do know it’s much safer to be outdoors than indoors and it’s much safer to be masked than unmasked,” she said. “I think as long as they can keep limits on capacity of the service industry … that’s going to help to mitigate transmission occurring.”
Experts said people should not think about the pandemic as “almost over,” especially given the state’s slow vaccine roll-out and the possibility of new variants increasing transmission in California.
Most California counties now return to the purple or widespread tier under the state’s Blueprint for a Safer Economy. That means hair and nail salons can open with modifications, restaurants can offer outdoor dining, and entertainment centers such as museums, cardrooms and zoos can resume outdoor operations.
The change is based on ICU capacity projections for four weeks in the future, or the week of February 21. While the Southern California region has 0% capacity now, it’s expected to have 33.3% of its ICU beds staffed and available at the 4-week mark, according to the state’s figures.
The San Joaquin Valley region has just 1.3% of its ICU beds available and staffed, but in four weeks that figure is expected to jump to 22%.
But the state has yet to release the formula used to create the projections. That's led to confusion over how the state came up with those projections, and whether the future figures take into account any potential community transmission that may occur as more businesses reopen.
Dr. Andra Blomkalns, chair of the Department of Emergency Medicine at the Stanford University School of Medicine, says that the projections assume that the slowdown hospitals have seen recently will continue.
“My personal reaction is that it seems like it might be just a little too soon,” she said. “I’d like to see us have a more definitive margin of safety.”
State health officials say they’ve been able to expand capacity in the most impacted areas of the state by deploying more than 4,000 additional health workers, vaccinating health care providers, setting up alternate care sites for COVID-19 patients in recovery and allowing overcrowded hospitals to more easily transfer patients to less busy facilities.
Blomkalns says the rise in projected capacity is tied to the reduction in patients needing ICU care, much more so than the creation of new rooms or hospitals. She said that if the “faucet” of patients was overflowing in the first two weeks of January, it has “now slowed down to a trickle” and that her hospital is busy, but not longer overly full.
CALPIRG, an independent group that raises awareness about issues such as the overuse of antibiotics, plastic pollution and lead contamination, says the state should be extending the stay-at-home orders, not canceling.
“Moving to reopen too quickly without suppressing the virus in the spring contributed to the summer surge, resulting in far more deaths than necessary,” said Emily Rusch, the group’s executive director, in a statement. “As we have learned over this past year, failing to control the virus also prolongs economic harm and keeps our schools closed. We should not risk a backslide in the recent gains we’ve made against this virus just to allow people to go out to eat at a restaurant or get a haircut again.”
There is also concern that new, more contagious coronavirus strains like those seen in the U.K. could soon lead to high transmission rates in California.
Mordecai, of Stanford, says we’re in a “small window” where the holiday period is fading, and we’re not yet seeing the impacts of the new variants.
“The question is just how long it takes for that variant to take over,” she said. “And the more we allow transmission to occur, the more quickly that’s going to happen and the more quickly we’re going to see another surge.”
But both Mordecai and Blomkalns say they understand that state officials are striking a balance between public health guidance, economic demands and mental health needs.
“The population is tired, and very tired of complying with these rules,” Blomkalns said. “In some ways, opening might actually help matters a little bit and help people feel like they’re assuming some level of normal activity, or ‘new normal’ activity, and have some optimism about the future. And I think that in and of itself is incredibly important right now.”
Mordecai said she’s glad that small, outdoor gatherings of fewer than three households for less than two hours will be able to occur again now that the order is lifted.
“Not that we should all have huge gatherings, but I think the ability to see people outdoors in a socially distanced setting, with a mask on, with small numbers of people, I think we all need that for our mental health and our social health,” she said. “So hopefully those types of gatherings that are now allowed will not lead to a lot of new infections.”
The state will now assess county case rates and hospital capacity on a weekly basis to determine which, if any, can move up through the tier system and open more sectors of the economy. Counties may also choose to keep stricter rules on businesses and gatherings than the state.
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