COVID-19 State Policy Update 06.29.20

Coronavirus

Today, Monday, June 29, Governor Newsom provided a live update on the COVID-19 pandemic where he updated state infection rates, discussed changes to the state’s watch list, and provided information to help the audience understand how the watch list works, conditions under which a county enters the watch list, and how the state provides technical assistance. 

Over the weekend, Governor Newsom acted to reverse the rising positivity rate and growing number of COVID-19 hospitalizations by ordering bars closed in seven counties on the state’s watch list and recommended they close in the other eight counties being monitored (read more here). Bar closures are ordered in counties on the watch list for 14 days or longer and include Los Angeles, Fresno, Imperial, Kern, Kings, San Joaquin, and Tulare. In the counties on the watch list at least three days, he is recommending closing bars, which includes Contra Costa, Riverside, Sacramento, Santa Barbara, Santa Clara, Stanislaus, and Ventura. The California Department of Public Health (CDPH) over the weekend issued new guidance documents that explain how the Governor’s action applies, including for dine-in restaurants serving alcohol (read more here). 

Guidance for producers of alcoholic beverages may be found here. In a news release the CDPH cited a number of reasons the action targets bars, including alcohol impairs peoples’ judgment and may lead to fewer people complying with mask and social distancing requirements, bars also tend to be louder leading to people projecting their voices and spraying saliva droplets further. “Californians must remain vigilant against this virus,” said Governor Gavin Newsom. “COVID-19 is still circulating in California, and in some parts of the state, growing stronger. That’s why it is critical we take this step to limit the spread of the virus in the counties that are seeing the biggest increases. Each of us has the power to limit the spread of this virus. Wear a face covering and keep physically distant outside the home. Don’t gather in groups, and if you are older or have a condition that puts you at higher risk of COVID-19, protect yourself by staying home.” 

Governor Newsom moved on to discuss the county monitoring, state of managing the COVID-19 pandemic, and going forward. Noting much has occurred over the past few weeks, the Governor began by reminding the audience the sequence of events that have led to where the state is at this moment in the pandemic. He reminded the audience the pandemic issue began in early 2020 with the repatriation of overseas flights, specifically those from Mainland China. He noted before the virus became a national issue, it was on California’s radar screen, which gave state officials time to establish important relationships with the Centers for Disease Control (CDC), Health and Human Services (HHS), and the Federal Emergency Management Agency (FEMA) and begin planning protocols and processes to manage a possible pandemic. Soon after, the Princess Cruise ship was repatriated off the coast of California, involving thousands of passengers and crew. The Governor noted the relationships forged with FEMA, HHS, and CDC helped the state establish initial screening protocols and begin the process of securing the assets necessary, such as PPE, ventilators, and additional medical and healthcare staff to protect public health. 

As state officials witnessed the growing COVID-19 case numbers in Washington state, CA saw its first case of community transmission, which led to formally moving forward with steps to protect the most vulnerable, such as urging those over age 65 and people with compromised immune systems, or underlying health conditions to stay at home, if possible, avoid travel, and contact with others who might expose them to the disease. As the case numbers grew, Governor Newsom was the first to order a statewide stay-at-home order and effectively shut down the state’s economy on March 19, 2020. He reminded the audience that the scale, size, and scope of the state (with 58 counties and nearly 480 cities) is equivalent to the population of 21 states, but officials believed the stay-at-home order was the only way to effectively contain a virulent and deadly disease. The stay-at-home order gave state officials time to procure much-needed PPE and hospital surge capacity, should the global pandemic hit the state hard.

The Governor reminded the audience that local officials in various counties reached out to state officials to bring their attention to the diverse nature of the state, noting counties experienced the virus differently depending on their geographic location and demographics, and whether they are urban versus rural. Some counties had many cases while others had as few as one case. Recognizing the need to address each county’s needs, the decision was made to have a bottom up versus a top down system to manage when the stay-at-home order would be lifted for each county. Local public health officials, in tandem with the local County Board of Supervisors, would have the ultimate authority, based on their unique knowledge of the county’s public health system, the population, and the healthcare system. The mantra, as the Governor noted, became, “localism is determinative” in other words, each county would determine when it would reopen the local economy and if the virus began to spread, local officials would determine if and when they needed to slow down or even roll back the phases to reopen the economy. 

State officials developed a Reliance Road Map (read more here) that articulates four specific phases to reopening the economy in each county. Counties would attest to their capacity to meet specific criteria to manage the pandemic. Based on their attestation, which included plans to mitigate and manage the virus, manage testing, case load, and hospitalizations, each county would move forward though the first three phases (Guidance for Phase 4 has not yet been developed by state officials) at their own pace and be prepared to rollback or halt progress, if needed. 

In consultation with the CDC, HHS, FEMA and local officials, state public health experts developed 30 sets of Guidance for reopening and operating various sectors of the economy (read more here). The Governor noted, since the stay-at-home order was lifted in early May, the state’s infection rate has risen to a level of growing concern (read more about modifying the stay-at-home order here). Last Friday, June 26, 2020, the Governor announced 15 counties were on the “watch list” and receiving technical assistance from state officials to manage their COVID-19 case load, testing, and hospital assets. Today, the Governor announced an additional four counties were added to that list, including Solano, Orange, Glen, and Merced. 

The Governor pointed to Imperial County as an example of a county that has been unable to move forward with attestation documents, as local officials have been unable to meet the state’s criteria, due to a positivity rate of 23% and more than 600 COVID-19 cases. He shared how the state has provided technical assistance to Imperial County, including sending a strike team to assist local officials and decompress the county’s hospital case load by seeking assistance from neighboring counties. Imperial County’s positivity rate is of such concern, the Governor announced recommending the stay-at-home order be reinstated. Over the weekend, the Governor dispatched three agency secretaries, including Public Health Director Dr. Sonia Angell, to Imperial County to meet with local officials. He noted the County Board of Supervisors are meeting today, June 29 and tomorrow June 30, to take up the issue of reinstating the stay-at-home order—and he stated, “If the Supervisors are unable to reach consensus on the issue, the state will assert itself and mandate the stay-at-home be reinstated.” 

The Governor stated on Sunday, “Recognizing transmission has increased in areas of the state to a level of significant concern, we moved forward in requiring six additional counties to toggle back by closing down bars and recommending eight other counties do the same.”  The Governor noted a total of 19 counties are now being monitored on the watch list and provided technical assistance to address their compliance issues with the state guidelines and attestations they have published (find the counties being monitored here). “We are doing this because we’ve seen increasing spread of the virus because, as we have reopened parts of the economy and people have begun to move about and come into contact with people outside of their immediate family and cohort, they are letting their guard down, maybe pulling their mask off and forgetting to put it back in place or sitting to close to someone and maybe hugging a distant family member, and before you know it we have increasing spread of the virus. As we move closer to the Fourth of July weekend, when people are more likely to get together with extended family, we are very concerned the virus will spread further.” 

The Governor noted the numbers tell the real story. He reiterated the point that while we have seen some increase in cases, due to increased testing capacity, officials know the virus is spreading because both the hospitalization rate and the positivity rate are steadily increasing. He noted in just the past seven days there is a 45% increase in the number of cases reporting positive in the state. “Weeks ago, when the pandemic first hit the state, we had a 14-day positivity rate of 4.4% and over time and with our efforts, we reduced it to 4.0%. In just the last 14 days, the state’s positivity rate has climbed to 5.5% and the 7-day positivity rate is even more concerning at 5.9%. Hospitalizations are up 43% in just the past two weeks.” 

The Governor introduced Dr. Mark Ghaly, the Secretary of Health and Human Services, who shared with the audience details regarding how the active data are tracked by state officials and how local conditions drive the state’s response.
 

  1. Elevated disease transmission
    1. No more than 25 cases per 100k residents over 14 days
    2. Positivity rate below 8% over 14 days
  2. Increased hospitalizations
  3. Average of 150 beds per day, per 100k residents over the past 7 days
  4. More than 10% change in 3-day average of COVID-19 patients
  5. Less than 20% of total ICU beds available 
  6. Less than 25% of ventilators available.
  7. Limited hospital capacity 

Dr. Ghaly provided detailed examples of how counties differ in the transmission patterns, which dictates how the state might provide technical assistance. He noted in Sacramento County, which is now on the watch list due to growing transmission data, contact tracing has revealed most cases are the result of family and/or friend gatherings and people not following the guidelines regarding wearing masks, keeping 6’ distance, and hand washing. In San Bernardino, on the other hand, the increase in cases of COVID-19 can be traced to increasing transmission rates among inmates in the jail and people in Skilled Nursing Facilities. Imperial County has seen increasing rates of community spread due to increased movement in and out of the county, due to its proximity to Mexico. Dr. Ghaly stated, “These examples illustrate the diverse nature of California’s counties and why it is so important to address the specific needs of each county in order to contain the virusEach county needs a different solution.” 

He went on to discuss the interventions that might occur, based on each county’s needs.

  • First level – Emphasizing education and outreach.
  • Second level - Providing technical assistance, new sector openings.
  • Third level – Continue technical assistance, identify sector closures, reinstate stay-at-home order.

Governor Newsom returned to the podium and stated, “We must take seriously the guidance that includes the requirement to wear a mask and maintain social distance. When I sign the state budget tonight, there is $2.5 billion in the budget to encourage and inspire more compliance.” 

The Governor noted he would like to address an additional issue regarding transmission within California’s correctional system. There are certain prisons, such as Lancaster and Chino where there were early outbreaks of the virus and in the total population of 113,000 inmates a total of 2, 589 inmates have tested positive and of that total 1,011 of them are located in San Quentin prison. “This remains an area of deep concern and focus. We are working to decompress the system and changing how and when inmates are moved or transferred.”  The Governor noted the Department of Corrections has identified another 3,500 inmates, including 110 who are medically vulnerable, for early parole release; however, 40 have no place to go upon release. The state will continue to work in this area and the Governor noted he looks forward to an upcoming Legislative oversight hearing. 

Q&A

The Governor opened the floor to questions from the media. The majority of questions focused on the order to close bars, e.g., whether the Governor thought further closures were required, beyond bars, as in many cases, someone need only order food in a bar for the establishment to be exempt from the closure order. Why just close the bars, when there are other reasons for community spread, such as family and congregant gatherings? The Governor responded, the order to close the bars came after observations made and reported by local officials that raised concerns for increasing community spread. Those reasons are articulated in the CDPH news release (read more here).

Another reporter asked about the state’s 16.3% unemployment rate and why CA’s rate is so high compared to other states. The Governor responded that traditionally in good times California does better than most and in bad times the state also feels it, but he is confident the state is on its way back and will recover and come back even stronger. 

The next reporter asked if the Governor is considering changes to policy regarding transferring inmates and if he is considering calls to replace the Federal Receiver over Correctional Healthcare. The Governor responded with a brief history on the issue of the court appointed receiver and noted the Receiver’s job is an extremely difficult one. 

The final question focused on the issue of loved ones wanting to visit family members in skilled nursing facilities and if the state is working on a way to allow family members to be together. The Governor invited Dr. Ghaly back to the podium to discuss briefly the state guidelines officials are working on to make that a reality and expect to make an announcement in the coming days.

The Governor concluded the press conference by reminding everyone to follow the mandate to wear a mask when outside their home. He also reminded them to social distance and wash their hands often. 

Key milestones – COVID-19 numbers – as of today (6.29.20)

  • 5,936 deaths, up by 31 overnight or +.5%; 14-day total up 847 or 16.6%
  • 216,550 positive cases-up by 5,307 or +2.5% overnight; 14-day total is 65,098 or up 43%
  • The 7-day positivity rate is 5.7%; the 14-day positivity rate is 5.3%
  • 4,061,692 tests conducted. One-day total 105,740 or up 2.7%
    • Latinos continue to have the highest percentage of positive cases at 56%; Caucasians 17%; Asians 7%, and Blacks 4%.
  • Hospitalizations 4,776, up by 199 overnight or 4.3%; the 14-day rolling average is 3,916.  
  • The majority of hospitalizations are in LA County 1,763 followed by Orange County 485; San Bernardino 376; San Diego 373; Riverside 367; Kern 146; San Joaquin 129; Fresno 118; Stanislaus 108; Imperial 72; Sacramento 87; Santa Clara 83; Imperial 72.
  • ICU – 1,465 up by 80 overnight or 5.8%; 14-day rolling average of 1,237
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