COVID-19 cases spike across Sacramento region amid gatherings, senior care outbreaks
As coronavirus numbers steadily improved, Sacramento County health officials hoped to qualify Tuesday to move from the red to orange tier within California’s coronavirus reopening system, a move that would allow businesses to reopen more widely.
Plenty would change at the orange tier. Restaurants would be allowed to expand indoor dining from 25% to 50% of capacity, a welcome move as the weather turns chilly. Indoor entertainment businesses like bowling alleys could potentially resume business.
However, after months of progress in lowering infection rates and related figures, the county instead hit a plateau. In fact, a Sacramento Bee analysis based on rolling 10-day infection totals shows the plateau giving way to a recent uptick in new cases in the county. Similarly, the county’s virus hospitalization numbers, which started falling in late summer, have also plateaued.
Sacramento County Health Officer Dr. Olivia Kasirye said some of that may be due to recent clusters of infections in long-term care facilities, which include skilled nursing homes, but she said the county has programs and teams in place to keep those from turning into larger outbreaks.
“Our hope is we’ll be able to get over this setback quickly,” she said. “We know a lot of what is causing the plateau: outbreaks in some long-term care facilities. Our hope is this will be very temporary.”
After months of improvement, infection totals have increased in recent days not just in Sacramento County but also in Placer and Yolo counties, The Bee’s analysis found.
For the period of Oct. 16 through Oct. 25, Sacramento County reported 1,377 new lab-confirmed COVID-19 cases, according to data from the California Department of Public Health.
Placer County added 292, Yolo County had 176 and El Dorado County’s total grew by 63 in those 10 days, according to data from the California Department of Public Health.
Except in El Dorado, those numbers all represent a significant short-term spike, bucking a trend of consistent and steady decline that lasted from mid-August through late September. Placer and Yolo’s new case rates, as a 10-day rolling total, have each doubled in recent weeks, reaching their highest points since the first half of September.
The capital region’s increases since mid-October are starting to show up in California’s weekly tier list assessments. Though none of the four Sacramento-area counties were in a position to be demoted entering this week, all four had higher new case totals than in the previous week’s update, according to data released by CDPH on Tuesday.
Sacramento and Placer’s case rates rose significantly, and the latter notched one week in the direction of demotion to the red tier. Another bad week would merit the demotion.
Sacramento County: Nursing outbreaks, big spike in cases
Recent data from the state show the county may now be closer to demotion to the purple tier than improvement to the orange one.
Sacramento’s rolling 10-day total of 1,377 new cases is its largest since Sept. 27 — one day before state officials promoted the county from the most-restrictive purple tier into the red one.
Sacramento County’s test positivity rate — the proportion of diagnostic tests that return positive for the respiratory disease known as COVID-19 — has also risen recently, indicating the high recent case total is unlikely to be an anomaly due to more testing. The seven-day rolling average increased from 2% on Oct. 12 to 2.4% on Oct. 17, the most recent day for which data were available.
With Halloween approaching, followed by the holiday season, more schools opening and weather driving more people indoors, Kasirye said the county is asking residents to play it smart this fall and winter.
“It gets more challenging,” she said. “COVID-19 is still here. We can’t afford to get fatigued. We know what happens if we don’t remain vigilant. It can have devastating consequences for families and our communities if we have a lot of people sick.”
The coming days and weeks should make clearer whether the county’s spike in cases is temporary or the start of a more serious local surge, but they are also a critical moment in the health crisis, with the above-mentioned holidays and other occurrences fast approaching.
They’re also key to keeping the economy open.
After the Oct. 20 assessment listed Sacramento County at 4.4 new daily cases per 100,000, this week’s data table saw it bump up to 5.7. Those updates looked at data from Oct. 4-10 and Oct. 11-17, respectively, which is mostly before the bulk of increased activity observed in more recent Bee analysis.
The recent 10-day case total of 1,377 for Sacramento County works out to nearly 8.8 new daily cases per 100,000 residents.
The county is not yet failing to meet red tier criteria, and data from earlier in the pandemic suggest the recent spike is not an irreversible trend, but it is concerning. If Sacramento’s rate were to exceed 7.0 new daily cases per 100,000 residents for back-to-back calendar weeks, it would have to return to the purple tier. That would mean closing restaurant dining rooms and other indoor businesses and activities, including places of worship, for a minimum of three weeks.
As Kasirye referenced, long-term care outbreaks account for a portion of Sacramento County’s recent uptick, including dozens of active cases at licensed skilled nursing facilities, according to a state data dashboard. At least 48 residents at Asbury Park Nursing and Rehabilitation Center in Arden Arcade and 11 at College Oak Nursing and Rehabilitation near American River College had active COVID-19 as of a Monday update from CDPH.
Cumulative resident infection totals for those two facilities alone, of 51 and 21 respectively, combine for close to 9% of the county’s 807 all-time resident cases at skilled nursing facilities, according to the state dashboard. Additionally, 33 employees at Asbury Park and 22 at College Oak have tested positive.
Skilled nursing outbreaks combining for dozens of residents and dozens of health employees are a critical factor in pandemic response, especially given the vulnerability of older residents for whom the virus is by far the most fatal.
But considering the county’s rolling 10-day tally has increased by more than 500 in about two weeks, from 850 to now nearly 1,400, nursing outbreaks alone don’t appear to be the sole factor in the recent uptick.
Pandemic fatigue is real, and it has undoubtedly worn on Californians’ adherence to gathering and social distancing guidelines. The state has now been under Gov. Gavin Newsom’s stay-at-home order for more than seven months.
Placer County: Too many gatherings, risk of demotion
Placer County is reporting new cases at as high a clip as it has since Sept. 7, but state data haven’t shown any significant long-term care facility outbreaks there in recent weeks.
Tuesday’s tier list update showed Placer’s case rate recede into red territory, just two weeks after it was promoted to orange.
For the survey week of Oct. 11-17, Placer had 5.0 new daily cases per 100,000 residents. The orange criteria is 3.9. Placer’s rate was 3.7 last week. Test positivity increased from 2.1% to 2.5%, still under the 4.9% threshold for that metric.
If it fails to meet both criteria again next week, Placer County could be sent back to the red tier.
Placer County Director of Health and Human Services and Interim Health Officer Dr. Rob Oldham acknowledged the recent uptick in cases. He attributes it largely to people getting together unsafely.
“While we have continued to see cases in congregate settings, trends from the last month suggest large gatherings are a big contributor toward increased transmission,” Oldham said.
Oldham said 16% of Placer residents who’ve tested positive in October have attended a large gathering, the highest percentage in any month of the pandemic thus far.
“We’ve seen upticks in mid-Placer, as well as Lincoln. We ask our community to focus on the basics: masking, distancing, handwashing and thinking twice before getting together for social gatherings.”
Placer’s test positivity rate went from 1.8% on Oct. 4 to 2.5% by Oct. 16, according to the county’s data dashboard.
Yolo cases largely rooted in nursing facility outbreak
Throughout the pandemic, Yolo County’s COVID-19 activity has been more highly concentrated in long-term senior care facilities than has been the case for its neighboring counties.
Alderson Convalescent Hospital in Woodland is in the midst of its second deadly outbreak of the pandemic. Yolo County officials first reported the current outbreak on Oct. 14, announcing 14 resident cases and four staff cases at Alderson. That figure has since grown to at least 44 resident and six staff cases. That’s at least 50 COVID-19 cases linked to Alderson this month, with 32 reported since Oct. 15.
The latter figure accounts for more than 17% of Yolo County’s overall reported case total since mid-month, according to CDPH data.
About 220,000 people live in Yolo. That means that a single COVID-19 outbreak in Yolo will have about a seven-times-bigger impact on per capita case totals than a similar-sized outbreak would in Sacramento County.
Through Monday, senior care facilities facilities accounted for 201 of Yolo County’s 3,207 cases, but 28 of its 59 reported coronavirus deaths.
Yolo County’s test positivity jumped from 3.6% at the end of September to 5% by Oct. 12, remaining close to that rate until Oct. 20 and more recently recovering down to about 4.4%, the county’s data dashboard shows.
Prompted by increasing COVID-19 activity, Yolo County last week announced additional restrictions on social gatherings, tightening them beyond the state’s guidance. The county limited get-togethers to 16 people.
El Dorado: Staying the course
Only El Dorado County, which throughout the pandemic has fared best among the four counties in its COVID-19 metrics, has maintained relatively low numbers among the four main capital-area counties.
El Dorado’s 10-day rate of new infections decreased in the first half of October, from a starting point of about 100 new cases, and has essentially stayed on a plateau since mid-month. Tuesday’s tier list data showed a marginal increase this week compared to last.
El Dorado has reported only four deaths during the pandemic, one of few counties with a single-digit total. County officials have for months attributed the success in part to adherence to state and local guidelines; in part to the rural county’s sparsely populated nature; and in part to good fortune.
Sacramento County using antigen testing for schools, jails and more
The county last week obtained BinaxNOW antigen testing kits from the state, and will begin dispersing them to schools, jails, urgent care clinics and other group facilities to expand instant testing.
The antigen test, which takes 15 to 30 minutes to produce a result, will allow group facilities to determine quickly if a person showing symptoms has COVID-19.
Jesuit High School is experimenting with daily antigen tests on campus as part of a controlled pilot program.
Kasirye said the county will be monitoring Jesuit’s testing program to learn from it, but Kasirye cautioned that antigen tests can produce false positive results. She is not recommending that schools adopt the testing for large populations of asymptomatic students.
“You can have false positives when using it in a large of group where the likelihood of COVID-19 (infection) is not very high,” Kasirye said.
She called the antigen test usage an “incremental step forward, an additional tool as we develop our plan to reopen schools safely.”
Schools are among the key areas of concern this fall as the county guards against a new wave of infections.
Elk Grove Unified, the largest school district in the region and one of the largest in the state, plans to open its doors on Nov. 17, but notably, its administrators are saying they plan to do so only if the county has achieved the state “orange tier” designation.
County health officials say their “contact tracing” staff of 100 is now capable of contacting every person in the county who has tested positive for the virus to instruct that person to quarantine themselves, and to attempt to contact other people who have been in close contact with the infected person, to ask them to get tested and to quarantine if necessary.
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