Sacramento’s stagnating COVID-19 case rate could hold off further opening until June

As Sacramento County remains mired in the state health department’s red tier of coronavirus restrictions, attention is shifting away from tier promotions and toward June 15, the date Gov. Gavin Newsom has said California plans to fully reopen its economy.

Local COVID-19 case numbers have plateaued in recent weeks, even as the county now has nearly 650,000 of its more than 1.5 million residents with at least one dose of vaccine.

The county health office dashboard as of Thursday showed Sacramento County averaging eight daily cases per 100,000 residents over the past week, compared to nine per 100,000 about two weeks ago. The percentage of tests returning positive has been hovering just under 2.5%. That’s not a concerning percentage, but it is about double the statewide rate as California now boasts the nation’s lowest positivity numbers.

The state’s orange-tier requirements include having a case rate below six per 100,000 for two consecutive weeks, and state health officials also assess the data on a longer delay of more than a week to account for lags in data reporting.

That means it’s unlikely Sacramento will notch the first of those two weeks in next Tuesday’s weekly assessment by the California Department of Public Health.

Even if Sacramento did see rapid improvement starting with the next update, the earliest it would be able to advance to orange within the current tier structure would be May 18. With a three-week minimum in one tier before moving to another, Sacramento wouldn’t be able to join the likes of San Francisco and Los Angeles in the least-restrictive yellow tier until June 8 — just one week before the tier structure itself is supposed to end.

Sacramento County health officer Dr. Olivia Kasirye affirmed Thursday that if the state’s “blueprint” framework for reopening its economy is retired on June 15 as planned, the county will end its local health order at that time as well.

Kasirye told The Bee last week that it “could be very difficult to enforce anything more restrictive” than the statewide order by mid-June. But she said Thursday she believes many local businesses are “willing to be patient” as they wait for the reopening orders to loosen. June 15 will mark about 15 months since California first initiated its stay-at-home shutdown in response to the pandemic.

“I am not concerned about any businesses trying to jump ahead before June 15,” she said Thursday morning on a teleconference call with reporters. “I think everybody is going to be able to wait for that. The question they are asking most of the time is ‘What do we have to do past June 15?’”

Kasirye said there will still be some form of mask mandate for at least the beginning of summer, as Newsom has said will be the case. She also said the county will await further state guidance on how to handle large events — things like concerts, or the State Fair, which was recently postponed so Cal Expo can continue as a vaccination site.

Why are COVID-19 infections still on a plateau?

As she said last week, Kasirye repeated that the stagnating local case numbers appear to be due to a few different factors rather than any one major outbreak or source. But she also emphasized the possibility that variants are becoming prevalent.

She said the county is monitoring to see whether genetic variants of COVID-19 are playing a large role in increasing spread. But lab limitations continue to make that a difficult process, with few sites in the state equipped to perform genome sequencing.

Jamie White, the county’s epidemiology program manager, said the county this week received from the state a backlog of about 300 specimens that had undergone genome sequencing to test for variants.

The batch included dozens of confirmed cases of variants of concern including B.1.1.7 (sometimes known as the U.K. variant), and B.1.427 and B.1.429 (the West Coast variants.)

But the cases came from a long reporting backlog spanning from mid-December to early April, leaving variants’ influence on the current trendlines less clear.

To date, the county has confirmed 53 cases of the U.K. variant and about 180 of the West Coast variants. White said there has been evidence that each of those variants can make the virus at least 20% more infectious.

Vaccination still the most critical factor

Kasirye also referenced Sacramento’s lagging vaccination rate, especially in low-income neighborhoods.

“When you look especially at families that have a higher percentage of people in the wealthier quartile” of the state’s Healthy Places Index, Kasirye said, “you see that they are doing quite well.”

The numbers from CDPH back that up: through Wednesday, only 43% of eligible (16 and older) residents in Sacramento County ZIP codes falling in the most disadvantaged quartile of the health index had received at least one dose, compared to 68% in the wealthiest quartile.

Overall, 41% of Sacramento County’s total population has had a first dose of vaccine, compared to 48% for California as a whole, CDPH data updated Thursday showed. But in some Sacramento neighborhoods, fewer than 20% of residents have had a dose.

The county health office next week is scheduled to receive its largest allocation of doses yet, at nearly 32,000 doses, vaccine program coordinator Rachel Allen said, which will give the county greater ability to support partnering community-based clinics or expand to more partners.

But as local health officials also said Thursday, vaccination issues have shifted from short supply to slowing demand along with the need to address access barriers, including socioeconomic ones.

As appointment slots at mass drive-thru sites have recently gone unfilled, California health officials are trying to pivot to a more targeted approach.

“We did focus a lot on our larger throughput sites, and then as we started getting more vaccine we were able to start the pop-up sites, but we are also are cognizant that there is a certain level of vaccine hesitancy,” Kasirye said Thursday.

With the shift to pop-up sites comes a new set of challenges. Mike Nguy, the county’s COVID-19 health equity official, noted the importance of working with many different community-based organizations to address vaccine hesitancy concerns, which he said can vary by nature in every community.

“This is why taking a multi-pronged approach of utilizing trusted messengers, to mitigate as many of the access barriers — transportation or other barriers — to really build up that vaccine confidence among disproportionately impacted, underserved communities is really critical,” Nguy said.

The “trusted messengers” can include leadership at places of worship, youth organizations and other community-based groups, Nguy said.

There are some other vaccine concerns as well. The county shared data Thursday showing that now 6.3% of recipients of Pfizer or Moderna have missed or skipped their second dose, up one percentage point from the 5.3% reported last week.

Though Pfizer is designed to be taken three weeks apart and Moderna four weeks, the second dose can safely come up to six weeks after the first, federal and state health officials say.