'The virus is moving in': why California is losing the fight against Covid

Early in the coronavirus pandemic, California was celebrated as a beacon of common sense in a country on the brink.

As Donald Trump shunned masks and restrictions and told Americans the virus “came out of nowhere” and “one day like a miracle will disappear”, California leaders were the first to order their residents to shelter in place.

For months, the state seemed to avert the calamity that had befallen New York and Louisiana. Despite being the nation’s most populous state, with the largest number of direct flights to the pandemic’s initial center in China, California’s death rate remained low.

By early summer, however, the pressure to open back up rose. Officials discovered the state wasn’t immune to the national fatigue with social distancing and mask-wearing. Amid a patchwork of haphazard rules and guidelines, cases crept up.

‘The most challenging moment’

Today, most of California is back under lockdown amid a dramatic surge in infections. The state has tallied more than 1.3m cases, and broke a record last week with more than 25,000 infections recorded in a single day.

Los Angeles county last week passed the disturbing milestone of 10,000 new Covid-19 cases a day, and officials there fear a spike in infections resulting from the Thanksgiving holiday could send hospitalizations surging further. LA officials said that one person is now dying of Covid every 20 minutes, and the county’s public health director, Barbara Ferrer, broke down crying at a briefing while talking about the “incalculable loss” of more than 8,000 deaths.

San Francisco has seen its average case rate soar from 15 to 30 per 100,000 residents since the holiday. And in San Diego, by the US-Mexico border, more than 1,000 people are being infected each day.

“This is the most challenging moment since the beginning of this pandemic,” Gavin Newsom, the California governor, said last week. “Lives are in the balance. Lives will be lost unless we do more than we’ve ever done.”

Hospitals across the state are already overburdened. In southern California, the capacity of intensive care units has dwindled down to 10%. In Santa Clara county in the Bay Area, just 31 ICU beds remain for 2 million residents. San Francisco is projected to run out of ICU beds by 27 December.

“The virus is moving in on all of us now,” said Marcia Santini, a registered nurse at the emergency department of the University of California, Los Angeles (UCLA) medical center. “We’re scrambling to protect ourselves and protect our patients. The next couple of months are going to be really scary.”

Staff on the frontlines say they are increasingly battling burnout after months of devastation and with a dark winter ahead. “I’ve seen younger people come in through the door, and be admitted right away to the ICU,” said Erick Fernandez, a 30-year-old ER nurse at Antelope Valley hospital (AVH), a facility north of LA. “Most of us have the same thought – what if it was us that got that sick? What if it was our family member?”

Fernandez’s hospital recently received a state waiver to increase the number of patients per nurse amid a massive Covid surge, further exacerbating the stress of staff, he said. “We are coping as best as we can, but it’s emotionally and mentally taxing.”

It was frustrating that the public no longer seemed to be taking Covid protocols seriously, Santini said. “Every day we go to work, we’re putting our lives and our family’s lives on the line.”

Back in lockdown

Facing an increasingly critical situation, the state last week moved to impose a new stay-at-home order, a regional one this time that would be triggered whenever an area’s ICU capacity fell below 15%. Southern California, the Central Valley and the Sacramento region quickly crossed the threshold. In the Bay Area, county officials pre-emptively enacted the measures. “We are not just doing this because we want to. This is about people’s lives,” San Francisco’s mayor, London Breed, said.

Political leaders and health officials say the new restrictions are crucial. “The virus is everywhere in our city right now, and in so many neighborhoods where it hasn’t taken hold before,” said Dr Grant Colfax, the director of the San Francisco department of public health. “Even lower-risk activities now carry substantial risk because there is more virus out there than ever before. Simply put and bluntly put, we can’t get away with things that we’ve been able to get away with so far.”

But the response from Californians has been more mixed. Many have said the rules, which are expected to last through Christmas and order residents to stay home except for essential activities, bar hotels from accepting most out-of-state guests, shut down outdoor dining and personal care businesses, were complex, and at times seemingly contradictory.

Why should residents minimize contact with people from other households, but retail shopping and entertainment production can continue? Why did rules initially order the closure of playgrounds, while allowing indoor shopping malls to remain open? And why do Californians need to limit social contact, when their governor and the mayor of San Francisco attended celebrations at a Michelin-starred restaurant?

Like Americans across the country Californians are facing “true pandemic fatigue”, said Monica Gandhi, an infectious disease specialist at UC San Francisco, meaning lockdowns, unlike at the beginning at the pandemic, “will be met with less compliance”.

Indeed, opposition to the new measures has been particularly strong in rural counties, some of which have long balked at – and at times, defied – any kind of coronavirus restrictions even though the virus has run rampant among the predominantly Latino low-income farm workers who keep the state’s $50bn agricultural industry afloat.

The restaurant industry, which has been among the hardest hit, is also balking at the new restrictions. Some restaurants have invested thousands in outdoor dining infrastructure they hoped would last them through the pandemic, only to see those facilities ordered to close.

Sharokina Shams, a spokeswoman with the California Restaurant Association, says that the organization’s research has shown that 43% of restaurant owners are unsure whether their business will survive the next six months. “People who started out frustrated – today they are feeling just outright desperate.”

Exacerbating inequalities

Meanwhile, the latest Covid surge continues to shine a harsh light on inequality. California has seen record levels of unemployment and countless businesses have been shuttered for good, yet some sectors – notably the tech industry – have continued to rake in revenue. Economists are predicting that post-pandemic, California could see a so-called “K-shaped recovery”, where the incomes of the highest earners continue to rise just as quickly as they plummet for those who are struggling.

Latinos in LA county, many of whom are working essential jobs, are also contracting the virus at more than double the rate of white residents. The toll in working-class neighborhoods has been especially devastating for undocumented people, who have been unable to access aid.

“It’s really dire for our folks. They have a right to paid sick days, but that doesn’t mean that right is respected,” said Marissa Nuncio, an advocate for garment workers in LA who have faced Covid outbreaks at factories where they are manufacturing masks. Nuncio said nine months into the pandemic, she still gets calls from infected workers who are struggling to access tests and are afraid to go to the hospital. “They just say, ‘I hope I’m able to recover from this at home.’”

The new lockdown measures do little to address those inequalities because they lack support for workers, said Marta Induni, the director of research at the Oakland-based non-profit Public Health Institute. “We have the confluence of factors where people are facing financial instability, and feel like they have no choice but to work even if they get sick,” she said. “And particularly in California, we have a large population of undocumented people who have been demonized by the federal government and are especially vulnerable.”

Activists hope that California will take those inequalities into account as it develops a plan to distribute Covid-19 vaccines. California is on track to receive 327,000 doses in its first shipment, which will reach hospitals in the coming days. The state aims to give the vaccine to 2.16 million people by the end of the year, starting with healthcare workers and residents of long-term care facilities.

Officials have pledged to consider racial equity in distribution efforts, but there is a long road ahead to build trust in the vaccine and to reach the hardest-hit communities.