‘It’s precarious.’ How San Joaquin Valley became a worrisome COVID-19 hotspot in California
As California more fully reopens its economy, the San Joaquin Valley is emerging as a trouble spot for coronavirus infections and hospitalization, prompting the state to put most of the Valley’s counties under a special watch this week.
Of the 15 California counties with the highest percentage of positive coronavirus tests over the past two weeks, eight sit squarely in the Valley, a McClatchy review of state health data as of mid-week shows.
The eight counties — Kings, Tulare, Fresno, Kern, Madera, San Joaquin, Stanislaus and Merced — comprise the entire Valley.
California health officials this week disclosed that they are conducting “targeted engagement” in five of those counties to help them improve their response to the pandemic.
The Valley, a 275-mile stretch from Stockton to Bakersfield, is a rich agricultural basin that produces a significant portion of the country’s fruits, nuts, vegetables, dairy and beef. It’s also a region of sprawling poverty and intense public health issues — and experts say those factors are likely contributors to COVID-19 infections.
Jonathan London, a UC Davis professor of human ecology, says the Valley’s air pollution has long made the Valley a hot spot for asthma and other respiratory illnesses, for example, which the U.S. Centers for Disease Control and Prevention says has been linked to serious COVID-19 cases.
“It’s poor, it’s precarious, people are just hanging on in the best of times,” London said. Preventive health care isn’t as widespread as in wealthier counties. “You have something like this, and it’s adding fuel to the fire.”
The state’s “targeted engagement” involves Fresno, Kern, Kings, San Joaquin and Tulare, as well as six other counties around the state, including Sacramento, another Central Valley county.
In San Joaquin County, hospitalizations jumped in the past three weeks amid disagreements among public officials over the wearing of masks. Kern County, at mid-week, had more current COVID-19 hospital patients than all but five of California’s 58 counties. Fresno County hospitalizations have risen steadily for months, but have leveled off in the past two weeks.
Kings and Tulare hospital cases have been increasing slowly. In contrast, Stanislaus has kept its COVID-19 hospitalizations steady. And although Madera just saw a spike in the last 10 days, the patient number remains low, only six.
The state spotlight on those counties and a few others comes at a critical moment.
On Friday, many counties in the Valley and elsewhere in California are expected to reopen bars, movie theaters, gyms and public pools. It’s the latest step toward a near-complete reopening of the California economy after two-plus months of shutdowns and “stay at home” orders as the state attempted to reduce the spread of the virus.
State officials have identified several likely sources for clusters of infections in the Valley. Avenal State Prison in Kings County had a large outbreak among inmates, and state health officials say they have recorded instances of prison employees bringing the virus back to their communities.
Like many communities in California, Valley counties also have seen a series of outbreaks in nursing homes. State officials say they are focusing their intervention efforts in particular at those facilities.
The cases of COVID-19 in the Valley have not been tied specifically to the agriculture industry, although experts believe it’s an area of concern. Farmworkers make up 39 percent of the infections in coastal Monterey County, one of the few jurisdictions to measure cases by occupation.
Phil Martin, a UC Davis expert on farm labor, said worker housing and packing plants loom as potential “danger zones” for the virus. A frozen food plant operated by Ruiz Foods in Dinuba, in Tulare County, reported 174 infections in mid-May. Latinos, who make up the bulk of the agricultural workforce, are twice as likely as whites in Fresno County to become infected, according to county health data.
COVID-19 testing still lagging in many counties
An increase in cases was expected as the state reopened and expanded testing.
“We’re in the land of trade-offs,” said Andrew Noymer, an epidemiologist from UC Irvine. “There is no reopening without an increase in cases. There is no increase in cases without some mortality.”
Nonetheless, in recent weeks, as of state data on Wednesday, only three counties exceeded the targeted infection rate — 8 positives out of every 100 people tested — set by the state as the threshold for deciding whether it’s safe to reopen more businesses. State officials said they wanted counties to have infections percentages less than 8 percent.
Two of those counties are in the Valley, Tulare and Kings, while the third is Imperial County at the state’s southern edge. Fresno and Kern counties, also in the Valley are close to the 8 percent target level.
The key to keeping people healthy, state health officials say, is to have adequate testing in place in each county to catch new cases, then to quickly track the people who have been in contact with those who are infected, to get them tested and isolated if need be.
But McClatchy’s review of weekly averaged state data as of a week ago showed as of Wednesday that 52 of the state’s 58 counties failed to conduct the level of testing the state said it believes is optimal for safe reopenings. That includes the eight San Joaquin Valley counties. That level is 150 tests on average per day for every 100,000 residents.
The only counties meeting that target as of state reports on Wednesday were Del Norte, Imperial, Napa, Los Angeles, San Francisco and Alpine.
Officials with the California Department of Public Health in an email Thursday said they are continuing to add test sites statewide, and are discussing “more aggressive testing (and) infection control strategies” with certain counties. They declined to be more specific. “Our goal is to ensure that anyone in California who needs a test can get a test.”
State officials said many counties are not seeing notable declines in cases and hospitalizations because California acted early and avoided the kind of spikes some other states suffered. “We saved thousands of lives and prepared our health care delivery system – and also prepared to reopen more safely.”
‘Fear and misinformation’ over COVID-19
Gov Gavin Newsom has repeatedly said the economic reopenings will be based on science and data, not emotion.
Nevertheless, counties have frequently reopened without meeting all the statistical standards the state had suggested they aim for, in most cases with tacit agreement by the state.
State health officials have said that those safety thresholds — such as 150 tests per day per 100,000 population — remain goals. But, they say they are more focused on whether or not each county has plans in place to react quickly if it experiences a surge in the virus.
Many local county leaders are pushing to reopen. That’s causing debate over whether jurisdictions, businesses and residents are taking enough precautions.
In San Joaquin County, which has seen a spike in recent weeks in cases and hospitalizations, Stockton Mayor Michael Tubbs this week chastised city and county leaders for resisting stronger steps to protect people from the virus. Tubbs’ city effort to require people to wear masks in public was defeated 6-1 by the Stockton council on Tuesday.
“A lot of this is based on fear and misinformation,” Tubbs said on Capital Public Radio’s Insight program this week. “Leaders, we have to speak hard truths. People are looking for government to signal this is serious.”
A county spokeswoman said the San Joaquin health officer had not yet, as of Thursday, determined whether the county should move ahead into the next round of business reopenings, approved by the state, which includes bars, gyms, movie theaters, card room, and campgrounds.
Tulare County, in particular, made statewide headlines last month when its leaders pushed ahead of the governor’s timetable for reopening, amid constituents calls for the county to get people back to work.
Tulare’s daily reports of new cases has shown large jumps up and down since then, but the numbers have increased overall. And, after a brief dip to 11 a month ago, the number of COVID-19 hospital patients increased to 38 as of Wednesday, according to state data.
State health officials say they intend to help Tulare step up efforts at nursing homes, and to enhance “contact tracing,” the effort to track down people who have been in close contact with newly infected people.
Phoebe Seaton, co-director of the Leadership Counsel for Justice & Accountability, a Fresno-based group that advocates for low-income residents, said what makes matters worse is that Tulare and other counties are not doing an adequate job of getting information and services to people with less access to healthcare, notably Latino communities where the language barrier makes it harder to get the word out about COVID-19.
Tulare moved into the next phase of reopenings “despite not meeting state requirements for doing so and despite not having followed state protocols for requesting variances from the state-wide shelter-in-place mandate,” according to a letter her organization sent the Tulare board of supervisors.
“The Board of Supervisors took this action without consulting with public health officials, impacted communities, essential workers, or city governments.”
Veronica Garibay, the co-director of Leadership Counsel, said Fresno County leaders have weakened protections against the disease. In guidelines issued last month, the county health officer initially said masks had to be worn in public. But two supervisors complained about that, and the policy was quickly modified so masks were recommended but not mandatory.
“You have decision-makers actively undermining” the message of the health officers, Garibay said.
This story was originally published June 12, 2020 at 5:00 AM.