The Sacramento region’s COVID rate is not improving. What that means for restrictions
California has made a comeback in the pandemic, boasting one of the nation’s lowest infection rates in recent weeks. But its capital region is struggling.
The Sacramento region has seen coronavirus activity stagnate above statewide levels, even as hundreds of thousands of local residents have been vaccinated in recent months. Sacramento County’s top health official says there appear to be “multiple factors” contributing to the plateau of virus activity.
California Department of Public Health data updated Tuesday showed Sacramento’s rate of daily new COVID-19 cases over the preceding week at 8.9 per 100,000 residents, which ranked seventh-highest among the state’s 58 counties. It’s close to triple the latest rates in Los Angeles or San Francisco, which were near three per 100,000.
Recent numbers have kept the area’s two most populous counties, Sacramento and Placer, in the second-tightest “red” tier of the state’s business and activity restrictions for several weeks, with a promotion still weeks away, at a minimum. A weekly update Tuesday from CDPH listed those two among 11 counties in the red tier without a week of progress toward the looser orange level.
County health officer Dr. Olivia Kasirye had projected a month ago, when the case trendline was headed downward, that Sacramento likely would reach the orange tier before the end of April.
Now, she says, her hope is that the county can qualify for the orange tier sometime late in May, which would only be about three weeks before the tier system is expected to be phased out entirely.
Kasirye described the current situation as a plateau rather than the early stages of another surge, but also called it “disappointing.”
“It was not due to any large outbreak, so it’s not easy to explain away,” she told The Sacramento Bee this week. “I think it is multiple factors.”
The return of students to schools and resumption of sports events in the past few weeks have bumped up Sacramento’s numbers, Kasirye said, but other counties throughout the state are sending children back to schools as well. Placer and Sacramento counties advanced out of strict purple-tier restrictions and into the red tier in March.
COVID vaccine vital to recovery
Kasirye and Placer County health chief Dr. Rob Oldham said the key way to turn the tide back in a positive direction is to get more people vaccinated quickly.
That presents its own issue: Although demand for the vaccine is still strong, some clinic slots are no longer filling up in Sacramento and Placer counties, possibly due to some level of vaccine hesitancy or disinterest among those who have not yet gotten shots.
“I’ve been agonizing about it for many nights,” Kasirye said. “The way out of this is with the vaccinations. We need to continue pushing that. That is the only thing right now.”
CDPH data show that just over 600,000 people in Sacramento County have received at least one dose of vaccine. That’s about 38% of the county’s total population, and roughly 48% of its 16-and-older population. None of the vaccines currently in use are authorized for children younger than 16.
In Placer, more than half of the adult population has now gotten at least one dose of vaccine, Oldham said. That gives him some confidence that the recent uptick in cases will not turn into a surge, at least not on the dramatic level Placer, Sacramento and other California counties saw in November through January.
“We have so many vaccines in arms now, it is less of a worry,” he said.
Oldham said he is hoping that as the vaccination effort evolves in the coming months, with more doses available at local clinics and private health care providers, some people who have been reluctant to trust the government will be more amenable to encouragement by their personal doctors to get the vaccine.
It will take a few hundred thousand more vaccinations to reach 70% of the population in Sacramento, Placer and other local counties, a number health officials have pointed to as a rough, low-end estimate for what may be necessary to reach herd immunity status.
Like in many parts of the country, bottlenecks for vaccine appointments have eased, and some clinics are ending the day with extra doses, an early sign that Sacramento may be reaching the point where “vaccine hesitancy” will slow progress toward the goal of getting 70-plus percent of the population vaccinated.
One new challenge the county faces, according to Kasirye, is to persuade and assure people that the Johnson & Johnson vaccine is safe, after use of it was paused nationwide for 11 days while federal officials investigated reports of a rare but severe blood clotting condition in a small number of recipients.
J&J has made up a small percentage of California’s vaccinations, at about 1 million of its more than 28 million doses injected, but it requires only one dose, while Pfizer and Moderna’s vaccines require two.
Part of what makes the case plateaus in Sacramento and Placer a bit more concerning is that they come even as hundreds of thousands more residents across the region have been vaccinated in the past two months.
CDPH data showed that more than 250,000 in Sacramento County received a first dose between March 1 and this past Sunday. Placer has one of the higher vaccination rates in California, with about 31% of its roughly 400,000 residents now fully vaccinated.
Local hospital numbers increasing as well
Sacramento County hospitals this past weekend spiked to 104 total confirmed COVID-19 patients being treated, according to state health data, after dropping as low as 79 on April 13. The total returned to triple digits for the first time since March 17.
A higher percentage of Sacramento’s cases have come among more active people in the under age 50 group, according to Kasirye. The county’s recent uptick in hospitalizations, though, still appears to be driven by patients age 50 and up, she said, a disparity that is difficult to explain.
The state on Tuesday reported Placer County with 41 hospitalized virus patients, up from 28 in early April. More concerning was the total in Placer hospitals’ intensive care units, which has jumped to 13 from two on April 7.
Placer, on its own local health dashboard, reported Monday that less than one-third of its COVID-19 patient total is made up of Placer County residents, with the rest from outside counties. Most of the county’s large hospitals are located near the border with Sacramento County.
Sacramento’s recent daily case rate of about nine per 100,000 was nearly double the statewide rate of 4.6 per 100,000. Also well above California’s overall mark were El Dorado (9.1 per 100,000), Nevada (7.8 per 100,000), and Placer counties (7.6 per 100,000).
Those counties fared slightly bit better when looking at test positivity rate, which can better reflect true spread of the virus while controlling for testing quantity, but the percentages were still higher than the statewide rate.
Sacramento County’s local health dashboard shows its positivity fluctuating between 2.5% and 3% since the beginning of March, most recently reported at 2.5%. Meanwhile, California’s statewide positivity rate has essentially cut in half since the start of March, from 2.5% to a record-low 1.2% for the past week.
Will Sacramento, Placer ever reach the orange tier?
Neither Sacramento nor Placer has recorded the first of two necessary weeks with a case rate low enough (below six per day per 100,000 residents) to advance into the orange tier. The red tier status is keeping a few types of entertainment businesses closed, as well as imposing tighter capacity limits at places such as restaurants and movie theaters. It also means tighter attendance caps for both indoor and outdoor live performances and sports events.
Red is the second-tightest tier in California’s system, but no counties remain in the tighter purple tier, and close to 90% of the state by population is now in either the orange tier, which now includes Sutter along with El Dorado and Yolo counties, or the yellow tier.
A big day is coming in less than two months: Gov. Gavin Newsom has said he plans to reopen most of the state on June 15, absent major setbacks in infections or the vaccine campaign.
With tier movements such a gradual process — updated once a week, with data from more than a week earlier to account for data reporting lags and requiring two consecutive weeks of meeting criteria before promotion — it’s plausible that Sacramento, Placer and other red tier counties could fail to reach orange before the tier system itself go away.
Even if Sacramento’s numbers are trailing the state at that point, Kasirye said she will follow the governor’s path and allow the same level of reopenings here.
“We would go with what the governor recommends. It could be very difficult to enforce anything more restrictive than that.”
In Placer County, health chief Oldham says the same. “There will be some restrictions, but most will go away. I think we are ready for that. That is why it is critical in the next six weeks we get as many vaccinated as possible.”
Could COVID-19 variants be to blame?
There is also the possibility that Sacramento is getting hit with some of the newer coronavirus variants that spread more easily than the original strain, Kasirye said.
A number of “variants of concern” have arisen worldwide and been detected in the United States, one of the most notable being B.1.1.7, which was first found in the United Kingdom.
Tens of thousands of cases of B.1.1.7. have been confirmed in the U.S., according to the Centers for Disease Control and Prevention. The strand has been blamed for a dire surge recently in Michigan, which appears to now be on the downswing and improving.
Genome sequencing to test for variants remains fairly limited, but Sacramento’s public health dashboard shows there have been at least 33 known cases of B.1.1.7 in county residents. It has also been detected in Placer and Yolo counties.
CDPH says there have been 2,524 cases of B.1.1.7 found among 38,408 samples in the California, for about 7% of sequenced cases, through April 21. CDPH does not provide a geographic breakdown of those variant cases.
But 38,000 sequences remains a relatively low total, with only a limited number of labs conducting genome sequencing. The state has recorded more than 3.63 million total cases to date, and, at the height of its winter surge in early January, was adding more than 38,000 new cases a day.
Because of lab limitations, it is difficult to determine the extent variants may be playing a role in a relatively modest uptick in cases. It becomes clearer whether variants are the culprit when there is a steep and sudden spike in cases — a trend Sacramento, like every community around the globe, hopes to avoid.
This story was originally published April 28, 2021 at 10:19 AM.
