How will Sacramento address new COVID surge, poor vaccination rates as Delta spreads?
New COVID-19 cases are pouring into Sacramento County at their fastest rate since February, hospitalizations have doubled in less than a month and the county’s graphs for each continue to grow more vertical almost every day.
The local health office reports that the daily case rate has soared in the past three weeks, from four per 100,000 residents to 10.4 per 100,000. State data show county hospitals now treating 115 patients, nearly double the 59 in beds two weeks earlier.
County health officer Dr. Olivia Kasirye during a Thursday call with reporters called it “quite a steep increase.” The latest case rate figure ties for the county’s highest since Feb. 23
In response to surging infections, the county on Thursday strongly recommended that residents wear masks in indoor public settings, even those who are fully vaccinated.
During California’s tiered reopening plan — the “Blueprint” framework, which expired June 15 — more than 10 cases per 100,000 would have had Sacramento headed toward the strict purple tier, which would have brought tight restrictions on indoor restaurant dining, movie theaters and numerous other types of businesses.
Kasirye said Thursday that the county currently isn’t considering any tighter restrictions beyond the mask recommendation — which is not a mandate — at the local level.
“Right now our expectation is that the measures we are taking are effective,” she said. “At this point, there are no considerations of additional steps. ... We are hoping that we will be able to bend the curve quickly.”
Spikes in virus cases and hospitalizations also prompt the question of how the situation deteriorated so quickly near California’s capital.
Kasirye over the past couple of weeks has largely attributed the spike in new infections to the combination of California dropping most pandemic restrictions, which happened a month ago Thursday, and the now-dominant spread of the highly infectious Delta variant of COVID-19.
“The messages we’re putting out: If you’re sick and having symptoms, please stay home, and also masking, and also being careful in large gatherings,” the health officer said. “When transmission in the community is high, it does increase the risk for everybody.”
“Everybody” means the fully vaccinated as well. While the vaccines are highly effective, they’re not a 100% guarantee of protection. And if there are more cases overall, there will likely be more breakthrough cases.
Kasirye linked the surge to Sacramento’s struggling vaccination rates, which are likely helping Delta take root.
She said during Thursday’s call that the number of ZIP codes with increasing COVID-19 case rates is falling. But in the neighborhoods where rates are increasing, they’re increasing fast.
“We do have these hot spots, and they tend to overlay” with areas that have low vaccination rates, Kasirye said.
During a presentation before the county Board of Supervisors on Tuesday, she pointed to one graph showing that the recent case rate among the fully vaccinated is about six times lower than those partially or unvaccinated, and that the gap appears to be widening as overall cases increase.
She pointed to other charts showing that larger percentages of total cases are being detected in Black residents, in underserved neighborhoods such as South Sacramento and North Highlands, and in children — all cohorts with comparatively low vaccination rates, state and local health data show.
Vaccinations key, but Sacramento coming up short
Kasirye hammers on the importance of vaccination near-constantly, referring to it Thursday as “our way out of this.”
But in the county of 1.6 million people, just 47% are fully vaccinated and 53% have had at least one dose, according to state health data updated Wednesday. For all of California, those rates are 52% and 60%, respectively.
The health officer fielded numerous questions Thursday about whether there’s a need to be more aggressive with the vaccination campaign.
“We are using trusted messengers. We are partnering with community-based organizations,” Kasirye said. “For a lot of people, it depends who’s providing information to them.”
The health officer spoke of the need to be “innovative.”
“Recently, some of our staff went to an event animal control had where they were offering rabies vaccinations to pets,” she said. “So our staff were there to offer (COVID-19) vaccinations to the owners of those pets.”
Asked why, specifically, rates remain so low in certain areas and neighborhoods such as North Natomas and North Highlands, Kasirye said there are “multiple factors,” including “barriers” such as cultural, language and transportation barriers.
The vaccination campaign is not just about holding clinics, but about reducing those barriers.
One way to do that is via public messaging.
Kasirye gave a striking statistic during the supervisors meeting, not previously disclosed: Among more than 700,000 county residents who have been fully inoculated against the coronavirus, only 19 have been admitted to hospitals with confirmed COVID-19 after vaccination.
Supervisor Phil Serna told Kasirye that the numbers told “a very, very partial story.”
But he wasn’t doubting the effectiveness of the vaccines. Serna wanted much more in-depth data from the health officer, showing a direct comparison of how the vaccinated hospitalization rate compares to the rate among the unvaccinated.
“If you were to just take what you said,” the District 1 supervisor told Kasirye, referencing the raw tally of 19 hospitalized, “that may actually have the contrary effect that we’re looking for in terms of underscoring the importance of vaccination.”
He urged the health officer to make charts of hospitalizations and deaths that compare the local rates of each metric over time between vaccinated and unvaccinated residents.
“I think that’s incredibly important,” Serna said, “especially as it relates to how we continue to message the importance of vaccination.”
California’s vaccine pace slows to a crawl
Demand for the COVID-19 vaccine has slowed to a trickle, both in Sacramento and statewide, figures from the California Department of Public Health show. The last significant uptick came when the vaccine became available for ages 12 to 15.
CDPH reports the rate for new first doses administered recently fell to its lowest point since last December — the very beginning of the rollout, when supply was extremely scarce and doses went exclusively to the most vulnerable populations.
California for the week ending Monday administered about 28,000 doses per day. In a state of 39.5 million, that’s a daily pace of 0.07% of the total population.
Sacramento’s recent pace, 1,100 doses per day, is almost identical to that per-capita, but the county also has more ground to make up at only 53% with a dose.
Epidemiology program manager Jamie White said Thursday that the county currently holds between 20 and 25 pop-up vaccine clinics a week, and that each administers somewhere between 20 and 100 shots. The county is also still vaccinating about 500 a week through its drive-through site at Cal Expo.
“Even a single vaccine is a success,” White said. “That’s one more person.”
Delta is dominant, health officer says
Many local health offices have not had detailed information on exactly how widespread Delta is in their counties, due to limitations on the state labs that process genome testing.
Those lab results can sometimes take weeks, Placer County health director Dr. Robert Oldham said in an emailed statement.
White additionally noted that the state labs prioritize samples from cases involved in outbreaks, hospitalized cases and cases in the fully vaccinated, meaning Sacramento’s tally of 101 Delta variant cases isn’t necessarily representative of the general population.
Kasirye couldn’t provide an exact percentage figure for Delta’s prevalence in Sacramento.
But she pointed to data recently shared by nearby Yolo County as affirming that Delta is indeed the dominant variant in the capital region.
Yolo, because of a local partnership with UC Davis, genome-tests as many of its positive COVID-19 cases as possible, giving a much clearer picture of variant spread.
Yolo County, in a Wednesday announcement of its own mask recommendation, said Delta made up 76% of samples collected between June 27 and July 7.
“From what they have shared,” Kasirye said Thursday, “we know that the Delta variant is now the dominant variant in the region.”
Kasirye mentioned that misinformation spreading online makes vaccinating residents hard. The U.S. Surgeon General on Thursday issued a warning calling vaccination misinformation an “urgent” public health threat.
“It’s definitely made our work more difficult,” Kasirye said.
She said the county encounters misinformation most frequently in younger adults.
“What we’re hearing is that oftentimes, they’re just repeating information they’ve heard from a video or something they’ve heard on social media, which might not be accurate.”
Did California reopen too soon for Sacramento?
In the spring, when COVID-19 activity was receding statewide following the devastating winter surge, Sacramento County for weeks found itself stuck on a plateau.
That plateau saw Sacramento, one of 58 counties in California, as one of the final eight remaining in the “red” tier of restrictions — one better than purple, in which no county had been assigned since early April — before it finally departed that level on June 1.
At the time, Kasirye noted that advancing in tiers, even just two weeks before the tier system disappeared entirely, was an important step.
“We want to get as low as possible when we get to June 15,” she said in late May.
When June 15 came, though, Sacramento County was still averaging 3.9 cases per 100,000 over the preceding week — nearly double the statewide rate of 2.2, and the highest of any of the 10 California counties with a population over 1 million, state health data show.
In other words, Sacramento entered the June 15 reopening with the highest baseline of cases among the state’s urban hubs.
Local health officials still expressed optimism just ahead of reopening.
But Delta may have changed the game.
Kasirye told reporters that ahead of reopening, she expected the case rate per 100,000 might go up perhaps a point or two.
It’s gone up by more than six per 100,000 and is still rising fast.
Surge extends beyond Sacramento
Infections are spiking statewide, and though the curve is particularly steep in Sacramento, there are also significant increases emerging in the Bay Area and Southern California.
Statewide test positivity has quintupled from 0.7% to 3.5% since early June, leaping from 3% to 3.5% in just the past day.
The concurrent hospitalized total has increased by 62% since July 1, state health data show.
Los Angeles County, which has roughly the same vaccination rate as California overall but still has millions of unvaccinated residents due to its vast size, has seen hospitalizations double from about 225 to 450 in the past month.
All 10 California counties with at least 1 million residents have seen their per-capita infection rate increase by at least 30% since the June 15 reopening.
That may be somewhat surprising, given that five of the 10 are above the state’s average full vaccination rate. But it’s likely because of the growing presence of the Delta variant, seizing on the hundreds of thousands or more unvaccinated residents living in each of those counties.
This story was originally published July 15, 2021 at 12:35 PM.
