COVID rates vary widely by region in California, 3 months after end of restrictions
Coronavirus cases and hospitalizations are trending lower for California as a whole, after the arrival of the delta variant brought the state its third major wave of the COVID-19 pandemic.
The daily case rate has dropped from about 33 per 100,000 residents in mid-August to 20 per 100,000 as of Tuesday’s update from the California Department of Public Health. Test positivity has fallen from 7.2% to 4.4% since late July. And the statewide total for virus patients has dipped from 8,350 to 6,800 since late August.
But the situation varies widely across different regions of the Golden State.
While declines in infections and hospitalizations in major population centers including Los Angeles, San Francisco, San Diego and Sacramento counties have driven down the statewide numbers, many rural areas of Northern California and the San Joaquin Valley continue to see COVID-19 activity at or near the worst levels of the entire pandemic.
Seven counties, all of them rural, had positivity rates above 12% as of Tuesday. Seven others came in below 2.5%, six of them in the Bay Area.
Wednesday marks exactly three months since California dropped most statewide pandemic restrictions including capacity limits, social distancing requirements and the mask mandate for the fully vaccinated, effectively putting the onus of COVID-19 response into the hands of local governments and their health offices.
More than two dozen counties combining for more than half the state’s population have since returned to indoor mask mandates regardless of vaccine status, but none have taken the type of strict measures used in 2020 such as ordering businesses to close.
Wednesday also marks five months since COVID-19 vaccines became available to all Californians ages 16 and older.
The regional divide has been clear in that arena, as well. At the top are a handful of Bay Area counties with more than 70% of their total populations fully vaccinated. At the bottom are sparsely populated rural counties with fewer than 35% of residents fully vaccinated.
In the middle are most of the Sacramento region, Los Angeles and Southern California, each within a few percentage points on either side of the statewide average, which sat just below 60% as of Tuesday.
Here’s where things stand across the state.
Sacramento-area hospitalizations, cases
The four-county region of Sacramento, Placer, El Dorado and Yolo counties has seen a decline in cases and early signs of hospitalizations falling during the first half of September.
Sacramento County peaked Sept. 1 at 449 hospitalized COVID-19 patients, including 114 in intensive care, but has since seen the totals fall below 350 hospitalized and 100 in ICUs, state data show.
The local health office reports the daily case rate has fallen nearly by half in the past month, from 46 per 100,000 residents to 28 per 100,000. Positivity, as a rolling one-week average, has fallen from 10% to 5.9% in less than four weeks.
Placer County, which broke its hospitalization record with 231 patients in late August and shattered its ICU record Sept. 1 with 56 in intensive care, has seen both totals start to slowly decline.
All four counties have seen their positivity rates fall significantly in the past few weeks, state data show. El Dorado and Placer have each dropped from peaks of around 13% down to 7%.
Yolo’s rate, reported Tuesday at 1.7%, remains the best in California, according to CDPH. It plateaued near 3.5% most of August. Yolo County has one of the state’s most aggressive testing networks.
Case rates still remain elevated in the region compared to spring. Prior to the delta surge, Sacramento County’s case rate had slimmed just below four per 100,000, seven times lower than its current rate.
The local health order in Yolo calls for the universal mask mandate to stay in place until the county reaches fewer than two cases per 100,000, about where it was in early June, for seven straight days.
Yolo’s rate was still at 21 per 100,000 as of Tuesday, according to CDPH — more than 10 times higher than the threshold to end masking.
Rural Northern California, San Joaquin Valley
More than a dozen counties have, since the start of August, broken their records for virus hospitalizations that were set last winter. Most are rural counties north of Sacramento and the Bay Area, along with a few agricultural counties in the Central Valley.
Hospitals in the San Joaquin Valley are being stretched thin by the delta surge.
Deluges of virus patients dropped ICU capacity for the region below 10%, making it the first region in the state to officially enter state-ordered surge protocols. The region includes Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare and Tuolumne counties.
Under a state health order, all general acute care hospitals in those counties that do have ICU beds available must now accept transfer patients when clinically appropriate.
Two of the region’s most populous, Stanislaus and San Joaquin counties, have started to record declines in hospitalizations, after approaching their records from winter around the start of September. San Joaquin has fallen from about 300 to 240 in less than two weeks, and Stanislaus from 350 to 290.
Fresno County is declining from a nearly three-week plateau around 400 virus cases in hospitals, reported Tuesday at 371. The situation has been dire enough that Fresno State is considering switching to all-virtual learning after Thanksgiving.
Tulare County has plateaued since the start of September between 170 and 180 patients.
Even with those early declines, all four of those counties have between 20% and 25% of all licensed hospital beds occupied by confirmed COVID-19 cases.
Three of California’s hardest-hit counties in recent weeks have been Butte, Shasta and Tehama, which combine for about 460,000 residents in the northern Sacramento Valley and Sierra Nevada foothills. All three have recently broken their previous hospitalization records, and have also tied or broken their ICU patient records, with Butte and Tehama doing so in the past week.
Butte, the largest of the three at 210,000 residents, recorded an all-time high of 114 confirmed COVID-19 patients in hospital beds Tuesday including 18 in intensive care units, state data show. Butte peaked last December at 100 patients, also with 18 in ICUs.
“We have reached a tipping point, and we need your help,” Enloe Medical Center, a hospital in Chico, wrote in a Facebook post Monday.
Enloe explained that it has been using monoclonal antibody treatments “to successfully reduce the severity of symptoms and avoid hospitalizations in COVID-positive patients, both vaccinated and unvaccinated,” but noted that even with this therapy, local hospitalizations have climbed.
“We have also been notified that rationing of this treatment is imminent and we may not receive the number of treatments we have requested,” the hospital wrote. “It is imperative that you vaccinate as soon as possible.”
Tehama County as of Tuesday ranked second-worst in the state in test positivity rate at 17%, nearly quadruple the California average. Butte has plateaued around 11% for more than a month, a transmission level the county only saw previously from mid-December to mid-January.
All 15 counties — Butte, Shasta, Tehama and the dozen included in the San Joaquin Valley region — trail California’s average for full vaccination, which was 59% of all residents, according to state data updated Tuesday.
Fourteen of the 15 trail it by more than 10 percentage points, all but San Benito County at 55%. Kings (32%) and Mariposa and Tehama (33%) counties had the second- and third-worst rates in the state, ahead only of Lassen County, according to CDPH. At the higher end of the Central Valley, Fresno and Tuolumne counties each have 46% full vaccination.
Just 33% of Tehama residents and 37% of Shasta residents were fully vaccinated, ranking fourth-worst and eighth-worst, respectively, among California’s 58 counties. Butte County has 44% of residents fully vaccinated.
Los Angeles, Bay Area hospitalizations
Much of California’s statewide decline can be attributed to Los Angeles County, which makes up 10 million of the Golden State’s 39.5 million residents, and the Bay Area.
Los Angeles County hospitalizations have dropped from roughly 1,800 to 1,200 since mid-August, CDPH data show. A global epicenter late last year, Los Angeles didn’t come close to its previous high of just over 8,000 concurrently hospitalized.
Riverside, San Diego, San Bernardino and Orange counties, which ranged from 370 to 540 virus patients in hospital beds Tuesday, have each had that total drop by more than 100 from their peaks in August.
Greater Bay Area counties, which make up California’s entire Top 10 for full vaccination rates, saw hospitalizations spike during the delta surge, but not nearly to the same degree as counties with lower vaccine coverage.
San Francisco, for instance, soared from 20 COVID-19 patients to more than 100 in hospitals in less than a month, from early July to late August. But its peak of 128 in mid-August only reached about half as high as its winter surge, and the total has since subsided to 80.
San Francisco, home to nearly 875,000 people, has had some of the most aggressive restrictions and maintained one of the lowest per-capita hospitalization rates for COVID-19 among all major U.S. cities throughout the pandemic.
No Bay Area counties have broken hospital records during the current surge. Bay Area positivity rates have also stayed consistently better than the state average.
COVID deaths are on the rise
Floods of virus deaths have followed hospital surges.
Del Norte County, in the bottom 10 for vaccinations with just 38% fully inoculated, had its lone hospital in Crescent City overwhelmed by virus cases in early August.
The county had just 10 deaths in the first 17 months of the pandemic, but has since reported at least 24 additional fatalities in the last six weeks.
Butte, which had 205 deaths in the first 18 months of the pandemic — an average of less than three a week — reported Monday that it had added 16 in the past week. The health office in a statement warned deaths would likely keep rising in the weeks to come, as hospitalizations have yet to peak.
Butte County health officials in a Monday news release noted that since April 15, the date vaccines were made widely available to adults, 25 county residents younger than 80 years old have died of COVID-19.
Twenty-four of those 25 deaths came in adults who were not fully vaccinated, the county health office said.
“Tragically, many of these deaths could have been avoided if more people had been vaccinated,” county epidemiologist Linda Lewis said in a statement.
Death spikes haven’t been limited to the least-vaccinated counties.
Sacramento County, due to its surge that peaked in mid-August, recorded more than virus 200 deaths that month, making it the county’s third-deadliest calendar month of the pandemic, behind only December and January.
Nevada County watched its patient total exceed the worst of the winter surge almost every day this August. The county reported just one resident fatality between late January and the first week of August — and has since tallied another 16 deaths in the past five weeks.
In both counties, about 54% of all residents are fully vaccinated — five percentage points below the statewide rate, but middle-of-the-pack among all 58 counties.
The statewide daily death rate is now about 0.2 per 100,000 and appears to be plateauing.
That’s nowhere near the 1.7 per 100,000 recorded at the height of the winter surge, thanks largely to high vaccination rates among the elderly, but it’s nearly a tenfold increase from the 0.03 daily deaths per 100,000 being recorded at the start of July.
This story was originally published September 14, 2021 at 2:26 PM.
