Sacramento County reopened too quickly and the coronavirus surged. Here’s the lesson

From an infinitesimally small number of cases in early February, Sacramento County’s outbreak of COVID-19 has grown — slowly at first, then significantly — to the current total of over 15,000 known cases.

The number of people hospitalized due to the virus reached a high of about 300 individuals (with 90 in the intensive care unit) a few weeks ago. Hospitalizations have since dropped modestly, as have ICU admissions.

Deaths due to COVID-19 have grown rapidly to a current total of over 250. The vast majority of deaths are in individuals over the age of 65 and/or with underlying conditions. The rate of positive tests is now 7.2% — clearly a concern.

We now have six months of history responding to the pandemic. We are no longer flying by the seat of our pants. The first three months of the outbreak, we (and much of the rest of California) were fairly restrictive regarding an array of local economic activities. We literally bent the curve in so doing, plateauing at only 5-10 cases per day in early May.

We then began activating parts of our society with guidance and direction from the State of California — permitting people to go to the gym and beauty salons, to eat and drink in restaurants and bars and to patronize virtually all indoor businesses. In retrospect, it is apparent that we probably opened up too widely, as we quickly surged to 250-300 cases per day.

Unlike the early days of the pandemic, when seniors were particularly hit hard, the overwhelming preponderance of cases in the second three months of the outbreak was in 15- to 49-year-olds. While this population is a bit less susceptible to the most dangerous consequences of a COVID-19 infection, they were also significantly more likely than older patients to be asymptomatic.

These individuals, without symptoms but still shedding the virus, were much more likely to spread the disease, unknowingly, to their colleagues, friends and family members. Indeed, the explosion of cases starting in June was ignited by gatherings of friends and families (often neglecting social distancing and mask-wearing). These infections then spread back into the community, particularly affecting essential workers, day laborers and migrant workers (most of those infected during this time are Latinx).

It is likely that we will soon be removed from the state watchlist — 14 days after that, schools can reopen, among other things. Schools must take reopening seriously. We can either have high schoolers congregating in the halls and middle schoolers gathering in the lunchroom (which will assuredly lead to outbreaks and shutdowns), or we can require face coverings and promote social distancing in less crowded classrooms and keep infections down.

We are now at a crossroads. It is critical that, this time, we bend the curve enough so that testing with rapid turnaround times provides teams of dedicated contact tracers the opportunity they need to manage new cases and quash any outbreaks at the source. We should also learn from recent experience and take a surgical approach to decisions about reopening businesses. We have to make tough decisions (based as much as possible on data) about which businesses are safe (or relatively so) to reopen, and which businesses (through no fault of their own) simply are not.

If we are not judicious in our decisions about which businesses can reopen, and how schools reopen, the pandemic will spiral out of control — particularly as we head into a potentially chaotic fall, where we will have to deal with the flu as well as COVID-19. This confluence of factors could dangerously stress our hospitals and ICUs; an important reason for EVERYONE to get the flu vaccine as soon as possible this year.

By approaching the next six months of the pandemic in a very pragmatic and deliberate manner, we can keep the number of cases and the concomitant suffering to a minimum. It will take all of us to do so.

This story was originally published August 29, 2020 at 5:00 AM.