In June of 2020, San Diego County’s public health department adopted a set of 13 triggers designed to signal that the coronavirus pandemic was worsening and additional measures were necessary to bring viral transmission back under control.
Eighteen months later, six of those indicators are in the red, enough to trigger modification of existing health orders. But there are no signs that anyone in county government intends to make any changes, even as the region posts record numbers of new cases and emergency rooms are flooded with coronavirus positive patients.
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Why hasn’t the region’s public health authority made any changes as its own triggers have flipped?
Neither Dr. Wilma Wooten, the region’s public health officer, nor any of her deputies directly responded to the question last week. The county’s communications office said in a short memo, not attributed to anyone in particular, that the county “constantly monitors and uses the trigger metric to inform local decision-making,” but that “decisions are made based on the totality of the information,” including knowledge gleaned long after the triggers were first devised 18 months ago.
Rather than modify its trigger list, local public health authorities have generally taken direction from the state, at least on a pandemic policy level. County supervisors did not respond when asked through their communications officers to comment on the situation.
Anyone can see that the pandemic landscape has changed dramatically, with the advent of an effective vaccine adding a mountain of hope to the picture. That key element appears to be a significant factor in the health department’s reluctance to make any significant changes — such as reinstituting business restrictions — as its trigger warning system has sent up red flags.
“San Diego County has since become one of the most highly vaccinated populations in the state and hospitalization numbers are far less than 12 months ago, along with the rollout of emerging treatments for those most at risk,” the county’s statement said.
Other large metropolitan areas in California have been more forceful in recent months.
Los Angeles and San Francisco, having maintained indoor masking rules when they fell away in most communities across the state this summer, have both instituted proof-of-vaccination requirements for bars, gyms, restaurants and other locations accessible to the public, though anecdotal reports of spotty enforcement have raised many questions about their effectiveness.
The latest numbers don’t seem to argue that San Diego has suffered due to its more open approach as the arrival of a more-contagious Omicron variant has sent cases soaring. As of Saturday, the state’s coronavirus website listed L.A. with a case rate of 76 per 100,000 residents, San Francisco hitting 69 and San Diego at 64.
Thus far, California’s pandemic stance has remained far more open than it was in late 2020 and early 2021. A wide range of businesses and venues have remained open as cases have surged.
But momentum is building in academia toward a more aggressive approach, especially as reports of overwhelmed hospitals continue to surface in communities across the nation.
Two weeks ago, a pair of Harvard professors urged Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, in a letter later shared online, to consider short-term shutdowns in order to slow the spread of the virus “with the narrow goal of avoiding catastrophic hospital overload and the avoidable deaths and suffering that would otherwise ensue,” when high infection rates generate more admissions than can be handled.
Often called “circuit breaker” shutdowns, the idea is generating significant discussion in the United Kingdom, with one group of researchers modeling the effects of a two-week pause of most activity in places where case rates are growing very quickly. Research results found that such a shutdown, if a large enough segment of the population complied, could function as a kind of “temporal reset,” breaking chains of person-to-person transmission for long enough that the number of recent infections, hospitalizations and deaths could be significantly reduced.
So far, though, there has been little response to the American call for any type of shutdown at all.
In San Diego County, the path is more visible than it is in most cities due to the formalized trigger system which states that the “Health Officer Order will be modified” when certain parameters get out of line. Just this week, a new indicator that shows how quickly local hospital beds are filling turned red. The trigger is deemed to be normal as long as the percentage of locally hospitalized COVID-19 patients is increasing at a rate that is less than 10 percent, a number which is calculated by comparing subsequent three-day averages of overall hospitalization across all non-military medical centers in the region.
Last week, the growth rate was listed at negative 4.5, meaning that the number of hospital patients with confirmed COVID-19 cases was shrinking. Last week, the number shot straight up, hitting 19.7 percent in just one week. The spike coincided with a crush of residents arriving in local emergency rooms, forcing many facilities to temporarily divert ambulance traffic even though most were said to have mild illness and some appeared to be trying to shortcut long lines at testing centers.
Other triggers such as the local case rate, the number of local community outbreaks, the number of people with COVID-19 or flu-like symptoms and the percentage of new cases being investigated in a timely manner by the health department were all in the red.