California seemed to do everything right. So why are COVID-19 cases surging?

Recent orders by California’s governor to halt indoor dining in many counties may not impact the Blue Plate Oysterette much. At the Santa Monica seafood eatery, diners lately have been ordering their oysters or king crab legs at an outdoor counter – housed in a vintage VW bus – and feasting at sidewalk tables or across the street overlooking the cliff-side promenade.

Nonetheless, owner Jen Rush has sharp views about Gov. Gavin Newsom’s decision to close indoor spaces such as restaurants, museums, and movie theaters for at least three weeks because of a surge in COVID-19 cases. Add to that beach closures over the July Fourth holiday weekend.  

“They should never have opened up,” says Ms. Rush, complaining that authorities moved too quickly between phased reopenings. She notes that on a recent drive to the restaurant, only about a third of pedestrians on Ocean Avenue were wearing masks. The “yo-yo” orders – from full closure, to takeout only, to indoor dining with social distancing, then back to outdoor service – make running a business “very difficult,” she says.

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When the novel coronavirus hit the United States earlier this year, California was held up as a model of response. It was the first state to go into lockdown, on March 19, and it never experienced the heavy death toll of New York. But a recent resurgence of the virus has caused the state’s Democratic governor to reimpose restrictions – and undercuts the narrative that the spikes in several Republican-led states can largely be chalked up to “bad behavior” by their leaders, says Robert Wachter, chair of the department of medicine at the University of California, San Francisco.

As in other places, Californians were “a little bit cavalier and careless” after opening up, says Dr. Wachter. The virus doesn’t care if a state has had a couple of good months if people then let their guard down, he observes.

Still, he believes that because of what California has done right, it will be able to get things under control faster than other states. “Yes, we’re having a surge, but there will be fewer people that die here per capita than in states that have been less responsible,” he says, adding, “It’s not at the crisis level you see in Houston or Phoenix.” 

Five states in addition to California are currently backtracking on reopening because of a surge in new cases – Florida, Texas, Arizona, Colorado, and Michigan, according to the New York Times tracker. Thirteen other states are pausing their openings, while new cases nationwide could rise to 100,000 a day, Dr. Anthony Fauci told Congress last week. The U.S. leads the world in cases as well as deaths from COVID-19 – with the nation’s death toll now at more than 130,000, according to Johns Hopkins University.

A microcosm of the nation

With 40 million people, California is the most populous state and a microcosm of the nation. It has every kind of industry, ranging from tech to agriculture. It has extreme wealth and poverty. Its geography spans rural and urban, coastal and inland, and the state is home to an ethnically and racially diverse population. As such, many of the nation’s challenges with the virus are mirrored here.

California has seen, for instance, numerous outbreaks in confined facilities such as nursing homes and jails. In Marin County, roughly a third of the inmates at San Quentin State Prison have tested positive since a May transfer of hundreds of inmates from another prison that had been battling the virus. Six people have died. The top medical officer for the state correction facilities was replaced on Monday.

Last week, the state’s health secretary, Dr. Mark Ghaly, characterized some of the causes of the surge throughout the state. Family gatherings in Sacramento County, where guidelines were not followed, likely led to outbreaks in families, which led to a rise in cases and a more than 40% rise in hospitalizations in three days, he said.

Rural Imperial County, which borders Mexico and Arizona, has the highest rate of positive tests in the state and has had to send hundreds of patients elsewhere because its health care facilities are overwhelmed. Some cases have been linked to cross-border traffic in a county where most of the population is Latino and many are migrant farmers. In California, as in the nation, the virus is disproportionately affecting people of color.

In Los Angeles County, the epicenter of the virus in California, public health officials found last month that of 3,700 restaurants and bars surveyed, more than 80% were not complying with reopening guidelines – a big problem being lack of face coverings.

As a result, the governor on June 18 made face masks mandatory in most public settings, followed days later by the closing of bars on the state’s county “watchlist,” and then last week’s restrictions on indoor settings for watchlist counties. The governor said California became too fixated on when to reopen and not enough on how. 

California officials put together a “really thoughtful road map” on how to reopen, “but we may have gone a little bit fast through these steps,” agrees Jeanne Ringel, senior economist and director of the Rand Corp.’s health care access and delivery program. Livelihoods and mental health were at stake, putting tremendous pressure on officials to reopen. Because California had flattened the curve, cooped-up residents may have perceived the risk of socializing as low, she says. 

What went right

Like Dr. Wachter, she says the state has also gotten a lot of the response right: ramping up testing, using time gained during the lockdown to build contact tracing and hospital capacity and buy personal protective equipment, and putting in place a transparent monitoring system and triggers to pull back counties if they fail to meet benchmarks.

While California’s leaders have been consistent about messaging – wear face coverings, wash hands, practice social distancing – it can be hard to communicate that message effectively to different cultures within the state, says Dr. Ringel. Residents in more liberal Los Angeles County might be more inclined to wear face masks, while less inclined next door in the more conservative Orange County.

Interestingly, several Orange County oceanside communities voluntarily joined Los Angeles County in the temporary July Fourth beach closures – in contrast to strong resistance displayed at earlier forced closures. The COVID-19 surge in their county seemed to spur them on as did, in the case of Newport Beach, two lifeguards who tested positive and the subsequent quarantining of 23 lifeguards. At the same time, many national Republican leaders are now urging everyone to wear face coverings.

People need to get back into “a frame of mind that recognizes the magnitude of this moment,” Governor Newsom said last week. If they don’t, he added, the state has $2.5 billion in funds it can withhold from county recalcitrants and a regulatory arm it can flex with businesses. 

That’s all right with resident Melissa Longmire, who came to Santa Monica’s beach with two family members to celebrate a birthday on July 1. “I’m in total agreement with the governor,” she says, emphasizing the need to social distance and wear masks.

While their original thought had been to have a larger gathering, they ultimately decided to keep it small. “Health is the most important [thing],” she says.  

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