The novel coronavirus blew into town in March, knocking us off our proverbial feet as cases roller-coastered around Tahoe, yielding small peaks and victorious valleys. State and local leaders, never before confronted with such a pandemic, battened down the hatches — closing businesses, begging for limited interaction among their constituents, and emphasizing hand washing and the need for face coverings.
Then the eye of the storm made landfall in May, COVID-19 curbing its wrath and giving false hope as case numbers slowed. Businesses surged ahead with reopening and socializing became almost normal again.
But as is often true of actual hurricanes, the highest storm surge comes after the eye passes and it’s likely to be a rough, wheels-up landing. Come press deadline, the U.S. sat atop charts of confirmed COVID-19 cases and deaths. On June 23, the state of California shattered previous single-day records of new cases, with 7,149. Locally, cases continue to spike with Tahoe’s return to a tourism destination. The uptick was expected, and it’s known it will continue in a second wave, but the difference is that we will be ready for it.
Yet with uncertainty raging and human lives at stake, the next steps must be walked carefully, and both medical experts and political representatives hope for a balance between protecting public health and maintaining a stable economy.
Avoiding the threshold
Allowing the state to reopen has been a piecemeal effort by Gov. Gavin Newsom — literally. With the California Department of Public Health at the helm of the ship, health officers from each county provide information about what would flood current availability.
Numbers of beds, ventilators, and other supplies differ from county to county. Based on the data, the state set thresholds each county must stay within to continue reopening.
In addition to the average number of COVID-19 tests being given per day, CDPH looks at three main areas when determining the success each county has in combating the virus:
1. Elevated disease transmission is considered if the case rate per 100,000 people is over 100 across two weeks or if the rate is over 25 and testing positivity is greater than 8%. The second option considers increased availability of testing.
2. The percent change of those hospitalized due to the disease is less likely to be influenced by an increase in testing. Still, if there’s a 10% bump in the average number of COVID-positive cases hospitalized across a three-day span, the threshold is met.
3. Lastly, regarding limited hospital capacity, if less than 20% of intensive care unit beds or less than 25% of ventilators are available, capacity is marked as insufficient.
CDPH updates where counties stand every day, and while the formulas are the same for each county, the numbers obviously differ based on population and whether the location is rural or urban.
“The bottom line is, [the state doesn’t] want to overwhelm the health system with so many sick people that we run out of resources,” explained Dr. Glennah Trochet, deputy public health officer for Nevada County. “All the benchmarks they want counties to meet, testing and the number of positive cases versus tests, are based on what would overwhelm the healthcare system.”
She said Nevada County isn’t near overwhelming what there’s room for — that’s why things have continued to open; “but it doesn’t mean we couldn’t get there.”
Both Nevada and Placer submitted attestations of readiness to the CDPH in mid-May, breaking down what they can handle in light of the coronavirus’ continued threat and why they were ready to reopen. In addition to the state’s monitoring indicators are county metrics that serve as triggers for slowing the reopening pace and/or tightening modifications made.
Placer County provided such triggers as a doubling of cases in less than five days for five consecutive days; rising number of new healthcare worker infections for five days straight; less than a seven-day supply of personal protective equipment for healthcare workers; and over 135% capacity at hospitals. Placer County’s May 11 attestation of readiness is available, and includes a full list of the triggers.
As of press time, Dr. Aimee Sisson, Placer’s health officer and public health director, said none of the triggers had been met, but she’s keeping a close eye on the rising numbers — in particular, the state’s metric of case rate per 100,000 residents.
“[Placer County’s number] falls below the 100 cases per 100,000 resident threshold, yet it has doubled compared to two weeks ago,” she wrote in an email on June 26. “Nonetheless, the current case rate of 62 per 100,000 when coupled with Placer’s testing positivity rate of 4% continues to indicate that the county has not exceeded this threshold. To reach a case rate of 100 per 100,000 residents, Placer County would need to add 400 cases in 14 days, an average of 28 cases per day. In the last seven days we have averaged 17 cases per day.”
If a threshold is met, she continued, she would engage with county leadership and CDPH to discuss a plan of action.
The state of Nevada has its own requirements to boost the economy back up. Gov. Steve Sisolak’s Roadmap to Recovery walks residents and visitors through four different phases of relaxing restrictions, including benchmarks for counties to meet at each point.
Rt.live, a website launched by the Instagram cofounders, tracks how fast the coronavirus is spreading. ‘Rt’ is the average number of people infected by someone who already has the virus. The sweet spot here is the number 1: If the Rt is above 1, the virus spreads quickly; if it’s below 1, the spread is slowed down. By the beginning of July, Nevada had the highest Rt out of all 50 U.S. states — an estimated 1.48.
Nevada currently sits in phase two of reopening, and Sisolak announced on June 29 a directive extending the phase until the end of July in light of COVID trends.
Still in the thick of the first wave
On May 8, California business owners began stretching their legs after the forced hibernation — utilizing outdoor dining and requiring face coverings in recognition of the new normal. Throughout the month, doors were unlocked, shades lifted, and patrons began to trickle in and out once more. Those able to reopen (thanks to online services, federal grants, or what have you) had survived.
Placer County District 5 Supervisor Cindy Gustafson told Moonshine that when things shut down back in March and April, she heard from multiple North Tahoe small businesses that if there was a time to close, this wasn’t the worst option.
“Our small businesses really depend extensively on the summer season,” she furthered. “It is our busiest and most reliable season for most small businesses. Getting reopened for the summer was important to them.”
The month of May was a brief respite, the eye of the storm. Nevada County remained at 41 cases from April 28 through May 31, while Placer saw a jump of 70 cases during that same time period (compare that to the 400-plus rise during the month of June). As cases spike again (now higher than ever), it’s difficult to not consider the possibility of future shutdowns.
But spikes do not equal a second wave. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the Associated Press on June 21, “When you have 20,000-plus infections per day, how can you talk about a second wave? We’re in the first wave. Let’s get out of the first wave before you have a second wave.”
For historical context, the 1918 flu pandemic had its first flare-up in the early months of the year, a second wave in September, and a third wave in January 1919.
While many have offered the idea that COVID will flare up once more come cooler weather (the true second wave), Sisson offers a different perspective: “The concern is less around the weather in and of itself and more around people being indoors, potentially closer together in less ventilated spaces as we move into fall and winter — environments that have been shown to promote transmission of COVID-19.”
Though numbers are currently on the rise, rather than demanding a second statewide stay-at-home mandate, Newsom is taking a cautious approach. On June 18, he required face coverings to be worn throughout the state in public locations. Just over a week later, on June 26, he announced that with a 23% positivity rate in Imperial County (compared to the average 5.7% statewide rate) his stay-at-home order was reinstated there. On July 1, restaurants, bars, wineries, movie theaters, zoos, museums, and cardrooms were mandated to close in 19 counties (notably absent, however, were any Tahoe counties).
This movement is what Gustafson wants to see: a one-size-doesn’t-fit-all approach.
Yes, she elaborated, a uniform approach across California for public education and compliance is necessary, but “there has to be some local variations for circumstances … Incidents of closures [should be] more based on the caseload and the capacity of the jurisdiction versus statewide.”
The risk, she continued, needs to be considered for the variety of businesses.
“We were in our first-ever pandemic, so hopefully going into [a second wave] we’ve learned from the contact tracing and we use more evidence-based [data] because I think then it has more credibility,” Gustafson said.
And regardless of current spikes, a lull, or the impending second wave, Ryan Gruver, health and human services director for Nevada County, says the tendency to argue for shutting down businesses to protect public health or remaining open to provide stable incomes and economies is an unfortunate mindset; it’s a multi-colored topic rather than a black or white one.
“I reject that characterization as an either/or choice,” he said. “The quickest way for us to get the economy up to full steam is to open in a way that’s safe and is going to give people the confidence to go out there and start using those businesses because they feel genuinely that it’s a safe thing to do at this point.”
Re-flattening the curve
Ironically, the only way to get back to the May stagnation of cases, Gruver said, is to actually re-enter the stay-at-home mandate. Even modest pull-backs on reopening, he continued, wouldn’t yield flattening to that same extent.
Realistically, however, the goal is to slow the virus’ spread and turn the spike into a gradual curve that leads to flattening.
“That’s what we seem to be seeing in California with this gradual increase that goes along with increased testing capacity and kind of a gradual transmission as opposed to a spike that overwhelms everything,” Gruver said. “… Obviously we’d like no new cases, [but] that’s not my expectation at this point; my expectation would be that we keep new cases at a level that’s manageable within resources so that we can mitigate the impact of that.”
The realities are not only tied to the economy, but human nature as well. Cindy Wilson, director of public health nursing for Nevada County, compared the reopening of businesses to the mindset of ‘everything’s okay now.’
“If everything was shut down, there’s something psychological about, ‘Oh, I need to stay home,’” she said. “But once things open up, we tend to have a little bit of a more blasé attitude about it. ‘Oh, if it’s opened, I should be able to go’ … when really that’s not the case.”
Wilson also pointed to fatigue and a lack of understanding as to why people are wanting to socialize again.
“Nobody is saying that means [everything is] safer,” she explained. “What we’re saying is we believe we have a better capacity than we did in March to be able to surge. That our hospitals are better prepared with PPE, some other things like that. Our public health department has had training to do the case investigations and the contact tracing and has extended our capacity from one communicable disease nurse to a team of 14 nurses who can do that as well as our contact tracers.
“We’re more ready than we were but we’re not ever saying that reopening means we’re safe from the virus.”