California was the first state to issue a stay-at-home order to stop the spread of the coronavirus. And it worked: For a few months after that mid-March directive, the California curve held steady, with fewer than 2,000 new cases reported each day.
But in the past two weeks, California has ceased to be the country’s shining example. The state reached its record number of new cases in a single day, more than 7,000, on June 23, according to government data. California has also registered more than 40,000 new cases of COVID-19 since June 20, bringing the total to more than 215,000.
“In the past seven days, we have seen a 45% increase in the total number of positive cases in the state of California,” Governor Gavin Newsom said Monday at a press conference.
Newsom on Sunday ordered the closure of bars in seven southern California counties and recommended that health officials in eight additional counties do the same. He had ordered the use of face masks statewide as of June 18.
“What we did wrong was start opening things too early,” John Swartzberg, an infectious disease professor at UC Berkeley, told Business Insider.
California lifted state restrictions as daily case numbers continued to rise. The state did not see any of the downward trends recommended in the White House guidelines, a two-week decrease in cases or a two-week decrease in the proportion of tests that tested positive, before reopening.
The state increase has reflected trends in many other states that also reopened without seeing a steady decrease in cases. The United States recorded a record high of more than 45,000 new coronavirus infections on Friday, according to data from Johns Hopkins University.
California’s challenges have also been complicated by a mosaic of different local rules between counties. Specifically, Southern California closed later than the San Francisco Bay Area, then reopened businesses earlier, making the state’s cases disproportionately concentrated in Los Angeles and San Diego.
“What happened to California? It’s called a pandemic,” said Swartzberg.
California took early action to close, but reopened too soon
Some of the earliest cases of the US coronavirus were detected in the Bay Area in February. The region’s six counties took the fastest and most decisive action in the country, issuing a joint refugee order in place on March 17. The rest of California did the same in a matter of days.
“We were cautious about wearing masks and social distancing, it really helped,” Swartzberg said.
But the days make the difference when a virus spreads exponentially, and the three-day delay in the closure of southern California after the Bay Area partially explains why its outbreak has been worse from the start.
“The problem is that COVID-19 replicates fairly quickly,” George Rutherford, a professor of epidemiology at the University of California, San Francisco, told The Wall Street Journal. “Even delays of up to a couple of days mean you get four times as many cases.”
The Bay Area and Sacramento have 25% of the state’s population, but they only had 16% of their COVID-19 cases and 14% of their deaths in mid-May, according to The Journal. The Bay Area has about 24,101 of the state’s 215,000 cases, according to SFist. Meanwhile, Los Angeles County has registered a total of 98,000 cases. Its surrounding counties have another 32,000.
California went into phase two of its reopening on May 8, allowing “least-risk companies” such as retail and nonessential childcare to reopen with social distancing. However, the Bay Area remained under stricter local rules, while Los Angeles reopened gyms, outdoor recreation areas, and museums. Some of the state’s rural low counties reopened retail and restaurant restaurants at the time as well.
Venice Beach on May 24 in Los Angeles.
David McNew / Getty Images
But the state’s cases continued to rise as those reopens began, and its positive test result rate remained the same, suggesting that the virus was still spreading undetected.
“By the second week of May, things were clearly starting to open up, and we really opened around Memorial Day,” Swartzberg said. He added that “Southern California has been too liberal in terms of openness.”
Why are Southern and Northern California seeing different outbreaks?
Since June 15, Los Angeles County has registered 39% of new cases in California, although it is only home to a quarter of the state’s population, according to the Los Angeles Times.
In addition to the timing of the closure and reopening of LA, another reason for the disparity between outbreaks in northern and southern California is that the LA area has more facilities housing older people and low-income residents, both groups are especially vulnerable to virus.
Rosa’s Hair Salon in Atwater, California on May 26.
Genaro Molina / Los Angeles Times via Getty Images
Additionally, Los Angeles has significantly more black and Latino residents than San Francisco, and those communities have been disproportionately affected by the coronavirus. In California, Latino patients represent 57% of all coronavirus cases despite representing just 39% of the population, according to The Guardian.
The reason for this disparity is that black and Latino people are more likely than white people to have pre-existing health conditions that put them at risk for serious cases. Those underlying health inequalities are the result of systemic inequality and discriminatory long-term public policies. People of color are also more likely to be essential workers with factory and farm jobs.
An outbreak in San Diego County was at a migrant worker center. Two major outbreaks in California prisons in May: Avenal State Prison and California Men’s Institution, killed inmates and spread the virus through staff to neighboring communities.
The evidence has increased, but it is not the reason why the cases are increasing.
While California has increased its testing capacity, testing more than 80,000 people per day, the proportion of tests that tested positive has also increased, suggesting that increased testing is not the main reason for the increase.
Newsom said Monday that California’s seven-day positivity rate was 5.9%. That’s an increase from previous weeks: From May 14 to June 21, the state’s positivity rate was between 4 and 5%, but never more than 5%, according to Johns Hopkins University.
The World Health Organization recommends that regions be in an order of stay at home if more than 5% of tests show positive results.
A coronavirus testing site in Bolinas, a coastal enclave in northern California, on April 20.
Kate Munsch / Reuters
California has hired nearly 10,000 contact trackers, but Dr. Art Reingold, chief of epidemiology at UC Berkeley School of Public Health, told Healthline that contact tracing alone would not fix the state outbreak.
“The fact is that even under optimal circumstances, this would be an incredibly difficult virus to contain, and frankly we are not doing a good job in some parts of California or in the United States,” said Reingold.
However, Swartzberg believes that the state can still prevent the situation from worsening.
“We will do our best,” he said. “We cannot predict the future, but we are going to look at these daily numbers very carefully, do as many tests as we can and let that inform decisions so that we can self-correct.”
