After months of decline, cases of COVID-19 are not declining — and increasing in some places — in the Bay Area and California, worrying public health officials as the holiday season looms and calls for urgent pleas for Californians to get vaccinated or get a booster to get shots.
While widespread vaccinations would make a winter wave much less deadly than last year’s, the current rise in cases in some places is a preview of what California could experience as people come in and travel more often for Thanksgiving and winter holidays.
The possibility of an increase in winter cases comes at a critical and confusing time in the pandemic. Mandates requiring people to stay at home as much as possible have been lifted and a majority of Californians have been vaccinated, leaving public health officials limited resources to prevent another wave of transmission beyond advising people to take the injections and hold themselves accountable. to behave.
“These are uncertain and troubling times right now because we can’t be sure of where we are and where we’re going,” said Dr. John Swartzberg, an infectious disease specialist at UC Berkeley’s School of Public Health. “We have to be very careful about how we behave as individuals and how we behave from a public health perspective.”
In Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara, infection rates have either leveled off or started to rise in recent weeks, data from those counties’ public health departments shows. Statewide, cases and hospitalizations declined for months, but now appear to be stubbornly stalled, with seven-day average test positivity rising from about 2% in late October to about 2.4% in early November.
Unvaccinated people make up the majority of COVID-19 cases and an even larger share of hospital admissions, with a rate of about 22 unvaccinated people being hospitalized per million versus 2 per million for vaccinated people, according to the California Department of Public Health.
In a statement to this news organization, the department wrote that it was monitoring COVID-19 trends that “signaled a possible winter wave.”
“The state is preparing to respond to different scenarios if we get another wave of cases,” the department said. “We’ve learned in the past two years that COVID-19 benefits if we’re on our guard.”
With approximately 66% of eligible Californians fully vaccinated, protection against the worst disease will help against the more than 20,000 hospitalizations that shook the state last winter. But immunity to shots received last winter and spring may wane, and so far fewer Californians than expected have received boosters.
In the Bay Area, public health officials are grappling with how to sound the alarm among pandemic-weary residents while staying informed about the wave’s potential effects. That means continuing to convince unvaccinated people to get the injections, said Dr. Matt Willis, Marin County’s top public health official, as he continues to remind vaccinated Californians that the pandemic has not gone away.
Willis is confident that a rise in the number of cases will encourage more people to get vaccinated in the coming weeks. But for many, the role of public health in dictating everyday behavior is “decreasing,” he said.
“The shift we are in now is trying to provide people with the information they need to navigate what ultimately are personal decisions about risk. And it’s hard,” Willis said. “Like, what are we trying to do here? Are we preventing falls? Are we preventing deaths? Hospitalizations? What’s our north star?”
Willis, Swartzberg and other public health experts agree that preventing the healthcare system from being overrun by COVID-19 cases remains the primary goal for the next phase
s of the pandemic. But with minimal research into the implications of long-term COVID, that priority could eventually shift to preventing all cases, including breakthroughs, said Dr. Naveena Bobba, San Francisco deputy director of health.
For now, though, there’s clear consensus on how Californians should approach the coming months, experts said: Unvaccinated people should get the vaccine, while older people and those with underlying conditions should get a booster shot.
On Thursday — following a similar announcement in Santa Clara County — California health officials told providers to give boosters to any adult who wants one.
dr. Jocelyn Freeman Garrick, deputy director for emergency medical services in Alameda County, acknowledged that public health guidelines in both California and the nation have been “extremely confusing” as vaccines became widely available. But behavior will still play a key role in how winter progresses, she said.
People should prioritize gathering with only those who have been vaccinated, she said, and wear masks indoors if people’s vaccination status is unclear. Health officials are also encouraging coronavirus testing before attending a major event, gathering outdoors when possible and staying home when sick.
“A year ago we were optimistic and then came the Delta variant,” said Freeman Garrick. “We don’t know if there are new emerging variants that will affect our province and state that could contribute to the increase in cases.”
More than ever, Californians need to practice being flexible as the reality of COVID-19’s longevity sets in, epidemiologist Swartzberg said.
“We don’t just wake up and accept it — it’s a process of adapting to it,” Swartzberg said. “That’s what we’re going to live with: an endemic, infectious disease with the ability to significantly harm and occasionally kill people.”