COVID-19 cases are leveling out. Can we avoid a new wave?

After months of significant declines, California’s new weekly coronavirus cases and hospitalizations have plateaued, as the critical holiday season approaches.

The state’s infection rate for coronavirus has long been among the lowest in the country, and officials hope vaccine requirements and other safety rules will prevent another increase in cases and deaths this winter.

But the arrival of Halloween will set in motion a packed board of fall and winter festivities that tempt many residents to travel and gather in a number not seen since before the pandemic.

Combine that with cooler weather, which is increasingly pushing indoor activities – where the risk of transfer is generally higher – and the apparent seasonal condition of COVID-19 itself, and there is potential for this recent break to be a starting point for a new influx of infections.

Although California continues to perform better than most states, it is still considered to have “significant” transmission – the second worst category in the US Centers for Disease Control and Prevention’s four-tier scale.

When the state celebrated its full economic reopening in mid-June, California reported fewer than 1,000 new coronavirus cases a day. Now the state sees between 5,000 and 6,000 on average.

And about 100 Californians still die from COVID-19 every day. Prior to the rise of the Delta variant, California reported about 25 deaths a day.

Dr. Regina Chinsio-Kwong, a deputy health officer in Orange County, has warned for weeks that a pandemic increase was possible as the weather cools if vaccination rates do not improve drastically. In mid-October, she pointed to the experience of Britain, which at times has heralded the direction the United States is heading.

“As the winter months come and as all these holidays come up, more people will gather and more people will be indoors,” Chinsio-Kwong said. “So if we do not take precautions before everyone gets some form of immunity, we are still at risk of continuing to have higher numbers in case rates, similar to the UK.”

California is not necessarily destined to follow Britain’s path. It is possible that a combination of the state’s relatively high immunization rates along with one higher degree of natural immunity, could place it to weather this fall and winter better than elsewhere.

But the state has so far stopped recording declines from week to week in cases of coronavirus and COVID-19 admissions. And the rate at which coronavirus test results return positive has crept up.

“Across California, our state is open and we realize that people are getting tired of wearing masks and that there is also declining immunity. And there are many more in our community who are still not vaccinated yet,” said Chinsio-Kwong on Friday. “So yes, when people go indoors, we expect things to either stay the same or actually increase.”

On Thursday, California reported 3,816 people with COVID-19 infections in hospitals across the country, a 4% increase from a week earlier.

The latest hospitalization figures are nowhere near the height of the summer rise, which peaked at 8,353 patients on 31 August. But it is still a quadrupling of the level before the Delta rise.

“We have certainly seen a cut in the increase we had, but things are flattening out and we do not see any further decline. Things have been pretty stable over the last few weeks,” said Dr. Marty Fenstersheib, vaccine officer for Santa Clara County, Northern California’s most populous. “We hope this is not the beginning of an increase.”

The state-wide test positivity rate over the last seven days is now 2.8%, up from 2.1% a week ago.

And after falling steadily for several weeks, the number of new daily coronavirus cases has leveled off. During the seven-day period ending Thursday, there were an average of 6,068 new cases each day in California. This is an increase of 10% compared to the previous week.

The arrival of last year’s holiday season meant a disaster for California and heralded a violent coronavirus wave that hit the state.

“I want to be sober about the moment we are in because it is in many ways reminiscent of where we were last year,” Governor Gavin Newsom told reporters Wednesday.

But he also acknowledged “the progress we have made because we should, and I would like to thank 40 million Californians for their resilience.”

Much is different this year than last year – including the introduction of vaccines – and health experts and officials generally believe that California is unlikely to experience the same unrest.

But COVID-19’s orbit is well known.

Assemblies, especially in crowded indoor environments, provide ample opportunity for transmission. Health officials “now also believe there are some seasonal conditions with COVID that could make it easier for it to spread during the colder months,” Los Angeles County Public Health Director Barbara Ferrer told reporters Thursday.

As of Thursday, Orange County reported an average of 279 new coronavirus cases a day over the past week, an 18% increase from a week ago. Los Angeles County’s seven-day average of 1,224 new coronavirus cases a day has risen 23% from a week ago.

More than 60% of residents of all ages in both LA and Orange counties are fully vaccinated, according to data collected by The Times.

But even in the San Francisco Bay Area, home to the state’s highest vaccination rates, some officials have reported that cases are no longer declining.

More than 70% of all Santa Clara County residents are believed to be fully vaccinated, but officials there are also seeing progress, with new average cases generally around 150 a day throughout October. In June, Santa Clara County generally reported about 30 cases a day.

In Fresno County, the recent improvement in COVID-19 hospitalizations has begun to evaporate. After peaking at 410 before Labor Day, the number of patients admitted to San Joaquin Valley’s most populous county dropped to 240 in mid-October, but has risen to over 300 in recent days.

Fresno County’s per capita COVID-19 hospitalization rate is five times worse than LA County’s and one of the worst in California.

“It’s actually a somewhat bleak view,” said Dr. Rais Vohra, Fresno County Temporary Health Officer. “Hospitals can actually experience the same level of stress and strain that they had with this last fall increase or last winter increase.”

Too few people have received their shots – just over 50% of residents are fully vaccinated – and too few have received boosters, Vohra said. “And we’re already starting with an extremely affected healthcare system.”

Most of California remains in the two worst categories of the coronavirus transmission scale – either “significant” or “high” as defined by the CDC. Los Angeles, Orange and Ventura counties had “significant” transmission from Friday, while San Diego, Riverside and San Bernardino counties were rated as “high,” the worst category.

And several counties were reclassified to worse categories Friday: Alameda, San Mateo and Monterey moved from “moderate” to “substantial,” and San Luis Obispo moved from “substantial” to “high.”

While health systems are no longer stretched to extremes, officials say they may be stressed by another, more familiar enemy in the coming months: the flu.

The nation was spared the typical flu season last year – a development expert largely credited measures to fight coronavirus, such as wearing face masks, practicing social distancing and avoiding crowded environments.

However, this is not expected to be the case this year. Companies that were closed or severely restricted last year are now running at full capacity. Sporting events and concerts have resumed. And many residents are expected to travel to see family and friends.

The prospect of flu season arriving amid a continuing high level of coronavirus infection is so worrying that it has even spawned a moniker: a “twindemic.”

“We know that there are other respiratory viruses that are starting to circulate, flu and others that affect both young people and adults,” said Dr. Mark Ghaly, California’s health and human secretary. “We are concerned that this will continue to be a challenge for our hospital system and that certain efforts to truly protect California must be doubled so that we can get through the next few weeks and months.”

Many are convinced that California is better equipped to cope with a COVID-19 storm this year, especially thanks to the widespread availability and prevalence of vaccines, which officials and experts say continue to offer strong protection against infection and serious illness.

According to state data, unvaccinated Californians are seven times more likely to be infected, 10 times more likely to be hospitalized and 15 times more likely to die than their vaccinated counterparts.

Already, nearly 69% of all Californians have received at least one dose, and about 62% are fully vaccinated. The inoculation campaign may soon get an extra boost when state and federal health officials extend vaccine access to children ages 5 to 11. If you do, an additional 9% of California’s population will be eligible for the shots.

Nevertheless, this coverage is far below the level considered necessary to provide lasting protection against future outbreaks.

Although only 32% of Californians are unvaccinated at this time, it is still more than 12 million people. It is larger than the population of all states except six.

And last year’s fall and winter rise proves how quickly the virus can get out of control.

On October 21, 2020, the state reported about 3,000 new cases, data from the Times shows. A month later there were 12,100. And a month after that, the daily reported total had risen to 58,400.

Community transmission did not fall back to pre-March levels until March.

“We are entering the next many weeks, confident of the situation with vaccines and their ultimate protection of so many, but careful and vigilant with our guard on to ensure that our hospital system is prepared, our public health system messages and measures are on space so we can make sure California gets through a very tough period last year, ā€¯Ghaly said.

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