One year after the COVID-19 pandemic triggered stay-at-home orders throughout the state, Californians are at a public health crossroads. Increased vaccination rates could mean looser restrictions on how we live — but the threat of the virus is far from gone.
Infection rates are on the decline. California is seeing a COVID-19 case rate of 3.8 per 100,000 as of March 15, compared to a rate of 104.3 on Jan. 7, according to the California Department of Public Health. Deaths and hospitalizations have also been trending steadily downward.
Experts are hopeful the worst is over, especially with vaccines becoming more accessible. But they say health officials now need to be very careful about which public health interventions to scrap and which to keep moving forward.
Rapid spread of the virus early on led to a spat of new health interventions, from spaced-out lines at the grocery store to plastic shields around restaurant tables. Experts say some of those changes were very effective at keeping deaths and case rates down, while others made only a marginal difference.
And they each had a varying impact on our mental, physical and economic well-being.
“There are some restrictions that have minimal cost to them, like masking, that I think will be around for a long time,” said Dr. Anju Goel, a Bay Area physician and public health expert. “But then there are other restrictions that really have some very significant side effects, so to speak. When we close schools and kids miss out not only on education but on social interactions, that has really serious implications.”
CapRadio asked experts about where we started with public health guidance, where we are now, and what could be to come as California moves closer to herd immunity.
- John Swartzberg is an epidemiologist at UC Berkeley
- Dr. Anju Goel is a Bay Area physician and president of the American Medical Women’s Association
- Andrea Polonijo is a medical sociologist at UC Riverside
- Interventions known to prevent spread — such as masking and physical distancing — will likely stay in place even after more people are vaccinated
- If people stop following public health guidelines now, California could see another surge — especially with new variants emerging
- If you haven’t been vaccinated, continue to mask in public, stay six feet from others, limit large gatherings and avoid out-of-state travel
- If you have been fully immunized (two weeks after your final vaccine dose), you can gather indoors with other fully vaccinated people without wearing masks, and see one household of unvaccinated people as long as no one there is high-risk. You don’t have to quarantine after an exposure unless you have symptoms.
Here's a closer look at how some public measures have changed since the start of the pandemic, and what you need to know going forward.
Business Closures And Restrictions
California issued its first statewide stay-at-home order on March 19, 2020. Though even before then, counties were making independent decisions to close bars, restaurants and other businesses.
“What was clear with that lockdown was that it really worked well,” said Swartzberg. “What we didn’t understand was that if we relaxed things too quickly we’d be back in the same position in the not-too-distant future.”
Health officials began easing restrictions in May, including allowing bars, gyms and movie theaters to start reopening in June. Many health experts now say the state reopened too soon in the summer. As cases rose, in August California health officials introduced the color-coded tiered reopening system.
Then as hospitalizations and deaths began to climb in winter, California introduced a regional stay-at-home order tied to intensive care unit capacity throughout the state. State health officials lifted those orders Jan. 25.
Goel says the restrictions that were put in place in January led to a “dramatic decline” in cases that eased the flood of patients hospitals were seeing after the holidays. She says experts anticipated another surge after those orders were lifted, but the numbers stayed low.
“I think that is due to the statewide restrictions that were put in place in the second half of December,” she said. “I don’t think that decrease was due to vaccination, because it happened too soon after the vaccine came out for that to have made a significant difference.”
Currently, counties can gradually reopen businesses according to the color-coded tier reopening system. The criteria allows certain establishments to open with modifications, based on their county’s case positivity rate and vaccines administered.
Most California counties are in the red or “widespread” tier, that’s the second-most restrictive category. This means many businesses, such as restaurants and fitness centers, can be open indoors at limited capacity.
But Swartzberg says California might again be opening up too soon, giving people the impression that they can go back to ‘normal’.
“After having gone through such a nightmare of December and January and seeing a really glorious decline in the number of cases so rapidly, everybody is emotionally exhausted,” he said. “People are taking off their masks too soon and travel is increasing too soon.”
He says the state should be “putting the brakes on opening things as rapidly as we are.”
For those who haven’t been vaccinated, experts say it’s best to continue to avoid crowds and limit the amount of time you spend in close proximity to others. If you want to patronize a restaurant or other business, doing so outside is much safer than being inside.
If You’re Vaccinated
Even after being immunized, people should be careful when they’re out in public and limit the number of interactions they have with unvaccinated individuals. While the three currently available vaccines are effective at preventing severe illness from COVID-19, early research shows that those who are vaccinated may still be able to contract coronavirus and spread it to others.
The U.S. Centers for Disease Control and Prevention says even if you are fully immunized, you should stay six feet from others and avoid medium and large gatherings.
There was a lot of mixed messaging about masks at the beginning of the pandemic, due to a lack of scientific research on the virus and a shortage of supplies for medical personnel. On April 3, the CDC recommended "cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure." California started requiring residents to wear masks in most public settings June 18.
California officials discouraged people from buying up masks with more advanced filtration methods, such as N95 masks, because these were being reserved for front line health workers. These masks were also in demand during wildfire season because they can provide protection from air pollution.
Throughout the pandemic, researchers learned a lot about how effectively cloth masks can limit the spread of coronavirus. Production of surgical masks and more advanced masks also increased throughout the course of the pandemic, though the CDC still recommends that N95 masks be reserved for health care settings.
The CDC now recommends that people wear masks anytime they interact with others, especially when they are indoors. Here are some examples of masks that will offer effective protection:
- Surgical or disposable masks
- Masks with 2-3 layers of fabric
- Masks made with cotton or other tightly woven fabric (light shouldn’t pass through it)
- Masks that fit snugly around the nose and chin (no bandanas, scarves or neck covers)
Recent research suggests wearing a surgical mask underneath a cloth mask can help increase protection if the cloth mask is only a single layer. Double masking is not necessary if the mask already has multiple layers and fits snugly.
If You’re Vaccinated
According to CDC guidelines, people who are fully vaccinated can spend time indoors, unmasked with people who are also fully vaccinated. They can also spend time indoors, unmasked, with one other household of unvaccinated people as long as those people aren’t at high risk for severe COVID-19.
Fully vaccinated people should wear a mask when in public and when at gatherings.
“You don’t know the vaccination status or the risk level of the people around you in these public places,” Goel said. “We have quite a lot of data for masking that shows that it is effective, places that implement masking policies do have lower transmission and a lower number of cases than places that do not.”
Travel and Social Visits
In November 2020, Gov. Gavin Newsom issued a travel advisory urging against non-essential out-of-state travel, and asking people who have traveled to quarantine for 14 days upon returning home.
Early on, people were encouraged not to share indoor space with anyone outside their immediate household. In October 2020, California issued gathering guidelines instructing people to keep social visits outside, with three or fewer households, for under two hours.
California’s current guidelines say people should avoid traveling more than 120 miles from their place of residence, and should self-quarantine for 10 days after arriving home.
People are still discouraged from indoor gatherings with people they don’t live with. The state is still discouraging gatherings, though worship services, cultural ceremonies and protests or political events are allowed. The state also loosened restrictions on outdoor performances and amusement parks, which will allow places like Disneyland to open soon.
If You’re Vaccinated
Polonijo says even after people are fully vaccinated, they should avoid out-of-state and international travel as they might be asymptomatically carrying the virus to other places.
“Stay close to home if at all possible,” she said. “Now is a great year to explore your own state or your own county.”
As for social visits, the CDC says people who are fully immunized — meaning it’s been two weeks since they received their final vaccine dose — can gather indoors with other fully immunized people without masks.
Fully immunized people can visit indoors with unvaccinated people from one other household, as long as no one in that household is at high-risk of severe COVID-19.
Swartzberg says these guidelines will go far to keep down the number of deaths and hospitalizations. But only if vaccinated people proceed with caution.
If you’re fully immunized, he suggests picking “the most important thing you haven’t been able to do but that you can now feel pretty safe doing,” such as visiting a friend or family member indoors (as long as they aren’t medically vulnerable).
“And do that, and nothing more for a little while. And see what’s happening in terms of the number of cases in your community, see what’s going on with the variants. If things are going well, take another step.”
Guidelines early in the pandemic encouraged people to stay more than six feet apart while around others. The virus travels primarily through the air and can only travel a limited distance, so staying spaced out can prevent spread.
At the start of the pandemic, scientists knew less about the way the virus behaved indoors and outdoors. It’s now known that unventilated indoor spaces are the most dangerous environment for COVID-19 spread, and masks and distancing should be practiced consistently in those environments. Physical distance markers are still the norm at grocery stores, airports and other places where people must be near each other indoors.
Health experts say masks and physical distancing should always be used indoors. Restrictions for outdoor interactions have evolved over the past year — and the CDC now says people can participate in outdoor activities without masking as long as they stay apart.
If You’re Vaccinated
If you’re fully vaccinated, experts say it’s OK for you to get close to other people who are fully vaccinated. If you aren’t, you should continue to keep a six-foot distance between yourself and people outside your household.
If you’re fully vaccinated, you should only have non-distanced interactions with one household of unvaccinated people. Out in public, continue to stay six feet from others. These guidelines may change as more Californians receive their vaccines and herd immunity is achieved.
Hand-washing And Disinfecting
At the start of the pandemic, scientists didn’t know much about how long the virus could live on surfaces. They were also unclear on how likely someone might be to contract the virus after touching a surface that a person carrying the virus had touched.
Initial guidelines from the state and federal governments encouraged people to frequently disinfect surfaces in their homes and businesses. Education about proper handwashing became prevalent, and people flocked to grocery stores to pick up hand sanitizer and gloves. There were lots of other tips about how to stay germ-free, like disinfecting your phone and training yourself not to touch your face. CapRadio listeners were asking questions about how to sanitize their groceries.
As the pandemic wore on, studies began to emerge showing that while coronavirus can live on surfaces, those surfaces are not a major source of infection. Scientists began to point out that all of the deep cleaning might be overkill.
Still, experts say it doesn’t hurt to be extra vigilant.
“New variants may be more contagious than in the past, so I think that it’s on the safest side to continue these measures in business,” said Polonijo. “It’s these layers of protection. It’s not just the plexiglass and the disinfecting, but it’s that combined with masks and combined with vaccinations that would allow us to more safely open the economy.”
Washing your hands frequently is just good public health practice, experts say. And Swartzberg says carrying around hand sanitizer will be a good idea even when the pandemic has abated.
If You’re Vaccinated
People who are vaccinated should still practice good hygiene, as it can prevent the spread of coronavirus as well as other viral infections.
But Swartzberg says when most people are vaccinated, we may be able to lighten up on some of the measures, like the deep cleaning.
“Some companies are spending a fortune on ‘sanitizing their environments’ on a regular basis, and I think much of this is for show as opposed to really an effective health intervention,” said Swartzberg. “So I would think, over time, that we’re going to see less and less of that.”
And neither personal hygiene nor surface disinfecting is a replacement for the masking and distancing guidance that everyone should be following, even vaccinated people.
“It’s not a bad idea to do the barriers and have cleaning in place,” Goel said. “But we need to recognize that those are not the primary modes of preventing transmission. But they’re relatively harmless interventions.”
An estimated 38% of Californians have some level of immunity from the virus, either because they’ve recovered from COVID-19 or because they’ve been immunized, according to a recent survey conducted by the state health department. But research is still emerging on how long that immunity lasts.
There are also new variants of the virus emerging in the U.S. and specifically in California. According to new CDC data, more than half of COVID-19 samples in California are now the B.1.427/B.1.429 variant, first identified in the state.
The variants worry experts because they can make the virus more contagious, more likely to make people sick, or make current vaccines less effective. But while researchers are concerned about the variants, they aren't panicked.
"They're definitely something that we need to be paying attention to and designing our pandemic response around," Trevor Bedford, a computational biologist at the Fred Hutchinson Cancer Research Center in Seattle, told NPR. "I don't think the sky is falling, but I think it's something that absolutely bears attention."
All of the measures that people and institutions have put in place over the past year have contributed to California’s efforts to “flatten the curve” and keep caseloads from becoming overwhelming for hospitals. While experts are hopeful that we won’t see another surge like we saw this past winter, they say people must continue to follow guidelines — even after being vaccinated — to be able to prevent hospitalizations and deaths.
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