PALM SPRINGS, Calif. – This Fourth of July looked different.
Californians didn’t gather en masse to wonder at the bursts of blues, golds and reds shimmering across the night sky. In response to the coronavirus pandemic, cities around the state cancelled large events, from festivals to fireworks displays.
What officials couldn’t stop, though, were gatherings of families and friends and travel over the long weekend to mountain lakes and other getaways throughout the state.
The Fourth of July holiday helped the coronavirus continue its spread, according to public health experts, although other factors also contributed to a high number of new cases. And while tourist-dependent communities feared that out-of-towners would spread the virus to locals, contact tracing is instead showing that, with bars closed, much of the disease’s transmission has occurred at home or at small get-togethers, among people who already know each other.
Prior to the holiday, Gov. Gavin Newsom took preventative measures such as re-closing bars and mandating face coverings in public. But communities like those tucked around Lake Tahoe hosted many travelers attempting to walk the line between social distancing and getting out of the house.
“We didn’t have fireworks or other large gatherings, but the July Fourth weekend was still definitely busy and has continued to be busy since the holiday,” said Jerry Bindel, South Tahoe Lodging Association treasurer and a resort general manager. “And not many people wore masks at the beach.”
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More than half of counties saw cases double
Since July 4, 37 of the state’s 58 counties have seen case counts at least double, especially in more rural counties and those in the Central Valley, according to California Department of Public Health data analyzed by The Palm Springs Desert Sun of the USA TODAY Network. And that number is likely low, as Riverside County officials said Friday that the state’s central reporting database has experienced technical issues in recent days, leading to an undercount.
Still, by late July, California had the most coronavirus cases in the country, roughly half-a-million, or 10% of all those reported in the U.S. After ticking up for months, California’s case count began skyrocketing in late June, a month after Memorial Day and following Newsom’s decision to walk back emergency orders and allow businesses to reopen.
As the number of cases continues to increase, it’s becoming more difficult to blame the upward trajectory on any single factor. Chris Herring, the Emergency Medical Services manager for the Imperial County Public Health Department, said there was a slight uptick in COVID-19 hospitalizations in the weeks following the Fourth of July holiday, but those have since stabilized, making it difficult to know if the holiday was the sole cause.
This differed from earlier in the pandemic when a clearer surge followed Memorial Day. However, Herring said, his department saw the same patterns after each holiday.
The Fourth of July contributed to case growth
Experts agree that holidays bring social gatherings, which bring new infections. But exactly how much impact this has is up for debate.
“There are not sufficient data to assess the impact of July Fourth festivities,” a spokesperson for the California Department of Public Health said in a statement to The Palm Springs Desert Sun.
Asked whether the holiday contributed to the surge, Andrew Noymer, an associate professor of public health at University of California-Irvine, answered, “Yes. But.” With the state and the country moving in fits and starts toward reopening, numerous factors come into play. “It’s a little hard to lay that at the feet of the Fourth of July in particular,” he said.
It also takes several weeks for an outbreak to show up in a way that public officials and epidemiologists can track. If a guest at a Fourth of July barbecue became infected, it would have taken several days for symptoms to develop, and it could have taken as many as several weeks before they went to a hospital.
Complicating the analysis, the U.S. Department of Health and Human Services recently changed how data are reported to the state and federal authorities.
As a result, data showing the number of patients in California hospitals with COVID-19 have been incomplete since July 23. Still, there were 20% more COVID-19-positive patients in California hospitals on July 22 than on July 4.
Smaller samples throughout the state mirror this.
In San Bernardino County, health officials have seen a 113% increase in cases since the Fourth of July, requiring a temporary pop-up hospital at Arrowhead Regional Medical Center to accommodate the crush of patients, according to San Bernardino County spokesperson David Wert.
“The rise in hospitalizations is concerning,” he said.
Intimate gatherings are drivers of new cases
County health officials throughout California are increasingly reporting that close social gatherings and spread of the virus within a household are larger drivers of transmission than tourism. While there are very real concerns about travel to far-flung and small communities where hospitals could be quickly overwhelmed, it isn’t currently public health officials’ main worry.
San Bernardino County Supervisor Dawn Rowe, whose district covers the tourist-heavy communities of Big Bear and Joshua Tree, for example, said those towns only accounted for a small percentage of the county’s cases despite their recent surges.
“Where we are experiencing a spike in new cases is in the more densely populated areas of the inland valley region,” Rowe said. “Consequently, imposing increased restrictions in the rural communities that are known for tourism is unlikely to have a significant impact in lowering our COVID-19 numbers countywide.”
Placer County Supervisor Cindy Gustafson, whose district covers part of the Lake Tahoe area, said concerns about tourists bringing the virus into the community led some locals in her district to ask to keep travelers out of town. Cities like South Lake Tahoe instead launched programs to hand out free masks to visitors and answer questions about the ever-changing COVID-19 rules.
“The good news, though, is that the transmission in the local community has not seemed to spike relative to tourism, and the transmission appears to be from family gatherings primarily, and from our vulnerable populations, but not as a result of tourism,” Gustafson said.
While short-term rentals were quickly scooped up once allowed to reopened, tourism is still down this year in the Coachella Valley.
This trend has bolstered Kaiser’s focus on social gatherings among close acquaintances who don’t live together and don’t need to be in contact.
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So what comes next?
Public health experts cautiously say that the latest information shows viral spread may have started slowing after Newsom began recommending — and then mandating — that certain businesses once again close in late June. Even though new daily case counts remained high, only 16 counties — home to slightly less than one-fifth of the state’s population — saw the virus pick up speed after the holiday. In the three weeks following the Fourth of July, these counties saw a larger relative growth of cases than during the three weeks preceding it.
In other words, viral spread may once again be slowing down, albeit to a small degree.
To measure a virus’ spread, public health experts gauge how many new cases result from each infected individual. The goal is to get that number below 1, meaning the virus will eventually peter out.
If it’s above 1, the virus spreads exponentially. As recently as mid-to-late June, each new infection in California led to 1.19 more, according to health department data. As of Wednesday, the number had fallen to 1.02, meaning the spread had become relatively stable.
But that doesn’t mean the virus is about to disappear without aggressive mitigation measures. Take, for example, Riverside County, home to nearly 2.5 million people, where the rate of transmission hasn’t risen in several weeks.
“You guys are basically just treading water,” UC-Irvine’s Noymer said. “Each case is generating another case. It’s basically holding steady.”
With the statewide rate of transmission also relatively stable, officials have declined to directly comment on whether Californians should expect further restrictions as flu season approaches. At the same time, the question of how to tackle a new school year remains the biggest concern nationwide for public health experts.
What became clear through each major event during the pandemic — holidays and each stage of reopening — is that moving too fast will topple the delicate house of cards. Newsom calls this ability to toggle back reopening his “dimmer switch,” but experts say he needs to to use it more quickly if there’s another major surge.
“This is not a one direction march to a destination,” said Dr. Thomas Tsai, an assistant professor of health policy and management at the Harvard School of Public Health. “You have to react to what the data show you, and the way to move forward is to keep the virus low. It may be two steps forward, one step back, but at least you’re moving forward.”
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