When will the Fresno region reopen from coronavirus? Here’s how it could happen
The number of people who have recovered from COVID-19 infections continues to climb in the central San Joaquin Valley.
So far, more than 300 people have been released from hospitals or cleared from quarantine after testing negative for the coronavirus or being free from symptoms for long enough to satisfy health officials that they no longer pose a danger for spreading the contagion.
Still, that’s fewer than one-third of all COVID-19 patients who have been confirmed in Fresno, Kings, Madera, Mariposa, Merced and Tulare counties since the region’s first cases of the virus surfaced less than two months ago.
As recoveries rise, so too does the number of people hospitalized with coronavirus across the Valley — 78 patients as of Thursday, the latest date for which figures were available from the state Department of Public Health. Dozens of other suspected COVID-19 patients in the region are in hospitals with symptoms consistent with the disease but who await test results to confirm or rule out a diagnosis.
In the meantime, tens of thousands of people in the Valley — and more than 3 million across California — are out of work, sidelined by business closures intended to prevent the spread of the virus.
The uncertainty of the growth curve of the coronavirus pandemic, in the Valley and throughout the state, also means uncertainty for answering the questions that so many people have: When will stores, restaurants, churches, businesses and more — many of which have been mostly closed for more than a month — be able to reopen? When will the stay-at-home/shelter-in-place orders be lifted?
And when they do, will it be business as usual?
Dr. Rais Vohra, interim health officer for the Fresno County Department of Public Health, and Dr. Mark Ghaly, California’s secretary of health and human services, both broadly suggested this week that there will be no rush or haste before the state or any of its regions begin to take the first gradual steps toward lifting the lockdown.
Ghaly on Wednesday said that a resumption of normal activities won’t be like flipping a light switch, but instead likened it to an adjustable dimmer. “We are constantly looking at how quickly we move that dimmer, understanding where we are with our data, where we are with our preparedness,” and collaborating with cities, counties and industries “to make sure we all move together.”
Ghaly’s remarks align with the state’s prescription for six major factors to be considered in tinkering with the dimmer switch and modifying the stay-at-home orders that began March 19:
▪ Expanding testing and contact tracing to be able to identify and isolate those with the virus.
▪ Preventing infection in people who are most at risk, including seniors in nursing and other care facilities as well as health care providers.
▪ Being able to handle surges in hospitals and the health care delivery system.
▪ Developing therapeutics including treatments and vaccines to meet demand.
▪ Ensuring businesses, schools and child care facilities can support physical distancing when they reopen.
▪ Determining when to reinstate certain measures like the stay-at-home order if surges of new cases materialize.
There’s also what Ghaly called the “must haves” — issues that must be handled before any consideration of modifying the lockdown can take place.
That includes securing enough masks, gloves, gowns and other personal protective equipment for health care providers.
Plus, there needs to be a ramping up of testing to levels needed to assure confidence there aren’t unknown pockets of people infected with coronavirus who could potentially spread it.
Guidelines on testing recommend a rate of 152 tests daily for every 100,000 residents to ensure adequate surveillance and monitoring of the virus’ spread. In California, Ghaly and Gov. Gavin Newsom said, that translates to ramping up to the capacity to conduct 60,000 tests every day.
“We want to make sure all Californians are tested,” Newsom said Wednesday. “Not all 40 million of us, but in every part of the state where we’re not leaving communities behind” including remote rural areas of the state and disadvantaged neighborhoods in major urban areas.
Currently, Newsom added, the state is processing about 16,000 tests per day.
In Fresno County, the amount of testing would need to gear up from the current rate of several hundred tests per day to about 1,500 to reach the desired threshold, Vohra said.
A small step forward
One modest step announced this week by Newsom was lifting a moratorium on scheduled, non-emergency surgeries. Newsom cited a stabilization in the demand for hospital beds, including intensive-care unit beds, to treat COVID-19 patients, as a confidence-building factor to allow the resumption of necessary, non-cosmetic surgeries such as heart procedures or cancer treatments.
In the San Joaquin Valley, hospitalizations of confirmed COVID-19 patients have generally been on the rise throughout the month, but not to levels that threaten the capacity of local hospitals. The number of suspected but unconfirmed patients with coronavirus-like symptoms has come down throughout the month of April.
Even in Mariposa County — the only Central California county without any confirmed cases of coronavirus — as many as four suspected COVID-19 patients have been hospitalized in a single day this month, according to the state health department.
Vohra said he was pleased by Newsom’s move to resume surgeries, but cautioned that it is simply one small step on a lengthy path toward reopening.
“This is the time to think about how do we go ahead, really look at how we’re doing locally and thinking about what processes need to be in place to safely reopen some of the businesses, some of the sectors and some of the activities that we’ve had to put on hiatus,” Vohra said. “I’m happy to hear that the state is watching that very carefully, and here locally we have a lot of interest in making sure that gets done well.”
He added, however, that “it’s still premature to assign a specific date to know exactly when we can go ahead and reopen everything.”
“I think it’s going to happen in phases,” Vohra said. “And I think we’re going to very carefully see just what our case counts are doing at every single phase so we can make sure that we do it very safely, that we do it in a way that protects the public’s health, and it protects all of the really hard work that we’ve already done in the health care sector and make sure we don’t lose ground.”
Learning from history
Ethan Kytle, a history professor at Fresno State, has spent about a month — since in-person classes at the university were shut down — researching a long-past health emergency, the Spanish influenza pandemic of the winter of 1918-1919, and how Fresno dealt with it.
The Spanish flu was blamed for killing about 50 million people worldwide, including about 675,000 in the U.S.
Fresno, then a city of about 45,000 people, sustained 258 deaths from the flu that winter, Kytle said. “If you translated that to our population today, that would be something like 3,000 Fresno residents who would die in a matter of five months,” he said.
Since the first documented cases of COVID-19 hit America in mid-January, the contagion has claimed more than 200,000 lives around the world, nearly 51,000 in the U.S., and more than 1,500 in California. In the central San Joaquin Valley, the death toll Saturday morning grew to 45, including 32 in Tulare County and seven in Fresno County.
Similar to what’s happened over the past couple of months in response to the coronavirus, Kytle discovered that “Fresno, compared to most California cities and most cities across the country, was fairly quick to implement some social distancing measures” when the Spanish flu arrived in early October 1918.
As the flu rampaged through the population, city leaders began to enact restrictions. “They shut down schools, they shut down theaters and movie houses and churches, (and) outlawed public gatherings,” Kytle said. That was followed by limiting hours for businesses including “department stores, restaurants, saloons and soda fountains.”
People were also required by ordinance to wear masks when they were out in public; those who didn’t comply faced fines and jail time. “The police rounded people up and threw them in jail,” Kytle said. “At one point … they threw over 100 people in jail over the course of three days.”
By late November, things seemed to be stabilizing. “The first wave has crested, things are getting a lot better, there are fewer cases, the hospital crunch dies down,” he said. “And they opened back up. They reopened schools, they reopened theaters, they cut down on the restrictions. They want people to continue to wear masks but we’re not going to penalize you for it.”
“And almost as soon as that happens, the second wave hits,” Kytle said, lasting from mid-December through early February 1919.
As city health officials tried to reimpose restrictions, they were met with opposition from residents, businesses and church leaders who wanted to stay open for Christmas services. “It’s a pretty nasty struggle,” Kytle said. “Ultimately it leads the city health authorities to rescind the measures that they had tried to implement (and) say, ‘OK, all bets are off,’ and then … the entire city board of health resigns in protest.’”
Over the next two weeks, with no restrictions in place to slow the flu’s spread, “dozens of people die,” Kytle said. “More than 1,000 people get sick.”
‘We could still screw this up’
Vohra said Kytle’s research offers a cautionary tale about the dangers of a rush to reopen the community at the risk of a renewed COVID-19 surge in the region. “We can all really spare ourselves the worst of this current pandemic by learning the lessons from past episodes,” he said.
“We’ve been very successful right now with COVID in Fresno, even though we do have cases and obviously we’ve had some very tragic fatalities,” Vohra said. “We haven’t been hit as hard as other places.”
“However, we could still screw this up. It’s that simple,” he added. “I hate to be blunt about this, but if we’re not careful and we stop doing the social distancing, stop using the masks and stop quarantining when we need to, we could really let this rage out of control. … We just cannot say, ‘You know what, we’re doing just fine.’”
When the time comes to begin easing the restrictions — and he didn’t offer an estimate of when that might be –— Vohra said it will likely represent a new idea of what “normal” is, at least for the short term.
And it’s likely going to look different depending on the facility, business or workplace. “Different buildings are set up differently. Different organizations have different numbers of employees,” Vohra said. “Different organizations have different shift times. And some of them need to be doing their employee screening a little bit differently.
“All of that really precludes us from creating blanket guidelines that make sense,” he added. “Our major focus right now is to make sure that as we take our foot off the brake and push on the gas pedal that we move slowly and don’t accelerate so fast that we get ourselves into trouble.”
The current recommendation for people to wear masks, and other precautionary measures, is likely to continue for weeks, and possibly longer, after the threat of the virus has diminished, Vohra said.
“The phrase I like to use is, ‘Reopen with grace.’ Let’s reopen gracefully and really be mindful of all the things that we’ve learned, that we know work, like the physical distancing, covering your face, good hand hygiene,” he said. “All of those have served us so well. Let’s keep all of those in place and then think about how we can reopen gracefully in a way that makes sense and keeps everyone safe.”
This story was originally published April 25, 2020 at 2:44 PM.
