‘It’s like the garden hose turned into a fire hose.’ COVID-19 continues to spread in Fresno
Editor’s note: A previous version of this story reported an incorrect figure about the average number of deaths locally from COVID-19. An average of 1.14 deaths per day occurred from COVID-19 in Fresno County from June 26 through July 9.
In just over four months, a previously little-known organism has managed to change the everyday lives of hundreds of thousands of people in Fresno County and millions across California and the United States.
The novel coronavirus, COVID-19, and the word “pandemic” have imprinted themselves on the consciousness of the world as the contagion continues to spread.
The virus has generated concern as the number of confirmed infections has risen seemingly unabated in the past two weeks. The number of cases in Fresno County climbed by an average of almost 240 cases daily between June 26 and July 9, leading to more than 7,600 people infected total since the pandemic began. Thousands more are believed to be carrying the virus but a lack of testing means they are going undetected.
It has stirred fear as the number of lives lost grows almost daily – a pace of more than one death per day in Fresno County over the last two weeks. As of Friday, 88 people had succumbed to COVID-19 in Fresno County, including 16 since June 26. They are among 300 people who have died across the Valley.
It has ignited worry in the medical community. Hospitals already busy with the acute-care and intensive-care needs of more routine illnesses, accidents and trauma find themselves coping with increases in the number of COVID-19 patients requiring hospitalization for their symptoms.
In the two weeks from June 25 through July 8, Fresno County saw a 67% increase in the number of people with confirmed coronavirus cases being treated in hospitals.
And it has sown discord, both in the Valley and across the U.S. Many residents dutifully follow health guidance to stay home, if possible, and practice social distancing and wear face coverings when they go out.
Others chafe at the recommendations or follow the lead of politicians who scoff at the severity of the pandemic, accuse the media and the medical community of exaggerating the potential danger, push for businesses and schools to reopen faster, and ignore or reject the advice of local, state and national health experts to avoid large gatherings and to wear masks to minimize the spread of the virus.
This, then, is what a pandemic looks like.
“It feels like the garden hose turned into a fire hose” over the past couple of weeks, Dr. Rais Vohra, Fresno County’s interim health officer, said last week of the rising case counts.
The continuing spread of the virus is not only challenging hospitals who are tasked with treating seriously ill patients, with or without COVID-19, but also stretching beyond the limits of the county’s cadre of contact tracers to follow up with people who test positive for the virus and track down others that may have been exposed.
“Unfortunately, just because of the sheer number of new cases that are coming in, we haven’t been able to reach out, or get a hold, of all those patients ...” said Stephanie Koch-Kumar, the county’s senior epidemiologist. “The investigation team is working hard, but unfortunately the more the cases go, the farther behind that gets.”
Alignment with reopening?
The increase in cases, deaths and hospitalizations in Fresno County come as state and county officials had authorized the reopening of a growing number of businesses that had, since mid-March, been closed as a means of limiting the spread of the virus.
On May 5, the day that the first phase of businesses were authorized to open under a statewide roadmap to recovery, Fresno County had 726 cases. Confirmed infections have risen by more than 950% since that date.
On May 21, when Fresno County had 1,362 confirmed cases, the state allowed Fresno County to reopen restaurants for indoor dining, as well as shopping malls. Cases since that point have gone up by about 460%.
On May 26, county leaders allowed barber shops and hair salons to restart their operations. Since that point, Fresno County’s positive tests for infection have risen by about 410%.
On June 10, when the county reported 2,324 confirmed cases, bars and wineries were given a green light by Fresno County to reopen. The county has seen an increase of almost 230% since then.
On June 26, nail salons, body art shops, aestheticians, and recreation venues like movie theaters and family fun centers were authorized to reopen. From that time, cases rose from 4,197 to 7,627 on Thursday – an increase of almost 82% in two weeks.
The continued rise in cases in Fresno and other hot-spot counties – including surrounding Valley counties – prompted Gov. Gavin Newsom to begin scaling back the reopenings. On June 28, bars and taverns were ordered closed, and several days later, on July 1, the state ordered an end to in-person dining at restaurants.
Because of the incubation time of the virus between exposure and the onset of symptoms, hospitalizations and deaths tend to be lagging indicators compared to positive testing, Vohra said. That’s why he sounded an alarm about the pace of new cases in June, predicting that as some of those blossom into illnesses among patients,
“We know just from the biology of this virus that the actual number of hospitalizations and the number of deaths usually trails (confirmed tests) by a couple of weeks,” Vohra said on June 30. The increase in infections that were confirmed in the last week of June “gives me a lot of indigestion going into the rest of the summer.”
“I think July is going to be very tragic in terms of the number of hospitalizations and the number of fatalities that we see as a result of COVID-19,” he added, “just given the fact that we’ve seen such an uptick in the number of total positive swab results that we’ve gotten.”
More than just numbers
But the pandemic goes deeper than than numbers, Vohra pointed out in remarks to reporters a few weeks ago.
“If you have never seen a patient with this disease, it does seem pretty abstract,” Vohra said. “For many members of our community, this just seems like an abstract epidemic that’s far away and these numbers don’t really hit home. It doesn’t really have a human face to some people.”
But as a physician who works shifts in the emergency room at Community Medical Center in downtown Fresno, Vohra gets a firsthand look at people who are being hit with the disease.
“Out of all these cases, these aren’t just numbers on a dashboard,” he said. “These are people’s lives that are affected. These are people’s relatives who are hospitalized, sometimes who pass away.”
In the earliest stages of the pandemic, COVID-19 was most vigorously striking the county’s older residents. Indeed, almost 70% of the people whose deaths are attributable to the coronavirus have been age 65 or older. But as testing increases, and more people resume activities after local and state shelter-in-place orders have been loosened, the infection is trending younger.
As of Thursday, children under 18 who have tested positive for the virus to date outnumber senior citizens by a ratio of about 3-to-2. But the majority of those infected – more than 6 out of 10 – are in the 18-to-49 age range.
Vohra and other health professionals have focused on concern for “the most vulnerable” portions of the community, the people most likely to suffer the most serious consequences from the disease. Those are senior citizens, people who are confined to nursing homes, and people with other chronic conditions that can magnify the severity of COVID-19.
So far, in Fresno County, that means people with conditions such as diabetes and hypertension as well as chronic breathing problems like emphysema or asthma. The county reports that at least 80% of the people who have died from COVID-19 as of early July also had a “co-morbid” condition, even if that was not considered the primary cause of death on the victim’s death certificate.
The largest number of those had diabetes and hypertension, or high blood pressure.
But what has Vohra and other doctors worried is that Fresno County, like the rest of the Valley, has significant numbers of people who have the kinds of conditions that health experts, including the U.S. Centers for Disease Control, say puts them at greater risk.
That’s why, as scientists search for medicines to treat the respiratory illness caused by the virus, and for a vaccine to inoculate people against it, health professionals continue to issue pleas to the public to take steps to halt the spread to seniors, the frail, and those with other medical conditions.
Those steps include frequent hand washing, exercising physical distancing from others when in public, and wearing a mask to contain droplets in exhaled breath that could carry the virus.
This story was originally published July 13, 2020 at 5:39 AM.
