When will ‘normal’ return? A year into COVID pandemic, we ran the numbers
One year ago Saturday, an elderly Madera County resident who had recently returned home with his wife from a cruise became the first confirmed case of novel coronavirus in the central San Joaquin Valley.
It was the first sobering dose of reality that a pandemic that was already affecting — and killing — thousands of people worldwide would indeed leave a lasting mark on central California.
Even so, when that cruise passenger’s test results came back as positive for the virus on March 6, 2020 — followed the next day by a Fresno County man who also recently returned from the Grand Princess cruise ship — few could have imagined what was in store for the region.
In the wake of state and local health emergency declarations, life as we know it was effectively upended. Restaurants and many businesses were closed. Schools were closed. Parks were closed.
Wearing a face mask became the norm for many people, but for others the moment became a rallying point over personal liberties. Physical distancing – the idea of staying at least 6 feet away from others in public – forced people to mentally calculate their distance from strangers whenever they left their home.
Kitchen and dining room tables, bedrooms, folding tables in garages – and any place that could accommodate a laptop computer – became makeshift offices or classrooms for thousands of students, teachers and office-industry workers.
A new era of widespread telecommuting, using Zoom or other video technology for remote classes and work meetings for those whose jobs allowed, gave rise to social media hashtags like #WorkFromHome or #WFH.
Almost 212,000 people in Fresno, Kings, Madera, Mariposa, Merced and Tulare counties – almost 10% of the region’s overall population – have tested positive for the virus at some point over the past 12 months.
COVID-19 has claimed the lives of more then 3,100 Valley residents as the official cause of death recorded on death certificates.
Even as antibody treatments emerge to treat mild cases of COVID-19 and vaccines become more available to prevent infections, the lives of many residents remain in a state of upheaval and uncertainty.
Vaccinations and masks
A sense of pandemic fatigue simply has people wondering: What’s next? When can we get back to normal? And will that “normal” look anything like life before the pandemic?
Such questions are difficult for experts to answer because it’s the coronavirus – not scientists or doctors or politicians – that’s calling the shots.
With each new infection, the virus undergoes tiny mutations or changes as it passes from person to person, which is giving rise to new fast-spreading variants that researchers aren’t sure will respond as well as the original strain to the vaccines and therapies designed to stop it.
“I always hesitate to be very confident in these predictions because this pandemic has a way of making you humble if you’re overly confident,” said Dr. Rais Vohra, interim health officer for the Fresno County Department of Public Health.
“I think that’s what makes this pandemic keep us on our toes, because it’s hard to predict exactly what will come next and where things will settle.”
Some of it may depend on how effective vaccines are in stopping the spread of the virus – as well as how many people are willing to get the shots and how long it will take to inoculate enough people.
The first two vaccines authorized by the U.S. government for emergency use, both of which require two shots given three to four weeks apart, became available in mid-December.
In Fresno County, with a population of roughly 1 million people, health officials have a goal of vaccinating 600,000 to 750,000 by the end of this summer. That meant getting enough vaccine to give 1.2 million to 1.5 million individual shots, since it’s a two-dose regimen.
A third vaccine that received emergency authorization in late February requires only one injection. But a limited early supply means it’s unclear how that might accelerate the efforts of local counties.
Vohra told The Bee last week that Fresno County’s vaccination program “feels like a race against time” to give shots to people before any of the virus variants that may be more contagious or more resistant to the vaccines gain traction in the population.
He and other health professionals also noted that none of the vaccines are 100% effective in preventing infection. Field trials for both of the two-dose products, one by Pfizer BioNTech and the other by Moderna, indicate 90 to 95% effectiveness, while the new one-dose Janssen/Johnson & Johnson vaccine is estimated to be about 85% effective.
Because all of the vaccines are new, there is also uncertainty over how long the protection from any of the vaccines will last, Vohra said. Six months is the goal that the U.S. Food and Drug Administration had for field trials.
“It might be a year, it might be longer,” he said. “We’re certainly hoping it’s as long as possible. But it would also not surprise us that perhaps when the antibody (levels) start coming down that somebody might need a booster.”
“And with these newer strains being described with the coronavirus epidemic, we may be entering a time when we’re thinking about providing boosters to people,” Vohra added.
All those factors suggest that precautionary measures like face masks and social distancing may be in order for months to come.
“It’s hard to know exactly when we can all be done with the masks,” Vohra said this week. “It really just depends on how soon the scientists studying this at a national level are able to reassure society that we’ve reached herd immunity.”
Reopening the economy
A shrinking number of new cases, and a declining pace of hospitalizations and fatalities over the past month, are pushing Fresno County and its neighboring counties closer to a point where more businesses can reopen. It’s hoped that those that are open can soon expand the capacity at which they can operate.
For now, five of the six Valley counties remain mired in purple Tier 1 of the state’s color-coded Blueprint for a Safer Economy, a four-tier playbook for when and how California counties can allow businesses to resume or expand operations after limitations aimed at slowing the spread of COVID-19 in communities based on risk of transmission.
Under the purple tier – the most restrictive of the four tiers denoting “widespread” risk of transmission – restaurants are allowed to only offer outdoor dining or to-go orders.
Also, gyms and health clubs can only operate outdoors and retailers — from mom-and-pop boutiques to big-box chains — are limited to operating at 25% of their occupancy capacity.
Bars and taverns must stay closed. Churches, synagogues, temples, mosques and other houses of worship can be open indoors at 25% capacity, after a U.S. Supreme Court ruling last month overturned California’s rule barring indoor services in the pandemic. Still, the ruling did leave in place the state’s ability to limit capacity.
In addition to capacity limits, other rules for businesses are to require staff and customers to wear face masks and practice physical distancing to minimize opportunities for the virus to be spread from one person to another.
Fresno, Kings, Madera, Merced and Tulare counties already meet two of the three requirements to graduate to the less restrictive red Tier 2. That includes having less than 8% of residents’ COVID-19 tests over the course of a week come back with positive results, and having under 8% of residents in the most disadvantaged neighborhoods testing positive for the virus.
For the third measure, each of the counties is closer than they’ve been in months to meeting the red-tier threshold for new cases per day. That threshold is a rate of seven or fewer new cases per 100,000 residents calculated over the course of a week.
And when California meets a new goal of delivering 2 million vaccine doses to its poorest ZIP codes and census tracts – perhaps within two weeks – that case-rate threshold will be relaxed to 10 new cases per 100,000 residents.
Tier 2, coded red for “substantial” risk of viral spread in the community, would allow for restaurants to reopen their indoor dining rooms at up to 25% capacity; gyms and fitness clubs could reopen their facilities at 10% of capacity, and retail stores could increase to 50% of their occupancy limit.
Even less restrictive tiers lie ahead: orange Tier 3 representing “moderate” risk, with accompanying increases in business operations and indoor capacity; and yellow Tier 4, “minimal” risk. At every tier level, even Tier 4, the state blueprint requires modifications to operations for ongoing safety, such as requiring staff and customers to wear face coverings and provide sufficient space for physical distancing.
Getting back to school
The pandemic struck the Valley with only a few months remaining in the 2019-20 school year, forcing schools to close and spoiling graduation celebrations for thousands of high school students. And while some schools received local and state waivers to reopen in a limited fashion last fall, many students have been away from their classrooms and expected to attend classes online for nearly a year.
That’s slowly changing now as COVID-19 eases its grip on California and the Valley.
Under the state’s blueprint, schools in kindergarten through sixth grades can reopen in Fresno, Kings, Madera, Merced and Tulare counties because the new daily-case rates have dipped to fewer than 25 per 100,000 residents in each of the five counties, provided they have completed a coronavirus safety plan and met other requirements for school reopening under state guidelines.
Some school districts brought elementary students back into classrooms in a limited manner last fall, during a window of about a month in which Fresno, Kings and Merced counties each made it into red Tier 2. Schools that were able to reopen during that period were allowed to remain open, even after the counties slid back into the purple tier and while a regional stay-at-home order was in place for the entire San Joaquin Valley from early December through late January.
Middle schools and high schools cannot reopen for in-person instruction until their county reaches the red tier in the state blueprint, also with the requirement that they prepare and post a coronavirus safety plan to their website before reopening.
Helping to speed the return to school is that teachers and other school staff became eligible to begin receiving COVID-19 vaccinations last week. Teachers in some districts had expressed frustration and concern for their personal health if their districts required them to come back into classrooms without the vaccines.
The Clovis Unified School District was among the districts that brought cohorts of elementary-grade children back in the fall and last month started bringing back middle and high school students in a hybrid program that combines in-person and online instruction to ensure required physical distance between students in classrooms.
In the Fresno Unified School District, the largest district in the Valley, officials originally said they did not plan to reopen schools until Fresno County reached orange Tier 3 of the state’s blueprint with a new-case rate of fewer than four per 100,000 residents. That plan became political football in recent weeks, with one Fresno City Council member going so far as proposing that the city sue the district unless it moved more quickly to bring students back to campuses.
That idea was shot down by a majority of the city council. But the district subsequently revised its goals and now anticipates a return to campus in early April.
Another large Fresno-area district, Central Unified, announced plans Thursday to also phase its reopening, first with elementary schools in early April and some middle and high schools possibly coming back in mid- to late April.
The accelerated opening plans for districts come as California state leaders approved legislation in recent days offering incentives to get students back into classrooms before the end of the current 2020-21 school year. Fresno Unified leaders said they expect to receive up to $79.6 million from the state, while Clovis Unified forecasts getting as much as $40 million.
It’s unclear how much Central Unified might get, but like its neighboring districts in Fresno and Clovis it is likely to be in the millions of dollars.
Even after reopening …
Joe Prado, who coordinates Fresno County’s vaccine efforts as community health division manager, said that despite the increasing availability of the shots, “we cannot get lazy with our prevention measures” including face masks, physical distancing, and hand hygiene.
“We all want to take off our masks and throw them away,” Prado said Friday, “but we can’t do that yet.”
Vohra, the interim health officer, said it’s difficult to assess what a post-pandemic “new normal” might look like in Fresno and the Valley. He cited a recent article in The Atlantic magazine to explain how or when our society will know when the pandemic is “over.”
“Their conclusion was we’ll be at a new normal, or we can declare that this pandemic is no longer a pandemic, whenever the rates of hospitalization and death mirror those of influenza,” Vohra said.
“Frankly, influenza is a terrible disease, and thousands if not hundreds of thousands, get affected and pass away from it year after year,” he added.
“The argument has been made that we don’t shut down society for influenza every winter,” Vohra said. “But this pandemic was clearly orders of magnitude more dangerous than influenza before we had vaccines, with the surges we experienced that were much higher than what we see with influenza every winter.”
The coronavirus is likely to remain in circulation for months or even longer in society, but at much lower levels than it is now. “I think it’s unrealistic to say we need to go to zero before we’ve declared ‘normalcy’ again,” Vohra said.
“I think it’s really that social contract, all of us making a decision together about what we feel safe doing,” he added. “Some of us may feel safe going to a movie theater right now; others are going to wait it out for several more months until they really see the numbers coming down.”
In addition to a societal expectation that people continue to take safety precautions like wearing masks, avoiding crowds and frequent hand washing, Vohra said he anticipates that improved and faster testing may eventually help people feel more secure about resuming many of their pre-pandemic social activities.
He noted ongoing development of home testing kits that rely on antigen tests – much faster, but currently less reliable than the tests used to confirm COVID-19 cases. “If you think about that technology, getting the accuracy better and cutting down on the time, you can sort of see the attraction of using something like that whenever you step out to go to a restaurant, for example, or you go to a festival or a concert,” he said. “You can do a quick test, make sure that it’s OK for you to interact with other people, and if you have coronavirus you would stay at home so you’re not spreading it to other people.”
Such rapid tests could also serve as a screening tool “for a lot of social activities and filter out people who are at high risk and otherwise admit people who are safe,” Vohra added. “These are the kinds of paradigms that … might be part of the new normal, that we’re just doing frequent testing wherever we go, and that will allow everyone to hopefully feel a little bit safer about doing these activities.”
This story was originally published March 7, 2021 at 5:00 AM.
