Fourth wave of COVID-19 bringing back restrictions in Sonoma County

Active coronavirus infections in Sonoma County have blown past the 1,400 mark, the most since March 6, with the vast majority of recent cases among unvaccinated residents.

Hospital emergency rooms are once again filled with COVID-19 patients, and administrators are scrambling to staff up to meet the demand as business and political leaders stand on the verge of reimposing mask mandates.

Just last week, 10 cheerleaders from Windsor High School tested positive for the coronavirus after returning from an out-of-town camp.

The outbreak came just days after Sonoma County officials confirmed that more than 30 inmates at the county jail have been diagnosed with new infections, and an outbreak at Santa Rosa’s Sam L. Jones Hall homeless shelter infected more than 110 people and has killed at least one person.

Signs of a fourth wave are everywhere, dashing hopes for a return to post-pandemic normalcy.

We’ve been here before, several times, as coronavirus case numbers rise and fall in a pandemic roller-coaster ride that doesn’t seem to end. And though we’re all on the ride, officials say it’s much rougher and potentially deadlier for those who have not been vaccinated.

There are now more than 11 new daily cases per 100,000 residents in Sonoma County, up from a low of 2 per 100,000 back in April. Under the state’s old reopening plan, Blueprint for a Safer Economy, the county would currently qualify for the most restrictive “purple tier.”

In neighboring Lake County, public health officials have described what is now the state’s most dramatic rate of disease spread — 50 new daily cases per 100,000 residents — as a “house on fire.” In Sonoma County, the rate of transmission has quintupled in the past three months.

“The pandemic is not over, and we need everyone to continue mitigation measures,” said Dr. Sundari Mase, the county health officer. “We’re looking at stronger (pandemic prevention) measures that we’ll likely move toward next week.”

Mase said great strides have been made toward vaccinating eligible residents, but 30% of the county’s population remains either unvaccinated or only partially protected. And the highly transmissible delta strain of the virus is currently raging through that population, sending transmission rates higher, she said.

“When you have a variant that is 60% more transmissible, this is the outcome,” she said.

The response to the growing surge has been widespread. This past week, both the federal Centers for Disease Control and Prevention and the California Department of Public Health urged a return to indoor masking, regardless of vaccination status. Some local employers have reinstated mandatory indoor masking for all staff.

Meanwhile, Gov. Gavin Newsom on Monday ordered all health care workers to show proof of vaccination or endure constant COVID-19 testing. Three days later, President Joe Biden encouraged some 90 million Americans to get vaccinated, and he ordered federal workers and contractors to do the same.

Biden said federal employees who can’t prove they’ve been vaccinated will be required to mask at work, get tested “one or two times a week,” maintain strict social distance and will not be allowed to travel for work.

The new state and federal guidance and requirements draw the clearest lines yet between two realities, that of the vaccinated versus the unvaccinated. For those who have received their COVID-19 shots, the risk of infection is greatly reduced, severe illness or hospitalization is almost unheard of and, until recently, masking rules had been relaxed.

For the nearly 100,000 eligible Sonoma County residents who haven’t been inoculated, the rate of infection is five times higher.

“What is happening in America right now is a pandemic of the unvaccinated,” Biden said Thursday. “Last month, a study showed that over 99% of COVID-19 deaths have been among the unvaccinated — 99%, this is an American tragedy. People are dying and will die. You don’t have to die.”

During a recent COVID-19 briefing, local health officials pointed out that since June 1, 83% of people hospitalized with COVID-19 and 100% of COVID-positive ICU patients were unvaccinated. Officials said of all the county’s COVID-19 deaths, only two were among vaccinated individuals and each was older than 90.

Kathryn Pack, health program manager for the county’s epidemiology team, illustrated these two realities. As of Friday, the virus transmission rate for the unvaccinated was 28.7 cases per 100,000 residents. For the vaccinated, it’s 5.6.

Mase, the county health officer, said this is the “best evidence and data to support vaccination. … We have five times the number of cases occurring in the unvaccinated population.” She said unvaccinated residents “are hanging out together, they are going to gatherings together, generally they’re (from) the same household and the same friend group.”

The delta variant, she said, takes advantage of the unvaccinated, readily spreading from one unprotected person to another. That in turn, Mase added, increases community transmission, with the virus spreading in public places, in stores and other indoor settings, as well as on public transportation.

“There’s going to be more cases among people who are out and about, and then fully vaccinated vulnerable people are more likely to be exposed to COVID,” she said.

The fourth wave of the pandemic is evident in the county’s latest public health statistics. But it is more clearly seen in recent large outbreaks that rival some of the pandemic’s biggest exposures events last year:

*Jeremy Decker, the superintendent of the Windsor Unified School District, confirmed that at least 10 cheerleaders tested positive for COVID-19 after coming back from an out-of-town cheer camp that took place from July 18 to 21. Four of the teens were vaccinated and all have been isolated under guidance of county public health staff, Decker said.

*The 31 inmate infections at the Sonoma County Jail mark the facility’s second outbreak during the pandemic. A dozen jail staff members are under quarantine after being exposed to the infected inmates. The Sheriff’s Office declined to say whether any staff had also tested positive.

*The outbreak at the Santa Rosa homeless shelter is the second-largest in the county since the pandemic started in March 2020. The largest, infecting 135 people, occurred at a local senior care home during the winter surge, according to county officials.

Public health officials confirmed Wednesday that a resident of the homeless shelter died as a result of that outbreak, which infected at least 110 of the facility’s 156 residents.

As the county grapples with increased community spread of the virus and large outbreaks, some employers and businesses are bringing back old prevention measures and requiring new ones. County officials are expected to introduce more pandemic restrictions on Monday.

Some local restaurants will begin requiring proof of vaccination for entry, taking their lead from a number of bars and eateries in San Francisco. At Fern Bar in Sebastopol’s Barlow complex, a vaccine card or a negative COVID-19 test taken within 48 hours will be needed for indoor service at both the dining room and bar.

Following county public health’s recommendation in mid-July for local residents, whether vaccinated or not, to mask indoors, Gina Huntsinger, director of the Charles M. Schulz Museum in Santa Rosa, asked staff and volunteers to do so. She said everyone complied, even though it was not a requirement.

“We are following the rules, and I think that’s the best way to keep everyone safe,” Huntsinger said.

In response to the latest surge, Santa Rosa Memorial Hospital officials have obtained permission from the state Department of Public Health to maintain pandemic-level staffing. The hospital’s “flexibility request” allows nurses to have one more patient if needed in specific departments.

For example, in intensive care, nurses can have up to three patients; medical/surgical nurses can have up to six; and emergency department nurses may care for up to five patients needing noncritical care.

As of Thursday, there were 18 COVID-19 patients at Memorial, the county’s largest hospital, two of them in ICU, according the state’s website on coronavirus hospitalizations.

Scott Rocco, manager of Memorial Hospital’s emergency department, said the latest surge in COVID-19 patients adds an extra level of pressure on emergency staff, at a time many in the county have returned to normal behaviors.

“They're back out on the lake, they’re back out riding their motorcycles,” Rocco said. “You have to layer on the fact that although our COVID numbers don't look as dire as they did in the winter/fall surge, we have had a significant increase in the just normal summertime, patients — we call it the trauma season.”

Rocco said he and other hospital staff see firsthand the difference between the unvaccinated and the vaccinated. Most vaccinated patients who test positive for COVID-19 won’t be admitted, nor will they need to be placed in one of the department’s four negative pressure rooms.

For example, Rocco said if two 75-year-old men with the same underlying conditions — one vaccinated, the other not — were to show up at the hospital with COVID-19, the vaccinated man usually goes home the same day.

“The person that’s unvaccinated will most likely end up admitted, and have more serious conditions than the vaccinated one,” he said.

In addition, there’s the impact on non-COVID-19 patients. The increase in coronavirus cases is causing longer wait times for people with other types of emergencies.

Rocco said they were still keeping average wait times under an hour for July, but they’ve been steadily increasing as this latest surge takes hold.

Dr. Gary Green, a Sutter Health physician who is among the county’s top infectious disease experts, said regaining momentum around the county’s vaccination efforts will be key to defeating COVID-19.

He said most virologists and evolutionary biologists believe COVID-19’s delta variant will surge and eventually regress. But he added it’s unclear whether it will be replaced by another variant or simply “regress on its own.”

Green said one possibility is that COVID-19 eventually mixes in with other seasonal coronaviruses that largely go unnoticed during the flu season. He said the virus that caused the influenza pandemic of 1918 circulated around the world three times in one year, and it was several years before it combined with other flu viruses.

“That may eventually happen with this coronavirus,” he said. “Where it becomes a little bit more embedded with seasonal coronaviruses that we already have circulating for the last number of centuries.”

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.