Poverty, an inability for some to isolate when sick with coronavirus slowing Sonoma County from wider reopening

Sonoma County has been stuck since the end of August in the infamous “purple” stage of the state’s four-part community reopening regimen — the most restrictive tier reserved for counties having the most difficulty curtailing spread of the coronavirus.

As the only one in the nine-county Bay Area in this precarious position, many local residents and businesses wonder when will the county be able to advance so restrictions can be eased and more commercial activity can resume?

On Monday, local health officials said it’s unlikely the county will meet the state’s three requirements to get approval Tuesday to move forward. Based on how the state rules work that means this area will stay in the bottom reopening stage at least two more weeks.

The other big question on the minds of many locals is why is Sonoma County for more than two months now been unable to advance under the state’s guidelines, while neighboring counties have been gradually progressing from one stage to the next? Last week, San Francisco, for example, moved up to the least restrictive stage. Napa, Alameda and Santa Clara counties aren’t far behind.

There’s not one answer to that question. Answers from the county’s top public health official, a local family doctor, a university public health professor and a county supervisor offer varied perspectives, some based on scientific data. The most common thread is low-income people who get infected keep going to work spreading the coronavirus to many others, instead of isolating at home.

“We’re actually quite different than our Bay Area county neighbors,” said Dr. Sundari Mase, the county’s health officer in charge of executing the challenging local pandemic response.

Mase said for a more appropriate geographic comparison, look outside the Bay Area and farther south.

“If you want to look at a more similar comparison, looking at a county like Monterey with our same population, similar demographics, similar agricultural, highly agriculture-based industries, wineries, things like that, that may be a more similar comparison,” she said.

Indeed, Monterey County also remains mired in the “purple” or bottom reopening stage.

Another key difference between Sonoma County and other Bay Area counties, Mase said, is local public health staff members have been doing “lots and lots” of testing, a help to get control of the pandemic in the long run rather than a short period.

“That means you’re finding a lot more cases,” she said. “Our new cases per 100,000 (residents) per day has been the one metric that’s holding us back in the purple tier at this time.”

And Sonoma County residents started getting infected by the contagion 4 to 6 weeks after Bay Area neighbors, Mase said, noting consequently improvements suppressing the virus will follow a similar lag.

Dr. John Swartzberg, clinical professor emeritus at UC Berkeley’s School of Public Health’s division of infectious disease, said unlike others in the Bay Area, Sonoma County has a large number of low-paid laborers, particularly agricultural workers. Many, he said, are forced to work because they can’t afford to stay home when they’re sick.

“These are the groups that we’ve seen consistently hit the hardest,” Swartzberg said.

Shirlee Zane, a county supervisor, said the biggest reason Sonoma County is stuck running in place, when it comes to reopening is the lack of affordable housing, forcing multiple families to live in one home or apartment.

“The number one health issue we have in this county is affordable housing,” Zane said. “It’s a social justice, health equity, health care issue and we have not done nearly enough.”

There’s also a nexus, the supervisor said, between low-wage workers who work in local nursing homes and residential care facilities, which have been certain COVID-19 hot spots for many months, that are forced to stay on the job when sick and therefore have infected many elderly residents.

Dr. Panna Lossy, a Santa Rosa family physician, said long wait times for COVID-19 test results continues to be problematic. But Lossy, who started a nonprofit called IsoCare to help residents, many of them Spanish-speaking, to isolate properly, said the county has too many low-wage earners with no choice but work when they’re sick. And this same group of residents often lives in crowded housing with extended families because of the county’s high cost of living.

For Sonoma County to advance to the next less restrictive tier, it must hit the state’s three COVID-19 benchmarks: less than 7 daily new cases per 100,000 residents; a virus test positivity rate of less than 8%; and a health equity virus test rate of less than 8%. The equity metric is the share of coronavirus positive tests among the county’s most disadvantaged residents, particularly Latinos who are getting the virus at a far greater level than other ethnic groups. State public health officials assess each of the 58 counties’ progress weekly.

As of Monday, the county’s new infection rate was 10.8 cases per 100,000 people; its test positivity rate was 4.8%, and the last calculated health equity metric was 7.5%, according to local health officials. Monterey County has a daily case rate of 8.3 cases per 100,000 people; its test positivity rate is 4%, and its health equity rate 6.9%.

Realizing a more aggressive pandemic response was in order, last week the Sonoma County Board of Supervisors unanimously approved a $16 million enhanced and long-term public health campaign against the virus. It focuses on the local Latino population and other community sectors where transmission is the worst.

Tactics include ramped-up testing in disadvantaged neighborhoods, giving gift cards to encourage people to get tested, providing $1,200 one-time stipends so low-wage workers without paid sick leave can isolate at home after contracting COVID-19 and conducting aggressive outreach and public health education in Latino communities.

Swartzberg, the public health professor, pointed out it’s plausible that one California county may not be doing something better than others to contain the virus, since there’s a lack of uniformity in how COVID-19 spreads.

“Before Sonoma County starts self-flagellating itself too much, I would suggest that there’s a randomness to this pandemic that we don’t understand at this point,” he said.

Furthermore, Swartzberg warned that coronavirus cases across the country are on the rise, a troubling sign with the approach of winter months and year-end holidays when many people traditionally gather. The rush for cities and counties to reopen may not be the wisest thing right now, he said.

“And, you know, maybe it's a blessing in disguise that Sonoma isn't in a position where they could open things up,” Swartzberg said.

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