As the state inches toward reopening from the COVID-19 crisis, counties are working to meet the California Department of Public Health's criteria in order to further relax restrictions on businesses and public movement. For some counties, the progression will be easier than in others. Santa Clara County, with one of the state's largest populations, has a way to go, according to its data.
The logistics of doing adequate testing for the deadly coronavirus, tracing a multitude of contacts with people who tested positive (known as contact tracing), housing homeless individuals who are most vulnerable to the disease and meeting many other requirements have been hampered by a lack of resources and untold complexities, public health department and county staff have said.
Last week, the county Board of Supervisors and the board's Health and Hospital Committee pressed the Public Health Department and county management to better define their roadmap for reaching the state's criteria.
They reached one milestone on Monday, May 18, announcing the relaxation by six Bay Area counties and the city of Berkeley of some restrictions, which will now allow curbside sales by many retail businesses — Stage 2 of the state's plan. The Stage 2 reopening will start on Friday, May 22.
The forward momentum was helped by changes to the state's criteria, which California's leaders also announced on May 18. The new guidance revised the maximum number of positive cases within a 14-day period to be higher. Santa Clara County would not have made the state's metrics for Stage 2 reopening without the change, according to its data.
This second stage of reopening is only one phase of the state's plan. The county is succeeding in some areas while lagging on other state requirements that would accelerate reopening. Here's how Santa Clara County is performing on the state's metrics.
Condition: Counties should have no more than 25 positive cases of COVID-19 per 100,000 residents within a 14-day period or show a positive test rate of less than 8%.
Condition met?: Yes.
With a population of 1.928 million residents, Santa Clara County had 194 positive cases in 14 days ending May 19, far less than the state's criteria of 25 cases maximum per 100,000 residents, which would be 482 cases. To date, the county has had 2,483 confirmed COVID-19 cases since the pandemic began, according to data posted Tuesday on the Santa Clara County Public Health Department's COVID-19 online dashboard.
Of those, 475 were cases in long-term care facilities such as skilled nursing, assisted living, board-and-care and congregate independent living.
Previous to May 18, the state's reopening criteria required counties to have no more than 10 cases of COVID-19 per 100,000 people in the past 14 days, or 192 cases in Santa Clara County. The county would have just barely missed meeting this criteria if it was still in place.
Condition: Counties can reopen to Stage 2 if the number of hospitalizations for COVID-19 patients doesn't increase more than 5% over seven days. Smaller counties have to show fewer than 20 hospitalizations on any given day for two weeks.
Condition met?: Yes.
Santa Clara County had a 15.4% decrease in COVID-19 hospitalizations from May 12 through May 19, with 82 patients hospitalized with the virus compared to 97 hospitalizations on May 12.
Condition: Counties should be able to conduct 1.5 COVID-19 tests per 1,000 residents daily, which would mean 2,892 tests per day in Santa Clara County. Testing should be available for 75% of residents within a 30-minute drive in urban areas or 60-minute drive in rural areas.
Condition met?: No.
The county has only conducted about 1,200 to 1,300 tests per day, which doesn't meet the state's condition. The county has its own minimal goal of conducting 4,000 tests per day by May 31, with an ultimate goal of 13,000 to 15,000 per day to include those whom they consider high risk, Dr. Marty Fenstersheib, the new head of the COVID-19 testing task force told the Board of Supervisors Health and Hospital Committee on May 14. He said he is confident they will get to the 4,000-per-day goal by the end of the month, but reaching the larger target is harder. "Getting to that goal is going to take some time," he said.
Condition: Counties should have 15 contact tracers per 100,000 residents.
Condition met?: No.
The county is working to prepare more than 700 people for the contact-tracing unit and support team, a spokesman said on May 19. The county will need to employ 289 people to achieve the state's requirement. The county has not yet provided a date for when the contact tracing will ramp up.
Condition: Counties should be able to temporarily house at least 15% of county residents experiencing homelessness.
Condition met?: Unknown.
The county has 9,706 homeless individuals, according to its 2019 point-in-time count, a survey that takes place in the last 10 days of January.
The county, city of San Jose, and Continuum of Care (a consortium of service providers) have a partnership to help homeless people affected by the COVID-19 outbreak.
The county and city of San Jose added a total of 1,245 additional units/beds to their temporary shelter inventory, including 575 motel/hotel rooms across 10 sites in six cities (Gilroy, Milpitas, Morgan Hill, San Jose, Santa Clara and Sunnyvale); 250 beds in the Field Respite Center at the Santa Clara Convention Center for COVID-19 positive patients; and 420 temporary shelter beds in San Jose at Gateway Pavilion at the Santa Clara County Fairgrounds, a family shelter at Camden Community Center, and the San Jose Convention Center's Parkside Hall and South Hall as of May 12, according to the county's COVID-19 response website, but that is short of the 1,488 beds needed to meet the state's 15% requirement for temporary housing.
The county has provided temporary shelter to 1,110 homeless individuals, according to a spokesperson for the county's Emergency Operations Center. In addition, it has found permanent housing for 400 people.
Every known homeless person who has tested positive for COVID-19 has been given shelter, the county said.
Condition: Counties should be able to meet a surge of at least a 35% increase in hospital demand due to COVID-19 on top of the usual non-COVID-19 care needs.
Condition met?: Yes.
This is one metric where staff are confident of the county's success. On May 19, the county had 82 people hospitalized with COVID-19. A full 100% of the 1,231 surge hospital beds are available. The surge-capacity beds represent more than 100% of the usual hospital bed capacity. On May 19, 51.34% of acute hospital beds were available and 51.90% of intensive-care unit beds were still available. The county has 847 ventilators, 119 of which were in use, but its data doesn't state how many are being used by COVID-19 patients.
Condition: All skilled nursing facilities should have a two-week supply of personal protective equipment for workers and their own sources of such equipment other than state supplies, and county hospital facilities should have plans for how to ensure all clinical and nonclinical workers have personal protective equipment.
Condition met?: Partially.
County Executive Jeff Smith told supervisors on May 12 that the news is mixed. All 11 hospitals and clinics in the county have certified they have enough personal protective equipment at this time. By May 19, a county spokesman said most of the hospitals had committed to a 30-day supply. The county Public Health Department checks in weekly on the hospitals' supplies.
Skilled nursing facilities are a different matter. Not all have certified their personal equipment supply.
"How can I say this politely? Some of them have ignored our request," Smith told the Board of Supervisors on May 12. He said the county Emergency Operations Center would supply the skilled-nursing facilities, and staff is doing one-to-one outreach. Those numbers were still not available on May 19. A county spokesman said staff members are working on the personal protective equipment supply levels for skilled nursing facilities and are procuring additional supplies and distribution channels through donations and the state.
Editor's note: This story has been updated to reflect that the state is no longer requiring counties to report zero deaths in 14 days to move into Stage 2 of reopening.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.