Santa Clara County had its highest number of COVID-19 cases ever recorded for a single day on Tuesday, raising concerns about the trajectory of the virus and causing the state to issue a notification that the county is on a "watchlist" because of the increase.
The county had 122 new cases recorded on Tuesday, county Health Officer Dr. Sara Cody told the county Board of Supervisors on June 23. (Update: The number of new cases rose to 125 on Wednesday.)
The rise in cases is part of a trend that the Public Health Department has seen over two weeks. New hospitalizations also appear to be trending upward, Cody added.
Sixty-one people were hospitalized as of Tuesday; over the past month, that number has ranged from 38 to 75 patients, according to the county.
Cody received word during the board meeting that the county is now on the state "watchlist," dashing hope for the time being that the county can petition the state to allow additional reopening.
"It's a worrisome sign. It reflects widespread testing but also an increase in cases because the virus continues to spread," she said.
She said health experts don't have a way to measure the percentage attributable to increased testing versus the increase in actual cases. The county has run pop-up testing clinics over the past several weeks and opened new testing facilities in the southern part of the county.
"There's generally a lag between uptick in cases and uptick in hospitalizations. The hospitalizations are the most stable trend; we're watching it very closely. If hospitalizations rise and stay consistently up, that's an indication that rise in reported cases represents rise in actual incidence, not just in (testing)," she said in an email to this news organization.
Earlier this month, the county relaxed its public health order to allow some businesses to resume, with protocols in place for social distancing and face coverings.
Nearly half of all cases are from unknown sources and are assumed to have been acquired in the community, she said.
But some businesses and industries have accounted for the increase in cases. Since May 25, 89 worksites have reported at least one COVID-19-positive case. Of those, construction worksites have been hit the hardest, making up 38% of the businesses, with 34 cases. Food service and restaurants comprised 11% of businesses reporting at least one COVID-19 case; retail stores constituted 9% and food-processing plants 7% of the 89 worksites, according to Cody.
Food-processing facilities have the largest outbreaks in terms of the number of people affected, according to the county.
Cody said the county has a team dedicated to worksite investigations. She also praised the construction industry for being candid and diligent when reporting cases.
"The construction industry has been quite progressive" in working with the county on protocols for their worksites, Smith added.
The county has made significant strides to stop outbreaks in congregate settings such as long-term-care facilities since May, a major effort.
Some areas and demographic groups within the county continue to be the hardest hit by COVID-19. South Santa Clara County and the eastside of San Jose and Latinx residents continue to bear a disproportionate number of cases, Cody said.
The county's uptick follows similar trajectories around the region, state and nation, giving rise to concerns that while Santa Clara County hasn't seen an explosive growth in positive cases, the signs are there that things could get worse if people are not careful, Cody noted.
"We're trying to manage a local epidemic, but it's not a local epidemic," Cody said, likening the situation to carrying a bucket with many holes. Travel, a high population and other factors mean the county doesn't exist in isolation.
"Los Angeles is blowing up. California is not trending down at all," County Executive Jeff Smith said, noting Bay Area counties are "not doing so well" and are trending upward.
Statewide, deaths are estimated to triple to 15,155 compared to 5,500 today — a 275% increase — and the U.S. death rate will rise to 201,000 (compared to 119,000 now) — a 68% increase — by Oct. 1, according to projections by the University of Washington, Smith said.
Cody noted, as she has in the past, that opening further — or retreating as necessary — is contingent on slowing the virus down. The most important actions to drive the numbers down still remain physical distancing and social-norm changes, including wearing face coverings, she said.
Contact investigation and contact tracing are also key to keeping the virus under control and understanding where and how it is spreading. The health department's COVID-19 tracing team has added more than 500 contact tracers. It hopes to meet its 1,000-person goal by the end of July. It has also reached its basic goal of testing at least 4,000 people per day, with some days having hit over 5,000 tests, staff said. The county still needs to perform 15,000 tests per day, according to its own estimates.
Cody credited the county's stay-at-home order, which it instituted earlier than anywhere else on March 16, with preventing many deaths. The early social-distancing protocols and order did enable the county to "bend the curve" and lower the number of cases and hospitalizations. As restrictions lifted in accordance with the state's indicators for reopening, county health leaders expected they would see a rise in cases, she said.
Editor's note: In a previous version of this story, Dr. Cody erroneously stated the number of new cases was the second highest.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.