‘Uncertain and disquieting times’: Experts warn of potential swell in COVID-19 cases

After months of decline, COVID-19 cases are failing to drop — and in some places are creeping up — across the Bay Area and California, worrying public health officials as the holiday season looms and prompting urgent pleas for Californians to get vaccinated or receive booster shots.

Although widespread vaccinations would render a winter surge much less deadly than last year’s, the current rise in cases in some places is a preview of what California could experience as people gather indoors more frequently and travel for Thanksgiving and winter holidays.

The possibility of a surge in winter cases arrives at a critical and confusing moment in the pandemic. Mandates that required people to stay home as much as possible have been lifted, and a majority of Californians have been vaccinated, leaving public health officials with limited tools to prevent a new wave of transmission aside from advising people to get the shots and behave responsibly.

“These are uncertain and disquieting times right now, because we can’t be confident in where we are and where we’re going,” said Dr. John Swartzberg, infectious diseases specialist at UC Berkeley’s School of Public Health. “We have to be very prudent in how we conduct ourselves as individuals and how we conduct ourselves from a public health standpoint.”

In Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara, infection rates have either flattened or started to rise over the past few weeks, data from those counties’ public health departments show. Statewide, cases and hospitalizations declined for months but now seem stubbornly stuck in place, with the seven-day average test positivity rising from about 2% in late October to about 2.4% in early November.

Unvaccinated people make up the majority of COVID-19 cases and an even larger share of hospitalizations, with a rate of roughly 22 unvaccinated people hospitalized per million versus 2 per million for vaccinated people, according to the California Department of Public Health.

In a statement to this news organization, the department wrote that it was monitoring COVID-19 trends “signaling a potential winter surge.”

“The state is preparing to respond to a variety of scenarios should we experience another surge in cases,” the department said. “We have learned over the last two years that COVID-19 takes advantage when we put our guard down.”

With about 66% of eligible Californians fully vaccinated, protection against the worst of the disease will help prevent against the 20,000-plus hospitalizations that rocked the state last winter. But immunity from shots received last winter and spring may be dropping off, and fewer Californians than anticipated have so far received boosters.

In the Bay Area, public health officials are grappling with how to sound the alarm to pandemic-weary residents while remaining measured about the potential surge’s effects. That means continuing to convince unvaccinated people to get the shots, said Dr. Matt Willis, Marin County’s top public health official, while constantly reminding vaccinated Californians that the pandemic hasn’t disappeared.

Willis is confident that any rise in cases will spur more people to get vaccinated in the weeks to come. But for many, the role of public health in dictating day-to-day behavior “is diminishing,” he said.

“The shift we’re in now is where we’re trying to offer people the information they need to navigate what are ultimately personal decisions around risk. And it’s hard,” Willis said. “Like, what are we trying to do here? Are we preventing cases? Are we preventing deaths? Hospitalizations? What is our north star?”

Willis, Swartzberg and other public health experts agree that preventing the health care system from getting overwhelmed by COVID-19 cases remains the primary goal for the next stages of the pandemic. But with minimal research available about the implications of long COVID, that priority could eventually shift back toward preventing all cases, including breakthroughs, said Dr. Naveena Bobba, San Francisco’s deputy director of health.

For now, however, there is clear consensus as to how Californians should approach the next few months, experts said: Unvaccinated people should get the vaccine, while older people and those with underlying conditions should get a booster shot.

On Thursday — following a similar announcement in Santa Clara County — California health officials told providers to give boosters to any adult who wants one.

Dr. Jocelyn Freeman Garrick, deputy director for emergency medical services in Alameda County, acknowledged that public health guidelines in both California and the nation have been “extremely confusing” as vaccines became widely available. But behavior will still play a key role in how the winter turns out, she said.

People ought to prioritize gathering with only those who are vaccinated, she said, and wear masks indoors when people’s vaccination status is unclear. Health officials are also encouraging coronavirus testing before attending a large event, getting together outside when possible and staying home when sick.