Why the third California COVID-19 wave could be the worst

Mario Tejada carries his son Mario Tejada Jr., 3, on his shoulders at Los Angeles International Airport on Tuesday.

Published Nov. 18, 2020 Updated Nov. 19, 2020 7:58 PM PT

SAN FRANCISCO — Faced with a third COVID-19 wave just as we enter the holiday season, it would be fair for Californians to pose some existential questions.

Why does this virus seem to be targeting us yet again? Why have we struggled to control it? Where did we go wrong?

The simple answer is: We actually do know how to fight the virus. We just got tired of doing it.

This third coronavirus wave is particularly troubling because “we never got back down” to a low baseline number of cases, said Dr. Sara Cody, the Santa Clara County health officer and a key architect of the nation’s first regional stay-at-home order.

Even worse, this surge is happening during the traditional cold-and-flu season, exacerbated because people tend to stay indoors, where it’s easier to pass along germs.

“We’re also facing this surge on the eve of what has traditionally been the greatest travel day of the year — and that’s the day before Thanksgiving,” Cody said.

Moreover, California won’t be able to count on help from other parts of the country. “Everyone is experiencing a surge at the same time,” Cody said.

Many unknowns remain. In general, deaths from COVID-19 have fallen since the spring as the infections hit a younger, healthier demographic and hospitals get better at treatments. Some workplaces and institutions such as nursing homes have gotten better at protection measures.

But hospitals are beginning to fill up again, and the rate of increase in cases reached unprecedented levels across the state.

The average number of new daily coronavirus cases over a seven-day period has jumped by 108% in the last two weeks, rising from 4,847 a day to 10,064 a day.

That pace is even faster than at the start of the summer, when the average number of new daily coronavirus cases jumped by 96%, from 3,703 a day on June 21 to 7,264 a day on July 4.

California on Thursday announced a limited nighttime stay-at-home order in most of the state, with certain exceptions, such as walking a dog or picking up takeout food. And Los Angeles County, which has been particularly hard hit by this latest wave, issued an order beginning Friday instructing restaurants and nonessential businesses to close by 10 p.m., although takeout and delivery orders will be able to continue overnight.

L.A. County has warned that it may impose even further restrictions if infections continue at their current rate, and could order a shutdown of outdoor restaurant dining areas and even impose a new stay-at-home order.

There is also a psychological dimension to the third wave that is particularly devastating. Many had hoped by now for a reprieve from the isolation, uncertainty and economic damage from the coronavirus, a chance to reconnect with family and friends, to do some in-person Christmas shopping and feel as if better times are ahead. The news of successful vaccines is a boost. But many enter the holiday season as anxious as ever.

Even in San Francisco, which has seen a relatively low number of deaths from COVID-19, “we are seeing an explosion of new cases throughout the city,” warned Dr. Grant Colfax, the director of public health.

“This rate of rise is higher than ever before,” Colfax said, adding that it’s possible that the city could run out of hospital beds and intensive care unit capacity.

“The choices we ... make in the next two weeks will determine the remainder of this holiday season,” Colfax said, urging people to cancel travel plans and stay home for Thanksgiving. “We have the ability to choose if we beat back the third surge, or if we fall victim to the surge, like we are seeing unfortunately in other parts of the country.”

California was once a shining example of how a state can marshal itself to prevent the pandemic from becoming a full blown catastrophe. With officials acting relatively early to impose a stay-at-home order, hospitals across the Golden State never became as overwhelmed as those in New York, which endured a wrenching death toll double that of California.

But California was not spared from a devastated economy, and that brought pressure to reopen from people desperate to save their businesses from ruin.

Attitudes also changed as the pandemic dragged on. California shows how a collective shrug, a lack of discipline and a yearning to quickly “get back to normal” can also result in a new season of death.

Loosened rules on restaurants and bars and a burst of social activity in the waning weeks of spring and the first weeks of summer resulted in California’s deadliest season of the pandemic, sabotaging efforts to reopen schools in time for fall.

Now, there’s fear that California is headed on that same path again, with the lure of Thanksgiving, Christmas and other winter holidays irresistible to some.

Mass fatigue and even resentment of the coronavirus are causing some people to defiantly hold dinner parties without masks and plan for holiday feasts.

The lure of social gatherings is strong: Gov. Gavin Newsom recently apologized for attending a birthday dinner for his political advisor, who is also a registered lobbyist, at an exclusive Napa Valley restaurant.

And health officials are urging people to not think they can use testing to give themselves a free pass to hold parties without needing face masks or social distancing. Doing so would be making the same mistake the Trump administration did when its testing strategy failed to protect President Trump from getting infected and allowed a super-spreading incident at a Rose Garden ceremony announcing his nominee to the Supreme Court.

Unless they’re canceled or dramatically scaled back, traditional social gatherings held amid the world’s worst pandemic in a century will lead to a season of heartbreak, overwhelmed hospitals and busy morgues as the weeks tick closer to Christmas.

Health officials are tracking this pattern across California, and it’s for that reason they’re terrified of what may hit the state if nothing is done to shift from this trajectory.

Statewide, the current acceleration in cases is the fastest on record, Gov. Gavin Newsom said on Monday.

It’s “simply without precedent in California’s pandemic history,” Newsom said.

In the late spring, scientists now believe, the rapid reopening of businesses that began in May and stories crowing about how California survived the pandemic better than the East Coast seemed to telegraph to people that, after two months of following a strict stay-at-home order, it was OK to loosen up.

But birthday parties and celebrations soon became super-spreader events.

There was the story about a truck driver who, after months of diligently isolating, finally went to a barbecue party. More than 10 people who attended the party ended up getting infected, and the driver, Tommy Macias, 51, died on the second day of summer.

Then there was the story, later in the summer, of a couple who traveled from California to Maine to get married in the small town of Millinocket. There were just 55 attendees at the wedding reception, but, over the next few weeks, 176 people would get infected, including a parent of a person who attended the wedding. That parent worked at a long-term care facility, and is believed to have introduced the virus among its residents. More than half of the facility’s residents were infected, and six of them ultimately died of COVID-19.

In Los Angeles County, Barbara Ferrer, the director of public health, has meticulously tracked key moments that preceded surges in coronavirus infections.

In hindsight, it’s now clear that L.A. County’s second surge in cases began to be detected on May 28, three days after Memorial Day, leading to a peak in daily coronavirus cases that would crest on July 14.

But the surge in hospitalizations would only begin on June 18 and peak July 20. The jump in deaths began June 30 and finally peaked on July 27, and it would take until early October before deaths hit a low point.

A similar timeline with L.A. County’s current surge would possibly translate to a surge in deaths beginning in early December, and worsening through Christmas and New Year’s Day into early January.

That’s a similar timeline forecast by the University of Washington’s Institute for Health Metrics and Evaluation. The institute’s scientists are forecasting daily deaths to begin rising in early December in California.

Daily COVID-19 deaths have already been rising nationwide for about a month, and the institute forecasts the pace will worsen through through mid-January.

Increasing travel recently may be a reason why officials noticed a sudden uptick in coronavirus cases in the first few days of November, Cody said, with Silicon Valley residents traveling to areas with more infection, getting infected without knowing it, and bringing the virus back home.

Also, “we see both accelerating transmission both within households and in private settings, and then in work sites, and back and forth,” Cody said. “We need to redouble our efforts on all fronts.”

Part of that is increasing public education, and emphasizing that people can be highly contagious with the virus without ever feeling sick — resulting in silent chains of viral transmission that result in a super-spreading incident, Cody said.

In fact, the idea that we could be facing several waves had been forecast ever since shortly after the pandemic began.

In a computer model developed by researchers at the Harvard T.H. Chan School of Public Health and circulated in March, scientists suspected that a one-time effort at social distancing in the spring would never be enough.

They forecast a situation in which we would need long periods of social distancing, perhaps with occasional periods of loosening, to keep the hospital system from being overwhelmed at any one time. And they suggested one plausible scenario that said social distancing measures would only be able to be relaxed by early to mid-2021, with the epidemic concluding by mid-2022.

Experts now say it’s likely that the widespread availability of promising coronavirus vaccines to most of the public won’t happen until mid-2021.

Times staff writers Karen Kaplan and Stephanie Lai contributed to this report.