Why struggling Sonoma County has the toughest COVID restrictions in the Bay Area

Pedro Toledo guided his 82-year-old mother by the hand to the intake window of a health clinic in Petaluma and found himself in an unfamiliar position – asking where to go for an appointment.

Most of the time, Toledo is in charge: He’s the administrative director of the Petaluma Health Center clinic network that serves about 40,000 patients in Sonoma and Marin counties. But on Monday morning, he was a worried son escorting a mother who was among the last in Sonoma County to be infected with the coronavirus.

Testing positive the day after returning home from a brief hospital stay, Toledo’s mother – who not only belongs to a high-risk age group but also suffers from the autoimmune disease lupus – is become one of more than 71,000 total residents who have been infected in a county that continues to have some of the highest coronavirus case rates in the Bay Area, even as the winter surge begins to level off in much of the region.

The seven-day average for Sonoma County was 233 new cases per 100,000 residents on Monday, according to an analysis of the California Department of Public Health’s Numbers Chronicle. Solano and Santa Clara counties followed with 208 and 202 cases, respectively, compared to 190 cases per 100,000 for the Bay Area as a whole. These case rates differ somewhat from those posted by Solano County due to time lags and differences between how the state and counties record positive test results.

Simona Toledo, who tested positive for the coronavirus, has her vital signs checked by medical assistant Edgar Esparza Lopez at Petaluma Health Center.

Alvin A.H. Jornada / Special for The Chronicle

Residents of Sonoma County are now living under tighter restrictions aimed at stemming transmission than other parts of the Bay Area, where cases mostly appear to be declining or leveling off. Its Latino residents continue to be hardest hit by disease and the economic ramifications of the pandemic. Local clinics and hospitals are under stress, with hospitalizations increasing. Demands for economic assistance from county residents skyrocketed.

“The outbreak is such that there’s so much COVID everywhere right now,” Toledo said, lamenting that his mother was infected even after he worked hard to protect her. “We took every precaution while trying to live life,” he said. . But at least her symptoms were mild, and he credited the three full doses of vaccine she received. Simona Toledo said she already felt better. They took daily walks and his blood oxygen level was good.

Sonoma County has historically lagged the Bay Area overall in seeing its cases rise and fall: It saw a slower rise in cases early in the pandemic but took longer to stem rising infections, a trend that has continued through the ups and downs of the pandemic. The county often retained pandemic restrictions during the reopening phases in 2020 and 2021, while other parts of the Bay Area that were progressing better were able to relax their rules earlier.

Today, the county has some of the toughest restrictions in the region, including a ban on large gatherings — anything over 50 people indoors and 100 people outdoors. In issuing the order, from January 10 to February 11, health worker Dr Sundari Mase also asked residents to voluntarily shelter in their homes to help stem the rise in infections. Similar restrictions were used across the state before vaccinations became widely available to curb the spread of COVID, especially during the first wave in March 2020 and during the surge last winter.

Mase said the order was to prevent hospitals from being overwhelmed. Between December and January, case rates rose from an average of 90 new cases each day to around 1,250 in the past week. At least three dozen cases have been traced to indoor sporting events, she said.

“We are at a crucial moment in the pandemic,” Mase told the oversight board during an emergency meeting about the omicron push.

Infection rates are highest among Latino residents of Sonoma County, who throughout the pandemic have suffered more disease than any other racial or ethnic group. The impacts of COVID-19 have historically been felt the hardest by essential workers, low-wage workers, immigrants and people of color, groups who suffer the effects of long-standing racism and health disparities. .

As of Jan. 17, case rates were 36% higher among Latino residents than among the general Sonoma County population, according to county data. The Latino population overall makes up about 27% of the county’s residents.

Additionally, this month’s surge caused by the highly transmissible variant of omicron came after the government’s emergency paid sick leave programs that helped coronavirus-infected workers stayed home expired. them earlier in the pandemic. This means it has become harder for much of the county’s low-wage population and essential workers to miss work when infected.

Calls to a hotline from people seeking financial help have gone from about 35 calls a day over the fall to an average of more than 1,000 calls a day in the past week, Javier Cabrera-Rosales said. , program director of the CURA project. The project provided more than $6 million in emergency financial assistance from October 2020 to last December, but the last two weeks topped everything else, he said.

A protective gown, face shield and stethoscope used by healthcare workers hang on a wall at the Petaluma Health Center in Petaluma.

A protective gown, face shield and stethoscope used by healthcare workers hang on a wall at the Petaluma Health Center in Petaluma.

Alvin A.H. Jornada / Special for The Chronicle

“We are inundated,” he said. “So we have to re-evaluate and shift to prioritizing people who are really in serious crisis.” Callers often feel forced to choose between keeping a job and staying home to care for a sick loved one, Cabrera-Rosales said. Many have no place to isolate themselves when they are sick. They may need food, money for funeral expenses, or temporary shelter.

“Essential workers continue to bear the brunt of the pandemic,” said Denia Candela, Sonoma County Health Services Equity Program Manager.

The county this month added COVID-19 testing and vaccination sites in central community locations like schools and partnered with churches and other community groups to distribute home tests to those who face the greatest risks.

At Petaluma Health Center, the impacts of the surge are felt daily.

“At this point, almost everyone who’s unvaccinated gets COVID — that’s what it looks like,” Toledo said, noting the tragic case of an unvaccinated pregnant woman who was infected and ended up being hospitalized in a medical coma on a ventilator. With local ERs full, an 8-year-old patient with a severe fracture had to be sent to a Sacramento hospital, Toledo added.

The timeline of seven-day averages for new cases indicates that the Sonoma County outbreak may be falling from a possible peak: This average has been trending lower since 253 cases per 100,000 people were recorded on January 16, according to analysis of state data by the Chronicle. But transmission rates remain high, with the number of cases putting pressure on available drugs and treatments, officials say.

Pedro Toledo, administrative director of the Petaluma Health Center, holds the hand of his mother Simona Toledo at the Petaluma Health Center after she tested positive for the coronavirus.

Pedro Toledo, administrative director of the Petaluma Health Center, holds the hand of his mother Simona Toledo at the Petaluma Health Center after she tested positive for the coronavirus.

Alvin A.H. Jornada / Special for The Chronicle

Doctors are working to ensure patients have equitable access to limited supplies of treatments, like Pfizer’s Paxlovid antiviral pill and monoclonal antibody infusions, said Dr. Nurit Licht of Petaluma Health Center. Prioritizing medications for those most in need, staff call pharmacies daily to determine where medications are in stock for these patients.

“We are really trying to remove all barriers to treatment for those who need it most,” Licht said.

In an exam room on Monday, Licht asked Simona Toledo in Spanish how she was feeling, and they discussed which medications might make the most sense given her other health issues.

Toledo knew medication would be in short supply when his mother tested positive at home on a Saturday. He called more than half a dozen pharmacies in the area before finding one with Paxlovid, driven by the feeling that he had to act quickly. He acknowledged that patients like his mother don’t always have family or other people to advocate for them.

“It takes so much work and advocacy and navigation,” Toledo said. “Primary care providers are trying to do their best – everyone is working to meet the needs of the community – but there are so many people infected and such a demand for care.”

Julie Johnson is a staff writer for the San Francisco Chronicle. Email: [email protected] Twitter: @juliejohnson.

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