What more can California do to stop the coronavirus?

The rising coronavirus case count in California is maddening, in part because the effects of our sacrifices feel unclear, diffuse: We are not going into bars, most of us are wearing masks and a vast majority of us are taking the threat seriously. So why are thousands of people still getting sick every day? Where are they getting sick? And why are dozens dying?

These questions came up again and again when we asked what you wanted to know about how the pandemic is reshaping life in California, and speak to the anxieties many of us are feeling.

Finding the answers to where the virus is spreading and why can be tough, especially given the limited state of California’s contact tracing efforts.

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So I spoke with Dr. Kirsten Bibbins-Domingo, the vice dean for population health and health equity at the School of Medicine at UC San Francisco, to get her insights on why the virus continues to ravage California, and what can be done to slow its spread.

First, I wanted to ask what you thought about Gov. Gavin Newsom’s new focus on the Central Valley.

If you look at transmission rates in the Central Valley, they’re super high.

One of the biggest challenges, especially among our front-line workers is that they need both personal resources to be able to figure out how to effectively isolate and to make sure their wages are protected if they need to take time off work.

But also, there needs to be investment in the sectors that employ these low-wage workers to make sure that this is possible.

And we need additional investments, including making sure there’s testing availability when departments of public health are really hard hit because of the higher burden of transmission.

It’s a little late, frankly, which is the unfortunate thing. But the Central Valley needs attention.

Right — I know from talking with you and other experts that it’s not news that these communities were vulnerable.

I think what’s challenging for the pandemic in general and for California in particular is we cannot, as a state and/or as a county, continue to just look at average effects. We have to basically shift our resources.

That’s what’s frustrating. You see that within the county of San Francisco — we focused on the Latinx community, because our average rates were low. But in all of our cities, it’s been late to even shift testing to where stuff is happening.

One of the things that’s striking in the Central Valley, also, is how much our rhetoric betrayed our very urban biases — like, “Close the beaches, close the bars.”

We should have said, “Being in indoor environments, even when you’re with your family, is bad news.” You could look at the congregate settings that our farmworkers are living in and just know they were vulnerable.

But something about this pandemic — it seems to be hard for us to be proactive.

Last time we talked, you mentioned being cautiously optimistic that this pandemic will show people how much communities’ health is interconnected. Do you still feel that way?

The thing that makes me optimistic is that the people who are trying to address the pandemic are realizing we can’t just put out nice public health announcements. There are big structural factors that make it challenging to control, and when things are challenging in one part of our community, the entire community can’t really do the things it wants to do and open up.

What makes me pessimistic over time is that there is fatigue with this pandemic, which can make people lapse into a narrative of “It’s those communities. I can get it under control, so what’s the problem?”

The reality is that we when our rural counties get overloaded, they airlift the patients to the other counties. We’re all taking care of patients from these counties. And the agricultural sector is an important part of our economy. If it falls through, it’s going to be something we all pay for.

How would you talk to someone who’s trying to navigate risk in their own life?

One of the things that I hear from epidemiology colleagues is one of the best things that departments of public health can do is just really go deep. Like in the last hundred cases — how did people get it?

I think we should be communicating to people so they can start to make decisions themselves, as opposed to just closing big sectors of life — that’s the mind-set we have to be in rather than, “All bars and dining are bad,” or “I can’t get together with anyone.”

The way I think about it is those enclosed, close-contact environments, and especially when you’re with many other people, are always riskier environments. And if you’re doing an activity that requires you to take that mask off, that is a thing that raises the risk.

Do you think some of these essential sectors have the potential to get it right — to be models for how to keep people safe inside?

I think that’s exactly right. You’re going to need some enforcement, because there are clearly bad actors.

What I would also hope is that the state pouring resources into our low-wage sectors really could allow businesses and community leaders to say, “How can we redesign this? How can we get people into humane housing?”

If we have creative and committed community leaders with resources, hopefully they’ll be able to think about sustainability.