For subscribers: After nearly three years, state COVID-19 emergency ends Tuesday. Now what? – The San Diego Union-Tribune

First declared on Feb. 14, 2020, San Diego County’s COVID-19 emergency officially ends Tuesday, the same day the statewide proclamation expires.

For the most part, this is a technical formality. It has been a long time since the virus put enough pressure on hospitals, either through the number of patients occupying beds, or by keeping a large percentage of the health care workforce home sick, to truly challenge the system’s ability to respond.

The latest weekly report from the county health department showed 1,816 cases reported last week compared to more than 29,000 the same week last year. That figure is surely skewed by the prevalence of home testing these days. Fewer test results are reported to health departments than was the case 12 months ago.

The formal end of the emergency comes as wastewater coronavirus detections have recently been on the rise, but so far have remained five times lower than the peak seen last winter.

Many of the most controversial edicts to arise from emergency powers granted to leaders have long ago been rescinded or pared back. The state lifted its indoor mask mandate, for example, on Valentine’s Day 2022, and moved away from its tier-based reopening system mid-2021.

Post-emergency masking will, according to the state, continue to be mandated in “high risk” locations such as hospitals and nursing homes. In an emailed statement this week, the California Department of Public Health said that “the masking requirement in health care and long-term care facilities is not dependent on the state of emergency timeline,” but did not say whether current requirements will change soon.

Medical technicians Ramtin Akefi, left, and Sabina Kommu pack up equipment and belongings as they close down the COVID-19 vaccination clinic Friday at The Oceanside Living Well Clinic in Oceanside.

(Sandy Huffaker / For The San Diego Union-Tribune)

Masking has long been the central symbol of those who have called the government’s pandemic response overblown, even draconian. For many, then, the end of the emergency is definitely a reason to celebrate.

Amy Reichert, the outspoken leader of ReOpen San Diego, a grassroots group that began demanding the end of the emergency in 2020, noted that even President Joe Biden said in public that the pandemic was over in September 2022.

She pointed to a press conference given by Gov. Gavin Newsom on April 1, 2020, as an example of the long-standing view that the emergency was maintained as much for political expediency as disease control. Toward the end of the governor’s remarks, a Bloomberg News reporter, noting “surprisingly generous unemployment benefits” for laid-off workers and bans on stock buybacks for companies included in the national coronavirus stimulus package, asks whether such moves meant “there’s a new opportunity for progressive steps.”

Newsom’s response, after talking income inequality and insisting that he supports capitalism as a small business owner, was “absolutely, we see this as an opportunity to re-shape the way we do business and the way we govern.”

Widely cited at the time, the answer helped convince some that the emergency declaration was being kept around out of political expediency.

“I agree with Gov. Newsom that the pandemic was exploited for political purposes beyond the scope of the public health crisis presented by COVID-19, and I agree with President Biden that COVID was over long before Feb. 28, 2023,” Reichert said.

Medical technicians pack up equipment and belongings as they close down the COVID-19 vaccination clinic.

(Sandy Huffaker / For The San Diego Union-Tribune)

Nathan Fletcher, who retained his seat on the county Board of Supervisors after a challenge from Reichert in the last election, rejected the notion that politics played any role.

“Protecting public health is never about politics and always about protecting people,” Fletcher said in an email. “That was what we did, and we did it better than most.

“It’s also a milestone in how far we’ve come in the fight to protect our residents and uphold the integrity of our medical systems from this deadly virus.”

Those literally responsible for protecting the public health note that the virus is still generating deaths and cases daily and is continuing to mutate in ways that can still produce variants capable of filling emergency rooms and hospital beds.

“We don’t know what the future is going to hold with the pandemic,” said Dr. Wilma Wooten, San Diego County’s public health officer. “Recently we have averaged between 200 and 300 cases per day, and that’s still more than it should be to say this is over.”

While some do disagree with the length of the emergency declaration, Wooten said it helped government move more quickly, whether in awarding contracts for the outreach workers who spread accurate information in the region’s poorest neighborhoods or by allowing paramedics and others to administer vaccinations.

“Not having a local emergency would definitely have been detrimental in terms of taking the steps that needed to be taken,” Wooten said.

San Diego was one of the first counties in the state to declare a local emergency on Feb. 14, 2020, more than two weeks before a similar move at the state level on March 4.

Many have connected this early action with San Diego’s overall success in preventing deaths, noting that the region has the lowest rate among Southern California counties as the three-year pandemic anniversary approaches. A look at the California Department of Public Health’s most recent lists of deaths by county shows that San Diego has indeed done the best in the south with 171 COVID-19 deaths per 100,000 residents compared to a statewide rate of 249 and 345 in Los Angeles County.

But, as researchers are fond of saying, correlation is not causation.

It would take a very deep study to prove which factors made San Diego’s COVID-19 death rate lower than it has been in other regions or, for that matter, higher than Northern California counties, which hewed even more closely to public health measures such as masking.

Locally, the end of the pandemic signals a change in testing and vaccination efforts. Several existing vaccination and testing locations are set to close this weekend, with the county planning to consolidate its efforts into its six main public health centers spread out across the region.

But Wooten said that another vaccination effort is soon to start. The immunization campaign, she said, will contract with the county to visit key locations in neighborhoods with lower-than-average access to health care services, such as churches in Southeast San Diego, to provide more direct availability to those who are less likely to have health insurance or money to get vaccinated at a local pharmacy.

“We know that there are people out there who don’t have access, and we want to bolster our capabilities where we know that the need exists beyond our public health centers,” Wooten said.

Medical technicians pack up equipment and belongings as they close down the COVID-19 vaccination clinic in Oceanside.

(Sandy Huffaker / For The San Diego Union-Tribune)

Currently, there are nearly 230 different locations listed in the immunization schedule through June with vaccination teams visiting locations that range from the express border crossing in Otay Mesa and the Northgate market in Chula Vista to Palomar and MiraCosta community college campuses in North County.

Given that no one knows if the world, nation or region will experience another sudden surge of coronavirus-related illness, it is critical that government agencies continue collecting the data that will provide as early a warning as possible.

Currently, laboratories are required to report positive results to county health departments and the state within 8 hours, and hospitals are required to report bed occupancy five days a week. In an email, the California Department of Public Health said that “the reporting frequency of these sources is not tied to the end of the California state of emergency.”

The amount of virus detected in wastewater is considered to be the most timely signal of coronavirus prevalence in individual communities. In San Diego County, SEARCH, an ad-hoc effort of several local research labs, releases new wastewater numbers every Friday.

Dr. Seema Shah, medical director of the county’s immunization and epidemiology services branch, said that the county has brokered a one-year contract worth about $360,000 per year with the SEARCH coalition to keep doing this critical work after the formal emergency ends.

She said information will continue to be updated once per week. Adding a second weekly update was considered, she said, but experts concluded that more frequent analysis of wastewater information could end up being counter productive. This data, she noted, can include a lot of noise because detecting the amount of viral genetic material in samples involves significant statistical sampling.

Medical technicians, including Ramtin Akefi, left, pack up equipment and belongings as they close down the COVID-19 vaccination clinic Friday at The Oceanside Living Well Clinic in Oceanside.

(Sandy Huffaker / For The San Diego Union-Tribune)

Looking at several days’ readings in a row from the previous week’s collections, then, provides a trend which is more valuable for decision making.

“We think it makes sense to look at wastewater week-to-week in a stable situation like the one we’re in right now,” Shah said.

But she added that no one should think the epidemiology department is checking in on the virus on a weekly basis. She, and others in her department, start every day looking at all new information that is reported to the county health department, she said.

“I wake up in the morning, and the first thing I do is look at everything,” she said. “That’s, you know, what a communicable disease unit does; we’re always looking for anomalous situations, is there a change like an unusual number of emergency department visits?”