Coronavirus Today: A pandemic’s public health lessons

Good evening. I’m Russ Mitchell, and it’s Tuesday, June 8. First, thanks to those of you who responded to our survey last week. If you missed it and want to share your feedback, you can do so here. Now, here’s what’s happening with the coronavirus in California and beyond.

Journalism is sometimes called the first draft of history. It’s far too early for deep, researched assessments of how Los Angeles County handled the coronavirus, but Times reporter Jaclyn Cosgrove gets things off to a running start with this well-researched, strongly written profile of Barbara Ferrer, the county’s public health director and one of California’s most aggressive public officials in pushing for lockdowns and business shutdowns.

Cosgrove, who covers county government for The Times, starts out by recounting some of the anger, hate and sometimes even death threats aimed at Ferrer over the past 14 months, from some business owners, churchgoers, protesters and politicians angry at lockdowns and mandates.

Public health leaders across the nation faced similar ire, in a divided nation whose culture throbs with love for individual freedom and support for free enterprise. Their pandemic responses have put these officials, who by definition are charged with serving the public as a whole, on the defensive, and nationwide, at least 190 have resigned, retired or been fired.

Ferrer, 65, has not, and even some of her critics credit her with stable leadership, as direction and information shifted dramatically from federal, state and local leaders. But she has been pilloried too — by some as too restrictive and hurting businesses, by others as too lax and putting people at risk.

Much of the criticism has been aimed at the perception — which Ferrer acknowledges was accurate — that the county didn’t do enough to protect people of color in poorer neighborhoods, where infection and death rates proved far higher than in largely white more prosperous cities and neighborhoods.

“When you have a responsibility and opportunity to help protect people’s health, and 24,000 people die, I think rightfully, I should feel bad,� Ferrer told Cosgrove. “I think it’s OK for me to feel bad about it — because it’s devastating.�

Ferrer had promised that the vaccine distribution would play out differently than testing, where the county had seen racial inequities — but by February, vaccine disparities were apparent.

Ferrer pivoted and moved to improve distribution when she realized how poorly the system served the disadvantaged, who may not have the internet access, the mobility or the time to book and show up for appointments. She began to work more closely with community leaders to bring tests and vaccines directly to those communities.

“The intentions were good all around, but this pandemic necessitated a response that our systems weren’t ready to give,� said Louise McCarthy, president and chief executive of the Community Clinic Assn. Of Los Angeles County.

Anger and questions remain in some quarters about whether the county could have handled matters better. And whether California leaders learn their lessons and improve their systems for future pandemics remains to be seen.

Ferrer’s agency made big strides in a short period of time, said Dr. Joai Crear-Perry, senior advisor the the equity-focused We Must Count Coalition. “We’re building relationships that we need to maintain for a long time. The trust-building is going to take awhile.�

Not just in L.A. County, but across the state and the nation.

By the numbers

California cases, deaths and vaccinations as of 7:38 p.m. Tuesday:

Track California’s coronavirus spread and vaccination efforts — including the latest numbers and how they break down — with our graphics.

Across California

As we Californians approach reopening day, June 15, the state’s color tier system becomes a bit less meaningful. The tier-based rules governing what can reopen, how and when will be subsumed into the mostly minimalist reopening guidelines. In fact, the color tier system goes away next week.

Still, the colors do indicate just how far the state has come from the dark days of COVID-19 winter. As more people become vaccinated, fewer people become infected, giving the state has a chance to reach herd immunity.

Five more counties, including San Diego, moved into the least restrictive yellow tier on Tuesday. The others are Alameda, Napa, San Luis Obispo and Santa Barbara counties. They join Los Angeles and Orange counties, already yellow. That means more than half of all California residents will live in yellow-tier counties.

Achieving yellow status required an adjusted daily rate of fewer than 2 new cases per 100,000 people, an overall rate of positive test results less than 2%, measured over two straight weeks.

Even at reopening, though, counties can opt to keep some restrictions in place, and businesses may face more specific rules, either self-adopted or imposed by state workplace safety regulators.

Gov. Gavin Newsom said he’ll retain his powers under California’s COVID-19 state of emergency order beyond June 15.

With all the hoopla around June 15, it’s important to remember that “reopening� does not mean “COVID’s over.� People are still getting sick and dying, if in dramatically reduced numbers. The more people get vaccinated, the safer everyone will be.

As more people get back to work, more people will be taking the train, and on Tuesday, a new vaccination site opened at Union Station. Located at the station’s East Portal and run by the Los Angeles Fire Department, the site will be open Monday through Saturday, 8 a.m. to 8 p.m. It’s one of five walkup centers offered by Metro. The others are in Hawthorne, Gardena, Rancho Dominguez and El Monte.

Also this week, Los Angeles County is dispatching 237 mobile vaccination sites — the most operating in a single week. The move parallels the city’s shift from mass immunization sites to mobile clinics operating at special events, in places with lots of traffic, in areas with low vaccine rates and vulnerable populations and with evening and weekend hours.

Another reminder not to let your guard down even as restrictions ease comes from Napa County, which recorded its first death of a fully vaccinated person from COVID-19.

The patient, who died June 2, was described as over 65 with underlying health conditions — factors that could have made her more vulnerable.

Coronavirus vaccines have proven tremendously effective, but the record is not perfect. In Napa, of 71,370 fully vaccinated residents, 32 have shown symptoms and tested positive for the coronavirus.

There are two primary factors behind such breakthrough infections, according to Dr. Edward Jones-Lopez at USC’s Keck School of Medicine: Most commonly, coronavirus variants evade vaccine immunity designed to protect against the original strain; less frequently, some people — such as the immunosuppressed and the elderly — cannot mount a strong enough immune response, and the vaccine doesn’t work for them as it should.

However, vaccines have shown to be largely effective against variants that have appeared thus far. Breakthrough infections are rare. And the few COVID-19 cases that do break through tend to be far less serious in vaccinated people than in those who’ve not received the vaccine.

“No vaccine is 100% effective,� said Napa County Public Health Officer Dr. Karen Relucio. But the vaccines, she said, “provide exceptional protection against death and illness.�

See the latest on California’s coronavirus closures and reopenings, and the metrics that inform them, with our tracker.

Around the nation and the world

Recent polls show President Biden continues to draw high marks in public opinion polls for his handling of COVID-10: A recent FiveThirtyEight analysis shows a pandemic-handling approval rating of 62.7 percent. But it looks like Biden won’t accomplish his mission of getting 70% of Americans at least partially vaccinated by July 4.

About 15.5 million unvaccinated adults would need to receive at least one dose before then for the goal to be met. But the pace of new vaccinations in the U.S. has dropped to below 400,000 people per day, down from nearly 2 million a day two months ago.

Many of the low-participation states are in the Midwest and the South. The White House is pressing governors to “pull out all the stops� on the vaccine campaign. But some resist the cheerleading.

Take Mississippi, which trails the nation in vaccination rates; only about 34% of the population has received at least one shot. Its vaccination rate in the state has dropped off so sharply that it would take the better part of a year for the state to reach the 70% target.

Gov. Tate Reeves, a Republican, has called Biden’s goal “arbitrary to say the least.� Reeves appeared on CNN Sunday and urged residents to get vaccinated, but he said the more important marker is the decline in cases: On Jan. 10, Mississippi reported a 7-day-average daily case rate of 2,432; on June 6, that number was 112.

The Biden administration has begun to downplay the goal, saying there will be little effect on the nation’s overall recovery even if it isn’t reached.

The U.S. State Department, meantime, has loosened travel warnings for dozens of nations, including Mexico, Canada, France, Germany and Spain. The new designations moved nearly 60 nations and territories from Level 4, or “do not travel,� to Level 3, or “reconsider travel.�

And Spain on Monday began welcoming vaccinated visitors from most countries, including the U.S., for the first time since the pandemic began.

Visitors must prove they were fully vaccinated at least 14 days before their trip. European tourists who offer proof they overcame COVID-19 sometime in the previous six months can get in without having been vaccinated. Spain for now will retain a ban on nonessential travelers from Brazil, India and South Africa, where virus variants remain a cause for concern.

Some people want to go to Spain. Others just want to see their kids. COVID-19 put tremendous strain on foster care systems meant to provide temporary shelter to children, and parents have been waiting to reconnect with them far longer than they’d imagined.

Thousands of families have found their reunification attempts snarled as courts delayed custody cases, went virtual or temporarily shut down. An Associated Press analysis of child welfare data in 34 states concluded there were 8,700 fewer reunifications in the early months of the pandemic than in the same period a year before, a 16% drop. Foster care adoptions fell 23%.

That means vulnerable families are suffering long-term and perhaps irreversible damage, which could leave parents with weakened bonds with their children, according to child welfare experts.

One child, identified as D.Y., a 13-year-old from Seattle, has been out of his mother’s custody since 2016 after an abuse report said she was physically disciplining her children. Living in a group home, he was able to get visits from his mother, and lawyers expected her to win back custody. But after the pandemic hit, staffing shortages and COVID-19 protocols meant that ended, and already-limited privileges were scaled back or revoked.

“I still want her to baby me,� D.Y. said. “I can tell she has high faith of when I’ll come home. I don’t know if it’s going to happen anymore.�

Your questions answered

Today’s question comes from readers who want to know: Do COVID-19 vaccines cause problems with pregnancy?

No. There’s new evidence that both mRNA vaccines currently authorized for use in the U.S. — those from Moderna and from Pfizer-BioNTech — are completely safe and effective for pregnant women, the National Institutes of Health says.

One recent NIH-supported study found that not only was the vaccine well tolerated by pregnant and breastfeeding women, it also produced antibodies against the coronavirus that neutralized variants of concern. Those antibodies were also found in infant cord blood and breast milk, suggesting that they were passed on to give some protection to babies.

Another study explored possible safety concerns for pregnant women by looking for any negative effects of vaccination on the placenta, the vital organ that sustains the fetus. That research found no signs that the shots led to unexpected placenta damage, and it too found that vaccinated pregnant women produced needed levels of antibodies.

That’s a welcome update to the dispatch my colleague Karen Kaplan brought you in January, which we detailed in response to a reader question in this newsletter. At the time, there were no hard data on the subject, so the Centers for Disease Control and Prevention and the American College of Obstetricians and Gynecologists both struck a neutral tone.

It’s also a welcome antidote to a completely false rumor making the rounds on social media that has scared a lot of pregnant women.

The misinformation began circulating with false claims that amino acid sequences on the spiky crowns that protrude from the coronavirus, helping it invade human cells, are similar to the genetic code of the placenta protein. A petition in the United Kingdom that sought to stop COVID-19 vaccine trials wrongly suggested that because of chemical similarities, the vaccine would attack a pregnant woman’s placenta and cause a miscarriage.

That’s not true, scientists say. “It’s inaccurate to say that COVID-19’s spike protein and this placenta protein share a similar genetic code,� says Dr. D’Angela Pitts, a maternal fetal medicine specialist with Henry Ford Health System. “The proteins are not similar enough to cause placenta to not attach to an embryo.�

“The protein on the virus, and the protein on the placenta, are both spike proteins,� said Ferrer, the L.A. County public health director. But they “are different spike proteins, and your antibodies can and do tell the difference,� she said.

There is no evidence that COVID-19 vaccines affect fertility or pregnancy.

We want to hear from you. Email us your coronavirus questions, and we’ll do our best to answer them. Wondering if your question’s already been answered? Check out our archive here.