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During the six months of living with restrictions brought on by the COVID-19 pandemic, Bay Area residents have endured a dizzying array of evolving regulations as the impact of the virus has peaked and subsided.

But for Dr. Chris Farnitano, health officer with Contra Costa Health Services (CCHS), one lesson has repeatedly been made clear.

“The virus hasn’t changed,” Farnitano said. “The only thing that’s changed is our behavior. So, let up on our behavior, the virus is just waiting there to come right back. If we change our behavior, we have to do it very slowly and cautiously.”

While the effects of a summer spike in COVID-19 cases is diminishing, between Memorial Day and Labor Day, Contra Costa County saw a rapid rise in infections, hospitalizations and deaths. The number of confirmed cases grew nearly 11 times during this time and the number of fatalities jumped from a total of 37 on Memorial Day to 201 on Labor Day, a 540% increase over 106 days.

There were 15 patients hospitalized on Memorial Day. That number peaked at 107 on Aug. 1 and has been falling steadily since then. As of the latest CCHS report, hospitalizations have fallen by more than half to 52 patients currently in county hospitals.

“On the good side, our numbers are trending down,” Farnitano said. “Our hospital numbers, our death numbers, our case numbers and our testing positivity numbers are all trending down. On the worrisome side, we’re seeing numbers rise in other parts of the country. We’re seeing outbreaks in colleges and universities among the students and spreading to the communities there.”

Transmission of the virus that resulted in this summer’s spike in cases is attributed, in part, to the number of holidays and related social gatherings like backyard barbecues, among other factors.

“I also think there was less adherence to masking, less promotion of masking, less buy-in of masking and less concern of the public because we were going in the right direction,” Farnitano explained. “We also didn’t have as much testing then to catch things. All of those things combined to see our numbers go up. With this virus, once our numbers go up, they start going up really quickly.”

As the summer wore on, messaging about the importance of wearing masks increased, and the compliance with the mask order broadened. As behavior started to change, the metrics measuring the spread of the SARS-CoV-2 virus eased. Additionally, testing turnaround times in the county and in the state were reduced, allowing quicker action to quarantine those patients who tested positive.

“Our test turnaround times within 24-48 hours allows effective isolation and quarantine, which allows us to stop the spread of the virus,” said Erica Pan, acting state health officer. “Laboratories around the state are reporting results within one to two days, with 69% reporting within one day and 90% within two days. This is a dramatic improvement in our turnaround times in the State of California.”

There is concern about how the impending flu season will impact the COVID-19 pandemic over the fall and winter. Flu symptoms closely match COVID-19 symptoms. The need to distinguish one illness from the other will increase the importance of testing. But, there is also evidence that measures taken to protect against the spread of COVID-19 may suppress the spread of the flu.

“There’s some encouraging signs from the Southern Hemisphere,” Farnitano said. “They’re just finishing up their flu season. So far the reports that we’re getting from places like South Africa, Australia and South America are that they’ve had a very, very mild flu season with a very low number of cases. That may be due to all the masking and social distancing. If that is the case, that’s encouraging for the Northern Hemisphere.”

Other news at the national level has caused some confusion about how SARS-CoV-2 virus is transmitted. The Centers for Disease Control and Prevention (CDC) has taken the position that it is transmitted via droplets that can only travel a few feet from an infected person. But CNN reported that the CDC quietly updated its guidelines to include language about the virus’ transmission through aerosols that are released by talking, breathing or singing and which are smaller, lighter, can travel farther and remain aloft longer than droplets. Masks and 6-foot social distancing can be less effective when dealing with an aerosol-based transmission. Several days after making the change, the CDC removed the language about aerosol transmission, stating that it had been posted erroneously.

“It is concerning that there’s doubt been sowed as to how much of the CDC’s recommendations are driven by pure science versus being influenced by political considerations,” Farnitano said. “In previous years, we’ve never questioned that. The CDC was our primary reliable source of well-respected, thoughtful, expert scientific recommendations. Now that source has been put into question.”

He added that there is general consensus that aerosols play a more limited role in COVID-19 transmission, but that the role of aerosols is not yet well understood. According to Farnitano, there is evidence that there is a correlation between the amount of virus ingested and the degree to which a patient gets sick, but that correlation also needs more study.