How will officials detect the next surge? By Rong-Gong Lin II and Luke Money

As the Omicron surge of the coronavirus continues to wane, Los Angeles County has been lifting COVID-19 mandates, including those on indoor masking and vaccine verification in certain settings.
But with those guardrails removed, how will health officials detect signs of potential surges?

The obvious tools — the tracking of new coronavirus cases and COVID-19 hospitalizations — are still in place. But there are seven other indicators that L.A. County plans to monitor as part of an early warning system, according to Public Health Director Barbara Ferrer.

The county needs to be prepared for worst-case scenarios that could warrant a return to universal masking or other mandates — such as if COVID-19 vaccines fail to provide robust protection against a new variant.

But Ferrer doesn’t anticipate a return to universal masking indoors anytime soon.

Areas of concern

According to the latest available data, L.A. County’s coronavirus status remains in good shape across all seven tracked metrics.

Variants: The goal is to have fewer than 5% of collected samples be new coronavirus variants of concern. There are currently no new variants of concern, as defined by the World Health Organization.

Emergency rooms: This metric measures the percentage of coronavirus-related emergency room visits over a week. The goal is fewer than 5%; the latest figure for L.A. County is 4.3%.

Low-income areas: The goal is to have fewer than 100 cases a week for every 100,000 residents in poor areas; the most recent rate for L.A. County is 51.

Nursing homes: The goal is to keep the number of weekly outbreaks at skilled nursing facilities at fewer than 11 a week; there were four in the most recent week.

K-12 schools: The aim is to keep the number of outbreaks at fewer than four a week; there were four in the most recent week.

Homeless shelters: Officials are seeking to keep the number of outbreaks in settings involving people experiencing homelessness to fewer than 11 a week; there were eight in the most recent week.

Workplaces: Authorities want to keep the number of outbreaks at work sites to fewer than 100 a week; there were 30 in the most recent week.

Mask rules

The only rubric that is causing health officials moderate concern is the number of new outbreaks in K-12 settings.

But that number has also been declining: There were four in the most recent week and seven the week before. The county says four to nine outbreaks a week represents a moderate level of concern, and 10 or more represents a high level of concern.

However, just because the risks at K-12 schools are lower now than earlier in the year doesn’t mean caution isn’t warranted.

L.A. County continues to strongly recommend the use of masks indoors for staff and students, even after state requirements were lifted Friday. L.A. County also is recommending weekly testing of unvaccinated people who attend or work at school sites.

If there are alerts in two or more areas that reach a moderate or high level of concern, “we’ll conduct an in-depth review of contributing factors and consider changes to community prevention strategies,” Ferrer said.
Aside from schools, Angelenos have been able to enjoy mask-free outings in indoor public settings for a week.

Ferrer said in a recent interview that the county’s decision to lift the mask mandate was not based on political pressure, though she acknowledged that there had been a loud group of people pushing for its end. Instead, she said, the decision was made in light of new guidelines established by the U.S. Centers for Disease Control and Prevention, which found on March 3 that L.A. County no longer was an area where universal mask use indoors was recommended.

Ferrer still strongly recommends the use of masks in indoor public settings, regardless of vaccination status, as do state health officials.

Although much attention has been paid to critics of the mask order, Ferrer noted that “a lot of people are still wearing their masks.” Those who are still wearing them are often not as vocal about mandates, she said, and she expects that they will “continue to wear their masks for some time to come and feel very comfortable wearing their masks.”

Case rates

Although L.A. County’s coronavirus community level is low — meaning the hospital system is not under severe strain — transmission rates are still considered substantial, at 73 cases a week for every 100,000 residents, according to The Times’ coronavirus tracker.

That “means there’s just a fair amount of virus still circulating,” Ferrer said at a briefing Thursday. To get to a moderate transmission level, the rate will need to dip below 50 cases a week for every 100,000 residents; for a low transmission level, it needs to be below 10.

At that point, officials might suggest that only those at high risk of severe illness from COVID-19 — or those who live with people at high risk — keep their masks on indoors. Ferrer said Thursday she would be looking closely to see whether case rates rise after the masking order at schools and child-care sites was lifted.

Response plan

L.A. County has prepared a five-step plan to respond quickly should signs emerge of an uptick in infections.

Outbreaks: Workplaces are required to report three or more coronavirus cases detected within a 14-day period, and officials will recommend measures employers can take to keep outbreaks under control.

Testing: The county aims to ensure access to free and accessible testing, especially in areas with high case rates.

Therapeutics: The county will ensure that there is a vast network of providers with anti-COVID drugs. Distribution of some of these drugs remains uneven countywide: It is low in communities that include South L.A., East L.A.; parts of the San Fernando, San Gabriel, Santa Clarita and Antelope valleys; and Malibu. Some areas are seeing higher levels of drug distribution, including the Hollywood Hills and the Palos Verdes Peninsula.

Vaccinations: The county aims to maintain a network of 300 mobile vaccination teams and 1,000 fixed vaccination sites. Officials also want to increase the number of health plans that provide vaccines to people who can’t leave home for health reasons.

Surveillance: The county will analyze 15% to 25% of collected coronavirus samples countywide and sequence them to identify variants. Officials will also expand wastewater testing to detect coronavirus infection trends.