November 23, 2020
Eden Health District COVID-19 Bulletin
“If you look at actual numbers of cases, those communities (of color) still have more, and they have had a disproportionate burden of Covid cases throughout this pandemic. But we are seeing rates increase in other more suburban communities and white communities. The rates are catching up, even if the absolute numbers are not. The curves are getting closer together.”
Ori Tzvieli, deputy health officer for Contra Costa County, 11/22/20

“There’s really just this sense of foreboding. We know what we might see in two weeks, and we know we’re running out of beds right now.”
Dr. Kelly Cawcutt, an infectious diseases and critical care physician at the University of Nebraska Medical Center, 11/23/20
Each year the Community Outreach Thanksgiving Dinner would typically host a Thanksgiving Day meal at St. Raymond's in Dublin, but like so many, the group was forced to cancel its beloved tradition due to the pandemic.

"It's disappointing because so many people are already homebound but (canceling) is for everyone's safety. We are giving it our all and hoping that by next year we are back to our normal routines," said dinner co-chair Janet Songie.

In response to the cancellation, Songie's group has focused its efforts on promoting other nonprofit organizations throughout the region that are providing food services.
One of those recipients, Valley Bible Church, also traditionally holds a meal event around Thanksgiving for residents, which it has canceled in 2020 due to the pandemic; however, church officials have adapted by donating Thanksgiving food baskets to residents.

"We're teaming up with Valley Community Church, and they are collecting the food and packing it out for me," said Kim Chew, director of the food pantry at Valley Bible Church. "I think everybody is missing out on their community, but our prayer is that the time that people are spending with their immediate family will be sweeter."
By the Numbers
Alameda County: 27,485*

Contra Costa County: 22,7478

Bay Area: 139,374

California: 1,110,745

U.S.: 12,314,229
Alameda County: 499*

Contra Costa County: 257

Bay Area: 1,926

California: 18,726

U.S.: 257,095
* Data as of 11/20/20 for Alameda County. Sunday and Monday data has not yet uploaded.
Bay Area News
Expanded Covid-19 Testing in Cherryland
Starting today, a free community testing center operated by La Familia at the Eden United Church of Christ, 21455 Birch Street, Hayward, will commence services. The center is open on Mondays, Tuesdays and Thursdays from 1 p.m. to 6 p.m. La Familia is also expanding the hours of testing at its Cherryland testing center located at 20095 Mission Boulevard in Hayward. Testing will be provided from 9 a.m to 3:00 p.m. Monday through Friday. The center welcomes walk-in visits. Both centers will be closed for Thanksgiving. Further information can be found on Alameda County's Covid-19 testing webpage.

“As we continue to see Covid-19 case counts rise in Alameda County, providing more testing is an essential part of mitigating the current surge in cases. La Familia are happy to be serving the unincorporated area of Alameda County in Cherryland and the Eden Area," stated La Familia CEO Aaron Ortiz.

Carolynn Langsdale, Psy.D. and Chief Program Officer for La Familia, added, “We are grateful for the continued support of our community, partners, and staff as we increase our testing capacity and specifically in the Cherryland and Eden Area, especially because we know that our Latinx community members are among the most affected by Covid-19. This expansion should help more individuals feel as confident as they can about their own health status during uncertain times. As always, we are honored to be here for our community.”

SF Chronicle, November 22, 2020
For the first time since the pandemic hit in full force, coronavirus cases among Latino residents — who for many months have borne the brunt of Covid-19 — are decreasing, while cases among white residents are increasing in parts of the Bay Area. The trend is emerging weeks after counties began easing restrictions in many places, including reopening indoor dining and increasing capacity at gyms and places of worship. That prompted many residents to let their guard down and expand their social bubbles, county health officials said.

The shift began in at least two Bay Area counties after mid-October, suggesting the third wave of the pandemic could look very different from the previous two, when Black and brown communities were hit with the vast majority of coronavirus cases. And it indicates the virus is more widespread throughout the community, not just concentrated in certain pockets.

Health officers attribute much of this demographic shift to more indoor activities, including dining, which counties have gradually allowed, with more capacity, in recent weeks. During the early months of the pandemic, those out in the community were mostly essential workers, who had little choice. Now, more people are choosing to partake in voluntary indoor activities. And indoor gatherings are increasingly found to be the source of infection by contact tracers.

Mercury News, November 21, 2020
Santa Clara County on Friday recorded its highest daily case total since the start of the pandemic. And if the county’s explosive rise in COVID-19 hospitalizations continues on its current trajectory, Santa Clara County will exceed its hospital capacity in just three weeks, health officer Dr. Sara Cody said Friday.

“We are indeed at a critical juncture in this pandemic and the choices that each of us makes may mean the difference between having enough hospital capacity to care for all of us and our family and friends and not enough,” Cody said during a news briefing Friday. The county recorded 407 new cases on Friday, the highest number seen in a single day since March, according to Cody. Meanwhile, the number of patients hospitalized in Santa Clara County rose from 110 to 166 — or more than 50% — in the past week alone, according to county data.

County Covid-19 Dashboard, November 22, 2020
As of November 21, 2020, 132 patients with confirmed or suspected cases of Covid-19 are hospitalized in Alameda County, including 25 patients in ICU. The low point of hospitalizations in the county since the Summer occurred on October 16, 2020. On that date, 95 patients were hospitalized with confirmed or suspected Covid-19 in the county. The peak number was on July 23, 2020, when 283 confirmed and suspected Covid-19 patients were hospitalized in the county.

SF Chronicle, November 22, 2020
The coronavirus has raced through Golden Gate Fields in the past week, infecting more than 200 people despite a shutdown of all racing at the Bay Area’s only horse track. Berkeley health and Golden Gate Fields officials announced Friday night that all employees who live or work at the track have been tested and that the screenings will continue.
Health News
STAT, November 23, 2020
AstraZeneca said Monday that its coronavirus vaccine reduced the risk of symptomatic Covid-19 by an average of 70.4%, according to an interim analysis of large Phase 3 trials conducted in the United Kingdom and Brazil. The results, while positive, suggest the vaccine may be less effective than two others. Earlier this month, Moderna and the Pfizer and BioNTech consortium announced their messenger RNA, or mRNA, vaccines showed 95% efficacy against Covid-19 infections in their respective clinical trials.

Still, researchers at the University of Oxford, which partnered with AstraZeneca to develop the vaccine, hailed the latest data as promising. The vaccine can be stored at normal refrigeration temperatures for up to six months, which will make it easier to deploy in more settings than the vaccines from Pfizer and Moderna, which must be stored at ultra-low temperatures. AstraZeneca said it is on track to be able to produce 3 billion doses of its vaccine in 2021.

STAT, November 23, 2020
Patients hospitalized with Covid-19 are surviving at higher rates than in the early days of the pandemic, gains that data and interviews with experts suggest are driven by a more refined understanding of the disease and how to treat it — and, crucially, less strain on hospitals that had been inundated at times. Other factors have contributed to the improved outcomes: Steroids that help save some lives are being used more widely, and people infected after the initial surge were, as a whole, younger and arrived at the hospital earlier in the course of the disease.

An analysis prepared for STAT by the independent nonprofit FAIR Health found that the mortality rate of select hospitalized Covid-19 patients in the U.S. dropped from 11.4% in March to below 5% in June, a threshold the rate has stayed below since. In September, the most recent month available, the mortality rate was 3.7%, according to FAIR Health’s data.

But clinicians warn that this progress won’t withstand what happens when crushes of patients again overwhelm hospitals, as is now occurring in dozens of U.S. states. Hospitals in the Midwest, Mountain West, and elsewhere are straining under a crush of patients, with others fearing what’s headed their way. Some have stopped accepting transfers, while others are trying to offload patients to other states. They’re converting other wards into new ICUs. They’re asking retired staff if they’re available. The surge is so widespread that doctors and nurses can’t go to help out in other areas like they did in New York in the spring.

As important a metric as death is, it is just one measure of Covid-19 outcomes. Even if more people survive their infections, their ordeals don’t always end there. Some “long-haulers” — even those who had mild cases and weren’t hospitalized — have for months had lingering symptoms, including fatigue, forgetfulness, and heart inflammation. Patients who do wind up in the ICU can have lasting physical and mental health issues.

NPR, November 22, 2020
One of the experimental drugs that President Trump received while he was battling the coronavirus has been approved for emergency use by the FDA. The drug, made by the biotech company Regeneron, is the second antibody treatment to win emergency use approval. In a clinical trial of about 800 people, the combination was shown to significantly reduce virus levels within days of treatment.

In its authorization, the FDA made clear that the drug is only for the treatment of mild to moderate COVID-19 in people 12 years and older who are at high risk of developing more severe symptoms. It's not for patients hospitalized because of Covid-19.

CNN, November 20, 2020
Most coronavirus infections are spread by people who have no symptoms, the CDC said in newly updated guidance. It's one of the main reasons mask use is so important, the CDC said. "Most SARS-CoV-2 infections are spread by people without symptoms," the agency said in a section of its website devoted to explaining the science of how to use masks to control the spread of the virus. "CDC and others estimate that more than 50% of all infections are transmitted from people who are not exhibiting symptoms," it added in the guidance posted Friday.
Morbidity and Mortality Weekly Report, November 20, 2020
On July 3, 2020, the Governor of Kansas issued a mask-wearing order, but gave counties the right to opt in or out. By August 23, 2020, the incidence of Covid-19 incidence had decreased by 6% in counties that mandated mask usage and increased by 100% among the counties without a mask mandate.
Physician Voices

Twitter, November 22, 2020
Daily reports tell us what happened last week, 2 weeks ago, 4 weeks ago.

This is why folks are worried about what's next.

Today's 7 day moving [averages]: 167K cases, 3,600 new hospitalizations, 1,460 deaths.

What does this tell us about upcoming weeks? It says we have a problem.

  • Today's 167K cases? Infections happened last week.
  • Today's 3,600 new hospitalizations? Infections happened about 12-15 days ago.
  • Today's 1,460 deaths? Infections happened about 3+ weeks ago.

And that's why we have a problem. About 3.5% of identified cases get hospitalized. CFR [Case Fatality Rate] right now about 1.7%.

So today's new cases will cause: 5,000 new hospitalizations in 10 days; 2,900 new deaths in 3 weeks.

  • Today's hospitalizations were cases 10 days ago
  • Today's deaths were cases 3 weeks ago

So, best guess by 12/1/2020? We'll have 120K hospitalized patients. 50% more than today.

This will strain capacity for hospital care in majority of states well beyond capacity. And it won't be lack of ICU beds, ventilators. Nope. We'll struggle with enough doctors, nurses. All based on infections we have already. But we'll add more infections in weeks ahead. Thus I think we'll be beyond capacity in majority of states in next 2-3 weeks.

And remember hospitals aren't just for COVID care. Others need it too. Overwhelmed hospitals bad for everyone. And also built in are deaths from COVID in next 3 weeks. I suspect about 40K or more. We'll easily be near 300K deaths by Christmas.

Obviously, things can alter this grim scenario. Michigan-style policies to slow spread. Won't help with infections we have but can prevent more.

But what can help folks already infected? Ideally widespread availability of Monoclonal [Antibodies]. Scarce supply is the challenge. Can be helpful for high risk folks.

So [that] should be our strategy:
  • Targeted restrictions
  • Push for more therapy
  • Hope for fast vaccine rollout
You know that moment when all the water pulls back from the beach until it’s completely & eerily empty right before a huge tsunami hits? That was how it felt leaving the hospital today. Nearly every patient I took care of was Covid-19 positive, up until the end of my shift.

All kinds of stories here — stories that I’ve heard before; stories from April when we had our last surge. People infecting their parents, roommates infecting each other; nursing home/group home patients infecting each other.

We tried to warn everyone to not travel unless it was an emergency & absolutely needed, not because we don’t want you to see your loved ones, but because we don’t want you to have to see them in a hospital bed as we see them. I am genuinely worried about what is coming next.

We can still avoid some part of this. Anything we do any decision we make; we have to believe it matters. If thousands of us begin thinking this way, & avoid unnecessary gatherings this coming week, we will prevent thousands of cases.

We have to believe in that.

Many of my colleagues are making *immense* sacrifices. I had offered one of them to see his Covid-19 patients for him as he has a family to go home to whereas I live alone. He thanked me, and he moved forward himself to care for his own patients.

This is the heart of medicine.

I’ll be frank — we appreciate your support, but we aren’t here to be admired or to get credit — we signed up for this. This was our choice. We are here literally pleading with you to think and rethink your plans this holiday. Please.
That is all we ask. Thank you!
US and California Data: Last 90 Days
Covid Tracking Project, 11/22/20 (bold lines are 7-day averages)
United States
California News
LA Times, November 22, 2020
California’s average daily number of new coronavirus cases has tripled in the last month, a Times analysis has found, as pandemic conditions deteriorated dramatically around the state.

The coronavirus is now infecting more Californians daily than at any previous point in the Covid-19 pandemic, raising concerns about a new peak in coronavirus-related deaths by Christmas. As of Saturday night, California was averaging more than 11,500 new coronavirus cases a day over the last seven days, more than triple the number a month earlier, on Oct. 21, which was nearly 3,200, according to a Times analysis.

NY Times, November 23, 2020
Last month, Gov. Newsom created an 11-member Scientific Safety Review Workgroup, made up of esteemed scientists from around the state, tasked with independently reviewing vaccines for safety. Officials are also working with the CDC to begin planning vaccine distribution in advance, working out the logistics of how they will supply vaccines to some 40 million residents.

Health officials have warned that the vaccines will be in extremely limited supply at first. By the end of this year, Mr. Newsom expects the number of available vaccines to be no more than two million for the whole state. According to California health officials, who published a working draft of their vaccine distribution plan, the vaccine will be rolled out in three phases. The first phase, when supply is the most limited, will be to inoculate health care workers working directly with patients with Covid-19, followed by people at risk for severe complications from the virus and other essential workers.

LA Times, November 22, 2020
A new surge of Covid-19 is battering Southern California, bearing down on exhausted healthcare workers, raising anxiety levels on hospital wards and stoking fears that there might not be enough staff and supplies for the difficult weeks ahead. The coming holidays only make the situation more dire.

The recent rise in Covid-19 patients in the middle of the country has sapped the nation’s reserves of nurses and doctors, as well as masks, gloves and other protective equipment. Good news about vaccines offers hope for the future, but it’s the present that worries those who care for California’s sickest patients.

Sacramento Bee, November 22, 2020
Gov. Newsom is quarantining for 2 weeks after 3 of his children were exposed to a California Highway Patrol officer with Covid-19, Newsom’s office announced Sunday night.

His office says he will continue to act as governor while he quarantines.
He and his wife, Jennifer Siebel Newsom, learned late Friday evening that three of their four children were exposed. Although the parents did not have direct contact with the officer, the whole family is now quarantining. All of them tested negative Sunday and will continue to be tested regularly, according to Newsom’s office.

LA Times, November 22, 2020
In a devastating blow to Los Angeles’ struggling restaurant and hospitality industry, L.A. County public health officials on Sunday announced they will suspend outdoor dining at restaurants amid a surge of new coronavirus cases.

The new rule takes effect at 10 p.m. Wednesday and restricts restaurants — along with breweries, wineries and bars — to takeout and delivery only for the first time since May. It will remain in place for at least three weeks, officials said. Wineries and breweries can continue retail operations.

LA Times, November 22, 2020
A couple hundred protesters, many donning bright red caps and waving American flags, gathered Saturday night at Huntington Beach Pier in defiance of the state’s coronavirus curfew that went into effect at 10 p.m.
Protesters have also gathered in Los Angeles County, where the average daily case count over the last four days has been 4,442.

Sacramento Bee, November 23, 2020
Reported gun assaults have jumped sharply in the city of Sacramento, part of a state and nationwide increase during the Covid-19 pandemic.
From March 20 through November 6, Sacramento police took reports of 157 assaults with a firearm, up by 63, or 67%, from the same period in 2019, city data show.

Those figures do not include homicides, which are also up in the city of Sacramento. Police responded to 32 homicides from January through September, up from 25 homicides during the same period in 2019. Murders and aggravated assaults increased in large cities statewide and across the nation from 2019 to 2020, FBI data show.

In Sacramento, police officials said increased gang activity is partially to blame for the increase in gun crimes. Two law enforcement officials told The Sacramento Bee this summer that incidents had risen after stay-at-home orders triggered by the coronavirus pandemic were eased.
US News
CNN, November 23, 2020
From surging case numbers to record hospitalizations, the US is grappling with what experts long warned could be the biggest spike in the Covid-19 pandemic — and it still has to get through the Thanksgiving holiday.
Historically, the week of Thanksgiving is one of the busiest for travel. But with the US reporting its 20th day in a row of more than 100,000 new cases Sunday, the CDC advised against traveling for the holiday this year to decrease risk of spreading infections.

As new cases spike, hospitalization rates have followed. At least 83,870 Covid-19 patients were hospitalized Sunday -- the 13th straight day the US has broken its hospitalization record, according to the Covid Tracking Project.

CNN, November 23, 2020
US Surgeon General Dr. Jerome Adams warned Monday that all Americans -- even at the White House -- should follow CDC guidelines and avoid gatherings during what he called a "dire point" in the pandemic. Invitations for White House holiday parties have started to arrive on Capitol Hill and to Republican donors, two people who have received them said. The sources said the invitations seemed like any other year, with no mention of coronavirus precautions. The parties are yet another example of those in the White House shirking the administration's own best practices, which has led to multiple outbreaks over the past few months and concerns it could happen again.

NY Times, November 23, 2020
Since the spring, American medical device makers have radically ramped up the country’s ventilator capacity by producing more than 200,000 critical care ventilators, with 155,000 of them going to the Strategic National Stockpile. At the same time, doctors have figured out other ways to deliver oxygen to some patients struggling to breathe — including using inexpensive sleep apnea machines or simple nasal cannulas that force air into the lungs through plastic tubes.

But with new cases approaching 200,000 per day and a flood of patients straining hospitals across the country, public health experts warn that the ample supply of available ventilators may not be enough to save many critically ill patients. Ventilators are exceptionally complex machines that require expertise and constant monitoring for the weeks or even months that patients are tethered to them. The explosion of cases in rural parts of Idaho, Ohio, South Dakota and other states has prompted local hospitals that lack such experts on staff to send patients to cities and regional medical centers, but those intensive care beds are quickly filling up.

NPR, November 22, 2020
Across the country, public officials are urging people to stay home and stay safe during the upcoming Thanksgiving holiday amid a dramatic rise in new cases of Covid-19 in nearly every state. Experts warn that the holiday week will be a crucial time for fighting the virus, and that even limited family gatherings could result in devastatingly high numbers of newly infected people.
Healthcare workers work together to reposition an intubated COVID-19 patient, who is on maximum ventilator settings and medicine, to the supine position to give them a break from being in the prone position in the ICU at Regions Hospital in St. Paul, MN.
Star Tribune, November 22, 2020
Open ICU beds were down to single digits in some parts of Minnesota last week, when Gov. Tim Walz ordered a four-week shutdown of bars, restaurants and entertainment and fitness establishments in hopes of slowing the virus’ spread to alleviate pressure on hospitals. “There’s no beds anywhere,” said Dr. Matthew Klee, whose ICU at Mercy is full and under pressure to take patients throughout Minnesota and western Wisconsin. “It’s become like a game of chess over the entire state.”

The Guardian, November 23, 2020
South Dakota has an alarming positivity rate of almost 60% – nearly 6 out of 10 people who take a Covid test are infected – second only in the US to neighboring Wyoming. More than 66,000 South Dakotans have contracted the disease and at least 644 have died, a number likely to rise as hospitals reach breaking point.
The South Dakota Medical Association has issued a statement in support of a statewide mask mandate.

Washington Post, November 23, 2020
Fifteen family members who contracted the coronavirus after a small indoor birthday celebration earlier this month where no one wore masks. Weeks later, in an emotional video shared by the city of Arlington, the family is begging others to avoid gathering with anyone outside their immediate household. Although health officials keep tracking superspreader events at large gatherings like weddings, smaller get-togethers like the indoor lunch have driven the latest spike of coronavirus cases.
CA Education News
Mercury news, November 23, 2020
With the virus now spreading so alarmingly that officials are telling people not to gather for Thanksgiving and shutting down classrooms again in places like New York City, reopened schools across the Golden State will be put to the test like never before.
Can they remain safe? The answer likely will determine how millions of K-12 students will be educated through the rest of the pandemic.

Despite growing restrictions to slow the startling wave of new Covid-19 cases, some of the country’s most vigilant public health officials aren’t ready to give up on keeping classrooms open. Santa Clara County Health Officer Dr. Sara Cody said that “as our cases are rising — and they are rising sharply — we’ll get more reports from schools.”

But Cody sees cases coming into schools from the community, not spreading there. And Cody, who led the Bay Area in the nation’s first lockdown and drew criticism for her slow business reopening pace, is so confident in class safety protocols that she said she’ll continue to approve elementary school reopening waivers.

Sacramento Bee, November 22, 2020
Sacramento State will further reduce the number of people on campus for the rest of the fall 2020 semester due to a rise in Covid-19 cases in the capital region.

University President Robert S. Nelsen announced Friday that many classes that have been held face-to-face this semester would switch to online, effective Monday. The cancellation of in-person instruction will exclude internships and student teaching assignments. Students living in dorms will be given the choice to stay or to leave the residence halls and receive a refund. All faculty and staff who are able to are being asked to work from home and avoid visiting the campus.

EdSource, November 23, 2020
Family life has been disrupted in innumerable ways during the Covid pandemic. Among them is the nature of our relationship to screens. After years of being warned by child development experts that limiting screen time is one of the keys to raising healthy, well-adjusted children in the digital age, parents are now being forced to ride herd on children for long days of Zoom school and online homework.

The strain of remote learning has exacerbated parental worries over a core question: How much screen time is too much for small children? Experts say too much screen time may have alarming effects on developing brains. A landmark National Institutes of Health study of 10,000 children that began in 2018 found that those who spent more than two hours a day using screens scored lower on language and thinking tests.
US Education News
USA Today, November 23, 2020
The dominos are beginning to fall at America's schools. After weeks or months of operating in person, schools are shifting students back to remote learning as the nation grapples with soaring Covid-19 infections. Starting Monday, millions more students will be connected to their teachers only by whatever internet or phone connection they can secure.

In many cases, schools are closing because too many teachers are quarantined or infected with Covid-19. Others are responding to high rates of virus transmission in their communities. Kentucky's governor announced a statewide closure of schools to take effect Monday, a move that followed Michigan closing all high school classrooms and New York City schools – the largest district in the country – moving back to all-remote learning. Already, just over 40% of schoolchildren are attending only virtual classes, a figure that's risen from 36.9% Sunday, according to Burbio, a company that aggregates school calendars. 

Boston Globe, November 22, 2020
Thousands of students nationwide are traveling hundreds of miles and leaning on their in-the-know private tutors and guidance counselors to get them a seat for entrance exams that many colleges have said will not be required during this pandemic.

Meanwhile, for high school seniors with less financial means, the SATs and ACTs have never been further out of reach. Their school districts, hard-hit by the coronavirus, have been closed for longer and many were forced at the last minute to cancel fall test dates due to a community resurgence in Covid-19 cases. As with much of life, the pandemic has swelled the disparities in standardized testing, with the winners hoping to use their test scores to land seats at top schools and earn big-dollar scholarships.

USA Today, November 21, 2020
It's a hard time to be in college. It's never easy, of course, as a major life transition into a new social setting on top of the actual school work.
But this year is proving to be especially difficult, with a pandemic and multiple hurricanes impacting classes, student activities, people's jobs and their health.

"So during January everything was fine; I really enjoyed going to school," said Jordyn Ratliff, 19, a sophomore chemistry major at the University of Louisiana at Lafayette. "March came around and everything crumbled so quickly." Most of Ratliff's classes are in math and science, which have not translated well to online learning. Plus, there's the lack of socialization.

"It's hard to stay motivated," she said. "I'm just sitting on a computer screen all day. It's become a lot harder to cope with all the stress I've been feeling."
Giving praise — and a reprimand
A Baltimore woman recovering from the coronavirus expressed her gratitude to the doctors and nurses who she said saved her life. Sharon Jones said she is still very weak physically and emotionally, but she is getting stronger every day. She started to feel ill just before the end of October.

"I was feeling weak and I started coughing," Jones said. Because she suffers from COPD, her doctor told her to get a coronavirus test, and it came back positive.

Her symptoms got much worse.

"All I know is, two days later, I wasn't breathing and ended up at St. Agnes Hospital," Jones said.

She said her oxygen levels were extremely low. She got care from medical staff, including infectious disease doctors, who put her on experimental drugs, plasma and steroids. "People need to know how well they are taking care of these Covid patients," Jones said.

A week later, her breathing was improving and the hospital needed the bed, so Jones was transferred to the field hospital at the Baltimore Convention Center, where she continued to get around-the-clock care.
She described medical staff at the convention center as nice, caring, nurturing and exhausted. "But I didn't ever hear any complaints. They kept moving, moving, moving. They always came in with a smile, (asking,) 'How are you feeling? What can we do for you?' They were very good. They need to be commended," Jones said.

Jones hopes go home this week, having been transferred to a hotel that was converted to a temporary care facility for coronavirus patients.

Jones gives a reprimand to people who aren't taking the recent spike in coronavirus cases seriously, saying: "I need people to put their masks on and their shields on because this is not good at all. If you don't want to protect yourself, protect somebody else."

Source: WBAL-TV
International News
Associated Press, November 23, 2020
British Prime Minister Boris Johnson says shops, hairdressers, beauty salons and gyms in England will reopen and some fans will be allowed back into sports stadiums when a four-week lockdown comes to an end next week.

Johnson confirmed to lawmakers Monday the government will lift the stay-at-home instruction on Dec. 2 that were introduced early this month to curb a new surge in coronavirus cases. Shops, gyms, personal care businesses and leisure facilities will be allowed to reopen, and collective worship, weddings and outdoor sports can resume.

The lockdown will be replaced with regional measures involving three tiers of restrictions based on the scale of the outbreak in different areas. The measures have been toughened slightly from a similar system that was in place last month because government scientific advisers say those measures were not enough to stop the virus spreading.

Reuters, November 23, 2020
Catalonia was the first Spanish region to fully close bars and restaurants amid the second Covid-19 wave in mid-October, and is the first to put them back to work as the contagion ebbed.
A nighttime curfew remains in place, and tough restrictions continue in the rest of the country as well as most of Europe. The region also reopened theatres, cinemas, musical halls and outdoor sports facilities with a 50% maximum occupancy.

But after the dismay caused by the second shutdown of the sector this year, proprietors showed little optimism, especially since they still have to close by 9.30 p.m. “It is a very slow process ... If there is no tourism our sales fall by half,” she said.

Reuters, November 23, 2020
New Zealand Prime Minister Jacinda Ardern said on Monday she offered President-elect Joe Biden assistance with tackling the rampant outbreak of Covid-19 in the United States. During the first talks between the two since Biden was elected as the next U.S. president, Ardern said she offered access to New Zealand’s most senior health officials. “I offered to him and his team access to New Zealand health officials in order to share their experience on things we’ve learnt on our Covid-19 journey,” Ardern told reporters in Wellington.

New Zealand is widely heralded as one of most successful countries in suppressing Covid-19. It has recorded just over 2,000 cases and 25 deaths, a feat achieved through strict lockdowns.

Associated Press, November 23, 2020
Chinese authorities are testing millions of people, imposing lockdowns and shutting down schools after multiple locally transmitted coronavirus cases were discovered in three cities across the country last week.

As temperatures drop, wide scale measures are being enacted in Tianjin, Shanghai and Manzhouli, even though the number of new cases remains low compared to the United States and other countries that are seeing new waves of infections. Experts and government officials have warned that the chance of the virus spreading will be greater in cold weather. Recent flareups have shown that there is still a risk of the virus returning, despite being largely controlled within China.

Wall Street Journal, November 23, 2020
The pandemic-fueled shift to online buying has exacted a human toll on the world’s delivery workers. Orders have surged 50% in Europe, 70% in Asia-Pacific and 120% in North America year-over-year, according to a July report from the Organization for Economic Cooperation and Development.

Delivery workers are particularly vulnerable in South Korea, where they are classified as independent contractors rather than full-time employees, meaning they lack guaranteed break time, caps on work hours or compensation if injured on the job.
NY Times, November 23, 2020
  • Dr. Lindsay Marr: "We will still roast a turkey, make cornbread stuffing and bake a pumpkin pie — and then eat too much of everything. But it may not be on Thanksgiving Day. Instead, we’ll aim for the warmest day that week and invite Grandma, who lives nearby, to share the meal outdoors under our newly purchased patio heaters."
  • Dr. Marc Lipsitch: "We are having Thanksgiving as a foursome (nuclear family) this year. We are staying in touch by phone/videochat and the like and thinking about possible smaller visits at less crowded times, but still uncertain."
  • Dr. Natalie Dean: "On at least one sunny afternoon while in Georgia, we will drive to great-grandma’s house for a socially distanced outdoor playdate. Great-grandma will sit on the porch in her rocking chair while the kids play in the yard."
  • Dr. Michael Osterholm: "I plan to spend the day with my partner. Just the two of us celebrating all we have to be thankful for in our lives. We will do virtual celebrations with our kids and grandkids."

Shannon McMahon, Washington Post, November 23, 2020
The Transportation Security Administration (TSA) recorded its highest number of weekend passengers since the pandemic began in March, with over 3 million people traveling in the past three days. The surge comes despite CDC guidance advising against Thanksgiving travel because of mounting Covid-19 cases across the nation.

Sunday was the busiest travel day since the beginning of the pandemic in March, according to TSA spokesman Daniel Velez, with 1,047,934 passengers. TSA screenings surpassed a now-rare amount of 1 million screenings on both Friday and Sunday; Friday was a slightly lower travel day with 1,019,836 travelers screened. On Saturday, TSA saw 984,369 travelers.

The new peak comes as U.S. coronavirus cases have also hit a new high, and just in time for Thanksgiving week — which typically brings the busiest travel day of the year on Wednesday.

Julie Rovner, Kaiser Health News, November 23, 2020
What can Biden do between now and Jan. 20? Some public health advocates suggest he could set up a shadow Covid effort, to compete with the Trump administration’s task force. “He could do briefings three times a week telling us what we know and what we don’t,” said Dr. Arthur Kellermann, a longtime public health expert who is now CEO of the Virginia Commonwealth University Health System.

Without better information for the public, Kellermann said, “we could lose tens of thousands of people between now and” Inauguration Day. But others worry that Biden needs to be careful not to appear to have more power than he does, lest he end up with the blame if things don’t go well, particularly on the complicated issue of getting a vaccine distributed and accepted by the general public.

Farhad Manjoo, NY Times, November 23, 2020
I decided to investigate my own potential lethality to the older people in my life. Among other things, I contact-traced myself — an exercise that ended up being nearly as vulgar as it sounds. I went to all of my regular close contacts, then I went to all of their contacts, and so on, asking everyone about their potential exposure to the virus. What I found floored me. Once I had counted everyone, I realized that visiting my parents for Thanksgiving would be like asking them to sit down to dinner with more than 100 people.

NY Times, November 18, 2020
Coronavirus cases are rising in almost every U.S. state. But the surge is worst now in places where leaders neglected to keep up forceful virus containment efforts or failed to implement basic measures like mask mandates in the first place, according to a New York Times analysis of data from the University of Oxford.
East Bay Focus
Alameda County
Widespread (Purple)
  • 7.0 Adjusted case rate of new Covid-19 cases per day per 100,000 residents
  • 2.5% Positivity rate
  • 2.8% Health equity metric
Contra Costa County
Widespread (Purple)
  • 10.0 Adjusted case rate of new Covid-19 cases per day per 100,000 residents
  • 3.7% Positivity rate
  • 4.1% Healthy equity metric
by day as of 11/22/20
by day as of 11/22/20
Over the last seven days, Alameda County officials have reported 1,613 new coronavirus cases, which amounts to 98 cases per 100,000 residents.
Over the last seven days, Contra Costa County officials have reported 1,232 new coronavirus cases, which amounts to 109 cases per 100,000 residents.
Top 10 Locations of Cases in Alameda County, as of 11/20/20. Alameda County does not publish cases per 100,000 in the last 14 days by city.
Oakland: 10,175

Hayward: 4,109

Fremont: 2.027

Eden MAC: 1,772

San Leandro: 1,546

Livermore: 1,197

Union City: 1,088

Berkeley: 1,077

Newark: 757

Castro Valley: 742
Top 10 Locations of Cases in Contra Costa County plus (in parentheses) cases per 100,000 in last 14 days, as of 11/23/20
Richmond: 4,149 (306)

Concord: 2,903 (152)

Antioch: 3,005 (269)

Pittsburgh: 2,418 (211)

San Pablo: 1,897 (516)

Bay Point: 1,093 (278)

Brentwood: 951 (193)

Walnut Creek: 843 (128)

Oakley: 728 (183)

San Ramon: 588 (114)
East Bay Resources

We are proud to partner with the East Bay Community Foundation in publishing this bulletin. Through donations to its Covid-19 Response Fund, the EBCF provides grants to East Bay nonprofit organizations delivering essential services to those most impacted by the economic fallout from the pandemic.
Holiday Celebration Guidance
CDC website, November 19, 2020
The safest way to celebrate Thanksgiving this year is to celebrate with people in your household. If you do plan to spend Thanksgiving with people outside your household, the CDC offers steps to make your celebration safer.

Contra Costa Health Services website
Embracing gratefulness, connection, resiliency and hope are more important than ever, as is protecting the ones you care about and are thankful for. As you plan for and enjoy the holidays, Contra Costa Health Services provides guidance on how to keep yourself and others safe while enjoying traditions.
In their November 19, 2020, podcast, Dr. Michael Osterholm and host Chris Dall discuss the exponential growth of cases in the US and elsewhere, more promising news regarding vaccines and the obstacles that remain, the impact of surging cases on healthcare workers, and an opportunity to help out with the Frontline Families Fund.
Purple (Widespread) Tier Restrictions Summarized
All Bay Area counties are in the state's Purple (Widespread) Tier for activity and business reopening, with the exceptions of Marin, San Francisco and San Mateo Counties that are in the Red (Substantial) Tier.

Below is a list of the restrictions for counties in the Purple Tier. Please view on a desktop or laptop computer. Source: California Dept. of Public Health

For East Bay specific reopening guidance, see

Outdoor playgrounds

Hair salons & Barbarshops

All Retail

Shopping Centers

Museums, Zoos & Aquariums

Places of Worship

Movie Theaters

Hotels & Lodging

Gyms & Fitness Centers



Bars & Breweries (where no meal provided)


Professional Sports

Amusement Parks
Outdoor only with modifications, maximum 3 households

Open with modifications

Open indoors with modifications

Open indoors with modifications, maximum 25% capacity

Open indoors with modifications, maximum 25% capacity, common areas and food courts closed

Outdoor only with modifications

Outdoor only with modifications

Outdoor only with modifications

Open with modifications

Outdoor only with modifications

Outdoor only with modifications

Outdoor only with modifications



Open without live audiences

New California Mask Order Summarized
All Californians are now required to wear face coverings whenever they’re outside their homes, with a few exceptions. Source: California Dept. of Public Health
Residents must cover their faces unless they are:

  • in a car alone or solely with members of their own household.

  • working in an office or in a room alone.

  • actively eating or drinking provided that they are able to maintain a distance of at least six feet away from persons who are not members of the same household or residence.

  • outdoors and maintaining at least 6 feet of social distancing from others not in their household. Such persons must have a face covering with them at all times and must put it on if they are within 6 feet of others who are not in their household.

  • obtaining a service involving the nose or face for which temporary removal of the face covering is necessary to perform the service.

  • workers who are required to wear respiratory protection.

  • specifically exempted from wearing face coverings by other state guidance.
Californians are only exempt from the order if they:

• are younger than age 2.

• have a disability or medical/mental health condition that prevents them from wearing a face covering.

• are hearing-impaired or are communicating with someone who is.


The new state mandate doesn’t specify any particular kind of face covering — all that’s required is that the nose and mouth are covered. “A cloth face covering may be factory-made or sewn by hand or can be improvised from household items such as scarfs, T-shirts, sweatshirts, or towels,” the state says.

Monday’s mandate replaces the one issued in June, which had required Californians to wear face coverings only in specified settings that were considered high risk, such as when shopping, taking public transportation or seeking medical care.
Mask On Eden Area
Working in collaboration with the Alameda County Public Health Department, the Cities of Hayward and San Leandro, and the Castro Valley and Eden Area Municipal Advisory Councils, the District has printed “Mask On” posters for each city and community in the Eden Health District area. The posters are free and intended for businesses, health clinics, schools, churches, public agencies and nonprofit organizations to display in their entrances.

“Wearing masks in public or any gatherings, including events with friends and extended families, is essential for slowing the spread of the virus,” stated Eden Health District Director Pam Russo. “While we are seeing signs of progress in California, Alameda County remains a Covid-19 'hot spot' in the Bay Area. Please wear a mask to protect yourself while protecting others.”
The public is welcome to download and print or share “Mask On” posters from the District’s website. Posters are available in English, Spanish and Chinese languages.

Posters may also be retrieved during business hours from the lobby of the Eden Health District office building located at 20400 Lake Chabot Road, Castro Valley. Posters for the City of Hayward are also available from the Hayward Chamber of Commerce located at 22561 Main Street, Hayward.
Public Education Covid-19 Flyers
Contra Costa County Health Services has recently published highly informative flyers addressing the risks of becoming infected in certain settings and activities.
Eden Area Food Pantries
We have posted information on food pantries and food services in the cities of Hayward and San Leandro and unincorporated Alameda County including Castro Valley and San Lorenzo. You can access the information here on our website. Alameda County has also released an interactive map listing food distributions and other social services. 
Your feedback is welcome. Please share the Bulletin.
The Eden Health District Board of Directors are Gordon Galvan, Chair, Mariellen Faria, Vice Chair, Roxann Lewis, Pam Russo and Thomas Lorentzen. The Chief Executive Officer is Mark Friedman.

The Eden Health District is committed to ensuring that policy makers and community members receive accurate and timely information to help make the best policy and personal choices to meet and overcome the challenges posed by the Covid-19 pandemic.

Each bulletin includes a summary of the top health, Bay Area, California, national, education and international news on the pandemic plus links to a diverse range of commentary and analysis. We publish the Bulletin on Mondays, Wednesdays and Fridays, unless the day fall on a public holiday.

Please share our bulletin with your contacts. Please click here to subscribe.

We welcome your feedback on our bulletin. Please contact editor Stephen Cassidy.