- As of Wednesday,
California had recorded morecoronavirus cases than any other US state, according to data from Johns Hopkins University. - Public-health experts say the state's outbreak spiraled out of control after officials lifted lockdown measures too soon.
- California has also struggled to enforce mask mandates and social-distancing guidelines.
California has surpassed New York as the US state with the most coronavirus cases.
California's infection count topped 409,000 on Wednesday, according to data from Johns Hopkins University. New York, the original center of the US outbreak, had reported 408,000 cases. New York, however, has seen four times as many COVID-19 deaths as California: about 32,000 compared with nearly 8,000.
Despite being the first state to institute a stay-at-home order, California has seen daily cases rise steadily for the past three months. As of Tuesday, California's average number of daily cases in July was more than double June's figure.
What caused the state's outbreak to spiral out of control?
The obvious answer, public-health experts say, is that California relaxed its lockdown restrictions too soon.
White House guidelines for reopening suggested that states see either a two-week decline in cases or a two-week decline in the share of coronavirus tests coming back positive. California began lifting restrictions without seeing either.
The state also struggled to control local outbreaks among prisoners and farmworkers in May and June. And on top of that, California has had difficulty enforcing mask mandates and social-distancing guidelines at restaurants, particularly in some southern counties.
These factors drove California into crisis mode, forcing Gov. Gavin Newsom to reinstitute restrictions. The state offers a lesson in staying cautious and vigilant, even when cases are low.
Lockdowns were lifted too soon
At the start of the pandemic, California seemed to be ahead of the coronavirus threat. On March 19, it became the first state to impose a stay-at-home order. Lockdowns were already in place in Los Angeles County, which locked down an hour before the statewide order, and the San Francisco Bay Area, which locked down on March 17.
For a while, that early response paid off. Transmission increased slightly in March, then leveled off in April.
"You have bent the curve in the state of California," Newsom said at a press conference on April 14. "The models have changed because of your behavior."
But on May 8, Newsom allowed certain businesses — including clothing stores, florists, and bookstores — to reopen across the state, though the Bay Area remained under stricter local rules. Religious services and in-store shopping were allowed in California on May 25.
Though cases started to rise in June, the state pushed forward: On June 12, California reopened the bulk of its businesses, including restaurants, hair salons, zoos, gyms, museums, hotels, and bars.
California's seven-day average of new coronavirus cases rose by about 65% from June 13 to 27, to about 5,000 from about 3,000. The state's coronavirus hospitalizations climbed by roughly 50% from June 22 to July 6.
Southern California has borne the brunt of the outbreak: A third of all hospitalizations have been in Los Angeles County. On Monday, its daily coronavirus hospitalizations hit a record high of about 2,200.
"What happened to California? It's called a pandemic," John Swartzberg, a professor of infectious diseases at the University of California at Berkeley, previously told Business Insider. "Southern California has been too liberal in terms of opening things up."
On July 1, Newsom again closed bars and restricted indoor activities in restaurants, movie theaters, museums, and zoos across 19 counties. But it was too late to undo the devastating effects of reopening too soon.
Many Californians ignored safety requirements
Even with a statewide stay-at-home order, many Californians didn't follow social-distancing guidelines.
In April, for example, Newsom briefly closed beaches and state parks in Orange County after the areas drew large crowds. In response, about 2,500 people gathered in Orange County to demand an end to California's stay-at-home order. Many more gathered for similar protests in Sacramento, San Francisco, Los Angeles, and San Diego on May 1.
Orange County residents also protested the county's short-lived face-mask requirement in June. The Orange County health officer who imposed the mandate, Dr. Nichole Quick, resigned on June 8 after she became the target of mounting public backlash. (A banner brought to a Board of Supervisors meeting even depicted her as a Nazi.) Under her successor, Dr. Clayton Chau, masks became "strongly recommended" instead of mandatory.
Newsom issued a statewide mask mandate on June 18.
Many local establishments also ignored state mandates. Los Angeles health officials reported in June that about half of nearly 2,000 restaurants they visited over a weekend weren't following the proper safety precautions.
Outbreaks among prisoners and farmworkers
As of mid-July, California's coronavirus tally included nearly 6,500 cases in local prisons, according to The Marshall Project and The Associated Press. More than 920 of them were at Avenal State Prison in the San Joaquin Valley, where a staff member had tested positive for the virus on May 16.
Another cluster of infections broke out at the California Institution for Men after two staff members tested positive for the virus in March. Since then, the prison has recorded more than 760 coronavirus cases. Some inmates were also transferred to other California prisons in May, possibly spreading the virus even farther.
These types of superspreader events may be responsible for the majority of coronavirus transmission, according to researchers in Hong Kong.
California also has one of the country's largest populations of farmworkers, many of whom are migrants. The workers are particularly vulnerable to infection, since they often live and work in close quarters. Many can't afford to take time off and lack access to healthcare.
In June, more than 175 residents and staffers tested positive for the coronavirus at a farmworker housing facility in Ventura County. More than 80% of the tests administered at the facility came back positive, the Los Angeles Times reported.
Testing also accounts for some of the surge
President Donald Trump has suggested that the US's skyrocketing case numbers can be attributed solely to increased testing. A recent STAT News analysis suggests that's not the case in 26 states, including California.
The analysis found that the coronavirus was more prevalent in Florida than anywhere else. That's because the percentage of positive cases in Florida ramped up much faster than testing capacity from May to July. The analysis identified a similar pattern in Arizona, Georgia, South Carolina, and Texas.
But increased testing may account for some of California's high case numbers over the past two months.
The state has administered more coronavirus tests than any other: about 6.5 million so far. California's testing capacity more than quadrupled from May to July, but its rate of positive cases increased by only 10%, the analysis found — a sign that increased testing could be capturing more cases than before.
Still, public-health experts say California's outbreak is largely the result of premature reopenings.
"It doesn't surprise me that there are more cases where people have been interacting more," Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, told Business Insider in June. "Stay-at-home orders are lifting, people are interacting, and the virus didn't go anywhere."
Holly Secon contributed reporting.