Ready or Not, the Reopening Is Coming

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Ready or Not, the Reopening Is Coming

Why the most important metric to watch is hospitalizations, and how we’re all now betting we’ll win the race with the virus.

Vaccine San Diego Gavin Newsom
Gov. Gavin Newsom speaks at a press conference for a pop-up vaccine site in City Heights. / Photo by Adriana Heldiz

At the beginning of the pandemic, I remember imagining that, one day, it would all suddenly open up and we would go back to our schools, churches, bars and ball games and cheer and laugh about how crazy that all was.

But slowly, the dread set in that something that abrupt and cheerful would never happen. Not that we would not eventually reopen, but that it would never be a clean transition on a single day. It would be a long, slow slog of gradually reintroducing ourselves to concerts and sporting events and schools. We would go back and forth, like we did in the fall when we went from sort of opened to really locked down again.

Restaurants would have to wait indefinitely to allow their dining rooms to fill to capacity. It would never be a grand reopening, with fireworks and everyone cheering when you walk back into your favorite bar.

Or will it? We seem to be marching toward a day kind of like that. April 15.

Like it or not, we have started the great re-opening. Most schools across the region will be doing some sort of reopening starting April 12. On Wednesday, the county allowed restaurants with bars to fill their establishments to 50 percent capacity. Gyms can now have 25 percent capacity.

Life around Petco Park has resumed. The Padres can now welcome 33 percent capacity in the ballpark. That probably won’t handle the demand for tickets, now that the team is so exciting and good, but it’s very close to normal volume during the mediocre years, on weeknights at least.

Padres fans enter the Petco Park stadium during MLB opening weekend. / Photo by Adriana

And Monday, Gov. Gavin Newsom announced that all remaining restrictions would be eliminated by June 15 assuming everyone over age 16 has access to the vaccine and hospitalizations remain minimal. More important than the actual percentages, all of this sends a message that we’re back, baby.

We will look back on this week as the beginning of the great reopening with a climax of April 15: the day the state will allow all adults to access the vaccines. People are starting to plan parties and trips. They’re going out for coffee. “So did you get your vaccine yet?” has become some of the most valuable small talk content we’ve ever had as we see each other again.

Now, before we’ve even opened access to the whole population of adults, more than a million San Diego residents have gotten at least one dose of the vaccine – almost 40 percent of the county’s over-16 population.

At the large vaccination site in Chula Vista, Monday, in the old Sears building, organizers were buzzing about an incoming surge of supply of vaccines and people wanting it.

This is good, because we’re betting everything on our ability to win a race with the virus. It’s not all together clear we will, though. And the consequences of losing are not something we want to imagine, but we should.

First, start with the vaccine. Shane Crotty is an immunologist and vaccine expert at the La Jolla Institute. His team at the Crotty Lab helped the world understand exactly how the human body reacts to the virus SARS-Cov-2, or SARS-2, as he calls it.

“It’s an infection fought on two battlegrounds,” he told me.

There’s the initial infection. The virus gets into a person’s nose and their upper respiratory tract. One of the worst parts of the virus is that, in these areas, it can replicate rapidly, so rapidly that it can start to spread – through the air – to other people before your body even knows it is there.

“Probably about half of transmissions occur before people are symptomatic. And that’s because the virus replicates so fast and evading your immune system, that by the time your immune system even notices that it’s there, there’s already so much virus in your nasal passages that it’s ready to spread,” he said.

But in contrast, the spread in the lungs is quite slow. That’s why it takes so long for people who do experience that to either recover or die.

When the virus enters your body, your nose, a race has begun with the immune system. The immune system has to try to stop it before it gets into your lungs. This is in your interest, so you do not die or go to the hospital, but this is also in the public’s interest because our major public collective concern is that we don’t want so many people to have this happen that we cannot take care of them in hospitals. The entirety of our public health response to this virus is built around that assumption.

The vaccines are extraordinarily effective at prepping our immune system to win this race. Even the least supposedly effective vaccines were 100 percent effective in preparing our bodies to stop the virus before it enters the lungs. In other words, we win the race.

But there’s a different, bigger race – and that’s between the virus and the vaccine. The virus has mutated into forms that spread more rapidly. And in places like Michigan, Toronto and Brazil, the virus is spreading rapidly.

The spikes those places are seeing are troubling. They will inevitably make their way here, as the surge did in November. (A handful of cases of the Brazilian variant, for example, have already been detected.)

The difference between now and then though is that 20 million people in California have had at least one dose of the vaccine. They’re prepared to win that race. A higher proportion of the people most vulnerable to losing the race – seniors and people with underlying medical complications – have been fully vaccinated.

That means that we are waiting to see one thing: When and if the number of cases in San Diego and California increases, will hospitalizations follow?

The governor doesn’t think they will. Neither does the county of San Diego. They both recently decided that we could have all these restaurants and museums open at half capacity not because the cases went down but because of the theory that even with more cases, we will not see more hospitalizations – they won’t track like they did before.

Because people are vaccinated.

That’s why the governor said that on June 15, as long as hospitalizations remain low, the number of cases should not matter and we can fully reopen.

They’re betting we can win the race. None of us want to imagine what happens if we lose.

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