Fifteen months after Californians faced their first COVID-19 stay-at-home order, most mandates will be lifted on Tuesday. And what a journey it's been — just months ago, hospitals were overwhelmed with severely sick people seeking scarce beds.
But while California's outlook is brighter, COVID-19 remains a very real threat. Even though the state's infection rate and hospitalizations are at an all-time low, the pandemic isn't over. People are still dying from COVID-19, just at lower rates than six months ago.
Restrictions like physical distancing and mask-wearing offered some protection to people who have not yet been vaccinated, and now that most of those are going away, infections are expected to start rising, said Dr. Kirsten Bibbins-Domingo, an epidemiologist at University of California, San Francisco.
As of Friday, 54.6% of eligible Californians — everyone 12 and older — have been fully vaccinated. Another 11% have received one dose.
But as vaccine demand fades, public health officials worry how new infections will play out among those not yet protected. Will the state see another uptick in cases? Who is vulnerable and where?
Here are six things you should know about where infections, deaths and vaccinations stand today.
Infections and hospitalizations are down, but not gone
At the peak of the pandemic, 17% of people in California tested for COVID-19 were infected. For about a month now, it's been under 1%.
Last week, California recorded between 792 to 1,136 new infections every day. That's comparable to the early days of the pandemic last spring.
Hospitalizations also have been on a downward trend for several months. As of Friday, 1,263 people statewide were hospitalized with COVID-19 and another 261 were in intensive care. During the mid-January peak, more than 22,000 infected people were hospitalized and more than 4,800 were in ICUs.
It's a new record low: Hospitalizations are now less than half what they were in mid-October, when around 3,000 infected people were hospitalized, according to the 14-day average.
At one point in the winter, nearly two dozen counties had fewer than 10 available ICU beds. In many cases, hospitals had to turn away patients or transfer them to hospitals hundreds of miles away.
The tragedies, however, remain. Fifty-five more people were added Friday to California's pandemic death toll, which now includes 62,593 people.
In the past few weeks, California has recorded among the lowest numbers in daily COVID-19 deaths, with numbers similar to April 2020.
California isn't close yet to herd immunity
About two-thirds of eligible residents have received at least one dose of the vaccine. And as the governor likes to remind us, California has administered almost 16 million more doses than the next most populous state, Texas.
State health officials don't set a vaccination goal for herd or community immunity, since children under 12 — 15% of the population — cannot yet be vaccinated and previously infected people may already be protected.
But experts say that 70% to 85% of the total population must be fully vaccinated to reach large-scale protection against the virus.
The state tracks vaccination progress for those eligible by county. As of last week, Marin County led with 75% vaccinated among its 12 and older population. Lassen County ranked last with 22%. The top six counties with the highest percentage of vaccinated populations are in the Bay Area.
Outbreaks are still possible
Experts say another wave of infections is possible. But they add that it probably won't be as severe as the past surges, when labs were overwhelmed with tests and hospitals exceeded their capacity.
"Let's not forget that this is an ongoing pandemic," said Andrew Noymer, epidemiologist at University of California, Irvine. For example, "in Orange County, Latino males are lagging in vaccination, so that is a group that is still at risk," he said.
Come fall or winter, it is likely the state will see another wave of infections, he said.
Dr. Mark Ghaly, the state's health and human services secretary, said he expects to see outbreaks, especially in counties with lower vaccination rates. "It's at those moments of an outbreak that we need to be ready to vaccinate additional people," he said.
That also means smaller, rural counties may still run the risk of overflowing their hospital systems if they experience an outbreak. "We know capacity is least in rural counties, and those counties also have lower vaccination rates," Bibbins-Domingo said.
Blacks and Latinos still at high risk
About 56.5% of Black residents and 55% of Latinos have not been immunized, compared to 38% of white residents and 15.5% of Asian Americans, according to the state's vaccination breakdown.
That means the groups that were harmed the most by the virus are still facing the most risk. Mistrust in the health system and vaccine hesitancy are barriers, but experts say access issues, like the inability to take time off work and lack of transportation are likely the bigger issue.
Dr. Efrain Talamantes, chief operating officer at AltaMed in East Los Angeles, has found that some patients are not necessarily against getting immunized, but just need a little more time or information to make up their mind.
Among Latinos, there is usually a community effect, he said. When one family member gets vaccinated, others tend to follow. But it works both ways. "They say, ‘well my comadre hasn't gotten vaccinated, so I'm not sure I want to,'" Talamantes said.
Many seniors aren't vaccinated, and most kids aren't even eligible
A significant portion of California's seniors — about 1.5 million of them — have not yet been vaccinated, despite being among the most vulnerable to the virus. Seniors make up almost 16% of the state's population, but 73% of COVID-related deaths. Still, 22% of them have not been vaccinated.
People 65 and older have been eligible for shots since mid-January, although the first few weeks were riddled with confusion and supply issues.
Many seniors may be facing access issues. If they don't drive, they likely rely on family members' schedules. If they are ill or homebound, they might be waiting for public health departments and providers to come to them.
Experts say it also will be important to see how infections play out among kids, many who will be heading back to the classroom soon for the first time in a long time. About 34% of children ages 12 through 17 have received at least one dose.
Vaccines for the approximate 6 million children in California younger than 12 years may not be available well until the fall. Last month, Pfizer said it expects to seek emergency use authorization from the Food and Drug Administration for its vaccine for kids 2 to 11 years old in September.
You may need a booster shot
Ghaly said there are two reasons people may need booster shots — waning immunity and the need for additional protection because of a more dangerous variant.
"I pray that it is very unlikely that it's the variant problem," Ghaly said. But if needed, California is ready to re-up mass-vaccination efforts, he said.
Like with many other diseases, immunity from vaccination can decrease eventually, but because COVID-19 is new, it's unclear how long protection will last.