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Maskless patrons enjoy tropical cocktails in the tiny interior of the Tiki-Ti bar as it reopens on Sunset Boulevard in Los Angeles on July 7, 2021. California COVID cases are climbing, especially in Los Angeles, just weeks after the state's broad reopening.

A month after California’s reopening lifted most pandemic restrictions, COVID-19 cases and hospitalizations are rising, worrying public health officials as they contend with the more infectious Delta variant and the lagging pace of vaccinations in some communities.

Los Angeles County has drawn particular concern, with five straight days of more than 1,000 new cases, a five-fold increase from mid-June.

Gov. Gavin Newsom on June 15 officially ended the state’s stay-at-home and mandatory mask orders affecting 40 million people, allowing most businesses to fully reopen. Vaccinated or not, many unmasked Californians eagerly crowded into reopened stores, restaurants, churches and sporting events..

The fallout: On Wednesday, nearly 3,100 new COVID-19 cases were reported, compared to 700 on June 15. And the state’s test positivity rate – a measure of how much virus is circulating in a community – jumped from 0.08% to 3%, according to the California Department of Public Health.

The actual numbers of cases remain small, however, compared to the peak of California’s devastating winter surge, when new daily cases topped 50,000.

Case counts and testing results can fluctuate because of reporting delays. But public health officials in some areas have reported notable spikes in cases and hospitalizations.

Between June 12 and July 12, San Francisco, Los Angeles and Orange counties saw the biggest jumps in the 7-day average of COVID-19 cases per 100,000 people, excluding very low-population counties, according to a CalMatters data analysis. San Francisco’s case rate nearly quadrupled to slightly more than six cases per 100,000 people. Los Angeles’ case rate nearly tripled, and Orange County’s more than doubled.

About 1,935 people were hospitalized statewide with confirmed or suspected cases on Wednesday, up about 54% compared to hospitalizations on reopening day. Hospitalization rates spiked in Yolo, Marin, El Dorado, Sonoma and Alameda counties.

Nearly all of the new cases, hospitalizations and deaths have been seen in unvaccinated people. About 40% of Californians remain unvaccinated.

Which raises the question: Did California reopen too soon?

Not necessarily, according to Dr. Peter Chin-Hong, a University of California, San Francisco infectious disease specialist.

“I think we were a very good place in California when we reopened,” Chin-Hong told CalMatters. “And we had no idea what the Delta variant was going to do.”

California waited longer than most states to reopen fully, Chin-Hong pointed out. “We always expected an increase in cases after that.”

California’s regional surges echo those around the nation, with COVID-19 cases rising by more than 50% this past week in 31 states and hot spots reemerging in Missouri, Arkansas and Florida.

Across California, the Delta variant as of July 7 has been found in 1,085 COVID-19 patients whose test results were genetically sequenced, according to the state public health agency. But as a percentage of the state’s cases, it has grown incredibly fast, from just 2.2% of all tests sequenced in April to about 43% of all tests in June.

Chin-Hong says it’s important to distinguish between infections and those that cause serious symptoms or death, because COVID-19 vaccines remain strongly protective against both, even against the Delta variant.

The death rate has actually declined slightly since reopening day; with most California seniors vaccinated, serious cases are seen far more often in younger people, who are more likely to survive the disease. About 70% of the state’s COVID-19 cases as of July 7 were seen in people under age 50.

Improved treatments, including monoclonal antibodies, also have improved patients’ chances.

Still, 30 deaths were reported statewide on Wednesday. About 1,935 people were hospitalized statewide with confirmed or suspected cases, up about 54% compared to the number of hospitalizations on June 15.

Chin-Hong said unvaccinated Californians accounted for nearly all of the hospitalizations and deaths. So-called breakthrough infections remain exceedingly rare in fully-vaccinated people, a tiny fraction of 1% among more than 20 million Californians.

There was a lot of second-guessing before and after Gov. Gavin Newsom’s decision to largely end pandemic restrictions in mid-June.

In late May, Santa Clara County public health officer Dr. Sara Cody – who helped spearhead one of the nation’s first shelter-in-place orders – voiced concerns about the state’s pace of reopening and warned of a potential surge in cases.

Two weeks after California’s reopening, Los Angeles County health director Dr. Barbara Ferrer recommended residents once again wear masks as the Delta variant surged throughout the state and nationwide.

But Chin-Hong suggests that these COVID-19 surges will become a regular part of life in California, much like flu season. It’s just that unvaccinated people will be far more likely to be hospitalized and die, he said.

“Just like there will be two Americas, there will be two Californias: the California of the vaccinated and the California of the unvaccinated,” he said. “If (non-elderly) people didn’t get a flu shot, they’ll probably do fine but with COVID, you’re going to have a very different trajectory.”

CalMatters data editor John Osborn D’Agostino contributed to this report.

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