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As we’ve seen throughout the pandemic, even in California, where support for restrictions has been relatively high, balancing the many considerations at play in managing the virus is exceedingly complex.

California’s long, complicated process of shutting down, then lifting restrictions and then reimposing them (but only in some places) is a testament to the difficulty of that task.

[What to know about the restrictions in place right now.]

But Dr. Kirsten Bibbins-Domingo, the vice dean for population health and health equity at the School of Medicine at U.C. San Francisco, told me that the fact that Californians had been under varying levels of restriction for roughly 10 months only makes the state’s plight now more vexing.

As cases began to rise again, policymakers took incremental steps to try to curb the alarming spread, rather than implement a more restrictive statewide order, like the one in March.

“They’ve tried to keep things open because of the economic need, which, unfortunately, makes the messaging more challenging,” she said. “Because now we really are in a crisis.”

Dr. Bibbins-Domingo emphasized another challenge facing the state, what she described as the “false dichotomy” of reviving the flagging economy and protecting public health.

Communities with higher concentrations of low-wage essential workers, who have been showing up for their jobs with little help from the state or federal government, are being disproportionately hurt by the latest surge, just as they have been for months.