The closures are depressing and economically devastating. But California may have no choice


Stay-at-home orders are becoming increasingly unpopular, destroying the economy, and making some people feel even more isolated and depressed.

But as California strives for the most dangerous outbreak of the COVID-19 epidemic, many public health experts say orders may be the best – and probably the only – way to slow the rapid spread of the virus.

Governor Gavin Newsom’s recent stay-at-home order has received criticism from all sides, with some saying it is too restrictive and killing small businesses, while others question whether the rules are strict enough and wonder why they are leaving shopping malls open.

Experts say the coronavirus is spreading so fast in the state these days, and hospital nurses are soaring so fast that the time for incremental measures has expired, and the most effective way to bend the curve is to make people as homely as possible.

Nuance can work in public health strategies, but sometimes “taking a more nuanced approach – what’s okay and what’s wrong is making people more confused,” said Dr. Shruti Gohil, UC Irvine’s Epidemiology and Infection Prevention Officer. . “By closing everything unilaterally, it sends the psychological message that we should stay home; it’s time to strike again. And it can save lives.

In other parts of the world, new waves have been curbed by aggressive action.

When Europe saw a severe peak in the fall, governments were forced to end the incremental approach and responded with quick closures that reversed the tide in a matter of weeks.

France, which observed a fourfold increase in daily coronavirus cases in October, has decided to take strong action to tackle its second wave: a wider curfew, between 21:00 and 06:00, in larger cities; orders the closure of non-essential businesses such as retail shops, restaurants and bars; making masks mandatory for 6 years of age and older; and travel bans, including second homes.

“This suggests that these types of measures will be achieved fairly quickly, for example within a few weeks,” said Dr. George Rutherford, an epidemiologist and infectious disease expert at UC San Francisco.

In fact, parts of California are now one step further than Newsom. Five counties in the Gulf area said on Friday they would make progress and implement Newsom’s stay-at-home order early next week and refuse to wait until the region’s increasingly crowded intensive care units fall below 15% of capacity as the state triggered the order .

“It should have come into effect a week ago, or just now, like the Bay Area. I think the longer we wait, the more trouble we will have, ”said Dr. John Swartzberg, clinical professor of infectious diseases at UC Berkeley School of Public Health. By continuing to wait for order to be made in the rest of the state, “we may be left out of the beds in the intensive care unit before the effects of the order of staying at home truly have a saving effect”.

The intense shortage of beds in Southern California entered the zone on Friday night, and if it persists, it will trigger the state’s home-staying order as early as Sunday. On Friday night, the California Department of Public Health released new figures showing that Southern California as well as the San Joaquin Valley now have a critical shortage of intensive emergency beds and less than 15% capacity is available in all areas.

Once an order goes into effect, it can take roughly two to three weeks for the effect to be felt in the intensive care unit, as it usually takes that long for someone exposed to the virus to get sick enough to need the intensive care unit.

Staying at home now in California would help avoid sinking into a historic crisis that would flood the state’s intensive departments to a point never seen in modern state history.

COVID-19 patients suffer not only from overworked nurses and doctors, but also from stroke, heart attack and car accident.

“We had 22,000 cases today, we had 18,700 cases yesterday,” Dr. Mark Ghaly, California’s secretary of health and human services, said in an interview Friday. “At this level … he says hospitals will have a much bigger impact in just two weeks than they do now.”

Some other countries have been able to avoid painful downtime in California. This is because they have been able to scan the virus much more successfully.

In Taiwan, only seven people die from the coronavirus, but he never had to shut down a wide range of economies because officials quickly imposed strict travel restrictions and carried out strict quarantines, closely monitoring those entering the country.

In Japan, California has about one-tenth of the deaths, despite having more than three times the population of the state. One reason for this is probably that the nation insists on wearing universal masks.

In contrast, the United States is arguably the worst achievement in the world in dealing with the epidemic. The United States is home to 4% of the world’s population but 18% of COVID-19 deaths. More than 279,000 deaths are the worst in the world.

“One of the biggest failures in the U.S. is that we have this piece of response file set, and it obviously doesn’t work,” said Dr. Kirsten Bibbins-Domingo, president of the Epidemiology and Biostatistics Department at UC San Francisco.

Among the setbacks: Political struggles to wear masks, nationwide and California, and a shoddy public health infrastructure that is not adequately equipped to enforce quarantine of arriving travelers.

“What makes the crisis particularly dangerous for the United States is that we continue to have polarization and, in fact, didn’t have the kind of infrastructure investment for testing and monitoring – all we can expect from a country like ours,” Bibbins said. -Domingo.

The continued lack of significant federal economic support for businesses and workers affected by pandemic constraints has also played a role in fueling the recent outrage against new home orders. Economic downturns would be much more bearable if the federal government provided controls issued in the first wave of the pandemic.

In contrast, European countries have much stronger social safety nets for people who have fallen ill and lost due to downtime, thus reducing the impact on the general public.

Clearly, the restrictions are subject to greater setbacks in Los Angeles County. Parents expressed outrage over the closure of playgrounds while retail businesses remained open. The suspension of outdoor dining in LA County has resulted in lawsuits and protests, with owners and customers being unfairly targeted, without clear evidence that restaurants have spread COVID.

The high-profile events in which some of California’s leading politicians dined with people outside their households in fancy restaurants while talking about the dangers only fueled further skepticism and anger.

But many experts say the dangers are real.

“When the community is widespread – as we are now experiencing in this viral tsunami – every place must have control measures in place,” said Dr. Robert Kim-Farley, a medical epidemiologist and infectious disease expert at UCLA Public School of Public Health. “At this stage, with this rapid increase in cases, basically everywhere there is a greater risk of transmission.”

The playgrounds have been closed since the beginning of the March pandemic and only began to reopen in late September. Since then, however, it has become clear that children and adults from different households are still getting very close to each other at a play structure, and some don’t wear a mask, Ghaly said, although this is a requirement for ages 2 and older.

In addition, there is no real opportunity to meet the capacity limit at many playgrounds, said Kate Folmar, a spokeswoman for the California Health and Human Services Agency.

The exception to the new home order is that non-core retail stores, including shopping malls, can remain open, albeit with only 20% capacity.

The big reason for the decision was what government officials observed in the spring. Only certain stores were allowed to open, such as grocery stores, which largely left only big-box stores open – and shoppers flocked there, resulting in long lines outside and it was difficult for store employees to keep customers physically away while they waited. , said Ghaly.

“So the concept of having more space to go – and about reducing the density in any retail store – was the idea of ​​keeping a wide range of the retail sector open in that order,” Ghaly said.

In fact, it is possible that a 20% capacity big box store is less risky than a small hair salon because – if everyone follows the rules – people are more than six meters apart, ventilation can be better and they spend less time in close contact with other people. said Bibbins-Domingo.