California squanders early lead in fight against coronavirus

When California governor Gavin Newsom issued the first US statewide stay-at-home order, on March 19, it was hailed as a bold but necessary step to contain coronavirus. Mr Newsom, a Democrat, told citizens to “recognise reality” and warned that more than half of California’s 40m residents could be infected within eight weeks unless serious measures were taken.

Soon he began recruiting an army of 10,000 contact-tracers to track the disease and ramped up testing. The strict lockdown measures worked: by mid-April, fewer than 1,000 Californians had died from the virus, compared with almost 12,000 in worst-hit New York.

But in recent weeks, the most populous US state has become a case study in how a few bad decisions can undermine months of good work, and how success in fighting the virus can breed failure when citizens let down their guard and become complacent.

“It is clear that after months of quarantine, combined with the reopening of many sectors in the span of several weeks, we have had a lot of people disregard the very practices that allowed us to slow the spread,” Barbara Ferrer, Los Angeles County public health director, told reporters this week.

As of Thursday, confirmed virus cases in California have spiked to more than 300,000, with 6,825 recorded deaths. About 8,000 new cases were being added every day and the number of Covid patients hospitalised has been climbing for 19 consecutive days, according to the state’s public health department.

California had once stood in stark contrast to other US states that are experiencing surges. Many politicians in some southern and western “red states” scorned the need for wearing masks or social-distancing measures — and their citizens followed their lead.

By contrast, Mr Newsom’s decision to take the pandemic seriously helped flatten the curve. But along with the leaders of other badly affected states, such as Texas and Arizona, he faces soaring case numbers widely blamed on the decision to end the lockdown and reopen before the virus was properly controlled. 

“We came back earlier than any guidelines suggested,” said Gary Tamkin, a physician and vice-president at California-based VEP Healthcare. How the situation evolves from here “is absolutely not clear and even becomes less clear every day,” he added.

As of today, California’s total number of cases is second only to New York, although its size plays a big role. By cases per 1m people, California ranks 26th worst of the 50 states. Nationwide, US virus cases surpassed 3m this week.

California governor Gavin Newsom insists the public health system is able to cope despite the number of people receiving hospital treatment for the virus rising 44 per cent in two weeks © Rich Pedroncelli/AP

Many lay the blame at the White House and federal government rather than state-level failures. Bob Wachter, chair of the department of medicine at the University of California, San Francisco, said Donald Trump, US president, and his fellow Republicans shared responsibility for taking basic medical precautions, such as wearing face masks, and turning them into political issues.

“California is a reliably Democratic state but there’s parts of the state that are more conservative, where there’s more pushback,” he said. “[And people] are still hearing — from Trump and others — stuff that is just wrong and crazy.” In mid-April, for instance, Mr Trump called for the “liberation” of US states under stay-at-home orders.

But there were mistakes at a local level too. Eric Topol, director of the Scripps Research Translational Institute, cited the “very bad decision” by state officials to begin phase two reopening in May — which included opening up retail such as books and clothing stores, and manufacturing — even as case numbers continued to climb.

Driven by a desire to restart the economy, this effectively threw away early lockdown gains, he said.

One reason the reopening took place at all is that Mr Newsom tried to avoid a “one size fits all” approach, so as not to inflict too high an economic toll on areas with limited outbreaks.

He opted to defer to county officials on when to reopen, so they could make decisions based on “real data at a granular level — bottom-up, not top-down,” he said on April 17. But, in such a highly charged environment, that created unintended consequences for public health officials with far less political clout than a governor.

“They became targeted — I mean literally targeted — with death threats, people going to their houses and threatening their families,” said Richard Pan, a Sacramento physician and Democratic state senator.

“Social media is actually abetting this, platforming this stuff and so inciting more violence,” he added.

Persuading 40m people to go into lockdown for a second time will not be easy, says Bob Wachter, chair of the department of medicine at the University of California, San Francisco © Jae C. Hong/AP

One example came when Elon Musk, the electric car pioneer, threatened to relocate Tesla’s operations from California, alleging that Alameda county’s “unelected” health chief had “illegally” kept his factory closed, and encouraging his 34m Twitter followers to “voice your disagreement as strongly as possible”. Within days, the county buckled and the Tesla plant reopened.

California’s coronavirus crisis is not statewide, but in pockets. Five of the state’s 58 counties account for 78 per cent of the deaths so far. Los Angeles County, home to about a quarter of Californians, has accounted for more than half the fatalities.

Yet prior to the Memorial day holiday at the end of May, Los Angeles was not a particular hotspot. That changed when large numbers of people who met up for private gatherings that weekend failed to “follow the most basic infection control and distancing directives”, said Ms Ferrer, the LA county public health director.

Then there is the outbreak at the state’s notorious San Quentin Prison, where 1,600 inmates and staff have been infected in just a few weeks. According to the San Francisco Chronicle, the cause was the transfer of about 200 vulnerable inmates from another facility that was dealing with an outbreak. None were tested, but some already had the virus.

Mr Newsom insisted this week that the public health system was able to cope despite the number of people receiving hospital treatment for the virus rising 44 per cent in two weeks. “We now have the capacity to treat 50,000 Covid-19 patients, well beyond that surge capacity,” he said.

Yet the number of virus cases in California are on track to double every 24.8 days, according to LA Times calculations, and many believe the state has no choice but to go back into a full lockdown.

“If you really wanted to do this right, we know ‘stay-at-home’ works really well,” said Scripps Research’s Dr Topol.

Persuading 40m people to go into lockdown for a second time will not be easy, but Dr Wachter of the University of California, San Francisco said the state needed to send a clear message.

“California has led the way in emission standards for cars, smoking cessation and other things,” he said. “We have Hollywood, Silicon Valley — we’re pretty good at convincing people to do stuff.”