Six months into pandemic, why things fell apart
We're wired to respond to immediate danger, but it's tougher to sustain vigilance as closures drag on
Duck, cover and hold on: Californians’ response to earthquakes is universal and effective.
But our reaction to a different natural disaster — the coronavirus — is profoundly personal and often divisive, revealing differences in risk perception, governance and equity as vast as the Golden State.
Six months after the state’s strict stay-at-home order, this response explains our notable early success against the virus, as well as more recent failures, say experts. It also sheds light on why viral spread is so highly clustered.
“Every day, 40 million people make 20 individual decisions,” said Dr. Bob Wachter, chairman of UC San Francisco’s Department of Medicine.
In case counts and burials, “we’re seeing the differences in what those decisions were,” he said.
From the beginning, COVID-19 has been a complicated threat, invisible and abstract. Humans are wired to respond to immediate danger, like the earth rumbling beneath our homes. But it’s tougher to sustain vigilance — especially as the closures, initially intended to be brief, have dragged on.
From early April through late June, the state’s seven-day average for daily deaths was well below 100 — but skyrocketed to 145 by Aug. 6. That seven-day average has since flattened to 88 as of Friday.
If we need another lockdown this winter, fears Andrew Noymer of UC Irvine, the public may be unwilling to comply. We locked down hard, for months. Few of us had a personal brush with death. Now, patience has worn thin.
Back in March, watching China’s catastrophe, we mobilized. The state’s quick and unified lockdown spared us a similar fate.
“California deserves the
credit for working collectively and with utmost caution at the start of the pandemic,” said Dr. Kirsten Bibbins-Domingo, chairwoman of UC San Francisco’s Department of Epidemiology and Biostatistics. “We acted quickly, we acted decisively.”
Shocked by the sight of New York’s makeshift morgues, Californians engaged.
“The overarching response was ‘This is serious. It is scary. I am going to believe the experts. I am going to believe the data. And even though it is hard personally and economically, I am going to do the right thing,’ ” said Wachter. What happened next? Some places, like the Bay Area, used the time to stock up on PPEs, prepare hospital beds, expand testing, erect clinics and launch educational campaigns. As early as the first week of March, our global tech companies sent employees home. Only essential workers were expected to venture out.
The result has been a shift in cultural herd behavior. Just as yoga is stylish and smoking uncool, mask-wearing has become de rigueur. Social distancing is expected, not asked.
In the mental juggling of cost vs. benefit, such sacrifices can seem simple.
But that’s not everyone’s experience. While an earthquake is a shared trauma, a virus — especially one transmitted with no symptoms — is an abstract threat, affecting different people in different ways. While the danger is clear of collapsed bridges or crushed schoolhouses, it is hard to imagine the lethality of a family barbecue.
COVID-19 cases and death rates also are disproportionately high among some people, such as Latinos, many of them “essential workers” in low-income neighborhoods. And the worst of the pandemic has shifted to agricultural areas, clustered in Central Valley counties with the highest per capita case counts in the state.
As the weeks dragged into months, our reactions to the reopening rules varied, driven by personal perceptions, local leadership, cultural influences, education, race, marital status, mixed messaging and realworld experiences.
And what seemed like a moment of triumph in March turned deadly with the speedy reopening in May and early June. Summer’s weekly death toll nearly doubled the spring tally. The devastating Loma Prieta earthquake killed 63 people; every day, a tiny virus claims far more.
The problem, said UCSF’s Dr. George Rutherford, is that the state handed over responsibility to the counties, and what had become a unified response fell apart.
“Fifty-eight counties did their own thing,” agreed Wachter. Said Bibbins-Domingo: “That was where we saw the biggest reversals in the gains we’d made.”
And many counties didn’t make good use of those precious months to prepare.
Meanwhile, local politicians pressured county health officials to ease restrictions on struggling businesses and frazzled residents.
Such decentralization of authority only works if local officials have strong guidance and support, said Philip Cohen, professor of sociology at the University of Maryland at College Park.
In more rural areas, he said, counties “just don’t have the infrastructure, the personnel, the experience or the resources to deal with the epidemic.”
California’s fractured approach violates one of the core principals of risk communication in an emergency: “Deliver a clear and consistent message by trusted messengers,” said Lori Peek, director of the Natural Hazards Center at the University of Colorado at Boulder.
Instead, the messages were mixed, and confusing. Masks were useless, then essential. The virus might kill you, or do nothing. Children are safe, except sometimes; schools are dangerous, depending. And the messengers were politicized: Republicans said the threat was exaggerated, killing jobs and undermining the president. Democrats warned of disaster, urging more spending.
Early on, we had a clear goal: Don’t overwhelm hospitals. But that shifted, said Dr. Rajiv Bhatia, clinical assistant professor of primary care and population health at Stanford.
“You cannot fight something without a goal and a measure,” he said.