California’s year of COVID-19 in perspective

State ended 2020 with the most COVID-19 cases and the third-most deaths in the country.

Despite early and aggressive measures to contain the coronavirus after seeing some of the first U.S. infections last January, California ended 2020 with the most COVID-19 cases and the third-most deaths in the country.

With 2020 now in the rearview, California, which prided itself on slowing the virus as it spread like wildfire across the Northeast and South last spring, is now driving the country’s caseload, with Southern California hospitals overrun like those in New York in March.

Even so, epidemiologists say the country’s most populous state faced unique challenges and that its early efforts have kept cases and fatalities per population lower than other large states.

“California still deserves credit for what it did well at the very beginning in terms of the lockdown,” said Dr. Kirsten Bibbins-Domingo, an epidemiology and biostatistics professor at the University of California- San Francisco. “And I think given as large a state as California is and particularly as large an urban center as Los Angeles is, that the early lockdown absolutely had an impact on cases that would otherwise have risen quite quickly as we see now what’s happening in LA.”

According to data from the New York Times, California recorded 2,322,661 cases in 2020 compared to 1,772,803 in Texas, 1,323,307 in Florida, 996,073 in New York and 652,952 in Pennsylvania, among the five most populous states. But per 100,000 residents, California had 5,878 cases in 2020 compared to 6,114 in Texas, 6,161 in Florida, 5,120 in New York and 5,100 in Pennsylvania.

On Thursday, California county health departments reported a record 571 new COVID-19 deaths, bringing the total for the year to 25,971, according to data compiled by this news organization. December’s total of 6,758 accounted for more than a quarter of the deaths.

But California had 66 COVID-19 fatalities per 100,000 residents, compared with 194 in New York — which finished the year with more than 30,000 fatalities after being hard-hit with spring outbreaks — 127 in Pennsylvania, 101 in Florida and 97 in Texas, according to the New York Times.

The United States on New Year’s Day, meanwhile, surpassed 20 million cases — the most of any country, nearly twice as many as India with the second-highest and almost a fourth of the more than 83 million cases globally, according to data from John Hopkins University. The U.S. was approaching 350,000 virus-related deaths.

California reached its g r im milestones even though it was the first to implement wide-scale shelter-in-place orders to slow the spread of the virus. Now, Los Angeles hospitals are being overwhelmed like New York City’s in the spring, with overflow patients moved to hospital hallways, gift shops, even a cafeteria, and refrigerated trucks standing by to store the dead.

Statewide, hospital intensive care unit capacity remained at 0%, indicating that staff are so stretched that they can no longer deliver optimal care to critical patients. Regionally, ICU capacities ranged from 33.3% in Northern California to 0% in Southern California and the San Joaquin Valley, according to the California Department of Public Health. The Bay Area was at 8.5% and Greater Sacramento at 11.1%.

A recent UCSF study concluded nearly 20,000 more Californians died in the first six months of the pandemic than would have been expected to die in a normal year, but the first lockdown — from March 19 to May 9 — lowered the number of excess deaths in the state. Not all groups benefited from the lockdown, specifically Latinos, who make up nearly 40 percent of the state’s population, and adults without a high school degree, researchers found.

Bibbins-Domingo said the state might be in a better position had it focused on the communities that have been the hardest hit, as well as figured out how to safely reopen schools and playgrounds sooner to ease “pandemic fatigue.” She also said the state would have benefited from more testing and better data to help manage the crisis.

“What we’re seeing 10 months in are some of the things we should have been able to do better and would have held us in better stead going into this winter surge,” she said.

The virus was shaping up to be the third leading cause of death in California in 2020, behind heart disease and cancer and just ahead of Alzheimer’s disease, according to preliminary data from the California Department of Public Health.