Risks, rewards in lifting orders
Gov. Gavin Newsom’s abrupt move to lift stay-athome orders — allowing outdoor dining and other business activities to resume — represents a gamble that California can avoid another deadly coronavirus surge in the coming months despite a slow, frustrating rollout of the vaccine and the looming threat of more contagious strains of the virus taking hold across the state.
After a catastrophic fall-and-winter surge left about 20,000 dead, California is rapidly bending the curve as new cases fall and hospitalizations decline. COVID-19 hospitalizations began to fall about 2½ weeks ago, and much of this progress can be attributed to residents changing their behavior by avoiding travel, staying at home more and following the new rules.
The question now is whether California can keep cases down even as activities such as dining, cosmetology and travel pick up.
Lifting the stay-at-home order should be a boost to some restaurant owners and other merchants whose businesses have been battered by cycles of closure since the pandemic began and who placed enormous pressure on the governor to ease restrictions as campaigns gather signatures to recall him from office.
But experts said it would not take a lot for the situation to spiral out of control again.
UC San Francisco epidemiologist Dr. Kirsten Bibbins-Domingo said lifting the order can work if the public — and businesses — follow the rules and show intense caution. This is more essential than ever, she said, because so much is still unknown about these new strains, which adds a new level of uncertainty to fighting the virus.
“Everything hinges on the behaviors we adopt. If we adopt behaviors where everyone is masking, everyone is keeping to distancing, that all of the rules the governor has in place are enforced, I think there’s a possibility for us to resume some of these activities,” Bibbins-Domingo said. “It’s not an outrageous idea. This is not an outrageous policy.”
Newsom, in announcing the changes Monday, also struck a cautious note but said he believed the conditions had improved enough to try it out.
“We’re seeing a flattening of the curve. Everything that should be up is up; everything that should be down is down — case rates, positivity rates, hospitalizations, ICUs. Testing is starting to go back up, as well as vaccination rates in this state,” he said.
The shift took some officials and others by surprise,
coming just a few weeks after California found itself the American epicenter of the coronavirus with hospitals overflowing, ambulance patients facing as much as a 17-hour wait to get into emergency rooms, hospital morgues overwhelmed and funeral homes forced to turn families away.
UC Berkeley epidemiologist Dr. John Swartzberg said he feared lifting the stay-at-home order was “premature” because the cases, while declining, remain very high. He said it might make more sense to wait a few weeks until cases go down further and California can begin reopening with a lower baseline.
He noted that after last year’s spring and summer surges, California failed to bring its case numbers to a low level before reopening. That meant that when the next surge hit, it became even bigger than the one before it, he said.
“It’s like we’re climbing this mountain. We go two steps up and we just take one step back, and we take two steps up from there and one step back and we keep just having more cases,” he said. “We’re doing a lot better than we were doing 2½ weeks ago, but we’re doing terrible compared to three months ago. We need to knock these cases down so
as we get more and more people vaccinated, we’ll get to a safer environment much more quickly.”
The autumn-and-winter stay-at-home order was unpopular in many corners, with some politicians saying it went too far and restaurant owners suing in an effort to bring back outdoor dining. Critics questioned whether there was enough evidence to show outdoor dining was a significant spreader of the coronavirus. But there is evidence the order changed behavior and helped slow the spread.
A calculation by the L.A. County Department of Health Services found that the transmission rate of the virus began to climb in the region in the weeks before Halloween and accelerated until late November, when it reached a peak of 1.2, meaning on average every person infected with the virus was infecting 1.2 other people — a recipe for a dramatic worsening of the pandemic.
It was also in late November that L.A. County became the first in the state in the autumn to shut down outdoor restaurant dining, and a few days later became the first again in the state to issue a stay-at-home order that once again banned almost all private gatherings and instituted tighter capacity limits on stores.
The county’s model suggests that was the time period when the transmission rate began to fall, and by late December fell below 1, meaning that every infected person on average was infecting fewer than one other person.
“I think that the early action taken by L.A. County as cases began to rise has blunted the magnitude of this tsunami that we experienced. It would have been even worse had some of these measures not been taken early on,” said Dr. Robert Kim-Farley, medical epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health, and a former health official with L.A. County.
It would end up taking roughly two months for the effects of L.A. County’s health orders to convincingly begin reducing hospitalizations and offering officials confidence to begin reopening businesses. That’s similar to the amount of time it took for the summer’s business restrictions to have a similar impact.
“It takes time from when you initiate a control measure to when you actually see the effects of having that control measure in place. It’s like trying to steer a large supertanker ship. When you turn the rudder, it takes a long time before the ship begins to move,” Kim-Farley said.
Epidemiologists said it’s essential health officials keep focused on at least two mutant strains of the coronavirus in California.
One of them, the B.1.1.7 variant first identified in Britain, is believed to be more transmissible and, according to new data, may be possibly more deadly, and has been detected in L.A., San Diego and San Bernardino counties.
A homegrown mutant strain in California, B.1.426, has also spread quite rapidly in recent weeks and officials are investigating whether it’s partly responsible for California’s devastating surge.
This should give the public pause, Bibbins-Domingo said. “If you take a long view of the pandemic, we actually need to reiterate more — not less — how much we need to be doing the types of things that are not fun for everybody, but have become the mainstay of policy until we get everyone vaccinated.”
Under Newsom’s changes, all counties will return to the colored tier system that assigns local risk levels based on case numbers and rates of positive test results for coronavirus infections.
Orange County Supervisor Don Wagner, a frequent vocal critic of the state’s pandemic response and of Newsom, said rescinding the stay-at-home order was “a step in the right direction, but I’ve also learned during the course of COVID that this governor is very erratic. Who knows what will get him to change his mind again?”
“It’s a long time coming,” Wagner added Monday. “It was an unnecessary step when he shut us down. It’s a necessary step for him to open us up. Let’s just not pretend there’s a lot of science that he’s revealed behind his decision.”