San Francisco Chronicle - (Sunday)
Waiting to see if curve flattens
Officials monitoring stayathome results
California has mounted a massive defense against its escalating coronavirus outbreak, ordering statewide shutdowns that haven’t been applied in the United States in more than a century — not since the 1918 Spanish flu pandemic — and that threaten widespread economic and cultural chaos in an effort to unburden hospitals and save lives.
The Bay Area led the effort, announcing a sixcounty shelterinplace order three days before Gov. Gavin Newsom did the same for the rest of the state. Now 40 million Californians are hunkering down for an indefinite period of isolation, while public health authorities watch for signs that the extraordinary response is working.
And that is the question on everyone’s mind: Will it work?
“We’re doing everything we can. The next level up is closing public transportation, maybe a couple more draconian levels,” said Dr. George Rutherford, head of the division of in
fectious disease and epidemiology at UCSF. “But we’ve used our big weapon.”
Rutherford and most of his peers think the Bay Area probably acted swiftly and assertively enough to tamp down the worst of the outbreak — to flatten the curve, so to speak. The same may be true for California too. But the entire country is on a steep trajectory toward a disastrous epidemic, they say. And California can only isolate itself from the rest of the world for so long.
The United States had more than 25,000 confirmed cases as of Saturday — more than twice as many as a week before, when President Trump declared a national emergency. Case counts are skyrocketing in New York state, which issued stayathome orders Friday, and they’re climbing in Florida, Illinois, New Jersey and other states too.
California was among the first places to identify outbreaks, including Santa Clara County. And it has launched the most assertive responses.
The Bay Area order that went into effect Tuesday called for sheltering in place until April 7, but infectious disease experts say it’s likely to extend far beyond that. In a news conference Friday, Newsom said the statewide directive could be in place for two months, or longer. Experts in studying the course of pandemics, and of coronavirus in particular, say some degree of social distancing may be required for a year, or until a vaccine or treatments are developed to fight the virus.
No one expects California, or other parts of the country that have since followed suit, to shelter in place for 12 months. But what the next phase of the pandemic looks like isn’t clear. Last week, Wuhan — a city of 11 million in China, and the epicenter of the global outbreak — finally began to emerge from a twomonthlong shutdown, with people just starting to return to jobs and school. South Korea, too, appears to be past the worst of its outbreak.
Public health authorities worldwide will be watching both places for evidence that their epidemics truly are under control. They don’t want to see flareups of new cases, or signs that people who became sick but got well can be reinfected. If the recovery holds in those countries, that may give U.S. public health officials some comfort that they can relax a bit sooner rather than later.
But they’re also watching Italy, where the case counts and deaths have skyrocketed and hospitals have been deluged with patients, despite the entire country being locked down. It’s possible they simply implemented national isolation strategies too late, infectious disease experts say. The Bay Area moved a bit faster, and that could make a big difference.
“We’re making these big, broad control measures, and it should work. What we’re doing in the Bay Area should theoretically work,” said Dr. Lee Riley, an infectious disease expert at UC Berkeley. “Italy is really kind of an exceptional situation. They made a very drastic control measure, but maybe it happened too late. Maybe in the Bay Area, we’ll be more like the situation in Asia than Italy. But I don’t know if we made the intervention early enough either.”
Bay Area health officers called for the shelterinplace order when they saw cases in the region mounting exponentially — meaning they were doubling or tripling every week. Due to insufficient testing supplies, California case counts — including reports by counties — are flawed and don’t come close to capturing the full extent of the outbreak.
Daily California cases and deaths from COVID-19
11
TOTAL: 1,464
Everyone’s got to be on board if we’re going to blunt this curve so we don’t overwhelm the health systems.”
Greene, like many of his peers, said he’s grown increasingly alarmed by the pace of the coronavirus outbreak internationally and in the United States. Projections of massillness and hospitals too overrun to keep up with demand seem to be playing out in real time in Italy, and in a few places in the U.S., including New York.
“I said early on in February this is not the apocalypse,” Greene said. “I’m not so sure I was right.”
One projection that has garnered widespread attention — published last week by Imperial College London scientists — suggests that more than 1 million people could die in the U.S. if the country keeps on its current course, which relies on advising older adults and other vulnerable Americans to selfisolate, and everyone else to avoid large gatherings.
More aggressive efforts, like what’s happening in California, could stop the outbreak entirely and prevent almost all of those deaths. But maintaining the necessary level of isolation is extremely challenging, the authors of the paper acknowledge. And their calculations suggest that stopping a national epidemic entirely would require a year or more of such restrictions.
So far, most people in the Bay Area seem to be obeying the spirit of the local orders. St. Patrick’s Day — which fell the day that the regional order went into effect — was quiet this year with bars and clubs closed. Aside from a few reports of joggers crowding the Embarcadero in San Francisco, or of shoppers getting a little too close at busy grocery stores, people seem to be keeping their distance from one another.
But massisolation is stressful — economically and socially. That stress has to be taken into consideration when deciding how long the shelterinplace orders stay in effect, said Dr. Shannon Bennett, a virologist and chief of science with the California Academy of Sciences.
“Right now we have to take this very seriously because we need to knock these cases down to nonexponential growth. But maybe we can climb our way out of this and ease back into things without respurring the trajectory,” Bennett said.
Rutherford agreed, noting that a “shock and awe” treatment of rigorous isolation could tame the outbreak enough that “maybe we could take our foot off the brake — slightly.”
“I’ve seen people keeping pretty far apart. If this works, if we really do reduce transmission, and if no one tries to recreate the St. Patrick’s Day that never was, we may truly see the effects in two weeks, maybe three,” he said. “And then you can go back to more of a maintenance phase.”
A “maintenance phase” might mean easing some, or most, social restrictions, while going back to aggressively identifying, isolating and tracking new cases as they come up, to prevent another outbreak. But public health authorities — plus Newsom — haven’t said at what point they’ll lift the current restrictions, or what reintroduction to socalled normal life will look like.
“I think we’re looking substantially beyond April 7,” said Dr. Art Reingold, an infectious disease expert at UC Berkeley. “It’s going to be continuing for at least, I would say, into May or June — and then we’ll see what the summer brings.”
Erin Allday is a San Francisco Chronicle staff writer. Email: eallday@sfchronicle.com Twitter: @erinallday