N.Y. fac­ing 10 times the cases seen in Cal­i­for­nia — but why?

San Francisco Chronicle - - FRONT PAGE - By Erin All­day

New York’s coro­n­avirus out­break has vi­o­lently erupted over the past few days, and the state is now driv­ing the na­tional epi­demic — while on the West Coast, pub­lic health ex­perts are won­der­ing if an early and ag­gres­sive re­sponse saved Cal­i­for­nia from a sim­i­lar fate.

Cal­i­for­nia re­ported some of the ear­li­est coro­n­avirus cases in the United States in late Jan­uary. And in the first week of March, Cal­i­for­nia and New York were neck and neck on cases of COVID­19, the dis­ease caused by coro­n­avirus. But over the past week, New York case counts have dou­bled ev­ery few days, and the state now has 10 times the cases Cal­i­for­nia does: 25,000 to 2,500.

Infectious­dis­ease ex­perts say early ma­neu­vers in Cal­i­for­nia, es­pe­cially in the Bay Area — first dis­cour­ag­ing peo­ple from gath­er­ing in crowds and then or­der­ing them to shel­ter in place — may have had a dra­matic im­pact, even if they came only a day or two ahead of those in New York.

But other fac­tors may also be in play. New York is test­ing far more peo­ple and there­fore iden­ti­fy­ing more cases, for ex­am­ple. And it’s pos­si­ble that what’s hap­pen­ing à,000 miles away could be Cal­i­for­nia’s fu­ture.

“New York may just be three or four days in front of us. We’re go­ing to see an in­crease in the num­ber of cases here as well,” said Dr. Warner Greene, a se­nior in­ves­ti­ga­tor at the Glad­stone In­sti­tutes in San ran­cisco who spe­cial­izes in HIV but is study­ing the new coro­n­avirus. “Days mat­ter — they re­ally mat­ter. You think you’re fine, you’re ab­so­lutely fine, but this thing is just wait­ing to ex­plode.

“But we went into shel­ter in place quicker× we got peo­ple apart quicker,” Greene said. “That could be a con­tribut­ing fac­tor to what we’re see­ing in Cal­i­for­nia now. And that’s why I think the whole coun­try should be shel­ter­ing in place.”

The World Health Or­ga­ni­za­tion on Tuesday iden­ti­fied the United States as the next po­ten­tial epi­cen­ter of the pan­demic, with China and South Korea both on a path to re­cov­ery and Italy start­ing to see signs of its out­break slow­ing down, though grad­u­ally.

New York state now makes up roughly half of the United States’ 50,000 cases of COVID­19. The state is also test­ing more peo­ple than any­where else in the coun­try — 90,000 as of Mon­day, com­pared with about 27,000 in Cal­i­for­nia.

How and why New York’s test­ing is so far be­yond Cal­i­for­nia’s isn’t clear. Cal­i­for­nia of­fi­cials will “ex­plain the am­bi­gu­ity” on Wed­nes­day, Gov. Gavin New­som said ear­lier this week.

But test­ing alone doesn’t ex­plain why New York’s case counts are so much higher than Cal­i­for­nia’s, or why the rate is spi­ral­ing up so fast on the East Coast. Al­ready hos­pi­tals across New York state, and in New York City in par­tic­u­lar, are fill­ing up, and Cal­i­for­nia hasn’t yet seen a sim­i­lar surge.

New York Gov. An­drew Cuomo is­sued “stay at home” or­ders last ri­day, just one day af­ter New­som did the same for Cal­i­for­nia, and four days af­ter 6.7 mil­lion peo­ple in the Bay Area were told to shel­ter in place.

The Bay Area and New York City had about à00 and 50 cases, re­spec­tively, when the Bay Area stay­home or­ders were is­sued on March 16. our days later, when Cuomo shut down the state, New York City had 5,500 cases. The Bay Area: 5à9.

Shel­ter­in­place or­ders hadn’t been in ef­fect long enough to ac­count for the dra­matic dif­fer­ences, but the Bay Area is­sued other di­rec­tives ear­lier, such as shut­ting down mass gath­er­ings, ad­vis­ing peo­ple to work at home when pos­si­ble, and ask­ing older adults and peo­ple with com­pro­mised im­mune sys­tems to stay home.

“We were more ag­gres­sive× we got out there a lit­tle ear­lier,” said Dr. John Swartzberg, an infectious dis­ease ex­pert at UC Berke­ley. “We were maybe a week up on New York, and that doesn’t sound like much time, but in terms of the spread of this pan­demic, it’s enor­mous.”

In­deed, lessons from the 191t in­fluenza pan­demic taught pub­lic health lead­ers

Misha Fried­man / Getty Images

Doc­tors test hospi­tal staff with flu­like symp­toms for coro­n­avirus as they en­ter St. Barn­abas Hospi­tal in the Bronx, N.Y.

John Min­chillo / As­so­ci­ated Press

A New York City sub­way rider pro­tects her hand with a tis­sue as she grips a pole. COVID­19 fears are shrink­ing rid­er­ship as the virus takes hold.

Mark Len­ni­han / As­so­ci­ated Press

3imes Square is nearly empty on Mon­day af­ter New York ov. An­drew Cuomo or­dered most New York­ers to stay at home.

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