With COVID-19: California May Have Only Delayed The Inevitable.

Journalist Joe Nocera has a problem. In his Bloomberg editorial this weekend (WARNING: paywalled), he wants to know why California, which is seeing a surge in COVID-19 cases, isn’t getting the type of criticism that Florida, Texas and Arizona are getting. In the Golden State, cases are surging, positive test ratings are surging and hospitals in Los Angeles, like those in Phoenix, Houston and Miami, are approaching critical capacity.

Nocera, a conservative, blames politics. California’s governor, Gavin Newsom, is a Democrat. He had been praised in the Spring for his COVID-19 response by experts and liberals who sought to compare and contrast his response to Republican governors and Donald Trump. The other three states have Republican governors who reopened their states against medical expert advice and declared victory when there were no spikes in cases after 2-4 weeks.

In fact, Florida Gov. Ron DeSantis went so far as the demand an apology from the media in late May for being “wrong” about predicting a surge in cases. The National Review’s Rich Lowrey even joined him in demanding people apologize to DeSantis for predicting a surge. In the face of the type of smugness and arrogance Republicans delivered during the reopening in May and June, versus Newsom, who had a more muted and methodological response to reopening, it is not surprising people are being harder on them than Newsom, party label aside. Newsom kept his state closed for far longer than the other governors, and didn’t spike the football when it appeared the worst had passed.

California tried, the other states didn’t, but California’s experience complicates the narrative of whether or not its possible to actually crush the curve without a big outbreak or more harsh mitigation measures. New York’s success may not be its speed and timing of reopening, but because it got hit hard in the first place.

STATE	Cases At Lockdown	Cases at Reopening	Cases as of July 10
California	1,006 (March 19)	64,561 (May 7)	296,499 (+495%)
New York	20,875 (March 22)	348,232 (May 15)	400,299 (+15%)

Did California reopen too early? Maybe. The state did not meet the protocols the CDC set out, specifically 14-day declines in cases, but California began reopening on May 8, when the daily case count was around 2,100 a day. New York began reopening on May 15 when the daily case count was around 2,500. So how did California screw up while New York didn’t despite the latter having more new cases?

Some have pointed to the fact that New York had a regional approach to reopening where areas like the North Country and Finger Lakes that weren’t hit very hard began reopening May 15, while New York City, where a majority of the cases were, didn’t start the reopening process until June. However, California did something similar – allowing rural counties to begin reopening earlier than Los Angeles and the Bay Area. California definitely did have more internal opposition to shutdowns and in populated areas, with conservative areas like Orange County, the Inland Empire and Central Valley opposing shutdowns in larger numbers than New York’s more rural conservative areas. California’s mask mandate came in June, while New York’s came in April, and California was doing less testing per capita than New York, so it is possible there were far more cases in California than New York at reopening that were missed. But there might be another reason for California’s inability to curb a second rise in cases.

When California reopened, though it had less daily cases than New York, the trend was very different. New York had over a month of declining cases, while California had plateaued at around 2,000-2,500 cases a day, seeing no declines. The situation basically forced Newsom’s hand. With no decline in sight, how long could California remian closed?

In May, Los Angeles County Public Health Director Barbara Ferrer made waves when she suggests the county’s “stay-at-home” order would have been in place until August. San Diego County extended its order indefinitely. The news led to some anger and frustration as to why California, which had been compared positively to New York in terms of controlling the virus by shutting down earlier, would need to stay in lockdown longer than New York. Republicans even sued Newsom, seeking to roll back his shutdown, buoyed by a decision by the Wisconsin Supreme Court that effectively ended Democratic Gov. Tony Ever’s stay-at-home order and business closures in that state.

Throughout this pandemic, we’ve been told to learn the lessons of the 1918 Spanish Flu. One of the most common comparisons that is made is to the responses from the cities of Philadelphia and St. Louis in 1918. At the start of the second wave of the pandemic, Philadelphia waited too long to implement mitigation measures, and instead held a parade to raise money for soldiers fighting World War I. St. Louis, on the other hand, instituted strict mitigation measures and did so early. As a result, Philadelphia had a much high mortality rate as compared to St. Louis and hospitals in Philadelphia were overwhelmed.

But as I mention in more earlier Fact vs. Fiction piece, that doesn’t tell the full story of what happened after. As the chart below shows, Philadelphia’s peak was way higher than St. Louis’, but the outbreak was over by November 16, 1918, while St. Louis struggled to bring the cases down, eventually reaching its peak in December, long after the outbreak was over in Philadelphia.

And what about mitigation measures? (I’m hesitant to call them lockdowns because in most places, there wasn’t a total economic shutdown, just mandating masks, banning mass gatherings and some business closures). Philadelphia lifted theirs after four weeks. St. Louis, under great public pressure, lifted them after six weeks, only to reinstate them a couple of weeks later for another month and a half. (see charts below from National Geographic). Much like California vs. New York today, St. Louis was still battling the pandemic, while Philadelphia appeared to have beaten it.

So what happened? How did Philadelphia manage to quell its much worse outbreak with only four weeks of mitigation while St. Louis struggled for three months? Well, when you flatten the curve, the timeline takes longer. Messaging early in the pandemic led many to believe that the flatter the curve, the quicker we would come out on the other side. But that’s only true if you crush the curve, which California did not do. Such a thing would likely require a Wuhan-style lockdown, which was never possible (and assumes the data we got from Wuhan is reliable).

Now, this isn’t an argument FOR herd immunity, because we don’t know how COVID-19 immunity works, but its worth exploring whether or not New York has been able to reopen effectively not only because its reopening was slower, but also because a significant portion of the state and city got hit the first place and has, at least, temporary immunity that is slowing transmission. This is also not to say the pandemic is over in New York. Certainly a second wave is possible, if not likely, but New York has brought down the daily case load to levels that contact tracing and isolation can work.

Basically, California may have delayed the inevitable. Perhaps that was the goal. Even with its new outbreak, projection models don’t have California reaching New York’s death toll before November. We’ve learned more about the virus and how to treat it. Remdisivir wasn’t approved as an emergency treatment when New York was in the middle of its epidemic; many more drugs are coming in the pipeline and a vaccine may be here as early as January. In delaying the inevitable epidemic, California may have given science time to prepare and learn.

But early messaging definitely did not prepare anyone, let alone Californians, for month and months of lockdown, especially when it works. Imagine telling someone in March – “If we do this right, you’ll be home for a year, but if we don’t, it’ll be over in a few months”

What do you think the response would be?