A UCSF doctor did some math to estimate the number of lives the San Francisco Bay Area may have saved by jurisdictions acting quickly and residents following strict shelter-in-place orders.
Dr. George Rutherford, a professor of epidemiology and the head of the division of infectious disease and global epidemiology, believes some 34,000 to 44,000 lives have been saved partially through the region’s early action, such as San Francisco Mayor London Breed issuing a state of emergency on February 28.
Rutherford pointed out that Breed’s declaration nudged people to start staying home nearly three weeks before the shelter-in-place order was issued, dramatically limiting people’s movement.
How did Rutherford get to these numbers? First, he looked at the worst-case scenario forecasts for deaths in the United States if no precautions were taken.
A top disease modeler at the U.S. Centers for Disease Control and Prevention forecast that the U.S. could see as many as 1.7 million deaths. The C.D.C. didn’t release the number to the general public, but the New York Times obtained screenshots from a presentation done on a phone conference and verified the data with scientists on the call. What’s more, a model from the Imperial College of London forecast 2.2 million Americans could die as a result of the coronavirus pandemic if people went on with their daily lives as disease spread.
Rutherford figured the six Bay Area counties that issued shelter-in-place orders on March 16 — Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara — make up about 2% of the U.S. population, considering these counties have about 6.6 million residents compared to the 328.2 million U.S. population.
Two percent of 1.7 million is 34,000 and of 2.2 million is 44,000; these numbers provide a very rough estimate of the number of deaths that could have occurred if no precautions were taken, according to the C.D.C. and Imperial College in London. In reality, Rutherford said, “We’ve had 200 deaths so far. That’s the delta. That’s the difference. That’s a lot.”
The reservation site Open Table is one indicator offering additional proof that people in the Bay Area were staying home earlier than those in other parts of the country. Rutherford said reservations dropped dramatically in San Francisco after February 28 while in Los Angeles and New York, the data shows people continuing to go out.
California Gov. Gavin Newsom was a guest on KCBS Radio Thursday morning and discussed the first modification to the state’s stay-at-home order that was issued last month to stop the spread of the coronavirus.
Newsom said “essential surgeries” are now allowed “because we believe we have appropriate capacity within our hospitals and alternative care sites to allow scheduled surgeries to go back and be conducted.”
Newsom added: “That’s a very positive thing. It’s the first sign of progress — an indicator light that went green, not red. I hope to be making subsequent announcements over the next days and weeks so that we can get back into the beginning of some semblance of normalcy.”
The governor initially announced the augmentation to the order at his Wednesday press conference and clarified that “essential surgeries” — not “cosmetic surgeries” — are allowed effective immediately. Examples include the removal of tumors or a heart valve procedure that isn’t an emergency but, if neglected, could become a problem.
“These are surgeries that are scheduled but also essential,” he said. “The surgeries where if it gets delayed it becomes acute.”
Find the full KCBS interview here and read more about Newsom’s press conference here.
Cumulative cases in the greater Bay Area (due to limited testing these numbers reflect only a small portion of likely cases):
Five Bay Area counties will begin enforcing face coverings in essential businesses and on public transit Wednesday to reduce the spread of the coronavirus.
In the following counties, you could be hit with a citation and/or a fine if you’re not following the order asking people to cover their noses and mouths with cloth.
Alameda
Contra Costa
Marin
San Francisco
San Mateo
Sonoma began enforcing its order last Friday. The cities of Berkeley and Fremont issued their own mandates.
Santa Clara County is “strongly urging all individuals” to wear face coverings when out of their homes to perform essential activities, but has yet to issue an official requirement that’s enforceable by law. In a statement, the county noted “enforcement resources across the county are limited” and the public has generally followed past guidance without enforcement.
The orders in all jurisdictions are generally the same, requiring people to wear coverings in public places, especially indoor spaces, where they’re unable to physically distance.
The reason for the new rules is that research shows a cloth covering the nose and mouth can help prevent the spread of respiratory droplets that are the main way the coronavirus is transmitted between people.
In all jurisdictions, the coverings can be manufactured or handmade or simply any type of cloth fabric or soft material such as a bandana, scarf or neck gaiter. Medical masks aren’t necessary and should be prioritized for health care workers.
Here’s a quick overview of the orders in each jurisdiction.
Alameda: The county is requiring members of the public and workers to wear face coverings while inside of or waiting in line to enter essential businesses, when seeking health care, and when waiting for or riding on public transportation. Read the full order.
Berkeley: Anyone out in public visiting essential businesses, seeking health care or using public transportation is required to use a face covering. Workers at essential businesses are also required to cover their face. Read the full order.
Contra Costa: Anyone working at or visiting an essential business, such as a grocery store or gas station, is required to wear face coverings. The order does not require children 12 and younger to wear masks. Read the full order.
Fremont: The East Bay city of Fremont is requiring workers and customers at essential businesses to wear face coverings amid the COVID-19 emergency. An employee can deny service to an individual who is not wearing a face covering. Read the full order.
Marin: Residents are being asked to wear a face covering when they are interacting with others who are not members of their household in public and private spaces. Children aged 12 years old or younger are not required to wear a face covering. Read the full order.
San Francisco: Residents and workers in SF will be required to wear face coverings at essential businesses, in public facilities and on transit. Read the full order.
San Mateo: The order mandates members of the public and workers at essential businesses to wear face coverings outside the home for certain activities and in places of business. The order took effect Friday night but will not be enforced until 8 a.m. on April 22. Read the full order.
Sonoma: All people must wear facial coverings before they enter any indoor facility besides their residence, any enclosed open space, or while outdoors when the person is unable to maintain a six-foot distance from another person at all times. Children over the age of 2 are being asked to wear face coverings. The requirement went into effect Friday. Read the full order.
Cumulative cases in the greater Bay Area (due to limited testing these numbers reflect only a small portion of likely cases):
California Gov. Gavin Newsom appeared on “CBS This Morning” Tuesday and co-host Tony Dokoupil asked, “Can you say from where you’re sitting at this moment that the worst is over in California?”
Newsom responded, “No, because if we all pull back, we could see a second wave that makes this pale in comparison. I can’t say that. Honestly, that’s determined by the act of 40 million Californians stepping in, continuing to meet this moment… ICU numbers are beginning to flatten, but we’re not seeing yet the significant decline that we need to see ultimately to toggle back. But we are committed to a process. We’ve socialized that process. And we are leaning in, working with 58 counties across the state to make sure that we do it together in a thoughtful and strategic way.”
Last week, Newsom announced the beginnings of a plan to relax the stay-at-home order and reopen the economy and society under new guidelines. Newsom alluded to the next phase on CBS, and the governor is expected to give more details in a press conference on Wednesday.
“I don’t anticipate that normalcy that many of us wish for happening any time soon,” Newsom said on CBS. “But we will begin to toggle back, to put a little dimmer switch up, and begin to change the way we currently are conducting ourselves from a full lockdown stay at home order to one that is more prescriptive, targeted and strategized.”
Dokoupil also asked Newsom about baseball and whether games may happen this summer, as soon as July. “But the idea of tens of thousands of fans coming together across their differences, high-fiving one another, hugging each other— after a base hit or a strikeout— is not something I’m anticipating any time soon,” he said on CBS.
Cumulative cases in the greater Bay Area (due to limited testing these numbers reflect only a small portion of likely cases):
On the morning of March 15, as Italy became the epicenter of the global coronavirus pandemic, a half dozen high-ranking California health officials held an emergency conference call to discuss efforts to contain the spread of the virus in the San Francisco Bay Area.
The tight-knit group of Bay Area doctors organized the call to discuss a consistent policy on public gatherings for the region’s 7 million people, which then had fewer than 280 cases and just three deaths. Soon, though, the conversation focused on the potentially catastrophic emergency on their hands and how stay-at-home orders could slow the advance of the virus.
Many factors have fueled the speed of the disease spread throughout the world. But that three-hour call and the bold decisions to come out of it were central to helping California avoid the kind of devastation the virus wrought in parts of Europe and New York City, experts say.
“It was obviously spreading like wildfire under our noses and literally every minute we did not take aggressive action was going to mean more and more death,” said Dr. Scott Morrow, health director for San Mateo County, just south of San Francisco and home to Facebook.
The doctors who met that day are members of the Association of Bay Area Health Officers, a group born out of the AIDS epidemic that ravaged San Francisco in the 1980s. The group usually meets a half-dozen times a year and has tackled other global threats such as Ebola and swine flu.
By mid-March, group members were alarmed by the spread of the virus since an initial case in the state was confirmed Jan. 26. Dr. Sara Cody, the top doctor in Santa Clara County, home to 2 million residents and the headquarters of Apple and Google, told her peers that COVID-19 cases were doubling every three days. In neighboring San Mateo County, every test conducted was coming back positive, shared Morrow. Across the bay in Alameda County, Dr. Erica Pan reported that cases were rising in areas bordering Santa Clara County.
A day later, the San Francisco Bay Area became the first place in the nation to order residents to stay home. At least 20 other California counties adopted the Bay Area order within hours. Two days later, Gov. Gavin Newsom ordered all 40 million Californians to stay home unless they had essential jobs.
It’s impossible to quantify how much those orders helped or truly compare states or countries because of other potential factors such as population density, international travel and the number of tests being conducted in each place. However, experts in disease control say the Bay Area’s early intervention clearly played a significant role in slowing the speed of infection throughout California.
On March 15, California reported 335 cases and six deaths. As of Sunday morning, the state had confirmed more than 30,800 cases and nearly 1,150 deaths. The slowing rate of infection, at 73 per 100,000 residents as of Friday, and deaths is one one of the reasons Newsom says the state can contemplate reopening businesses.
The area is now reaping the benefit of putting stringent recommendations in place “very, very early,” said Robyn Gershon, a clinical professor of epidemiology at New York University’s School of Global Public Health.
“In New York, by the time social distancing came we already had many, many people sick. Without tests, without a vaccine, your only tool is having people not contact each other,” Gershon said.
Just a few days after California’s order, with the number of infections above 15,000 in New York state and more than 100 dead, New York Gov. Andrew Cuomo ordered businesses and workplaces to shut down.
Most people recover from the new coronavirus with symptoms such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, and death.
In January, the group in California began holding twice weekly phone calls to prepare for coronavirus, initially discussing how to monitor Americans returning from China, where the virus began, or how to disinfect ambulances that had transported COVID-19 patients.
But on March 15, the call focused on “extreme social distancing.” Marin County Public Health Director Dr. Matt Willis wondered whether such a radical measure was needed in his county, which at the time had only 10 cases. But with no federal or state guidance, he soon agreed “an aggressive approach to a shelter-in-place policy was really the one lever that we had.”
Cody, who has been credited by many for driving the urgency during that call and whose county was the first to declare a state of emergency in California, told colleagues of increasing hospitalization rates there, sharing early data from a Centers for Disease Control and Prevention community survey that found about one in 10 of those seeking medical care for flu-like symptoms at public clinics had coronavirus.
“We realized we were not that far behind what was happening in Italy,” the Santa Clara County health director said.
On March 15, Italy’s hospitals were already overwhelmed, with more than 1,800 having died. Less than a week earlier, officials had imposed countrywide, strict stay-at-home orders after they failed to contain the outbreak in the hard-hit north. The death toll has now climbed to nearly 23,000. The European country had confirmed its first two cases on Jan. 31.
Officials have contemplated why San Francisco Bay Area residents have largely complied.
Californians were already seeing daily images of a cruise ship off California’s coast with at least 21 confirmed coronavirus infections aboard before it docked on March 9, so the virus was front-of-mind. Tech conferences that typically bring international travelers to the Bay Area each spring were being canceled and tech companies from Silicon Valley to San Francisco began telling employees to work from home. It’s also the makeup of the Bay Area, officials say, including people with connections around the country and world.
San Francisco residents generally are willing to comply with such things “when shown the science, when shown the data about what can be accomplished,” said Dr. Susan Philip, director of disease prevention and control at the San Francisco Department of Public Health.
In the month since, Bay Area residents have largely continued to heed the mandate, quickly understanding the concept of “flattening the curve” to slow the rate of infection and avoid overwhelming hospitals.
“The timing of instituting the stay-at-home order is very, very critical in blunting the epidemic,” said Lee Riley, a professor of epidemiology and infectious diseases at the University of California Berkeley. He warned, though, that complacency could ruin any initial success, noting “we need to remain vigilant.”
Still, a challenge looms for the Bay Area doctors who continue to talk to each other twice a week: How to lift the shelter-in-place orders without creating a second surge.
“We’re going to be relying on the same kind of partnership that we relied upon for the first stage of this to help us through,” Willis said.
San Francisco Pride officials announced Tuesday they were cancelling the 2020 Pride Parade and the weekend Pride 50 celebration over concerns raised by the continuing coronavirus outbreak in the San Francisco Bay Area.
The parade and weekend celebration of diversity and the LGBTQ community, originally scheduled to take place June 27-28, annually brings massive crowds to San Francisco, presenting a difficult challenge to organizers in these times of social distancing.
As 2020 is a historic 50th anniversary, upward of a million people were expected to attend, to witness more than 275 contingents march down Market Street toward Civic Center, where more than 20 community-programmed stages and gathering spaces highlight the diversity of all LGBTQ experiences.
The California Department of Public Health provided new data on the state’s positive COVID-19 tests on Wednesday, and provided the striking piece of information that health care workers make up nearly 10 percent of the state’s confirmed cases.
At the time of the report’s publication, there were 16,957 confirmed cases in the state, and 1,651 involved health care workers. However, just 299 of health workers were known to have acquired the virus in a “health setting,” while 462 were exposed via travel, close contacts, or community transmission, and a whopping 890 cases are of unknown origin.
“Since COVID-19 is moving rapidly within the community, health care workers now appear just as likely, if not more so, to become infected by COVID-19 outside the workplace,” the report states.
The report did not give any additional information on which workers are seeing higher infection rates.
“This larger number, which includes both occupational and non-occupational exposures, is important because it shows the overall impact of COVID-19 on the health care workforce,” the authors of the report write. “Regardless of the source of exposure, an infected health care worker needs to isolate from the workforce to prevent risk of infection to colleagues and the patients they serve.”
Researchers at Stanford Medicine are working to find out what proportion of Californians have already had COVID-19. The new study could help policymakers make more informed decisions during the coronavirus pandemic.
The team tested 3,200 people at three Bay Area locations on Saturday using an antibody test for COVID-19 and expect to release results in the coming weeks. The data could help to prove COVID-19 arrived undetected in California much earlier than previously thought.
The hypothesis that COVID-19 first started spreading in California in the fall of 2019 is one explanation for the state’s lower than expected case numbers.
As of Tuesday, the state had 374 reported COVID-19 fatalities in a state of 40 million people, compared to New York which has seen 14 times as many fatalities and has a population half that of California. Social distancing could be playing a role but New York’s stay-at-order went into effect on March 22, three days after California implemented its order.
“Something is going on that we haven’t quite found out yet,” said Victor Davis Hanson a senior fellow with Stanford’s Hoover Institute.
Hanson said he thinks it is possible COVID-19 has been spreading among Californians since the fall when doctors reported an early flu season in the state. During that same time, California was welcoming as many as 8,000 Chinese nationals daily into our airports. Some of those visitors even arriving on direct flights from Wuhan, the epicenter of the coronavirus outbreak in China.
“When you add it all up it would be naïve to think that California did not have some exposure,” said Hanson.
For years California has been the No. 1 travel destination for Chinese tourists in the United States. Even after the U.S. halted flights from China this winter Chinese travelers were still able to come to California on flights from Europe and Canada.
Hanson said through all of this the Chinese have been disingenuous about the timing of the initial outbreak of COVID-19.
“They originally said it was in early January, then it got backdated to December and then early December and now they are saying as early as November 17,” said Hanson.
If Californians were exposed earlier than the rest of the country to COVID-19 we may have had a chance to build up some herd immunity to the disease. We won’t know if that is the case until results from the Stanford Medicine study come back.
On Friday and Saturday, the study’s co-lead Eran Bendavid coordinated testing at sites in San Jose, Los Gatos and Mountain View. The teams used an antibody test from the company Premier Biotech. Technicians use a finger prick to draw blood for the test and it can tell within minutes if a person developed antibodies to COVID-19.
The same brand test is being offered at a lab in Monterey and healthcare workers there are closely watching the study. Spenser Smith with ARCpoint Labs is aware of the theory that COVID-19 arrived here as early as the fall and that some people may have had the virus unknowingly.
“Knowing the levels as to which that happened would be great and one of the tools you can use is this test,” said Smith
ARCpoint Labs started offering the antibody test in Monterey last week and has since tested 500 people. Smith said ARC has had some positive results for COVID-19 and is reporting all results to Monterey County’s Public Health Department.
Hanson said the testing could help us as we start the recovery process. He does not advocate lifting social distancing rules right now but said testing could help get some people back to work.
“It is going to allow us to get back to normal much more quickly because there will be many more people than we think that have anti-bodies,” he said.
Positive results in recovered folks could get nurses and caregivers back on the front lines of the pandemic as well as dishwashers and small business owners who keep our economy going.
The results of the study could also help us all to feel less scared of COVID-19. Limited testing has resulted in an artificially high death rate. The more people we can test who have mild symptoms, who are asymptomatic or who have recovered the less-lethal COVID-19 will seem.
The same brand test is being offered at a lab in Monterey and healthcare workers there are closely watching the study. Spenser Smith with ARCpoint Labs is aware of the theory that COVID-19 arrived here as early as the fall and that some people may have had the virus unknowingly.
“Knowing the levels as to which that happened would be great and one of the tools you can use is this test,” said Smith
ARCpoint Labs started offering the antibody test in Monterey last week and has since tested 500 people. Smith said ARC has had some positive results for COVID-19 and is reporting all results to Monterey County’s Public Health Department.
Hanson said the testing could help us as we start the recovery process. He does not advocate lifting social distancing rules right now but said testing could help get some people back to work.
“It is going to allow us to get back to normal much more quickly because there will be many more people than we think that have anti-bodies,” he said.
Positive results in recovered folks could get nurses and caregivers back on the front lines of the pandemic as well as dishwashers and small business owners who keep our economy going.
The results of the study could also help us all to feel less scared of COVID-19. Limited testing has resulted in an artificially high death rate. The more people we can test who have mild symptoms, who are asymptomatic or who have recovered the less-lethal COVID-19 will seem.
Despite encouraging signs that social distancing is working in California, where most residents are in their third week or more of sheltering at home, state officials are still projecting COVID-19 infections will peak in mid- to late May.
The reason for that is not because social distancing is failing — it’s an intended consequence of shelter in place. Social distancing is not meant to end the coronavirus outbreak; it’s meant to slow it down until a vaccine is widely available. By “flattening the curve,” California health officials hoped to buy time, preventing the type of overloading of the health care system that’s happening right now in New York City.
“We know that the bending or flattening of the curve means two things,” said Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, on Tuesday. “It means our peak comes down, but it also means it goes further out. We move that lower and further out. So our thinking around May, and late May in particular, means it follows this idea of flattening. It’s not just a reduction down, it’s moving it out.”
A consequence of flattening the curve — unfortunately for those hoping to leave home soon — is that it lengthens the duration of the outbreak. This, however, is a tradeoff most governments are willing to make. The alternative, where people are allowed to leave their homes unfettered, means many people will become sick at the same time. Hospitals, already under strain, won’t have the supplies or beds to care for everyone. This worst-case scenario occurred in Italy, where resource-strapped doctors reported having to decide which patients lived or died.
“I’ve talked about the curve bending but also stretching,” California Gov. Gavin Newsom said Tuesday. “And that’s why I just want to impress upon people that our modeling shows that we’re not at peak in a week or two. That we are seeing a slow and steady increase, but it’s moderate. And it’s moderate, again, because of the actions all of you have taken.”
One country that did briefly consider shortening its coronavirus timeline was the United Kingdom. U.K. officials floated the possibility of allowing up to 60% of the population to contract COVID-19, thus achieving “herd immunity.” At that point, enough individuals would be sickened and recover from the virus that transmission slows to an eventual halt.
As the number of COVID-19 cases continues to rise in Los Angeles County, the City of West Hollywood continues to have the highest rate of infection of any city countywide.
According to the Los Angele Department of Public Health, as of April, 2 there are 68 confirmed cases of COVID-19 in West Hollywood. Public Health data shows that one out of every 529 West Hollywood residents have tested positive for COVID-19, the highest rate of any city in Los Angeles County. Across Los Angeles County, there are 4,045 confirmed cases of COVID-19.
Nearly 40% of West Hollywood’s population identifies as LGBTQ, according to Visit West Hollywood, a Tourism Business Improvement District. Many public health experts say that LGBTQIA+ people and HIV positive individuals are likely at elevated risk for COVID-19 infection.
“Everyone is at risk of infection in this pandemic. But history shows that people who are marginalized and consequently experience disparities in health will suffer disproportionately greater harms than the general population,” said Sean Cahill, Director of Health Policy Research at The Fenway Institute. “Because of higher rates of chronic disease and risk factors like smoking and vaping, LGBTQIA+ people and people living with HIV should strictly adhere to social distancing guidelines and take care of their health as best they can right now.”
People with chronic health conditions, including HIV/AIDS, may be at elevated risk of serious complications from COVID-19. According to health experts, of most concern are people living with HIV who are not treatment adherent and virally suppressed.
“People living with HIV should make every effort to adhere to their treatment regimen by taking their HIV medication daily and engaging in other activities to remain healthy such as eating well, exercising, and avoiding tobacco and other substances,” The Fenway Institute said in a media release.
In addition, due to experiences of discrimination in health care settings as well as the impact of stigma and minority stress on health, many say that LGBTQIA+ people are more likely to have some of the underlying health conditions that could increase their vulnerability if they are exposed to the novel coronavirus.
According to The Fenway Institute, gay and bisexual men, as well as transgender women, have disproportionately higher rates of HIV. Lesbian women are more likely to have poor or fair health, multiple chronic conditions, heavy driving and heavy smoking compared with straight, cisgender women. Bisexual women are more likely to have multiple chronic conditions, severe psychological distress, and engage in heavy drinking and moderate smoking. Lesbians, gay men, and bisexuals of all ages are more likely to be living with disabilities than the general population. LGBTQ youth have higher rates of sedentarism, pre-diabetes, and diabetes. LGBT people are more likely to smoke and vape, and to use substances.
“A real concern for LGBTQIA+ people during this pandemic is that we know that they avoid seeking needed health care due to previous experiences of discrimination in health care settings or the fear of experiencing discrimination,” Cahill said. “We’ve also seen new policies enacted at the federal level and in some states that make it easier for health care providers to refuse treatment based on religious or moral beliefs. Discrimination in health care is never acceptable. During an unprecedented global health emergency, this is especially true.”
Another vulnerable group of people are transgender elderly people. An estimated 162,300 LGB and 9,000 transgender people age 65 and older live in California and are at high risk for serious illness from COVID-19, according to the Williams Institute at UCLA School of Law.
Health officials have associated high risk with people age 65 and older and those with compromised immune systems or serious chronic medical conditions like heart disease, diabetes and lung disease. Using data from the California Health Interview Survey, researchers found that 53,100 LGB people and 3,000 transgender people in California age 65 and older have fair or poor health.
“Social and economic vulnerabilities can also contribute to an increased risk of serious illness related to COVID-19,” said lead author Ilan H. Meyer, Distinguished Senior Scholar of Public Policy at the Williams Institute. “In addition to age and health, California’s public health measures should consider these factors, as many elderly LGB and transgender people in the state live alone and in poverty and may need special assistance.”
