State and local leadership is much better than most — but that’s not going to be enough
As the COVID-19 pandemic subsides substantially in New York and New Jersey, it’s rising dramatically in red states in the South and Southwest, where governors have long been in denial. As of June 22, the 14-day trend in COVID-19 cases was up 169% in Florida, and up 121% in Texas and Arizona. The increases in those three states alone since June 1 was roughly equivalent to all of the sharp drops in cases from New York and New Jersey that occurred the month before. Oklahoma, which hosted Donald Trump’s disastrous campaign reopening, saw a much more dramatic 261% increase.
Those two ongoing trends have been the most significant pandemic stories over the past month, as attention has been primarily focused on Black Lives Matter protests across the country and around the world.
But there’s another story that’s been missed in all this: The anomalous case of California, where its 14-day trend rose 36% despite an early, robust and sensitively-designed response, and the even more anomalous case of Los Angeles County, where matters are significantly worse. The county crossed the 3,000 deaths threshold on June 18 with 3,027 recorded. It also passed the 75,000 case threshold two days earlier with 75,172, and has now passed 85,000 as well.
As of June 22, almost 38% of California’s cases had occurred in June.
“We’re not into the second wave,” Gov. Gavin Newsom warned in a press conference. “We’re not out of the first wave.”
The same day, Los Angeles County Director of Public Health Barbara Ferrer warned, “This is our third day in the past week when we reported over 2,000 cases during a single day.”
It had only happened once before that.
Public exposure was a growing concern, according to Christina Ghaly, director for Los Angeles County Department of Health Services.
“The model suggests that about 1 in 400 Los Angeles County residents are currently infectious,” she said.
That excludes known cases who are hospitalized or self-isolating. With that infection rate, “It’s entirely possible, or even likely, after safer at home orders are paired back, that an average person in an average day may come in vicinity of others who are infectious,” Ghaly said.
But just the week before, both Newsom and Ferrer had seemed cautious and self-confident. At his June 15 press conference, Newsom cited a broad range of indicators showing relative stability — the positivity rate of COVID-19 tests, hospitalization rate, and intensive care unit patients as well.
He acknowledged that rates weren’t coming down, but sought to normalize what was happening.
“We have a state that is holding strong, in terms of stability in case rates,” he said. “We didn’t experience the great spikes as a number of East Coast states did, and so in consequence, we’re not experiencing a precipitous decline in the number of positive cases, but the stability remains and is holding strong.”
But part of what was stable was an increase in cases, from a seven-day average of 2,635 on June 1 to 2,876 on June 15, with eight all-time highs in 14 days.
At the same time, the reopening process had advanced significantly, with county health departments setting the pace, subject to state oversight and guidance.
When asked whether the state was prioritizing the economy ahead of health concerns, Newsom pushed back.
“This is not an economic question — it’s a health question, broadly defined,” Newsom said, citing poverty rates, unemployment rates, people lacking access to preventative health care and those suffering with mental health issues.
“There’s a certain point where you have to recognize, you can’t be in a permanent state where people are locked away for months, and months, and months, and months on end … to see lives and livelihoods completely destroyed, without considering the health impact of those decisions as well,” he said.
Despite an outsized role in contributing to statewide cases and deaths, Los Angeles County’s reopening process has been fairly rapid. On May 29, the health department issued protocols for re-opening restaurants for on-site dining, along with hair salons and barbershops. Then on June 12, it provided for the opening of multiple sectors, subject to protocols for infection control and distancing. These included:
• Gyms and fitness facilities
• Pro-league arenas without live audiences
• Day camps
• Museums, galleries, zoos and aquariums
• Campgrounds, recreational vehicle parks and outdoor recreation
• Music, film and television production
• Hotels for leisure travel
The consequences of these last two phases of reopening will only start to register in terms of case rates around June 27 through July 1.
In that same June 15 press conference, Newsom also stressed the strength of the state’s contact tracing program, saying the state aims to reach 10,000 contact tracers by July 1. Ferrer addressed the subject that same day.
“Contact tracing is a confidential and simple process that has been used by public health departments for decades to slow the spread of infectious diseases and avoid outbreaks,” Ferrer said.
“Currently, Public Health has over 1,500 persons working as contact tracers for the COVID-19 response,” a department press release explained. “Public Health interviews persons who have tested positive for COVID-19…. This involves identifying and interviewing every person who has been in close contact with someone who is suspected or confirmed to have COVID-19 in order to quarantine those exposed (contacts) and monitor them for signs and symptoms of the disease.”
But the inadequacy of contract tracing with such high case rates was highlighted by Harvard epidemiologist Marc Lipsitch.
“Countries that have had great success with contact tracing didn’t reopen with 100s or 1,000s of new known cases a day,” Lipsitch tweeted on June 23. “Korea reopened with 5 [cases]/day in 50m[illion] population. Europe reopened around 2 [cases]/100K [population]/day or less.”
In contrast, he noted multi-stage data analysis from New York City showed that “at most (approx) 22% of transmissions could be captured with present performance.”
Even if Los Angeles County did twice as well, less than half of transmissions would be traced.
And the county remains a significant hot-spot. On June 17, the county’s seven-day average death rate accounted for 4.84% of the nationwide total, after a week at over 5%, with just 3.02 percent of the national population. That made our seven-day death rate 60% higher than the national average. And it’s since risen to over 5% once again. It’s outpaced the national average every day since May 19, but exceeded it just once before that.
Our seven-day case rate looks even worse in this comparison: On June 18, it dropped below twice the national average for the first time since George Floyd was murdered on May 29.
In short, while California and Los Angeles County are much more serious in dealing with COVID-19 than Republican governors in Florida, Texas, Arizona and elsewhere, they appear to be calibrating their actions against questionable background assumptions. Being smart compared to Trump or Republican governors following his lead is not being smart enough.
This was evident in Newsom’s June 15 press conference, where he stressed the need for vigilance, and measures like mask-wearing and presented a slide of the case-rate trajectory of 1918-19 pandemic, with its three distinct peaks.
“Let us be cognizant of our past and let us be mindful of our present,” Newsom said. “We don’t want to experience a second wave, as they did in 1918, in the fall, and even in the early part of spring, 1919, that third wave, without the kind of preparation that is required of this moment…. The future’s not just something you experience. It’s not just in front of you, it’s inside of you. It’s our decisions that determine our fate and future. We have agency. We can manifest the future we want, as long as we’re smart.”
Newsom was showing a clear grasp of history, and what the last comparable respiratory pandemic has to teach us. He was far more reality-oriented than Donald Trump or any of the Republican governors who’ve followed his exhortations and rushed to open without carefully monitoring the pandemic’s response. But he was not oriented toward the substantial gains that have been made since then—gains that have informed the far more robust responses of countries that didn’t simply aim to flatten the curve, and prevent hospitals from being overwhelmed, but to crush the curve, so that containment strategies: testing, contact tracing and isolation — could be employed to reduce infections to virtually zero, as Lipsitch noted.
What all this means for Harbor Area residents varies greatly depending on where one lives. Case rates vary widely across communities, while generally reflecting the racial and wealth disparities seen nationwide, based on geographic distribution. (The county’s racial case data is woefully inadequate with almost half listed as “Other” or “Under Investigation.”) Case rates ranged from zero in unincorporated portions of the Palos Verdes Peninsula and Harbor Gateway and 103 per 100,000 in Rolling Hills as of June 21, to 2265 in La Rambla, the ninth highest rate of any community in Los Angeles County. Castaic had the highest rate countywide at 6366. There were 22 communities with no cases at all, including the City of Avalon.
The rate was 1379 in San Pedro (including the Terminal Island federal prison), 816 in Wilmington, 613 in Carson, 495 in Harbor City, 440 in Harbor Gateway, 355 in Palos Verdes Estates, 318 in Lomita, 285 in Rancho Palos Verdes, and 222 in Rolling Hills Estates. La Rambla, San Pedro and Wilmington were all above the national rate, which was 677 on June 20.
Recent case rate increases also varied widely. In the four weeks from May 31 to June 20, there was no change in Rolling Hills, while the rate in La Rambla increased 370%. Wilmington increased 65%, Harbor City 42%, Carson 40%, Harbor Gateway and Rolling Hills Estates 29%, Lomita and Rancho Palos Verdes 27%, San Pedro 18%, Palos Verdes Estates 14%.
In the next two weeks, we’ll begin to see the impacts of the latest reopening waves.
“The number of cases will increase as the number of people are out of their homes,” Ghaly said. “It’s going to be very important to watch how this increase in cases translates into our daily hospitalizations over the next few weeks.”
Let’s hope we don’t look back at where we are now and call it “the good old days.”