COVID CHRONICLES 05/12/20
Ready to Stop Distancing? Dr. Fauci Says No.
Last I left things, we were in a challenging place. I’m happy to report that the quality of information has significantly improved since then, and we’ve gotten some helpful direction from Lisa’s doctor and other reliable sources.
The study I referenced about a second strain of the virus has been challenged by other scientists. It hasn’t been proven wrong; it just hasn’t convinced everyone. Regardless, according to her doctor, it doesn’t seem that Lisa is at risk of getting re-infected. So that’s a relief. As far as our next steps go, the doctor ordered an antibody test for Lisa, and her father is in the screening process for the same test. There’s a lot to sort out with these tests, so I’ll write separately about that later this week.
Speaking of testing, my younger son got a COVID-19 “brain swab” when he was in Boulder through the county health department. He wants to make sure he isn’t bringing the virus back home to his mom or girlfriend. We’re still waiting to hear the results, but they should come through any day now.
The main thing Lisa’s doctor continues to emphasize is that Lisa had a serious illness that takes significant recovery time, and she should behave accordingly. Lisa has been following the advice and not pushing it. Her energy has definitely improved and it’s clear she is VERY SLOWLY getting better. I haven’t been pushing it either and continue listening to my body. I mean, push for what, why?!?
Living in California, especially adjacent to the Bay Area, has provided some comfort ever since we returned home. That’s because we not only have a living, breathing governor, but one who is leading the country in spearheading a response. Along with media-favorite Andrew Cuomo, right-wing punching bag Gretchen Whitmer and a few select others, California Governor Gavin Newsom has been a role model in how to respond to this crisis. If you want to know how your state SHOULD BE responding, watch what he’s been doing.
A week ago, Gov. Newsom announced that some businesses could begin to reopen. However, the path he’s laid out is nowhere near the fast lane, as described in the San Francisco Chronicle.
Newsom said he would put out guidelines that stores across the state could adopt to sell clothing, books, music, toys, sporting goods and flowers again starting Friday. Those guidelines will not be unveiled until Thursday, but Newsom said they would include providing curbside pickup rather than allowing customers back into stores.
Manufacturers and suppliers for retailers capable of curbside service will also be eligible to resume operations Friday, Newsom said.
Shopping malls, dine-in restaurants and office buildings will stay closed for now. However, counties will soon be able to ask the state for permission to reopen restaurants and some other businesses on a local, case-by-case basis.
Taking a step back, the Los Angeles Times laid out each of Newsom’s stages and when experts expect them to take place. It’s pretty sobering.
One expert, Dr. Robert Kim-Farley of the UCLA Fielding School of Public Health, told the LA Times it would be a slow process that could take over a year. But as some counties have pushed to reopen faster, Newsom is moving ahead with initial steps in the second stage of his previously outlined four-stage plan.
So when might California be ready to really loosen up its statewide stay-at-home order?
Stage 1: Continue with the stay-at-home order
This is the stage we’ve been in.
Expert forecast: Between the end of May and mid-June, Kim-Farley expects that places that have effectively maintained distancing measures will see significant reductions in the numbers of cases. He also suspects that, around this time, there will be enough capacity to offer both virus and antibody tests (which determine possible immunity) to meet the demand.
Stage 2: Gradual opening of lower-risk workplaces
Opening up with new restrictions.
- Retail, but with adaptations, like offering curbside pickup
- Factories, such as those that manufacture toys, clothing and furniture
- Offices, where telecommuting is not possible, but with modifications to lower risk
- Modified school and child-care programs
Expert forecast: As of last week, Kim-Farley suspected California would move to Stage 2 in mid-June or July but added that the government’s timing could shift depending on the status of the pandemic.
Newsom said some initial parts of Stage 2 would begin as soon as Friday, beginning with the opening of nonessential stores for curbside pickup — including bookstores, clothing stores, music stores, toy stores, florists, sporting goods retailers and so on.
Other parts of Stage 2 are still on hold — offices, shopping malls, and seated dining at restaurants, for example, are still ordered shut.
Stage 3: Opening of higher-risk workplaces
As state health officer Dr. Sonia Angell said last week,
“There will need to be much more modification to these [higher-risk] workplaces to make them safer. We need to know much more about the movement of disease to be able to make data-informed decisions about what’s safe for folks.”
These higher-risk workplaces and gatherings include:
- Hair and nail salons
- Movie theaters
- Sports without live audiences
Expert forecast: In general, Kim-Farley expects Stage 3 may occur sometime in the late summer or early fall, around August or September. He expects social-distancing measures — like wearing face coverings and limiting the number of people inside a store — to continue.
Again, as with all things in this pandemic, the timing could be earlier or later depending on how the situation is progressing.
Stage 4: Full opening
The full end of the stay-at-home order, allowing the resumption of:
- Sports with live audiences
- Convention centers
- A degree of normalcy in our everyday lives
This may not be implemented until the middle or latter part of 2021, Kim-Farley said.
Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), has said that, even under the most optimistic scenarios, it would take 12 to 18 months for a vaccine to become available. As Stage 4 cannot proceed without widespread vaccinations, its timing is the hardest to predict.
Does that sound like California life is getting back to normal anytime soon?
The San Francisco Chronicle’s Editorial Board made its position clear in its Friday editorial “California isn’t ready to reopen.” [emphasis added]
California reported its greatest single-day surge of new coronavirus cases to date on Tuesday. On Thursday, the number of Californians lost to the pandemic reached 2,500. And on Friday, Gov. Gavin Newsom began reopening the state.
Newsom’s limited easing of distancing measures, allowing curbside retail, some manufacturing and more local flexibility to depart from the orders, came amid substantial pressure. He has faced scattered but growing defiance of his shelter order among businesses and counties, one of which went so far as to allow a shopping mall to reopen this week, and he just announced a startling budget shortfall and job losses.
But for all the state’s success in slowing the contagion — and despite the economic and political costs of doing so — Newsom has noted correctly that the state’s return to normalcy must be guided by the data. And the data show California isn’t ready…
To his credit, Newsom is allowing only a phased reopening, delaying more risky and less necessary interactions. His administration has discouraged local officials from jumping ahead of the state guidance, dispatching regulators to salons and restaurants that defied his orders in Yuba and Sutter counties this week. It also issued stringent requirements for counties to reopen, including maximum case counts and minimum testing and tracing capacity.
Reopening the Bay Area
Meanwhile, the six largest counties in the Bay Area (Alameda, Contra Costa, Marin, San Francisco, San Mateo and Santa Clara) have their own criteria based on even more stringent standards for reopening, which take precedence over the state’s stages(our county, Santa Cruz, generally follows the Bay Area’s lead).
- Case counts and hospital numbers — Public health officials want the counts of both new cases and hospitalized patients to stay flat or decrease for at least 14 consecutive days.
- Hospital capacity — One of the primary goals of sheltering in place has been protecting the regional healthcare system and keeping hospitals from being overwhelmed with seriously ill patients. Therefore, hospital capacity (specifically, the percentage of total beds that are occupied by COVID-19 patients) is an important marker of our readiness and the risk of reopening.
- Testing — The Bay Area has set an ambitious target for testing: 200 tests a day for every 100,000 residents. That number is higher than what Newsom has said is needed to reopen the state, or about 150 tests per 100,000 residents. But Bay Area health officers have been more aggressive in their coronavirus response than many other parts of California: the region was the first in the country to issue shelter-at-home orders, three days before Newsom locked down the entire state.
- Contact tracing — Infectious disease experts say that even more important than testing may be contact tracing: the work of investigating every reported case of the coronavirus, identifying anyone in close contact who may be infected as well and making sure all those people are isolated or quarantined to prevent further spread of illness. Contact tracing is critical to preventing another outbreak. However, it requires an army of trained workers, plus resources such as housing to help people stay isolated if they can’t do so at home, making it a considerable logistical undertaking.
- Personal protective equipment — This is the most challenging to track, and may still be up for debate: all hospitals, outpatient medical clinics, skilled nursing facilities and first responders must have a 30-day supply of personal protective equipment, including face masks, gloves and gowns.
The Chronicle has developed a tremendous online tool. They’re mapping every reported coronavirus case in the Bay Area, California and the U.S. They are tallying the number of confirmed cases, deaths, hospitalizations and tests reported across the state by day, and tracking how Bay Area counties are progressing on criteria for reopening
Reopening the Country
Dr. Anthony Fauci is literally the only credible spokesperson in the federal government on COVID-19, just as he was with HIV. Today, in a hearing in front of the Senate Health, Education, Labor & Pensions Committee, he made clear the serious consequences states (and the country) face if they reopen too quickly. From the LA Times: Fauci warns coronavirus not ‘under control,’ says rapid reopening risks new outbreaks.
“The consequences could be really serious” if states move too fast, Fauci told the panel.
“My concern is that if states or cities or regions in their attempt, understandable, to get back to some form of normality disregard to a greater or lesser degree the checkpoints that we put in our guidelines … there is a real risk that you will trigger an outbreak that you may not be able to control.”
That “paradoxically will set you back, not only leading to some suffering and death that could be avoided, but it could even set you back on the road to trying to get economic recovery because it would almost turn the clock back,” he said.
In response to a challenge by Sen. Rand Paul,
“I think we better be careful if we are not cavalier in thinking that children are completely immune to the deleterious effects” of the illness, Fauci said, noting that there is a lot unknown about the virus and its effects.
When asked about schools reopening by Sen Cassidy (LA), Fauci replied,
“I don’t have an easy answer to that. I just don’t. We just have to see on a step-by-step basis as we get into the period of time with the fall about reopening the schools, exactly where we will be, and the dynamics of the outbreak.”
And he made clear that he did not agree with many of Trump’s optimistic statements about having the disease under control.
“I think we are going in the right direction, but the right direction does not mean we have by any means total control of this outbreak,” he said.
So, hunker down folks.
Californians — especially Bay Area residents — aren’t being released anytime soon, regardless of what the beach mobs may think. If you’re in a state where your governor doesn’t see protecting public health as their highest priority, you can still personally follow the experts’ guidance and keep yourself protected until we’re sure this thing has passed.