SACRAMENTO, Calif. — Nine months ago, when the globe was beginning to realize the enormity of the coronavirus, experts say California made an important decision.
Standing at a podium surrounded by fellow state leaders on March 19, Gov. Gavin Newsom addressed the state, saying they faced a grim outlook if decisive action wasn’t taken quickly.
“I have long believed that the future is not just something to experience,” he said. “It is something to manifest — that our fate and future is inside of us.”
At that point, California was averaging about 37 new cases per day. Many counties had already instituted stay-at-home orders, but now, the governor was announcing a statewide mandate.
“It is decisions at the end of the day, not conditions, that determine that fate and future,” Newsom said. “We’re not victims of circumstance. We can make decisions to meet moments and this is a moment we need to make tough decisions.”
For a while, it worked.
Californians hunkered down, and just as many had hoped, the state began to bend the curve of coronavirus transmission. In April, when New York City was experiencing 1,200 coronavirus deaths a day, California, with four times the population, recorded about 70. Throughout the spring and into early summer, while death rates shot up in states like Florida and Texas, California’s stayed relatively low.
The reprieve was short-lived. Now, even though 98.3% of the state’s population is under stay-at-home orders, more than 250 Californians are dying daily, with hospital staff and resources stretched thin. In Southern California, some Los Angeles County mortuaries are running out of room to store the dead.
The toll in California isn’t yet as severe as some states.
Florida, with many fewer restrictions, ended the year with an average of 100 deaths per 100,000 people, while California reported 64 deaths per 100,000. But the full impact of the holidays has yet to be seen, and a new, more transmissible variant of the virus has arrived.
So how did we get here? Short of a robust national emphasis on testing that never materialized, human nature, “COVID fatigue,” and holiday gatherings are chief culprits, say those who study pandemics most closely.
“What you’re seeing right now is a complete function of people not being able to stay apart, not being patient,” said Bradley Pollock, associate dean for Public Health Sciences at the UC Davis School of Medicine. “This is just human nature, we’re social creatures.”
Thanksgiving is a major culprit for the recent surge, Pollock said, and gatherings from Christmas and New Year’s Eve could make things even worse.
Even though state officials implored people not to gather outside their households for Thanksgiving and to avoid traveling, some still did. The TSA reported screening more than 1 million airline passengers nationally on four days during the holiday. It’s only about 45% of the 2019 travel volume, but its still the second-highest rate of travel the nation has seen during the pandemic.
“I don’t think people are catching it from being on an airplane,” Pollock said. “It’s where they’re going. It’s getting together with people, their family members that they don’t live with for the holiday and somebody who’s got an asymptomatic case is shedding virus and they infect others.”
A surge following Halloween and Thanksgiving surge led to Newsom’s latest stay-at-home orders, tied to the point at which regional ICU capacities fall below 15%.
Dr. Mark Ghaly, California’s Health and Human Service secretary, acknowledges the fatigue and frustration Californians feel at this point.
“The level of exhaustion that people feel, the trauma that people feel in their communities, the level of impact on our day-to-day lives has been tremendous,” he said. “And wherein we might have been able to do this for three, four, five, six or seven months, getting to this point, it feels long for many people. I know most are not acting in a malicious way or in a harmful way.”
Mixed messaging about who the virus effected and how it could be spread also likely led to some confusion and doubt among Californians, experts say.
“People didn’t realize that the whole time, we’re developing more and more evidence for data,” Pollock said. “It’s not like we knew all the answers back in March. Even with the mask-wearing, there wasn’t very strong scientific support for it, but over time, you amass more information, more data, and now we’ve got an evidence base that says ‘gee mask wearing on an overall average is better, it’s good.’”
China contributed to early confusion, according to Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases and a top leader on the White House’s coronavirus task force.
At first, the Chinese said the virus didn’t pose much risk of human-to-human transmission, Fauci said Wednesday during a virtual conversation with Newsom. Then they said it was only transmissible by people who show symptoms.
When it finally became apparent that asymptomatic people could transmit the virus, it was a game changer, Fauci said.
“It was the game changer in everything we did,” he said. “It was the game changer in testing, because you can’t just test people who are with symptoms. Mask wearing became much more important. If you don’t know who’s infected, then everybody should be wearing a mask, which is the real, fundamental rationale to say we need universal and uniform wearing a mask.”
One of the most “surprising and disturbing” aspects of the pandemic was the range of reactions to the virus, Fauci said. Some people are totally asymptomatic. Others end up on ventilators, and eventually, dead. It’s the reason some people, especially the younger population, are lax about social distancing.
“I’ve never seen a virus like this, and I’ve been dealing with viral outbreaks for 40 year,” he said. “The mystery of how you can have so many people who have no symptoms and so many people who get seriously impacted is one of the reasons why we have a messaging difficulty.”
Going forward, as California looks to reopen schools, Fauci said widespread testing should be a key factor. It’s not enough to test just those with symptoms, he said. Communities like schools, nursing homes, and prisons, should be actively testing to identify asymptomatic cases and get an accurate read on how much transmission is occurring.
“I think we should put much more emphasis on community type of surveillance testing so that you get a feel for where you are … with schools, prisons, with nursing homes,” he said. “That’s the way to go, because this virus is spread in a way that’s without symptoms of many people, and you’re not going to get to them by only testing people with symptoms.”
Vaccine distribution has begun, but widespread access to the vaccine isn’t likely to happen until April. In the meantime, leaders like Ghaly are urging people to follow-the stay-at-home protocols. In the short term, officials say the state will pay a price for its holiday behavior.
“This concept of a surge upon a surge or exposure upon exposure is real,” Ghaly said last Tuesday. “Christmas gathering and infection becomes amplified, a bit more exponential, over the New Year celebrations, and we could see the worst of it in early January.”
“Frankly, many of the hospital leaders that I’ve talked to … are bracing for exactly that.”