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GUEST BLOG / By Debra Kahn
and Carla Marinucci, writers for Politico.com--California State leaders and
doctors are cautiously optimistic that the Bay Area's early moves to lock down
residents two weeks ago have prevented surges of coronavirus patients from
overwhelming the region's health care capacity thus far.
Six Bay Area counties were
first in the country to adopt aggressive tactics with an enforceable March 16
order requiring residents to stay at home. Gov. Gavin Newsom quickly followed
with a statewide order three days later restricting the state's 40 million
residents from all but essential activities.
After 14 days — the outermost
period at which symptoms are believed to emerge post-infection — doctors at
area hospitals are now reporting fewer cases than they expected to see at this
point, and officials credit the lockdown with stemming the tide of patients
they feared would flood into emergency rooms.
Northern California offered a
rare glimpse of optimism Monday as the U.S. recorded its most coronavirus
deaths in one day and Washington, D.C.-area jurisdictions — Maryland, Virginia
and the District of Columbia — issued their first enforceable stay-at-home
orders. Health officials across the nation are eyeing the Bay Area as a
bellwether to determine the effects of social distancing, since the region's
policies were replicated in various states and cities in subsequent days.
The Bay Area's primary goal
two weeks ago was to slow the growth of serious cases, buying public officials
and hospitals enough time to increase the number of hospital beds, respirators
and staff necessary to handle a coronavirus surge.
"We believe very
strongly the stay-at-home order has helped advance our efforts in reducing the
stress on the system that we believe would have already materialized in more
acute ways had we not advanced those protocols when we did," Newsom said
Monday in his daily press conference.
While officials remain
adamant that people stay home and adhere to social-distancing guidelines — the
Bay Area Monday extended its stay-at-home order to May 1 — they also are
praising residents for following orders and expressing optimism that the
measures will continue to work.
“Just generally when you look
around Oakland now, what you are seeing gives you hope that makes you feel good
about what's going on here," Oakland Mayor Libby Schaaf said in an
interview. “People really got the message … and I believe that it will show
that we will have flattened that curve.”
Stephen Parodi, a infectious
disease doctor and associate executive director with The Permanente Medical
Group in Northern California, said that Kaiser Permanente is "seeing a
leveling off of Covid-19 cases in our hospitals" across Northern
California, where it serves 4.5 million members. Kaiser has also seen calls
related to colds and coughs drop by more than half since social distancing took
effect, a key indicator that precedes hospitalization, he said.
"While we still predict
an upcoming surge, the partnership between the health system and public health
officials on the local and state levels to implement social distancing has
given us more time to put a lot of pieces in place to prepare for a potential surge,"
Parodi said in a statement.
Many Bay Area residents have
faced restrictions for longer than 14 days. A week before the shelter-in-place
order, Santa Clara County issued an enforceable ban on gatherings of more than
1,000 people, a move that forced cancellation of pro sporting events and
concerts. San Francisco and Oakland soon followed suit. The jurisdictions also
strongly urged that employers shift to remote work.
Because testing remains
uneven, it's difficult to draw broad comparisons between regions. A few weeks
ago, America's most populous state drew the nation's greatest concern after
community spread was detected here first. But California now has fewer total
deaths than five other U.S. states, according to the Johns Hopkins University
Coronavirus Resource Center. And on a per capita basis, 13 states had a higher
death rate Monday.
Not all Bay Area counties are
feeling as confident as others. Santa Clara County, which was the state's
epicenter and took the earliest actions on social distancing, still has an
outsize share of coronavirus cases for its size, with 848 cases and 28 deaths.
The Bay Area's other eight
counties have been faring better, reporting 1,352 cases and 24 deaths total,
according to the Johns Hopkins data. Statewide, California has 6,400 confirmed
cases and 146 deaths.
Officially, hospital
spokespeople are hesitant to identify trends. But individual doctors say the
stay-at-home order has likely helped to keep numbers lower than they would be
otherwise.
"It's really the only thing
we can point to that reliably would suggest that's why we have fewer cases than
other communities around the country," said Jahan Fahimi, medical director
of the emergency department at University of California, San Francisco's
Parnassus campus, which has about 15 patients with Covid-19, nine of them
critically ill. "We're definitely cautiously optimistic."
Fahimi acknowledged that
testing is still patchy, but said the low number of patients needing intensive
care is evidence that the spread has been slower than feared.
"What I can say is how
many critically ill patients we have, and that has not surged," he said.
"Something is working."
On the supply side, hospitals
have bought time by rescheduling elective procedures, setting up respiratory
care units in parking lots and other areas and procuring more ventilators and
personal protective equipment.
"The result has been we
didn't get this huge influx of patients, and we emptied out the hospital in
preparation," Fahimi said. "We have the capacity to meet the demand
as it comes through the door."
The South Bay is further from
declaring victory.
“I am not yet optimistic
because we don't have enough data to really know,’’ San Jose Mayor Sam Liccardo
said in an interview. “And in the absence of surveillance testing at a scale
that we see in places like Taiwan and Singapore, we simply don't have enough of
a handle to understand whether we've contained this.’’
“I will say that we are
looking at independent or other sources of data about movement and travel and
it appears that there is relatively good compliance in places like San
Francisco,’’ he said.
To be sure, California is far
from being out of the woods. But it's on a slower upswing compared to the
nation as a whole, according to the University of Washington's Institute for
Health Metrics and Evaluation. While the nationwide curve is projected to peak
on April 15, California is on a trajectory to hit peak demand on April 26, when
it would need about 10,500 hospital beds and 1,250 ventilators.
The hospitalization total is
far better than some projections; Newsom last week said California could need as
many as 50,000 extra beds.
On Monday, state Health and
Human Services Secretary Mark Ghaly struck a relatively confident tone, saying
California currently has enough ICU beds and ventilators for anyone who needs
them and is likely equipped for "weeks to come."
Still, California leaders are
urging that residents need to stay the course and not let up one bit.
“We still have plenty of work
to do,’’ Liccardo said. “And one thing I know is that we've got some rough
weeks ahead. … This would be far too early for us to be patting ourselves on
the back, because we've got very heavy slogging ahead.”
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