California’s Recovery Problem

Most of California is still under strict “shelter-in-place” guidelines. It appears as though we’ve flattened the curve and, as a result, can ease up on the “lockdown” rules that have chafed most citizens.  However, before we do this, we have a couple of big hurdles to overcome.

On April 29, Governor Newsom amplified his plan for reopening the golden state. (https://www.nytimes.com/2020/04/29/us/california-reopen-coronavirus.html )  We’re in phase one: “[G]overnment and private organizations are working to make it more consistently safe for essential workers, like grocery store employees or nurses. Those workers need more protective equipment and a more robust testing and tracing system.”  Phase two will involve opening lower-risk businesses, such as retail stores with curbside pickups, and “schools and child care facilities.”  (On May 4th Newsom, was more specific: “Under the new guidelines… bookstores, music stores, toy stores, florists, sporting goods retailers and others can reopen for pickup as early as [May 8].”)

Phase three would see reopening of higher-risk businesses “[such as] nail and hair salons, gyms, movie theaters and sports without live audiences, as well as in-person religious services.”  “Stage 4 will be the end of the state’s stay-at-home order. That will be when concerts, conventions and sports with a live crowd will be allowed to reopen.”

California is stuck moving from phase one to phase two.  It’s one thing to open lower-risk businesses and quite another to open schools and child-care facilities.  In the San Francisco Bay Area, there are six criteria that will permit this to happen (https://www.sfchronicle.com/bayarea/article/Bay-Area-has-6-criteria-for-loosening-coronavirus-15242821.php)  — these are criteria jointly developed by the six major Bay Area counties: San Francisco, San Mateo, Santa Clara, Alameda, Contra Costa, and Marin: 1. Case counts; 2. Hospital numbers; 3. Hospital Capacity; 4. Testing; 5. Contact Tracing; and 6. Personal Protective Equipment.  (Governor Newsom indicated that these criteria will be applied throughout California but he is giving individual counties discretion on the pace of reopening — for example, Los Angeles County — which has the largest number of COVID-19 cases — will proceed more slowly that the Bay Area counties.)

Case Counts: Newsom has consistently been concerned that California’s hospitals might be overwhelmed by a sudden influx of new COVID-19 cases.  Accordingly, he wants the number of new cases to stay flat, or decrease, every day for a two-week period.  At the moment, the six Bay Area counties are meeting this measure.

Hospital Counts: Not every new case of COVID-19 requires hospitalization — some new cases are mild or asymptomatic.  The six Bay Area counties have seen hospital counts slightly decline over the past 14 days.

Hospital Capacity: Governor Newsom wants to ensure that no more than 50 percent of hospital beds, in a county, are occupied by COVID-19 patients.  In fact, in the six Bay Area counties, it is believed that less than 30 percent of beds are occupied by COVID-19 patients.

Testing: The six Bay Area counties set a goal of administering 200 Coronavirus tests a day for every 100,000 residents.  So far none of these counties are meeting this objective:  San Francisco, a county of 870,000 folks is conducting about 900 tests per day.

It’s clear that the pace of testing is the biggest impediment to completing phase two — to opening schools and child-care facilities.

A recent NPR study ( https://www.npr.org/sections/health-shots/2020/05/03/849243723/californias-coronavirus-testing-still-a-frustrating-patchwork-of-haves-and-have-) examined California’s testing problem: “It’s hard to overstate how uneven the access to critical test kits remains in the nation’s largest state. Even as some Southern California counties are opening drive-through sites to make testing available to any resident who wants it, a rural northern county is testing raw sewage to determine whether the coronavirus has infiltrated its communities.  County to county, city to city — even hospital to hospital within a city — testing capacity varies widely, as does the definition of who qualifies for testing.”

But the testing situation is improving. As of May 8, California has administered 842,000 tests and for the past week, has tested an average of 30,000 per day On April 29, Los Angeles Mayor Eric Garcetti announced that all Los Angeles residents will have access to free coronavirus testing — even those without symptoms.

Contact Tracing:  Contact tracing requires investigating every reported case of the coronavirus, identifying those who may be at risk of infection, and ensuring they are quarantined, to prevent further COVID-19 spread.(https://www.cnn.com/2020/04/27/health/contact-tracing-explainer-coronavirus/index.html)  It’s estimated that each county will need trained contact tracers at the rate of 25 per 100,000 population.  Early indications are that all the counties are very short of skilled contact tracers.  (The University of California at San Francisco has just launched a contact-tracer training program ( https://www.ucsf.edu/news/2020/05/417346/ucsf-partners-state-develop-public-health-workforce-covid-19-response).)

Personal Protective Equipment (PPE): The six Bay Area counties set a goal that each would have a 30-day supply of PPE including face masks, gloves, and gowns.  Governor Newsom is working with them to meet this goal.  In April he signed a $1 billion deal with Chinese manufacturer to obtain million of PPE units.  This is the website (https://public.tableau.com/profile/ca.open.data#!/vizhome/COVID-19CountyProfile/COVID-19CountyProfile) the Golden State provides in order to track the acquisition of PPE: this shows that million of items have been procured, including 45.9 million n-95 respirators.

Summary: California is stuck moving from phase one to phase two.  On May 8 we’re going to open lower-risk retail businesses.

Nonetheless, it will be a while before we open schools and child-care facilities.  These openings will depend upon the availability of testing — we’re getting there — and contact tracing — the critical path activity.  Opening schools and child-care facilities will also depend upon a rigorous testing protocol which has yet to be made public.  (For example, for a child-care facility: test all staff and students before opening; take everyone’s temperature every day, test staff once a week; and test students randomly.)

Governor Newsom has California moving in the right direction but it will be a while before we meet our phase two objective.  Prediction: July for child-care facilities; August for schools.