The Health 202: Even California is faltering in the coronavirus fight

The Health 202: Even California is faltering in the coronavirus fight

with Paulina Firozi

It’s telling that even California is now struggling to contain the novel coronavirus.

California’s leaders acted more swiftly and dramatically against the outbreak than in any other state. Yet those efforts haven’t shielded the state from an early-summer resurgence of the virus afflicting the southern and western parts of the United States.

“It’s nice to have patted ourselves on the back for three months, but the virus doesn’t care,” said Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco.

Cities and states are reinstituting restrictions as officials warn the pandemic is out of control in some places.

The way things are going, the nation could soon could reach 100,000 new cases a day, top infectious disease expert Anthony Fauci said at a Senate hearing yesterday.

“Nationally, new infections have topped 40,000 in four of the past five days during an accelerating outbreak that exceeds the worst days of April,” Scott Wilson, Anne Gearan and Annie Gowen report.

“The number of people hospitalized with covid-19, the disease the virus causes, is surging in seven states,” they write. “In Texas, Arizona, Nevada, South Carolina, West Virginia, Georgia and California, seven-day averages are up at least 25 percent from last week.”

“I’m not satisfied with what’s going on because we’re going in the wrong direction,” Fauci told senators.

Gov. Gavin Newsom (D) plans to today reverse some of California’s reopening measures.

He previewed the announcement yesterday, saying it’s time to “toggle back” and “tighten things up” on the state’s stay-at-home order. He has already ordered seven counties to close bars again and reimposed stay-at-home orders for the state’s southern-most county, Imperial County.

“We bent the curve in the state of California once. We will bend the curve again,” Newsom said. “We will crush this pandemic. We will annihilate it. We’ll get past this, but we’re going to have to be tougher.”

“The re-closing of California has begun in earnest amid an alarming spike in the past two weeks of new coronavirus infections,” Scott reports. “Now nearly three in four Californians live in counties that have been ordered to reverse their economic reopening or that have been recommended to do so.”

“The whipsaw nature of the state’s regulations, praised for being prescient in March, has left many in the nation’s most populous state confused, angry and worried that the virus is spreading faster than it can be contained,” he adds.

California now has a quarter of a million infections, with nearly half of them concentrated in Los Angeles County.

Hospitalizations in the state have risen 43 percent over the past two weeks, causing public health officials to worry once again about potentially overwhelming the medical system. Los Angeles and neighboring Riverside County have reported their hospitals are at 99 percent of their capacity, Scott reports.

Barbara Ferrer, the L.A. County public health officer, said county hospitalizations have increased 27 percent over the past two weeks. She said the virus could become “a runaway train unless we put the brakes on it.”

“This is a time to hunker down, back in your home, whenever possible,” she said.

California mayors are cracking down.

Beaches in L.A. will be closed over the coming holiday weekend, and Mayor Eric Garcetti also announced a ban on Fourth of July fireworks displays in hopes of keeping people from gathering together.

In San Diego County, leaders have chosen to today close bars. The county announced its own single-day record – 498 cases – on Monday and health officials there say the trend is worsening.

New York has noticed all this. It has now added California to its quarantine list, which presently includes 16 states. All travelers from California to New York will be required to quarantine for two weeks.

And Disneyland announced last week it will back off a planned reopening of its California theme parks on July 17.

The situation is worse than public health experts had expected, given California’s efforts.

If any state was going to tamp down the highly infectious virus, it would have been California. The state had been the first to lock down and one of the last to reopen. 

“I’m quite surprised,” Wachter told me. “I had gotten used to how well we had done for the first three and a half months.”

Newsom and the mayors of the Golden State’s largest cities were consistently ahead of the game on requiring people to wear masks, socially distance and avoid nonessential businesses.

Their actions paid off. As New York watched its death toll skyrocket into the tens of thousands, deaths grew much slower in California. As case growth seemed to level off in the first half of May, deaths in the state remained below 3,000 and hospital systems maintained plenty of capacity to care for covid-19 patients.

But the virus can spread so stealthily that typical measures for containing it aren’t working.

Fauci told me last week he is reconsidering whether the traditional tools for fighting infectious diseases identify, isolate and contact trace are even effective against the novel coronavirus, given how easily asymptomatic people can spread it. 

Wachter also pointed to studies finding that up to 40 percent of covid-19 cases are asymptomatic. If that’s the case, many more tests would need to be conducted daily on people who aren’t sick to better track the virus’s spread. And that’s a challenge even for well-resourced health departments.

“It’s not feasible for us to be testing everyone in San Francisco who feels fine every day,” Wachter said.

Ahh, oof and ouch

AHH: Oklahoma voters approved a ballot measure yesterday to accept Medicaid expansion under the Affordable Care Act.

The state was one of just 14 states that still reject the ACA’s offer of extra federal payments to cover people living at up to 133 percent of the federal poverty level. While a handful of other states have expanded Medicaid through ballot initiatives, Oklahoma is the first to do so during the pandemic. The measure passed narrowly, with just 50.5 percent support.

“Ballot organizers said the coronavirus crisis would help make their case for expanding Medicaid in the deep-red state,” Politico’s Rachel Roubein reports. “The average number of new cases in Oklahoma has more than doubled in the past month, and the state reported a record 585 new infections on Tuesday.”

The vote “also throws a wrench in the Trump administration’s plan to make Oklahoma the first state to receive its permission to cap Medicaid spending, a longtime goal of conservatives hoping to constrain the safety-net entitlement program,” Rachel writes.

OOF: Years of funding cuts have left the nation’s public health system unable to confront the worst pandemic in a century.

Spending for state public health departments has dropped by 16 percent per capita and spending for local health departments has fallen by 18 percent since 2010, according to an investigation by Kaiser Health News and the Associated Press. There are at least 38,000 fewer state and public health jobs since 2008, leaving a severely diminished workforce in the world’s wealthiest nation, the investigation found.

“Marshaled against a virus that has sickened at least 2.6 million in the U.S., killed more than 126,000 people and cost tens of millions of jobs and $3 trillion in federal rescue money, state and local government health workers on the ground are sometimes paid so little, they qualify for public aid,” Lauren Weber, Laura Ungar, Michelle R. Smith, Hannah Recht and Anna Maria Barry-Jester write.

“They track the coronavirus on paper records shared via fax. Working seven-day weeks for months on end, they fear pay freezes, public backlash and even losing their jobs…So when this outbreak arrived — and when, according to public health experts, the federal government bungled its response — hollowed-out state and local health departments were ill-equipped to step into the breach.”

OUCH: Top Trump aides are split over whether to resume public briefings on the pandemic.

“The brewing internal fight shows the extent to which the White House has lost control of its messaging on Covid-19…as the majority of voters disapprove of Trump’s handling of the virus, according to interviews with a half-dozen current and former senior administration officials and Republicans close to the White House,” Politico’s Nancy Cook and Gabby Orr report.

Those against resuming briefings include: White House chief of staff Mark Meadows, senior adviser Jared Kushner, press secretary Kayleigh McEnany and counselor to the president Hope Hicks.

They’re “arguing against these regular sessions because they want to keep the White House focused on the path forward and the nascent economic recovery — without scaring too much of the country about a virus resurgence when infections are rising at different paces in different regions,” Nancy and Gabby write.

Yet Vice President Mike Pence and his team – who handled much of the public messaging in May – want to bring back the briefings. 

“Now, Trump aides are trying to decide whether to put the national spotlight back on what they have spent months arguing is a series of state and local issues — that had previously been relegated to the vice president’s office,” Nancy and Gabby write.

“Cutting back on the briefings left a void that was filled by the media and the president’s political opponents in order to mislead people, and it resulted on the administration being put on the defensive,” a second senior administration official said.

Sugar rush

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