For a good while, it seemed California had skirted past calamity. It was the first US state to order residents to shelter in place in March, and its early, aggressive actions paid off. Despite it being the most populous state and an international hub with the largest number of direct flights to China, where the coronavirus first appeared, California’s death rate remained relatively low.
By May, Disneyland announced plans to reopen. The nation’s top health official Dr Anthony Fauci praised Governor Gavin Newsom’s leadership. And as the weather warmed, Californians flooded back to beaches and bars.
“We had reason to feel confident,” said Dr Bob Wachter, who chairs the department of medicine at the University of California, San Francisco. “And then, we hit some trouble.”
A few outbreaks sparked an explosion, with an average of about 6,000 to 7,000 new cases each day over the past week. Los Angeles county began to count more residents sick with Covid-19 cases anywhere else in the nation and Disneyland postponed its reopening. As hospitalizations surged, the death toll climbed past 6,000, and ICU beds in some regions began filling to capacity, California’s governor, Gavin Newsom, ordered bars, restaurant dining rooms, cinemas and other indoor venues in the hardest-hit counties to close back up.
Now, health officials and epidemiologists sifting through the rubble are left wondering how the Golden state lost its status as the public health golden child.
‘People began to fixate on individual liberties’
“Looking back, the decision to reopen when we did seemed perfectly reasonable,” Wachter said. “We were doing pretty well, we had the resources in place to deal with an uptick in cases.” Despite some stumbles, Newsom had set and ultimately met fairly ambitious goals to test 60,000 to 80,000 Californians each day, and stock up on protective equipment for healthcare workers.
The Los Angeles Times editorial board wrote that California was lucky to have Newsom as its leader. “People are alive today because of Newsom’s expeditious action,” it asserted. The state’s death rate was similar to that of Germany, a country widely regarded as a public health success story.
The Newsom administration’s four-phase plan to reopen slowly, while encouraging Californians to remain vigilant about wearing face coverings and maintaining distanceto stop the spread of disease seemed “perfectly good and smart”, Watchter said.
“But what I think we didn’t get right was the national political scene,” he said. California, despite its reputation as a progressive state, wasn’t immune to a growing conservative movement that rejects face masks as muzzles on independence and vilifies public health officials as enemies of the people.
In Orange county, where more than 15,000 people have been infected, health director Nichole Quick resigned in mid-June after being confronted with a banner depicting her as a Nazi, protests outside her house and personal threats. Quick had issued an order requiring residents to wear masks in public, which the county sheriff insisted he wouldn’t enforce. After she became the third high-level health official in Orange county to quit, the county quickly reversed Quick’s order – recommending, but not insisting that residents wear masks.
By the Memorial Day holiday Californians “thought they were safe to just have parties, go to overcrowded beaches, to get close to other people and take off their masks”, said Lee Riley, an epidemiologist at the University of California, Berkeley. “People began to fixate on individual liberties without understanding that one of the most fundamental civil liberties in the US is the right to health – the right to stay alive.”
‘This isn’t a political issue’
As restaurants, bars, zoos and movie theatres reopened across the state, outbreaks in southern California have been the most worrying, with Bay Area counties seeing more modest rises. Over all, despite its huge caseload, about 6.9% of those tested for coronavirus across the state have gotten a positive result in the past week. That’s higher than the 5% the World Health Organization recommended as the upper bar for reopening and much lower than the 25.2% positive test rate in Florida and 17.7% in Arizona.
Scientists are still working out in what context most of the cases are spreading – early tracking data in LA county suggests that outbreaks in nursing homes added up with cases traced back to restaurants, workplaces, warehouses and retailers account for just about 15 or 20% of all cases. While the disease may have also spread amid the massive protests against police brutality, epidemiologists aren’t connecting big outbreaks to the demonstrations. “We don’t know yet where the majority of cases are spreading, but my suspicion is individual households,” Lee said.
Demographic data suggests that younger people, between the ages of 18 and 50, are fueling the current wave of infections, accounting for nearly 60% of cases statewide. “Maybe they feel invincible, so they go out to bars, they gather in big groups,” Riley said. “But then they can spread the virus to their grandmas and grandpas, their parents, their buddies with asthma or diabetes, who are more vulnerable.”
Among the hardest-hit regions are rural counties in the south and the Central Valley, where farmworkers have been toiling through each stage of this pandemic. California is referred to “the breadbasket of the world” for good reason: it is the world’s fifth largest supplier of food and agricultural commodities.
As more Californians emerged from their homes, crowding restaurants and public spaces, “it really put our essential workers most at risk”, said Ninez Ponce, director of the UCLA Center for Health Policy Research. The vast majority – more than 90% – of farmworkers in California are Latinx, working in precariously crowded environments. More than 60% of workers involved in food preparation are Latinx as well. And it’s those workers, many of whom lack access to healthcare and can’t afford to stay home, who have the most to lose as the virus barreled through the state, Ponce said.
Latinx, Black and other minority groups are disproportionately infected with and dying of Covid-19, according to a tracking tool designed by UCLA, and early metrics suggest that the state’s reopening has exacerbated disparities. Devastating outbreaks in California’s prisons and homeless shelters have further fueled inequities.
The many complicated factors driving the surge of coronavirus in California have all collided in Imperial county, a rural community along California’s southern border with Mexico and Arizona. Out of every 100,000 people in the country, more than 3,700 have been infected with the coronavirus – that’s several times higher than the statewide average of 600 infections per 100,000.
As the region’s only two hospitals ran short of beds, concerned residents wrote to Newsom, asking him to intervene as local leaders allowed businesses to continue reopening. The community, which had already been besieged by toxic dust storms, suffering with one of the highest rates of poverty in the state, “was ill-prepared to respond to even a small outbreak of cases, let alone what we’re seeing now,” said Luis Olmedo, a community advocate who runs a local advocacy group called the Comite Civico del Valle. And though the local council eventually reined in its optimistic reopening plan, officials remained more concerned with appeasing the loud, privileged few pushing for a hasty return to normal, than protecting minority workers, Olmedo said. “I want our leaders to all step up and take care of the whole community,” he said, “because right now they’re ending up in the emergency room and they’re ending up in body bags.”
Looking back, Richard Pan, a physician and a state senator, said the state rushed its reopening plan. Initially, officials had set two weeks of declining as a benchmark for advancing through each phase of reopening. “We wanted to not only flatten the curve but see a downturn,” he said. “Then we began seeing the anti-lockdown protests, basically egged on with a wink and a nod from Donald Trump, and the governor faced increasing pressure to move faster.”
As the number of cases swell, the governor’s recent orders pausing the California’s reopening, and his statewide mandate requiring residents to wear masks, are laudable, he said. “Still, we’re only successful if people follow the order – and right now, they’re not doing it.”
Pan, who recently introduced legislation to protect health officials against attacks, said that the governor’s presence at the top of every health briefing, as the face of the pandemic response may have backfired. Governors and mayors across the country probably felt a need to step up, and combat Trump’s dramatic, bombastic – and counterproductive – daily missives, with daily press conferences of their own. “But they should have let their public health officials take the podium.” he said, “They should have let them lead the conversation – to show that this isn’t a political issue.”