California's spike in cases, deaths challenges conventional wisdom on COVID-19 lockdowns
Stay-at-home orders, face covering mandate appear to have had little effect on disease's spread in Golden State.
A recent rise in COVID-19 cases and deaths in California has raised questions about whether the state's strict pandemic mitigation measures — including a long-running lockdown, shuttering of countless businesses, and statewide mask mandate — have had much effect in countering the virus spread there.
Gov. Gavin Newsom was the first governor in the country to issue a statewide stay-at-home order, directing all residents on March 19 to refrain from leaving their homes indefinitely. A few days before, he had ordered all bars and nightclubs in the state to close down, and had also slashed indoor dining occupancy limits by half.
By that time many schools across the state had closed down, and at the beginning of April Newsom indicated that they would remain closed for the rest of the academic year.
In mid-June, about six months after the pandemic officially landed in California, Newsom ordered all state residents to begin wearing face coverings while in public.
Despite such measures, daily new cases in the state have continued to increase, growing slowly throughout April and May before beginning to skyrocket in mid-June, according to official state data.
The accelerating rise in cases would seem to belie the Newsom administration's claims that their mitigation efforts were critical in stopping the spread of the coronavirus in California. Six weeks after it was imposed, even Newsom's mask mandate appears to have had little effect on the transmission of COVID-19 in his state.
'We will get to herd immunity sooner or later'
Newsom's efforts were part of a widespread push by U.S. governors in March and early April to "flatten the curve," locking down huge swaths of society in the hope of spreading out the initial wave of coronavirus transmission over a longer period of time, avoiding a crushing surge of cases in order to save healthcare systems from collapsing under the weight of major patient influx.
Most U.S. health experts at the time said that such policies were preferable to one of unregulated "herd immunity," in which the virus is allowed to work its way through society unabated until a sufficient number of individuals have recovered from it, rendering the disease much less capable of spreading to new hosts. Some medical authorities argued that the virus could claim millions of lives before a sufficient level of immunity was reached.
Since March, many authorities have shifted their mitigation strategies, effectively declaring an indefinite campaign against COVID-19 that could incorporate widespread closures, lockdowns and stay-at-home orders at any given time depending on a governor's assessment of his or her state's outbreaks. Newsom himself declared in a May press conference that the state was "not going back to normal" and that it had entered a "new normal, with adaptations and modifications, until we get to immunity and a vaccine."
Dr. Martin Kulldorff, a population medicine scholar at Harvard, believes prolonged lockdowns until a vaccine is developed are inadvisable. In late April, Kulldorff broke from academic orthodoxy with a column at Newsweek arguing that governments should consider a middle-of-the-road strategy: Allow younger populations to resume relatively normal activities, while older and vulnerable populations are directed to isolate — all in order to reach herd immunity and neutralize the major threat the virus poses.
"I think it has to be done gradually, because if you suddenly release all lockdowns and countermeasures, we will overwhelm the hospitals," Kulldorff told Just the News.
"Herd immunity is not a strategy but a scientifically established phenomena," he continued, "and with a pandemic, we will get there sooner or later, either with the help of a vaccine or through natural infections."
A vaccine, Kulldorff argued, is "the best way to generate herd immunity." Yet, he pointed out, "the development of an effective and safe vaccine could take anything from six more months to never."
Kulldorff said that natural herd immunity "generated by low-risk individuals" could help move societies toward that goal while a vaccine is potentially developed.
'We don’t know what level of immunity must be obtained'
Andrea LaCroix, the Chief of Epidemiology at the University of California, San Diego's Department of Family Medicine and Public Health, argued on the other hand that such a strategy would be risky and potentially catastrophic in terms of the death count.
"I'm all for herd immunity, whether it's obtained from surviving infection or vaccine, but how many lives will we lose along the way?" she asked. "How do we minimize the number of lost lives?"
Given the novelty of COVID-19, we "don't know what level of immunity must be obtained for herd immunity to kick in to prevent spread of this particular virus," LaCroix argued.
"For measles it's estimated at 94%," she said. "For COVID-19, it's still unknown."
LaCroix argued that broad stay-at-home orders should be in place, along with robust government assistance efforts to offset the economic fallout from widespread closures.
When asked about California's apparent failure to contain the virus even with its numerous heavy lockdown measures, LaCroix said that Newsom had been subject to "political pressure to reopen" before viral levels were sufficiently low throughout the state.
"What was happening was that Gov. Newsom was pressured and threatened by Donald Trump," LaCroix said. "There was a period of very intense pressure for him to stop the stay-at-home order. There were all these metrics counties were supposed to meet [for reopening], and in response to political pressure, Newsom let the counties petition to reopen with exceptions to the criteria."
Though it is not clear whether Trump pressured Newsom to lift the stay-at-home order, the governor did in mid-May relax the state's strict reopening requirements for counties, allowing for a broader set of criteria by which local governments could move toward reopening. The relaxed guidelines, for instance, eliminated a requirement that a county must log no COVID-19 deaths over a two-week period, something many local leaders decried as unreasonable.
It is not immediately evident that that decision had any major effect on California's transmission rates: New cases did not begin increasing at a noticeably faster rate until a month after Newsom's decision. Average daily deaths, meanwhile, declined over that time before beginning to increase in July.
Kulldorff in the case of California said that it's "important to distinguish between cases, hospitalizations and deaths," arguing that the latter two are the more salient metrics by which to judge the disease's progress through a given state. By those measures, California is plainly dealing with an active virus outbreak: Average deaths and total hospitalizations have both notably increased in the past six weeks, even though Newsom in mid-June ordered state residents to begin wearing masks while in public.
LaCroix argued that "non-compliance" with state orders, particularly by gyms, has been driving some of the outbreaks. She also cited "gatherings at homes, churches and church services, and hospitals" as being hotbeds of transmission. "Any place where people are together for long periods face-to-face, there's risk," she said.
The unexpected increase in cases frustrated Newsom so much that in early July he ordered restaurants and indoor businesses in nearly 20 counties to shut down; a week later, as cases continued upward, he ordered a statewide shutdown of indoor dining, movie theaters, wineries, museums and other entertainment venues.
Since the second wave of shutdowns, daily new cases in the state, as well as hospitalizations, appear to have leveled off, mirroring similar trends in states such as Arizona and Texas. Whether or not Newsom's policies have finally had an effect on the pandemic remains to be seen; authorities have stressed throughout the pandemic that case and death data only become reliable after one or two weeks' worth of lag to allow for entry and refinement.
LaCroix expressed pessimism over the patchwork efforts across the country to try and contain the virus over the past several months.
"How many people are going to die under all these different ideas about how to control the pandemic?" she asked. "We're already up to 150,000. It could be a million. It could be two million. Are we willing to tolerate — while we argue with each other about the right way to do this — that many deaths?"
Kulldorff dismissed speculations about millions of fatalities. "Any estimates about the total number of deaths are just wild guesses that scientists should refrain from," he said.
"In my view," he said, "it is precisely because it is a very serious and dangerous disease that we should reject the idea of a general lockdown, and instead be scientific and smart about it."
"With the current U.S. strategy," he added, "we are protecting very low-risk children, college students and young professionals that can work from home, while high-risk older adults and the working class are slowly building herd immunity. That is not the way to minimize the number of deaths."