What will ‘back-to-normal’ look like for California? Some businesses could restart before others
How will California get back to normal amid the coronavirus outbreak?
There will be no getting back to normal anytime soon, with the new coronavirus unlikely to ever be completely eradicated, and a vaccine 12 months to 18 months away under the most optimistic scenario.
Certainly, society will be opened back up eventually. But the process is likely going to be slow and methodical — guarding against new outbreaks in an effort to prevent a resurgence even worse than what California is experiencing now, but also focusing on starting to reopen the economy.
Depending on various models, the peak in cases in California could come anytime between mid-April and the end of May.
California has not been hit as hard as hot spots such as New York. But officials remain cautious.
Los Angeles County health officials warned Friday that the region needs to significantly increase social distancing to slow the spread of the novel coronavirus and that stay-at-home restrictions could remain into the summer.
Even with the dramatic social distancing the county is now seeing, officials forecast that up to 30% of residents could be infected by mid-summer without more behavioral changes. And abandoning the stay-at-home order now could mean that hospitals would be swamped with severely sick people by mid-May.
Los Angeles County health officials show what might happen if the stay-at-home order is lifted in mid-April, and what may happen if residents get even better at physical distancing in the coming weeks.
Gradual relaxation of stay-at-home orders
Rather, experts both in California and nationally talk about a gradual relaxation of elements of the stay-at-home order — an intermediate step that should not be skipped until an effective vaccine is available.
“Is it wearing masks? Probably. Is it continuing to restrict large gatherings? Yeah, probably,” said Dr. George Rutherford, epidemiologist and infectious diseases expert at UC San Francisco. “Is it continuing to have older people stay home more than they would otherwise? Yeah, probably.”
“When we return to work, do we all go back on the same day, or do we stagger that?” Rutherford asked.
Perhaps factories use staggered shifts to avoid too many workers mixing with each other. Maybe manufacturing and construction are opened up first, Rutherford said, and then, a bit later, nonessential retail stores, and then some time after that, restaurants.
“If you’re going to open the bars, you’re going to have to take out every other stool — I mean, I don’t know what the governor is going to decide,” Rutherford speculated. “And then maybe everybody who can telecommute would just sit tight for a while.”
As restrictions are eased, officials will need to monitor cases to see if coronavirus cases start to flare up dramatically again.
Looking for a decline in cases in national hot spots
Experts say national progress needs to be made in reducing coronavirus cases.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has repeatedly said the public should be expecting a gradual peeling back of stay-at-home orders.
“When you say get back to normal, you’re really talking about a really clear indication that those areas — like New York City, like New Orleans, like Detroit — that have big outbreaks with peaks, have not only stabilized in the number of new cases and hospitalizations, but have actually turned the corner and are starting to come down,” Fauci said in an interview with The Journal podcast that aired last week.
“And history with other countries tell us that once you turn that corner and come down, the decline is pretty steep,” Fauci said. “I don’t think that you need to get down to zero before you can start contemplating gradually relieving some of the restrictions. It isn’t like a light switch, on and off.”
One idea might be having a 50-seat restaurant only seating a maximum of 25 diners, he said. “Bottom line is, it’s going to be gradual. It’s not going to be all or none.”
And some changes might be permanent, he said, adding: “I don’t think we ever should ever shake hands ever again, to be honest with you.”
On Sunday, Fauci said the New York City metro area last week suffered a terrible week of death, but also began to see a flattening of hospitalizations. “It’s starting to turn the corner.”
Once a sharp decline is seen, “then you can start thinking about how we can keep it that way and prevent it from resurging — when you’re starting to think about a gradual reentry of some sort of normality, some rolling reentry,” Fauci told CNN. “So you’re trying to balance two things: You want to make sure you don’t do something prematurely and precipitously. But at the same time, you pay attention to the need to try and get back to normal.”
No sports games until Thanksgiving, at the earliest?
Some local officials in California have suggested ongoing restrictions lasting toward the end of the year. The top administrator for Santa Clara County — home to the San Francisco 49ers, San Jose Sharks and Stanford University — said at a meeting of the Board of Supervisors last Tuesday that he suspected sports games wouldn’t be held until Thanksgiving at the earliest.
On Thursday, he doubled down on his comments. “Even if we do well here in Santa Clara [County], if you have a big event that attracts thousands of people from all over the nation, you run the risk of reinfecting everyone,” Dr. Jeffrey Smith, the Santa Clara County executive officer told KPIX-TV.
“In my opinion, it’s unlikely that the shelter-in-place [order] will be lifted at least until the late fall, because we don’t have a national shelter-in-place program,” Smith said in an interview aired Thursday night.
A longer-term coronavirus strategy lasting at least through the end of the year is something other nations are realizing is unavoidable.
Singapore was once lauded for keeping the coronavirus under control, but a wave of new cases, brought by travelers returning home, forced the dense city-state at the beginning of April to order schools and nonessential businesses to close for at least a month.
Officials in Singapore now say they need sustainable measures to slow down the virus that can last through the end of the year.
After appearing to have the virus under control, Singapore, Vietnam and Hong Kong are imposing new controls as COVID-19 infections continue to rise.
Returning to containment
Infectious disease experts say easing out of stay-at-home orders will require four developments: a dramatic reduction in virus transmission; lots of testing capacity; plenty of hospital space; and robust local resources to aggressively investigate new infections to isolate the infected and quarantine close contacts who might get sick, a practice called contact tracing.
“Otherwise, what’s going to happen is we will end up in a situation which I would call a smoldering epidemic, in the sense that we will be having cases with us, kind of like seasonal influenza — it may wax and wane,” said Dr. Robert Kim-Farley, medical epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health.
San Francisco’s director of public health, Dr. Grant Colfax, has likened the current coronavirus outbreak as a wildfire sweeping across the city. The goal is to reduce the number of new cases so much that new cases are seen more like smaller spot fires, which can be identified and contained before getting out of control.
Keeping disease levels low in the coming weeks and months will also give scientists and doctors more time to identify life-saving drugs that need time to be identified.
“I think within the next few weeks, we’re going to have some good knowledge about what those look like based upon clinical, randomized controlled trials,” Kim-Farley said.
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Boosting the investigation of new cases
Already, Rutherford is working on a project aimed at dramatically increasing San Francisco’s capability to do contact tracing, which involves investigators asking infected patients where they were when they got infected — typically five days before developing symptoms. They’d also ask where the patients were while infectious, which probably starts one or two days before symptoms became apparent.
Rutherford’s UC San Francisco team of about three dozen people — who normally work on projects focused on Asia and Africa — will assist in the effort. And the goal is to “get a bunch of medical students and the city librarians to come in” and help boost staffing, he said.
So instead of roughly 10 disease investigation specialists working on this contact tracing effort, soon, there could be 100 people working on it for San Francisco, work that is done mainly by telephone.
Adding on undergraduate students — for instance, those interested in public health at San Francisco State — could dramatically help expand the manpower. A big need will be investigators who can speak Spanish. “So you get 600 undergraduates as opposed to 100 medical students, we can work on it,” he said.
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