Coronavirus Today: What sex ed can teach us about the pandemic

Good evening. I’m Amina Khan, and it’s Monday, Dec. 7. Here’s what’s happening with the coronavirus in California and beyond.

With coronavirus cases rising in the wake of Thanksgiving gatherings, roughly 33 million Californians are now under a new regional stay-at-home order that began Sunday night.

“My message couldn’t be simpler: It’s time to hunker down. It’s time to cancel everything,” said Los Angeles Mayor Eric Garcetti. “If you’re able to stay home, stay home.”

This kind of blunt talk worked to bend the curve in the spring, when fear of the virus was fresh. “But nine months later, the words seem to have lost their meaning,” my colleague Soumya Karlamangla writes.

That’s clear in the numbers. Despite weeks of pleas from health officials, the percentage of Angelenos staying home except for essential activities has remained the same since mid-June (55%, if you’re curious), a USC survey shows. The same phenomenon seems to be happening around the U.S., as millions of Americans crisscrossed the country to gather with family over the Thanksgiving holiday in spite of health officials’ emphatic warnings to stay put.

“It’s not because the public is irresponsible; it’s because they are losing trust in public health officials who put out arbitrary restrictions,” said Dr. Monica Gandhi, an infectious-disease specialist at UC San Francisco. “We are failing in our public health messaging.”

Gandhi and a growing number of experts think there’s a better way to engage people who do want to take the pandemic seriously: a proven strategy in the public health playbook called harm reduction.

Harm reduction is the principle that guides sex-education programs as well as needle exchanges for drug users. The goal is to mitigate the risks of dangerous behaviors instead of trying to get people to stop engaging in those dangerous behaviors altogether. In other words, abstinence-only messaging doesn’t prevent young folks from having sex. But educating them on how to do so safely will at least mean fewer poor health and academic outcomes.

So far in the pandemic, L.A. County has pretty much stuck with the “just say no” tack. Last week it became one of the only places in the nation to halt all outdoor gatherings among people not from the same household. That means two friends can’t meet in a park or go for a hike even with masks on. Gov. Gavin Newsom then included that ban in his regional stay-at-home order.

Banning relatively safe outdoor activities risks alienating those folks who would otherwise be inclined to follow the rules, experts say.

“Some of the things they’re telling you not to do are incredibly low-risk,” said Brown University health economist Emily Oster. “When you are so strict about what people can do, they stop listening.”

A harm-reduction pandemic response would explain the risk levels of different activities and let people decide their own comfort levels (though the most dangerous activities could still be prohibited). Research has found that this strategy makes people feel empowered to make their own choices and that, ultimately, they don’t take more risks than they would have otherwise.

Dr. Eric Kutscher, an internal medicine physician at New York University, said he finds it “terrifying” that people are still planning to get together for the holidays. “It really upsets me, but I think we need to figure out how to get beyond that visceral response to instead focus on an actual productive conversation.”

By the numbers

California cases and deaths as of 7:08 p.m. PST Dec. 7:

See the current status of California’s reopening, county by county, with our tracker.

Track the latest numbers and how they break down in California with our graphics.

Across California

Millions of people across Southern California and the San Joaquin Valley spent their first day subject to a new set of COVID-19 restrictions that went into effect 11:59 p.m. Sunday. The rules will last for at least three weeks, which means those regions won’t be able to come out from under the state’s latest stay-at-home order until Dec. 28 at the earliest. Among other things, the new restrictions require bars, wineries and personal-care services to close, limit restaurants to takeout and delivery service, and prohibit gatherings of people from different households.

And five counties in the San Francisco Bay Area said last week that they’d implement the new rules proactively and planned to keep them in place until at least Jan. 4. Altogether, those regions are home to about 33 million Californians representing 84% of the state’s population.

While the timing could be little worse for many businesses who rely on the holiday shopping season, officials have said that desperate times call for desperate measures. Hospitals are trying to manage more than 10,000 COVID-19 patients, and the state has logged more than 20,000 coronavirus deaths. More than 33,000 new coronavirus cases were reported Monday alone, according to The Times’ county-by-county tally of infections. And the worst may be yet to come, as experts say the full ramifications of the Thanksgiving holiday have yet to emerge.

Cases that stem from “dinner tables or activities and plans, travel through Thanksgiving, are going to show up right about now,” said Dr. Mark Ghaly, California’s health and human services secretary. “We know we’ll be seeing that for many days to come.”

Los Angeles County topped 10,500 new cases on Sunday, a mind-numbing number for a single-day total that may reflect post-Thanksgiving spread. Hospitalizations in L.A. County approached 3,000, and that number could rise dramatically in the next few weeks as the full toll becomes clear.

Sunday marked the county’s seventh day in a row of record-breaking COVID-19 hospitalizations, which are now more than four times the number from early October. At that point, about 700 people in the county were hospitalized with the disease.

“I wouldn’t be surprised if we start seeing daily hospitalizations approaching 4,000 in a couple of weeks,” L.A. County Public Health Director Barbara Ferrer said in an interview Sunday. “I am positive that we haven’t seen the full increases in our case numbers associated with the Thanksgiving holiday, just based on the timeline.”

Another consequence of the surge: Starting Thursday, LAUSD campuses will shut down all in-person tutoring and special services, Supt. Austin Beutner announced Monday. The move directly affects some 4,000 students in kindergarten through 12th grade and outdoor conditioning for athletes.

It’s not clear when special needs students will be able to return to campuses, but a full reopening of L.A.’s public schools will be pushed further into 2021, Beutner said.

Beutner said the crisis requires a “Marshall Plan for schools” that includes four elements: creating a safe school environment; school-based coronavirus testing and contact tracing; mental-health support for children; and funding for in-person instruction next summer. This would cost roughly $125 billion, less than a fifth of the total earmarked for the Paycheck Protection Program. He also called for teachers and other school staff to be near the front of the line for receiving vaccines.

He added that schools should be prioritized for reopening ahead of card rooms, bars, gyms, indoor malls and even restaurants.

“Schools must come first, not last,” he said.

Around the nation and the world

Children and teens who are in the throes of a mental health crisis must wait days in emergency rooms because of a scarcity of psychiatric beds. And the pandemic has made it even harder to help those children than before, experts and parents say.

Take Claire Brennan Tillberg’s 11-year-old daughter, who has autism, depression and anxiety. She’s been hospitalized twice in recent months after revealing that she’d had suicidal thoughts. The first time in July, the Massachusetts girl waited four days in an ER before being transferred to a different hospital. The second time, in September, she waited a week.

Tillberg said things worsened when the pandemic hit and her school and therapy sessions went online. Suddenly, the structure and rituals that many children with autism thrive on were gone.

It’s not just the United States. Children and teens in Asia, Australia, Canada and Europe also have shown overall worsening mental health since the start of the pandemic.

Food banks are feeling the pressure from skyrocketing demand as hunger, a harsh reality in the world’s richest country, is worsening during the pandemic. With the pandemic triggering illness, job loss and business closures, millions more Americans are facing empty refrigerators, and the amount of food distributed by food banks this year has risen sharply compared with last year. Many parents are skipping meals so that their children can eat, while others rely on cheap food without much nutritional value.

Aaron Crawford, a 37-year-old Navy vet Aaron Crawford, is one of the millions who turned to a food bank. The pandemic hit while he was looking for work and his wife needed surgery. His family of four had no savings, mounting bills and a shrinking paycheck as the pandemic ate into his wife’s hours. Still, he hesitated to ask for food at first. “I felt like I was a failure,” the Apple Valley, Minn., resident said.

Donna Duerr, waiting to pick up food in a drive-through donation in New Orleans, could relate. Her husband was laid off and she’s unable to work due to surgeries on her spine and her arm. And she has two grown children who’ve moved home since the start of the pandemic.

“This is a hard thing to accept that you have to do this,” said the 56-year-old Duerr. But painful choices must be made. “I either pay bills or get food.” At least the donations have brought some relief.

Britain, the first Western nation to authorize a COVID-19 vaccine after advanced clinical trials, is ramping up for the start of its vaccination operations. It’s been nicknamed “V-Day,” in reference to the D-Day landings that took place in France during World War II.

The first brigade of 800,000 doses will be administered to people older than 80 who are either hospitalized or who already have outpatient appointments scheduled, as well as nursing home workers. Most other folks will have to wait until next year before there is enough vaccine available to expand the program.

Public health officials worldwide are watching to see how the country’s efforts go. While the U.K. has strong infrastructure for delivering vaccines, it’s mostly focused on vaccinating specific groups — such as schoolchildren or pregnant women — not the whole population.

“Our goal is totally to protect every member of the population, Her Majesty, of course, as well,” said Dr. June Raine, chief executive of Britain’s Medicines and Healthcare Products Regulatory Agency.

Your questions answered

Today’s question comes from readers who want to know: What’s the difference between vaccination, inoculation and immunization?

The imminent arrival of a COVID-19 vaccine has brought with it an entourage of terms you might not usually throw around at the breakfast table. My colleague Karen Kaplan has put together a handy primer on these terms and more. Now you can learn what the difference is between regular immunity and herd immunity, the definition of an adjuvant and the purpose of a booster injection.

But, to answer the question above: Vaccination is the process of administering a vaccine to the body. While this is typically done via an injection, some vaccines can be swallowed or even given as nasal sprays.

Inoculation is pretty much a synonym for vaccination in these modern times, but it can also describe other methods of inducing immunity to a disease, such as early methods to fight the spread of smallpox. (One of them involved taking material from an infected person’s sores and scratching it into the arm of a person who had never had the disease.)

And immunization is simply a process that makes someone immune to a disease. That’s the goal of vaccination.

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1:00 p.m. Dec. 9, 2020
For the Record: This newsletter includes an out-of-date California reopening map that does not show counties affected by the Stay Home Order. The map with the information that is correct as of Monday is shown below.

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