Looking east, California can imagine its future as a coronavirus in New York City’s crowded medical centers. Looking west, one can hope for the rapid decline of the disease in Asian countries, which quickly imposed strict physical isolation measures on infected people.
Two months after its first confirmed case of fatal respiratory disease in California, the state is preparing to face the cruelest month that the health authorities agree – an April that marks a climax in sickness and death.
How cruel remains to be seen. The officials hope that severe restrictions on the work and public activities imposed by Governor Gavin Newsom on March 19 and subsequently imposed in some cities and counties will hinder the spread of the COVID-19 racehorse.
The enormous social reengineering of the past few days has closed companies and emptied public places. But its ultimate effectiveness remains one of several unknowns – depending on the countless actions of millions of Californians.
Hospital administrators across the state were preparing for the worst, clearing away all available beds for an influx of patients on Friday. San Francisco ordered priority tests for doctors and nurses to prevent sick health practitioners from becoming super-spreaders of the disease. Los Angeles County has closed all beaches to limit social interaction. And the Navy hospital ship Mercy, with 1,000 beds and 800 employees, went to the port of Los Angeles to relieve the health care system of the county.
The number of confirmed coronavirus cases in California rose from 1,468 on Sunday to 4,598 on Friday, while the number of deaths rose from 27 to 93. However, since the number of cases continues to depend on tests that are expanding but still lag behind other countries, the actual incidence of The Disease is certainly much more common.
“The numbers can get huge, which means that the impact on the health system is just as dramatic,” said Barbara Ferrer, director of public health in Los Angeles County. “Without slowing the spread, we could easily overwhelm our system here in LA County and the entire healthcare system in California.”
Although system congestion remained a concern, a projection by University of Washington epidemiologists indicated that the 9-day-old California order to stay at home could keep hospital congestion below a catastrophic level. And Dr. Robert Kim-Farley, a UCLA epidemiologist, said on Friday that after a significant increase in some cases: “I think we should see some flattening of these numbers in a few weeks due to physical distance measures. ”
While the U.S. is currently having the worst outbreak of any industrialized country in the world, UC Berkeley biostatistics professor Nicholas Jewell said California will soon learn whether its borders for work and public movement have paid off.
Due to a delay of up to two weeks between the transmission of the disease and the onset of symptoms, it takes time to assess the benefits of physical distance. With California staying home for eight days on Friday, people who report the disease may have been infected before the restrictions.
“We still need a week or two to really see if California’s relatively quick protection made a difference,” said Jewell. “It has the potential to make a big difference. I know that mathematically … But I don’t know for sure. “
Some experts continue to fear that the disease curve will flatten out, but at a dangerous level that sends too many patients to hospitals for months. “The problem is not the culmination of the epidemic wave,” said John Ioannidis, an infectious disease expert at Stanford University. “The problem is: how long have we been above the saturation point for the medical system?”
However, forecasts by the Institute of Health Metrics and Assessment at the University of Washington show that California may have a milder number of cases than the state of New York predicts.
While the state of New York recorded the worst daily death toll in the second or third week of April with around 550 deaths from the coronavirus – with a range from only 124 deaths per day to a maximum of 1,357 on the possibly worst day – in California. that at the end of April the worst daily death toll was recorded, perhaps around 150 deaths in a single day.
A best-case scenario puts the number of deaths in California at two deaths per day, and a worst-case forecast predicts 370 deaths a day at the peak in late April.
The study recognizes a number of possible outcomes. Overall, this indicates that there are 6,109 deaths in California, but there are big differences – only 898 deaths and 13,650 deaths. New York would have 10,243 deaths, with only 5,167 deaths and 26,444 deaths. For example, the death toll in the United States could range from 38,000 to 162,000.
The University of Washington researchers warned that their projections are loaded with significant uncertainty derived from thousands of computer simulation runs to achieve a single, most likely outcome.
Unlike other models of the new coronavirus trajectory, the study draws on deaths from the United States and around the world. The scientists believe that these numbers are more reliable than counting the confirmed number of infections, which vary widely due to the different test rates in the United States and worldwide.
And the differences in the number of hospital beds that are needed in California also varied widely, from just 1,200 to almost 36,000. Demand for intensive care beds has also been broadly forecast, from a low of 90 to a high of 5,700.
“We believe we will see a fairly late peak in the California epidemic, and that’s because growth is very slow – deaths and cases in California,” said Dr. Chris Murray, the author of the study and the institute. “And that may be due to earlier social distance. We do not know it. But it is certainly not the trajectory that we see in New York, Louisiana or Georgia, for example. “
The debate over possible outcomes has been clarified in Silicon Valley, where the city of San Jose predicted the number of possible deaths for the region to have its estimate promptly questioned by Santa Clara County officials.
City officials said during a discussion with the San Jose City Council on Thursday that they had predicted at least 2,000 deaths from the disease of at least 2,000 for Silicon Valley by the end of May. A day later, Santa Clara County released a statement that the San Jose projections were not “produced, reviewed, or verified”.
The overseas lessons seem to be that physical isolation measures can work, said Kim-Farley, the UCLA epidemiologist.
Italy issued strict instructions to stay at home, but it is likely that they were only introduced after the coronavirus spread. “I would expect the number of cases or deaths to slow down within a week or two and ultimately decrease as we have seen in China,” said Kim-Farley.
American experts will also be looking overseas to see what happens when the rules on social separation are relaxed, as it will be when the Chinese return to work in the coming weeks. “It is hoped that they won’t see a big second wave,” said Kim-Farley. “That’s the $ 64,000 question: what’s going to happen?”
Uncertainty was not easy among nurses, doctors, and other hospital staff preparing for a rush of cases.
A nurse in the emergency room of a large Los Angeles hospital said that concern among staff is increasing as the number of COVID-19 patients increases, with fears compounded by a worldwide lack of protective equipment.
“Many of us are really afraid to go to work,” said the nurse, who was not authorized by her facility to speak to the media. “Our families are literally scared when we get home from work.” When she sees that people outside the hospital do not follow the rules of physical distance, she becomes angry.
“We wish we could stay at home too,” said the nurse, who refused to be called. “But we can’t.”
An operating room nurse at a Kaiser Permanente hospital in Los Angeles County shared this feeling of foreboding and gave advice on how best to protect workers every day, with guidelines becoming less stringent.
“We are all just so to speak” What in the world are we going to do? “We didn’t register for that,” said the nurse, who also asked not to be named. “We didn’t think we would ever be in the position of health workers working in a third world country in the middle of the forest … It was chaos.”