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The trend lines are as sharp as they are confusing: Daily COVID-19 infections in New York City have fallen more than 90% from their peak in mid-April, while new cases in California have increased tenfold during this period.
New York, a springtime coronavirus horror, has since won praise for corralling the contagion. California, a model for its first stay-at-home order across the nation to slow the spread of the virus, is now a cautionary tale as it reverses reopening in a fight to contain outbreaks. The state’s public health director resigned without explanation last weekend, and New York is insisting on visiting Californians in quarantine for two weeks.
What happened in the world?
There are no easy answers. Infectious disease experts cite a number of things that have influenced states’ epidemic trajectories, from how state leaders have handled reopenings to public health compliance, to different levels of immunity. and viral strains and even just luck.
But many point out that the virus was so apocalyptic for New Yorkers – with nightly sirens from ambulances rushing disaster victims to overwhelmed hospitals where lobbies have been turned into emergencies and cooler trucks into curb mortuaries – they remain much longer. vigilant.
“The cases have broken out, and the deaths – I’m still panicked about it,” said Maureen Miller, infectious disease epidemiologist at Columbia University’s Mailman School of Public Health in New York City. “The back of your face was really terrifying.”
This was not the case in California, where hospitals and makeshift emergency rooms were nearly empty in the first months of the pandemic – but by Friday the state had totaled more than 600,000 cases and 11,000 deaths. Miller noted that a relative in San Diego only recently started wearing a face mask on a regular basis, which she and other New Yorkers have been doing since April.
Unlike Republican-led Texas and Florida, which have also seen cases skyrocket over the summer, California and New York are Democrat-led. But although New York Gov. Andrew Cuomo and California Gov. Gavin Newsom share a similar policy, their style differs.
David Vlahov, an infectious disease epidemiologist at Yale University who lives in New York City, found that Cuomo, 62, was more effective at communicating what was needed to clear the virus than Newsom, 52.
“Cuomo was able to take some very complicated information and make it accessible,” Vlahov said. “When he had his daily briefings, the world would stop, people would stop to watch him. He really had empathy, people related to that. I saw Gavin once and thought this guy was really gossiping. It is neither inspiring nor informative. “
Close examination of how each state responded when their epidemics increased shows that they have taken broadly similar approaches with a few notable exceptions, suggesting that there is more to the results than their policies.
“Politics is only part of it,” said Dr. Amesh A. Adalja, senior researcher at the Johns Hopkins Center for Health Security in Baltimore. “Respect for politics is another factor.”
California experienced its first cases of COVID-19 in January. In mid-March, the Bay Area and Southern California counties were ordering residents to shelter in place, followed by Newsom’s March 19 stay-at-home order statewide. .
Meanwhile in New York City, which only saw its first case in March, Cuomo and New York City Mayor Bill de Blasio were still debating the need for such drastic measures. Cuomo’s New York State equivalent of the break order went into effect on March 22. Epidemiologists have even said that a few days of delay could have allowed the virus to spread exponentially in New York.
But while New York’s leaders were slow to respond at first, the unfolding nightmare quickened their pulse. On April 15, as daily cases peaked in New York City, Cuomo became the first U.S. governor to require residents to wear masks. Los Angeles and San Francisco issued similar warrants around the same time, but Newsom didn’t make them statewide mandatory until June 18, more than two months later.
Amid protests from residents asking for the reopening, the two states began in May to establish ground rules for regions to ease phased lockdowns, as they met criteria for reducing hospitalizations and deaths and increasing capacity to detect and investigate cases. In mid-May, Newsom relaxed some requirements after criticizing that some of the criteria for reopening California – such as no deaths in the past 14 days – would be unobtainable for most counties.
Rural and suburban communities in both states began to reopen over the next few weeks, but the situation was quite different in their largest and hardest hit towns. For example, in Los Angeles, bars, restaurants, gyms, wineries and nail salons have welcomed clients indoors, even as new cases and hospitalizations have increased. In New York City, even now, restaurants and bars still cannot serve customers indoors.
By July 7, new daily cases in California had more than doubled in a month, while New York City held on with about a tenth of cases. It was at this point that Newsom ordered the closure of indoor restaurants and other businesses in Los Angeles and other urban counties where business was soaring.
And then it happened: On July 22, California passed New York by recording the highest number of COVID-19 cases in the country during the pandemic: 413,576. The day before, California had recorded its newest. daily cases, 12,807, prompting San Francisco Director of Public Health Dr Grant Colfax to darkly warn that “it is plausible that we could end up in a situation similar to New York at the late summer or early fall. “
The highest number of new cases in New York on April 15 was 11,571 – as of July 21, it had only 855.
To be clear, with half the population of California and more than double the deaths so far, New York has seen a worse situation. But if you wanted to pick a place today to be more immune to the coronavirus, there is no doubt that it wouldn’t be California. Dr Bob Wachter, who heads the medical department at the University of San Francisco, said when it comes to the virus, New York “is now probably the safest place in the country.”
But the question remains here: Did California invite disaster by reopening too quickly?
Experts like Adalja say New York has done a better job putting in place a strong system of investigating cases before reopening to trace close contacts of those newly infected and alert them for testing and isolation – standard public health practice to contain epidemics.
California Health and Human Services Secretary Dr Mark Ghaly has defended California’s response to the pandemic.
“This idea that we did something completely wrong is something that I strongly dispute,” Ghaly said in an interview with the Bay Area News Group.
Ghaly added that while the state has provided reopening advice, it has not always been followed.
“In Los Angeles, the county I live in, there were a lot of restaurants, for example, that weren’t following the guidelines as well as we would like,” Ghaly said. “They saw masks in the low-lying restaurants and overcrowded bars.”
It wouldn’t surprise Mindy Yuen, 34, a digital designer who, after recovering from the virus on her own, left New York City in June with her husband and son to stay with her parents in Vacaville before giving birth to their second child. She was amazed at how cavalier Californians seemed about the pandemic.
“In New York, it was very serious the way people talk about the virus,” said Yuen, who is preparing to return to the Big Apple, where the spring nightmare remains a living memory. “You would hear sirens every night, drive and see those freezer trucks outside hospitals – it was very real.
Yuen understands that things weren’t so bad in California, where temporary hospitals like the one set up at the Santa Clara Convention Center in anticipation of a surge in patients have done little to help. But she laments that California’s more relaxed attitude is rubbing off on her and making her uncomfortable.
“It’s not a big deal here,” Yuen said. “It’s not taken seriously. I felt it was so weird.
However, experts are not convinced that the pace of reopening or social respect for public health measures fully explains the different results. Miller cites a preliminary study by the Scripps Research Institute which suggests that the strain of the new coronavirus that took off in Europe and then New York spreads much more easily than the first California strains from China. This European tension has since made its way across the country and could be the source of the summer surges in the south and west.
Wachter is not convinced by this theory, but points to other studies indicating that one in five New Yorkers now have antibodies following exposure to the virus, compared to one in 33 Californians, a level of immunity that can be achieved. spread in the east. And he notes that California was fortunate enough to avoid a “super widespread” event earlier this year like the ones that hit New York.
“We were good at the start,” Wachter said, “and we were lucky.”
Ghaly said experiences in different states at different times did not lend themselves to easy comparison, noting that knowledge of the virus is changing. It is becoming increasingly evident, for example, that the virus spreads more easily indoors than outdoors, which California learned when it reopened and he said the city of New York had been able to learn from the Golden State. California, in turn, learned better treatment methods from early New York experiments, helping to reduce the death toll.
And he said it was too early to reverse a pandemic that is still unfolding – there are indications the summer case outbreak in California has already peaked.
“We’re in a moment in time in all of this response in COVID-19,” Ghaly said. “To critics who are trying to draw conclusions now, I would say… we are still writing our story.”
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