SALT LAKE CITY — In New York, news about the coronavirus crisis becomes more dire with each passing day: soaring case numbers, rising death tolls, overflowing hospitals, inadequate medical protective equipment, heartbreaking tales of sick and dying loved ones.
But in the past week, a more positive story has been unfolding on the other side of the country. Some places — such as Seattle and the San Francisco Bay Area — are managing to “flatten the curve,” or slow the virus’ spread so that fewer people are seeking medical treatment at the same time.
In the Seattle area, where the first known case of the coronavirus in the United States emerged and where 37 of the first 50 known victims died, preliminary statistical models suggest that the spread of the virus has slowed in the past week, according to data analyzed by the Institute for Disease Modeling, a research group in Bellevue, Washington. Deaths are not rising as fast as they are in other states, and hospitals have not been pushed beyond their capacity, The New York Times reported.
While earlier in March, each infected person was spreading the virus to an average of 2.7 other people, that number appears to have dropped, with one projection suggesting the number was down to 1.4, according to the report by the Institute for Disease Modeling, which was provided to public officials in Washington State earlier this week.
Seattle’s slower infection rate may be evidence that the region’s aggressive approach to social distancing measures are working, said Dr. Jeff Duchin, epidemiologist and public health officer for Seattle and King County, in a press call earlier this week.
“The bottom line here should be that what we’re doing now appears to be working, that we should in no way take these findings as an indication to relax our social distancing strategy, that we need to continue this for weeks,” he said.
But while Seattle and the Bay Area have been under some type of stay-at-home or shelter-in-place order for several weeks, other states’ approaches to social distancing has varied widely, with some slow to close bars, restaurants and schools. Others have been hesitant to legally enforce social distancing measures.
In Utah, social distancing is strongly encouraged through a “stay safe, stay home” policy, announced by the governor March 27, with both Salt Lake County and Salt Lake City mayors bringing “the force of law” to the policy by issuing proclamations.
With Seattle and the Bay Area beginning to show signs of improvement, other states can learn from their proactive approach, epidemiologists say.
What Seattle and the Bay Area are doing right
“Flattening the curve” is a term many people are still unclear on what it actually means, said Dr. David Witt, an infectious disease specialist for Kaiser Permanente in Northern California. It refers not to the number of cases itself, but to the rate of increase in cases each day, and how sharply that rate goes up.
“What’s most important for the health care system is to keep the peak low,” said Witt. “If you have an unexpected maximum number of sick people coming in, there isn’t a cushion in the hospital system to take care of them.”
Seattle and the Bay Area have thus far managed to avoid this scenario. What made the difference? The answer appears to be early and aggressive social distancing measures.
In Washington state, some companies mandated that their employees work from home even before the state required it. On March 4, Microsoft — based in Redmond, Washington — asked employees to work from home, and shortly after, Amazon did the same. That translates into thousands of employees. Washington public schools closed on March 16.
Also on March 16, six Bay Area counties became the first in the country to implement an enforceable shelter-in-place order. California Gov. Gavin Newsom followed three days later with a statewide order that required the state’s 40 million residents to stay at home. Now, two weeks later, the state is starting to see what officials believe are positive results.
“We believe very strongly the stay-at-home order has helped advance our efforts in reducing the stress on the system that we believe would have already materialized in more acute ways had we not advanced those protocols when we did,” Newsom said Monday in a press conference.
Northern California is “seeing a leveling off of COVID-19 cases in our hospitals,” Stephen Parodi, an infectious disease doctor and associate executive director with the Permanente Medical Group in Northern California, told Politico.
“While we still predict an upcoming surge, the partnership between the health system and public health officials on the local and state levels to implement social distancing has given us more time to put a lot of pieces in place to prepare for a potential surge,” Parodi said in a statement.
By contrast, New York City Mayor Bill de Blasio has come under fire for what some have called a sluggish response, missing critical weeks when the city could have prepared for the outbreak.
“I’m encouraging New Yorkers to go on with your lives + get out on the town despite coronavirus,” he tweeted on March 2, the day after New York City had confirmed its first coronavirus case. New York Gov. Andrew Cuomo has been praised for his decisiveness and daily press briefings that become must-watch TV for New Yorkers (and the nation) stuck in their homes in search of information.
New York state has since become the epicenter of the virus, with more than 57,159 cases and 1,562 deaths, as of Friday. New York City’s cases constitute nearly a quarter of the confirmed cases in the whole country, which was 239,279 on Friday, with 5,442 deaths. The number of coronavirus cases in the world has now exceeded one million, at 1,095,134 cases with 58,791 deaths.
Some state leaders were even more openly resistant to taking the virus seriously. On March 14, Oklahoma Gov. Kevin Stitt faced swift backlash after tweeting a photo of himself and his children at a crowded restaurant, stating, “Eating with my kids and all my fellow Oklahomans at the @CollectiveOKC. It’s packed tonight!” He later deleted the tweet.
But this resistance to undertaking strict social distancing measures appears to have had real consequences in many areas, exacerbating the outbreak when the United States was already behind in responding to the threat posed by the virus, said Witt.
“I think this country was two to three weeks behind, in recognition and in addressing it seriously in having the testing,” he said. “So by the time we really geared up to start being able to do something, this was pretty widespread in some places.”
‘Get prepared now’
The major lesson to learn from Seattle and the Bay Area is that states must be proactive, not reactive, to the coronavirus pandemic, said Witt, the infectious disease specialist in Northern California.
“What is really disturbing to me is that we’re seeing around the country that the places that are having major outbreaks are doing major mitigation, but the places that aren’t having major recognition are not, and won’t do it until they have major problems,” he said. “It’s the exact wrong way to solve this.”
First, hospital systems everywhere must prepare for a surge, even if right now the numbers of cases aren’t yet flooding the medical system, said Witt.
“Get prepared now,” he said. “Prepare for beyond what you ever thought you’d see in North America.”
While thus far Utah’s hospitals have been “under capacity,” with enough beds for patients and protective gear for doctors, a “surge” of cases is expected in the next two weeks, an ER doctor in Salt Lake City told the Deseret News.
Utah has 600 intensive care unit beds in the system, with about half of them currently occupied — mostly by patients without coronavirus. At the virus’ peak, 227 intensive care unit beds will likely be needed for COVID-19 patients, Retired Maj. Gen. Jefferson Burton, who was recently appointed to lead the Utah Department of Health’s pandemic response, said.
The state is believed to have enough ventilators, with 28% of 1,000 ventilators currently in use by other patients, Burton said Friday. Health officials in the state said they are working at preparation and gathering adequate resources “seven days a week around the clock since January,” Jenny Johnson fo the Utah Department of Health said.
Second, social distancing is vital. Closing schools and isolating family units is key. If you are sheltering in place, it’s OK to take walks or get exercise outside, but don’t gather in large groups at parks or on beaches.
At grocery stores, take precautions by sanitizing your hands on your way in and out. Using a mask when in public settings could also help stop the transmission of droplets from one person to the next, but people should not use N-95 masks as those must be reserved for doctors working in the coronavirus units at hospitals.
The Centers for Disease Control and Prevention recommended Friday that Americans use “nonmedical, cloth” masks, continuing to social distance in public. President Trump said the recommendation is voluntary.
“In common sense epidemiology, the coronavirus pandemic is a forest fire,” Witt said. “If you have a lot of big, dry trees next to each other, it’s a bigger fire, and it will burn faster and quicker.”
Social distancing, in essence, is like taking the majority of the trees out of the forest, so there is less kindling for the fire and ultimately much less devastation.
But while Seattle and the Bay Area’s early successes at flattening the curve may seem like a strong indication that the rest of the country should follow their lead, actually doing so may be a challenge.
That could be because America could be hamstrung by its own democratic virtues. The things that we often count among this country’s greatest strengths — freedom of thought and movement, resistance to authoritarianism, the power of individual states to counterbalance the authority of the federal government — may be impeding the ability of the country to have a coordinated, comprehensive response to the coronavirus pandemic, said Witt.
While in China, as an authoritarian state, the government locked down the country and monitored the whereabouts of its citizens, thus managing to reduce the impact of the virus, the United States response has been less unified.
The Centers for Disease Control and Prevention has no authority to require any state or county or city government to implement any policies or procedures, it is merely a group of experts who issue guidance, said Witt. Health measures are not even uniform within a given state — each county health department has the authority to decide what measures work best for its own citizens, unless the governor intervenes.
But there’s one safety mechanism built in to the system, in case of a crisis: the guidance of the president of the United States can turn a series of disparate, competing authorities into one well-oiled machine, he said.
“The state has limited authority over each of the counties, unless there’s a governor’s declaration, and the feds have limited authority over the states unless there’s a presidential declaration,” he said. “So the emergency declarations are what start permitting us to act with unity.”
But leaders are often hesitant to invoke such declarations, especially when it means they will undoubtedly cause suffering: by shutting down the economy and leaving thousands of people with no source of income, or by restricting access of visitors to their loved ones who are sick in the hospital.
But, said Witt, we’ve already seen the consequences of such hesitance to take dramatic steps to reduce the virus’ toll. As of Wednesday evening there are 214,482 people listed as infected and 5,093 deaths in the United States, numbers expected to increase until the height of the curve is reached.
“It really takes a gutsy decision by the government to make it effective,” he said. “It’s a really difficult decision for our leaders, and they will be criticized either way. But I think the right answer here is for leaders to recognize this as early as you can and stop it, because it’s not going away, and you are not going to be spared.”
But unlike in China, the powers of the president are limited, even during a pandemic, said Mike Leavitt, former governor of Utah and secretary of health and human services from 2005 to 2009. Trump declared a national emergency on March 13,
which freed up $50 billion in federal resources to combat coronavirus, but did not require any uniform action across the country, such as requiring all Americans to shelter-in-place.
“The President does not have the authority to render a full quarantine across the entire country,” he said. “That power resides in the states and local governments.”
Leavitt says that in his view, the pandemic has not produced division and disorganization but unity and leadership, exemplified by Congress’ efforts to pass legislation to address the crisis, such as the recent coronavirus relief bill.
“There is a growing sense of unity and and fighting a common enemy,” he said. “Who would have thought three months ago that a Congress as divided as this one...could come together in a matter of days and do what they did?”