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What Would It Take to Eradicate Coronavirus in California? What Would It Take to Eradicate Coronavirus in California?
(about 2 hours later)
Good morning.Good morning.
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Earlier this week, Dr. Bob Wachter, a professor and chair of the University of California, San Francisco’s department of medicine, told us about what trends we should be paying attention to in the coronavirus crisis now.Earlier this week, Dr. Bob Wachter, a professor and chair of the University of California, San Francisco’s department of medicine, told us about what trends we should be paying attention to in the coronavirus crisis now.
Today, we’re looking a little further out.Today, we’re looking a little further out.
As the chief health officer of Santa Clara County, Dr. Sara Cody announced the first case of coronavirus in the Bay Area in January. Last month, she led the rollout of the nation’s first shelter-in-place order.As the chief health officer of Santa Clara County, Dr. Sara Cody announced the first case of coronavirus in the Bay Area in January. Last month, she led the rollout of the nation’s first shelter-in-place order.
My colleague Thomas Fuller talked with Dr. Cody about what lies ahead for California. Here’s their conversation, lightly edited and condensed:My colleague Thomas Fuller talked with Dr. Cody about what lies ahead for California. Here’s their conversation, lightly edited and condensed:
A question about the future: Flattening the curve is a short-term solution. It slows down the first wave, the rate of infections and death, but it doesn’t eradicate the disease by any means. What’s the longer-term solution?A question about the future: Flattening the curve is a short-term solution. It slows down the first wave, the rate of infections and death, but it doesn’t eradicate the disease by any means. What’s the longer-term solution?
This is extraordinarily challenging. We look at the options before us and none of them are particularly shining and bright — none of the options looks great. We are trying to optimize and do the very best we can given the circumstances.This is extraordinarily challenging. We look at the options before us and none of them are particularly shining and bright — none of the options looks great. We are trying to optimize and do the very best we can given the circumstances.
For example, we do not have widespread testing.For example, we do not have widespread testing.
We don’t yet have a widely available antibody test in order to be able to pair someone who is immune and put them out on the front line for all the essential work that needs to be done. We have a shortage of personal protective equipment. We need to be very careful about how we assess our supply, how we estimate what our demand and burn rate is going to be.We don’t yet have a widely available antibody test in order to be able to pair someone who is immune and put them out on the front line for all the essential work that needs to be done. We have a shortage of personal protective equipment. We need to be very careful about how we assess our supply, how we estimate what our demand and burn rate is going to be.
Do I hear from you that it’s been so difficult that you haven’t had time to think about how to handle the next waves?Do I hear from you that it’s been so difficult that you haven’t had time to think about how to handle the next waves?
We are already thinking about that. But I’d be lying if I told you that we had exquisitely detailed plans.We are already thinking about that. But I’d be lying if I told you that we had exquisitely detailed plans.
There are phases. The very first phase was containment. That was when every single case we had, we absolutely went to the mat. We found every single contact we possibly could. Every case was quarantined under a strict legal order, every case was isolated under a strict legal order. We followed them carefully, their symptoms, visits, tests.There are phases. The very first phase was containment. That was when every single case we had, we absolutely went to the mat. We found every single contact we possibly could. Every case was quarantined under a strict legal order, every case was isolated under a strict legal order. We followed them carefully, their symptoms, visits, tests.
Then at some point the rocket ship takes off and you need to shift strategies. And that’s when we moved to mitigation. That’s when we started doing things like the first order to ban gatherings greater than 1,000, and then moving to gatherings greater than 100, and then finally to the first shelter-in-place order.Then at some point the rocket ship takes off and you need to shift strategies. And that’s when we moved to mitigation. That’s when we started doing things like the first order to ban gatherings greater than 1,000, and then moving to gatherings greater than 100, and then finally to the first shelter-in-place order.
The idea is that we slow the train down for a couple reasons. The top level reason is to preserve the capacity of the health care system to care for people who get sick. But the other is if we bend the curve and are able to reduce the case count then we can go back to more refined containment strategies and marry those with the mitigation.The idea is that we slow the train down for a couple reasons. The top level reason is to preserve the capacity of the health care system to care for people who get sick. But the other is if we bend the curve and are able to reduce the case count then we can go back to more refined containment strategies and marry those with the mitigation.
With more testing available, can the shelter-in-place orders be lifted and as soon as an outbreak is identified, a rush to contain it? Are you hoping that’s what comes next?With more testing available, can the shelter-in-place orders be lifted and as soon as an outbreak is identified, a rush to contain it? Are you hoping that’s what comes next?
That’s exactly right. We started out with containment, we are now in very broad-based mitigation.That’s exactly right. We started out with containment, we are now in very broad-based mitigation.
Eventually if we slow it down enough, when we put together more resources and the numbers are less than 1,000, then we could do some more of the individual case investigations, rapid isolation, and that would be another way to slow things down.Eventually if we slow it down enough, when we put together more resources and the numbers are less than 1,000, then we could do some more of the individual case investigations, rapid isolation, and that would be another way to slow things down.
All of this we’re doing while there’s a race to develop a vaccine.All of this we’re doing while there’s a race to develop a vaccine.
But we don’t know if a vaccine will come or not. We’ve had mixed results with previous coronaviruses.But we don’t know if a vaccine will come or not. We’ve had mixed results with previous coronaviruses.
That’s right.That’s right.
There’s this paradox that the better you are at managing the first wave of the virus, the more vulnerable you are to the second wave because you have so many people who are not immune. Is there a fear for the second wave, that the initial success will not lead to any permanent solution short of a vaccine?There’s this paradox that the better you are at managing the first wave of the virus, the more vulnerable you are to the second wave because you have so many people who are not immune. Is there a fear for the second wave, that the initial success will not lead to any permanent solution short of a vaccine?
My hope, and I’m generally an optimistic person, is that if we had just a few more tools at the ready we could focus our resources in a more precise way.My hope, and I’m generally an optimistic person, is that if we had just a few more tools at the ready we could focus our resources in a more precise way.
For example, if we had antibody tests, if we could stand on that, then we would do a much better job with health care workers.For example, if we had antibody tests, if we could stand on that, then we would do a much better job with health care workers.
And we would also be able to understand how much of our population is immune and how much of our population is susceptible. And we could fold that into a model and estimate what might happen in a second wave — and plan.And we would also be able to understand how much of our population is immune and how much of our population is susceptible. And we could fold that into a model and estimate what might happen in a second wave — and plan.
Can you imagine a world where people who have an appropriate level of immunity are cleared to work — where the immune population would be allowed a different lifestyle than the vulnerable and not-yet-immune population?Can you imagine a world where people who have an appropriate level of immunity are cleared to work — where the immune population would be allowed a different lifestyle than the vulnerable and not-yet-immune population?
I think I’m mostly thinking about it in terms of health care workers because of their intense exposure and because of how critical they are to the work force.I think I’m mostly thinking about it in terms of health care workers because of their intense exposure and because of how critical they are to the work force.
Do you fear an unwillingness to shelter in place? How much of that is going to factor into your decisions?Do you fear an unwillingness to shelter in place? How much of that is going to factor into your decisions?
To go back to a fire analogy, right now where we are is fire over the ridge, fire over multiple ridges. We are just dumping fire retardant over huge swaths of land.To go back to a fire analogy, right now where we are is fire over the ridge, fire over multiple ridges. We are just dumping fire retardant over huge swaths of land.
Updated June 12, 2020 Updated June 5, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Once we get the fire under better control we can focus and address spot fires in a more focused way and not have to rely on the massive, entire population to shelter in place.Once we get the fire under better control we can focus and address spot fires in a more focused way and not have to rely on the massive, entire population to shelter in place.
But we also have to understand that our populations are really mobile. Just because we might get things under control in our corner of the land doesn’t mean there won’t be continual importations from other parts of the state or the country or the world. We are a very mobile group.But we also have to understand that our populations are really mobile. Just because we might get things under control in our corner of the land doesn’t mean there won’t be continual importations from other parts of the state or the country or the world. We are a very mobile group.
And this is why, at this point, we can’t plan? We don’t see a way of getting this completely under control?And this is why, at this point, we can’t plan? We don’t see a way of getting this completely under control?
We all have to just take a very deep breath and understand that this is our new normal for a while.We all have to just take a very deep breath and understand that this is our new normal for a while.
[Read the latest updates from California on the coronavirus pandemic.][Read the latest updates from California on the coronavirus pandemic.]
We often link to sites that limit access for nonsubscribers. We appreciate your reading Times coverage, but we also encourage you to support local news if you can.We often link to sites that limit access for nonsubscribers. We appreciate your reading Times coverage, but we also encourage you to support local news if you can.
Farmworkers are often undocumented immigrants. Now, they’ve been deemed essential by a government that has sought to deport them — an irony that’s not lost on those picking the food feeding Americans as they shelter in place. [The New York Times]Farmworkers are often undocumented immigrants. Now, they’ve been deemed essential by a government that has sought to deport them — an irony that’s not lost on those picking the food feeding Americans as they shelter in place. [The New York Times]
Start-ups are feeling the squeeze: Dozens have laid off thousands of employees, slashed costs and are rethinking their businesses. [The New York Times]Start-ups are feeling the squeeze: Dozens have laid off thousands of employees, slashed costs and are rethinking their businesses. [The New York Times]
“I wouldn’t go in the water if you paid me $1 million right now.” Think the ocean is a respite? Think again, scientists say. [The Los Angeles Times]“I wouldn’t go in the water if you paid me $1 million right now.” Think the ocean is a respite? Think again, scientists say. [The Los Angeles Times]
Income tax filers got a delay. But if you’re a homeowner, you should still plan to pay your property tax next week. [CalMatters]Income tax filers got a delay. But if you’re a homeowner, you should still plan to pay your property tax next week. [CalMatters]
And finally, a review of “Wow, No Thank You,” by Samantha Irby, our “great bard of quarantine.” [The New York Times]And finally, a review of “Wow, No Thank You,” by Samantha Irby, our “great bard of quarantine.” [The New York Times]
California Today goes live at 6:30 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com. Were you forwarded this email? Sign up for California Today here and read every edition online here.California Today goes live at 6:30 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com. Were you forwarded this email? Sign up for California Today here and read every edition online here.
Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles — but she always wants to see more. Follow along here or on Twitter, @jillcowan.Jill Cowan grew up in Orange County, graduated from U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles — but she always wants to see more. Follow along here or on Twitter, @jillcowan.
California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.