2040 MATTERS

It’s time for the State to change course as well by re-empowering our local governments to take the lead in protecting public health.

On April 8th, I wrote that that the COVID-19 hospitalization data pointed to a bent curve. Just three days later, the data tell us the statewide curve was flattened days ago and is now completely bent downward.

Now what? The arc and timing of this curve was predictable and predicted. I’ve been urging our elected officials for weeks to plan for the success of the stay at home order. Now they need to act. One option they could implement by May 1st: The State could replace the statewide order with a set of statewide minimum social distancing standards that could be augmented by locally-based, and far more carefully-tailored, public health measures that would allow people to lead more normal lives while still protecting public health and preventing a catastrophic spread of the virus. The data tell us this can be done – it worked from March 8th to March 19th. Austria is starting to do something similar. Italy is not far behind.

This is California. We are supposed to lead the nation. We did it by beating back the virus. Now let’s do it again by gradually and sensibly resuming our lives.

Let me be entirely clear about this: I am not advocating that public health measures simply end when the statewide stay at home order is lifted. Please do not be distracted by the red herring that is beginning to appear in many public health presentations – arguing that the stay at home order must be extended because the virus would resume its uncontrolled spread if the stay at home order were lifted and not replaced with other social distancing measures. No one is arguing that significant social distancing measures are no longer required. To the contrary, as I’ve written repeatedly, we are going to need a range of public health and social distancing measures for weeks and months to come. I am confident that these can be designed and implemented at the local level, beginning today.

Hospitalizations Are Plummeting

This chart shows the updated trajectory of net daily hospital admissions since the State began reporting this data (if you need a primer on how the State reports hospitalization data, click here):

California’s statewide COVID-19 hospital admissions have plummted over the past 10 days.

As a reminder, the stated goal of the stay at home order was to flatten the daily hospital admission curve to the point where our healthcare system could provide the highest quality care to both COVID-19 and all other patients by ensuring that new admissions never exceeded the number of discharges on a given day.

The early predictions were that we would need more than 50,000 beds to achieve this goal, with thousands of new admissions each day during the peak of the pandemic. We have done it with far less than 6000 beds (we are using fewer than 3000 beds for confirmed cases today), just as I predicted weeks ago. Contrary to reports that it has yet to arrive, the statewide hospitalization peak has already occurred – it happened between March 27th and April 1st. Today, we are almost certainly discharging more COVID-19 patients than we are taking into the healthcare system. We are restoring healthcare capacity every day across the State (although the precise conditions in a local jurisdiction may vary depending on the timeliness and scope of compliance with the stay at home order). [UPDATE: On April 10th, the State data demonstrated that we discharged more patients than we admitted – the bed count for confirmed cases decreased.]

Three days ago I wrote that I was confident that the decrease in hospitalizations was not a blip on the radar. With 10 days of data, now we know it is not. We are seeing the full impact of the stay at home order manifest itself in the data as I predicted it would. Three days ago, I also wrote that I expected to see a continuous, but bumpy, deceleration in the virus. We have, and we will continue to do so. I also wrote that we would continue to follow in Italy’s footsteps. Here, I may have been wrong: We may soon surpass Italy in our dramatic reversal of the trajectory of the virus. In short, we did it!

The virus has changed course. Now the State must follow.

The State can no longer credibly claim that it needs “a few more weeks” (as the Governor suggested yesterday) to assess the impact of the stay at home order. The data are unequivocal. It is equally clear that there is no “sneaker wave” of hospitalizations building in the statewide data, as some have claimed (without supporting data or precedent). Remember, the impact of staying at home for the past two weeks will be seen in the data for the next two weeks. With each additional day of social distancing we add now, we are ensuring there is simply no stimulus to change the overall trajectory of the virus into late April and early May. The State may be belatedly figuring this out. Yesterday, the Governor and Public Health Department began publicly distancing themselves from prior projections by stating that new data showed the stay at home order had exceeded projections for curtailing the spread of the virus. Better late than never.

If the State still believes there is a reason for everyone in California to continue staying at home to preserve our healthcare capacity (as opposed to empowering local governments to transition to less disruptive public health measures based on their unique circumstances), then it must transparently explain and defend its position with actual evidence (not its flawed modeling) that we are likely to see a roughly ten-fold increase in hospitalizations under the stay at home order sometime after April 25th. It will not find any support for its position in the trajectories of Italy or Austria – the two countries transitioning from full lockdown orders to less disruptive public health measures. If the State cannot offer compelling evidence to support the statewide stay at home order, then it should restore local control over public health, with rigorous minimal standards that must be met (and that localities are empowered to exceed if necessary to ensure healthcare capacity in their area). Here too, the Governor and Public Health Department signaled yesterday that they are beginning to think about the next phase for California, starting perhaps in early-to-mid-May. Again, better late than never. But we should strive to be on time.

We have sacrificed for weeks. The toll this has taken on our residents is enormous and growing. We have more than achieved the stated goal of the statewide stay at home order. Our statewide healthcare system has at least 20,000 beds available for COVID-19 without any extraordinary surge capacity. We have used no more than 15-30% of that capacity to meet the moment. The government has ample room to maneuver in protecting public health and moving to a new normal – the data over the past 5 weeks make this abundantly clear. With the downward trajectory of the virus cemented for another two weeks, the time to insist that the State begin the process of transitioning to our new normal by re-empowering our local governments to implement rigorous and tailored public health measures is now. Please make your voices heard. Our elected officials need to hear them.

Be safe. Stay healthy.

Updated on April 12th to include reference to data reported by State on April 11th demonstrating that discharges exceeded new admissions on April 10th. 

Updated on April 13th to note that all California statistics used in my analysis are based on the official daily statistics provided by the California Department of Public Health.