Theories on how L.A. County became the home of state coronaviruses

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In mid-March, as the specter of a rising pandemic of society grew, Los Angeles County emerged as a kind of bright spot.

When Bay Area counties ordered all residents to stay at home on March 16, officials said it made no sense in LA County as far fewer cases of coronavirus had been detected. .

“We don’t have the same trajectory as they have in the North,” said Barbara Ferrer, director of public health for the county of LA that day, when asked about a home stay order. .

Two months later, the situation has radically changed. Los Angeles County now has the highest death rate from COVID-19 in the state, and the second highest infection rate. On Friday, federal authorities singled out Los Angeles because of the stubbornly high number of coronavirus cases, despite the precautions taken to slow the spread.

With so many factors at play, it is almost impossible to know who is at fault, especially in the midst of a changing epidemic, experts say.

Many epidemiologists have reported densely populated neighborhoods with overcrowded housing, as well as high rates of poverty, homelessness and even pollution that could fuel poor outcomes in L.A. County.

Another factor could be the closure of local authorities. The Bay Area issued its residence order on March 16, followed by the County of L.A. three days later. Although earlier than the rest of the nation, the delay may have set the stage for L.A. County to take over the Bay Area as California’s center for COVID-19.

“The Bay Area probably understood this earlier, and that is why the Bay Area seemed worse at first,” said Dr. Timothy Brewer, UCLA epidemiologist. “I think L.A. was a little behind S.F. and some of the surrounding areas in the bay area … and now we see the aftermath of that. “

Los Angeles County officials say that while deaths are still extremely high, there are other indicators that the region is starting to turn the page. But understanding how things got so bad in the first place is going to take time.

“The way the coronavirus works in a certain way is unique to different cities and counties around the world,” said Amanda Daflos, innovation manager for the city of L.A. “

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Compared to Canadian cities, the rate of COVID-19 cases and deaths in Los Angeles is relatively low. About 2,000 people died in Los Angeles County from COVID-19, while in New York City, which has roughly the same population size, the death toll has exceeded 20,000.

But the region has become an outlier in California. In Los Angeles County, 426 out of 100,000 people tested positive for COVID-19, up from 270 in San Francisco. In Los Angeles, 20 out of 100,000 residents died from COVID-19, compared to 4 in San Francisco.

“If you look at the different counties and cities, L.A. has been a home,” said Bradley Pollock, UC Davis epidemiologist.

To try to make sense of these trends, data auditors from the L.A. County Public Health Department recently released figures, said scientific director Dr. Paul Simon.

They checked to see if the population of Los Angeles County was older than that of the rest of the state. In Italy, an older than average population would have contributed to the alarming death rate in this country. But analysis of Los Angeles County has revealed that its population is no older than the rest of the state and may even be slightly younger, said Simon.

Analysts also looked at whether county residents were more likely to have diabetes, high blood pressure or obesity compared to the rest of the state, factors that could make them more likely to die from COVID-19. . Again, they found no difference, he said.

“What does that leave us with? Said Simon. The answer was a bit of a puzzle, he said.

A part can be the delayed home stay order.

Although it appeared in March that LA County had less coronavirus transmission than the Bay Area, experts say it is now clear that there was likely widespread coronavirus transmission long before it be detected, especially in Los Angeles County, with its high number of incoming travelers.

Thus, the idea that the Bay Area had more transmission than the rest of the state was only an indicator of who detected it first, experts said. And early detection of these cases may have helped the bay area, as it sparked rapid action and changed public sentiment, experts say.

In San Francisco, fewer people went to restaurants and other public spaces as of late February, long before such a change was seen in L.A., said Dr. George Rutherford, epidemiologist at UC San Francisco. Many Bay Area tech companies have asked their employees to work even before these orders, which is more difficult in Los Angeles County, where fewer people are working in high-tech jobs, he said. .

The city of Los Angeles, the largest in the county, ordered bars and restaurants not to go out until March 16, the same day that the Bay Area put in place its stay at home order. But the county-wide warrant only came three days after that of the Bay Area, and the real effects of the warrant likely weren’t felt for a few days after it was ordered, based reports that people crowded the beaches the weekend after the announcement, Rutherford told me.

“Functionally, it was probably six days later, which could represent up to 1.5 more generations of viral spread, which makes a big difference,” he said.

But Rutherford and other epidemiologists have agreed that the delay ignores the high rates of cases and deaths.

The city of Los Angeles has widely expanded the tests, now even for asymptomatic residents, which may explain why the number of cases does not decrease rapidly despite the stops, but that does not explain why the mortality rates are also higher, according to experts.

The most commonly cited explanation was density: many people living close to each other, creating the perfect conditions for the spread of the coronavirus. Data from other regions shows that the virus is often spread within households due to close and prolonged contact which facilitates its spread. Once the virus enters these parameters, it can spread widely, experts say.

“The county is 10 times the density of the state as a whole,” said UCLA Brewer. “If you think of the places where we have seen very explosive epidemics, they have tended to occur in places like meat packing plants, skilled nursing homes, retirement homes – places where people spend a lot of time together in close contact in closed environments. “

Los Angeles County also has higher poverty rates than all of the Bay Area counties, as well as almost all of the state’s urban counties. The poor are more likely to be homeless and unable to stay home when sick, have access to healthy food and medical care, and more likely to live in polluted areas.

These factors have paved the way for epidemics in L.A. County in the past, including typhus, hepatitis A and measles in recent years, said USC epidemiologist Dr. Neha Nanda.

Experts say their understanding of the lingering L.A. outbreak will continue to grow in the coming months, although there are already signs of hope.

Officials announced earlier this week that the rate of transmission of the coronavirus has dropped lower than ever. Before the stay orders in March, everyone in L.A. County likely infected at least three other people. Now that number has dropped below 1, a sign that the epidemic may start to decrease.

But experts say that with infectious diseases, when a single case can turn into thousands, it’s impossible to predict what will happen next. With regard to the L.A. County epidemic, certain factors are beyond its control, said Rutherford of the UCSF.

“It is also a matter of luck,” he said.



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