There is growing evidence that blunt locks, which force people to stay at home except for certain permitted activities, are effective in slowing the spread of the virus, especially as the number of cases and hospitalizations increase. But these controls are difficult to maintain and can cause serious economic damage.
California health officials have mostly resisted such orders since the launch of the first shelter-in-place order in March, relying instead on a so-called “dimmer” approach promoted by Gov. Gavin Newsom, that targets specific activities and industries.
But cases are exploding across California and parts of the state are on the verge of reaching intensive care capacity in hospitals. The governor said some areas could run out of intensive care beds within a week or two. And that’s before California saw the impact of Thanksgiving gatherings and trips.
“They want to balance security and sustaining the economy, and they try all of these different things to see what works. But that kind of half-hearted approach, especially when the flare increases – I’m not sure that will work, ”said Dr. Lee Riley, an infectious disease expert at UC Berkeley.
San Francisco executives said Tuesday they plan to issue new orders this week, possibly Wednesday, after local cases quadrupled in the past month and hospitalizations doubled in just 10 days. The rollbacks would likely include tighter limits on retail capacity and other indoor activities and further reductions in the size of outdoor gatherings, as well as mandatory quarantine for people coming from there. out of town in San Francisco.
“Our dangerous winter has arrived,” the Mayor of London Breed said in a briefing Tuesday afternoon. “We’re going to have to take more restrictive measures, and it pains me to say that.”
Neither Breed nor Dr Grant Colfax, head of the Department of Public Health, have said they plan to issue another full stay-at-home order. Instead, they said they were considering restrictions like those announced last weekend in Santa Clara County. This order includes limits on retail capacity and gatherings, as well as travel quarantine. He also bans contact sports unless people are in the same household, which has kicked the 49ers out of Levi’s Stadium. San Francisco did not say Tuesday that it plans to issue a similar sports ban.
On Monday, Newsom said it expected to issue a stay-at-home order for parts of the state that could look like the first highly restrictive shelter-in-place from March. If the state continues to see a rapid increase in the number of cases and growing demand from hospitals, “we’re going to have to take much more dramatic, arguably drastic, measures,” he said.
The state reported, on average, more than 9,900 cases per day in November, nearly triple the rate for October, according to an analysis of data from The Chronicle. Over the past week, the average has risen to almost 14,000 cases per day. The state reported a record 21,848 cases on Monday, although that number includes cases overdue from the long holiday weekend.
Newsom did not specify what a new stay-at-home order would involve, or which parts of the state would be affected. The new restrictions will come on top of a wave of increasingly urgent orders, including moving the vast majority of counties to the most restrictive purple level in mid-November and then adding a curfew.
The effectiveness of these narrow approaches is unclear, public health experts have said. Managers will often make decisions about things like shutting down indoor restaurants – or schools, playgrounds, and hair and nail salons – based on limited evidence or assumptions about how the virus is spreading.
“What we need is the granularity of the data to make these decisions, and I’m not sure we have it,” said Dr. Stephen Shortell, former dean of UC Berkeley School of Public Health . “For now, rather than locking everything, we’re going to lock X, Y, Z but not A, B, C – nail salons and hair salons are OK, but restaurants aren’t. You need to analyze these locks and see how much they help. ”
Evidence of full closures, such as shelter-in-place orders, is more reliable, said Shortell and other experts. A handful of studies have looked at lockdowns around the world and found evidence that they cause the disease to spread much lower. In California, the shelter-in-place order pushed cases to their lowest level during the pandemic in April and May.
“The evidence base for many public health maneuvers is not the type we’re used to when we are testing vaccines or drugs. It’s very difficult to randomize a city or state for lockdown or not, ”said Dr. Robert Wachter, chair of the UCSF Department of Medicine. Yet, he added, “the physics of lockdowns makes sense in the world.”
“We know how the virus is transmitted,” he said. “We understand that if you can have less interaction between infected people and others, you will reduce the spread. ”
A home support order in the spring in Delaware led to an 82% reduction in the incidence of COVID-19 and an 88% reduction in hospitalizations, according to a study by the United States Centers for Disease Control and Prevention. In England, a second national lockdown in November resulted in an average 30% reduction in overall viral prevalence, according to scientists at Imperial College London.
Another study, published in the medical journal Health Affairs, found that government-imposed social distancing measures by state and local governments in the United States on average reduced the daily growth rate of confirmed cases of COVID-19. 5.4% after one to five days, or 6.8% after 6 to 10 days, 8.2% after 11 to 15 days and 9.1% after 16 to 20 days.
Wachter said he appreciates the desire to strike a balance between keeping the economy open and slowing the spread of the virus. He understands why political and public health leaders are trying to curb the current epidemic with targeted restrictions.
But he fears some hospitals are already nearing capacity – and the Thanksgiving push is still ahead.
“Because the trendlines are all going in the wrong direction, I would be wrong on the conservatism side,” Wachter said. “It would take me away from a surgical approach, to do a little thing here and a little thing there and wait a week and see how it goes. We are in December. We are talking about how we spend the holidays.
“I don’t know if this takes us completely back to March 16 or just,” he added. “Suppose it will continue to get worse. Let’s not be surgical. Let us be decisive now.