Early intervention, or population density? NPR reporters based in the Bay Area and New York City offer explanations as to why the two regions are seeing such a wide contrast in experiences during the coronavirus outbreak.
"Is social distancing working?" asks Mary Louise Kelly, co-host of NPR's All Things Considered, in the introduction to a six-minute comparison (audio available) of how two regions: six counties in the Bay Area and the five boroughs of New York City, are experiencing the coronavirus outbreak that has infected almost 393,000 Americans, the highest in the world, and killed almost 13,000 as of April 7.
The report aired on Wednesday, April 1. The virus is spreading exponentially, but often the only data available on trackers or county/city departments of health is daily, so current case and fatality numbers are placed in [ ] adjacent to what the reporters cite to illustrate the rapid increase of infection and death attributed to COVID-19.
"Nearly 50,000 people have tested positive [68,776 on April 6]. Nearly 2,000 people [2,738] have died in the city. Hospitals are full of people with severe cases of COVID-19. Some doctors and nurses are starting to get sick. And as the governor of New York, Andrew Cuomo, said today, New York is still climbing the mountain."
"California is not experiencing anything like what's happening in New York," states John Ruwitch.
"The caseload here is a fraction of New York's today. Gavin Newsom, the governor of California, announced that there were just over 8,100 confirmed cases in the state [17,321on April 7] compared to 138,683 in New York State]. And it's America's biggest state—with about 40 million people. One thing to note is that California has been behind New York in terms of testing, so we don't really have the full picture. But experts and the government here are keeping track of hospitalizations and numbers of people in ICUs as sort of the key indicators. And those numbers are lower than New York's, too.
Kelly then asks Ruwitch the key question, "And where you are in California, the Bay Area specifically, was one of the earliest parts of the country to issue a shelter-in-place order. Is that early shelter-in-place order one possible reason why cases there seem to be progressing more slowly?
RUWITCH: Doctors I've talked to here think the shelter in place has potentially been a big part of it. People here have certainly been taking it seriously—and it's worth noting—for over two weeks now [since March 17], which is the outer limit of what people think the incubation period is for this virus.
"Preliminary, very preliminary indications are that things seem like they're going in the right direction," states George Rutherford, a professor of epidemiology and biostatistics at the University of California, San Francisco. "But it could all change quickly, and we want to make sure everybody keeps doing what they've been doing."
Less guarded was his colleague Travis Porco, a biostatistician at UCSF who has been tracking several data points to follow the progress of the Bay Area outbreak. "At this stage, it looks like the beginnings of a trend toward flattening," he told Erin Allday of the San Francisco Chronicle on April 6.
"It’s unmistakable for some counties. I definitely am guardedly optimistic."
On March 31, the six counties and the city of Berkeley, which operates its own public health department, extended their shelter-in-place orders through May 3.
Kelly asks Hersher, "What is driving the trajectory there in New York, which is also under stay-at-home orders. So how does that factor in?"
HERSHER: Yeah. New York did issue its stay-at-home order slightly later than California and especially almost a week later than the Bay Area.
Gov. Cuomo issued the original PAUSE order on March 20, the morning after Gov. Newsom issued the nation's first stay-at-home order. But unlike his California counterpart, who made is order effective immediately, Cuomo's order took effect two days later.
Hersher continues: And that may matter. It's too soon to know, though. What epidemiologists have told me about what's happening in New York—what's definitely important that we already know is important is the density. So you can just imagine people are living in buildings with a lot of other people, right? New York City, Manhattan, even the outer boroughs—they're extremely dense. And there's a huge reliance on mass transit.
Is Hersher describing density or crowding? Native Americans living in sparsely populated reservations but in overcrowded housing may suffer among the highest rates of COVID infection, according to The Washington Post.
"So people—they're packed closer together. They're sharing more surfaces—elevator buttons and door handles and railings. Like, imagine getting food without a car, without touching anyone or anything. It's really hard," adds Hersher.
Density and mass transit increasingly appear to be blamed by some public health experts for the high death toll in New York City.
"Los Angeles has the worst public transportation system in the country. Everyone drives," Lee Riley, a professor of infectious disease at the University of California Berkeley, told The Washington Post. "This has actually turned out to be protective for this kind of virus."
Early intervention more important
Dr. Martin Makary, a Johns Hopkins health policy expert, surprisingly cited the Bay Area-New York City comparison in his response to a question asked by Fox News host Harris Faulkner on April 6 about whether all states need to issue stay-at-home orders, a reference to the eight states that have yet to issue them
"San Francisco had [only] 8 deaths on Friday. Why is that? That’s because they had a very early 'shelter in place' and good social distancing education," he responded. "A lot of us have been wondering, what’s worse?"
A busy public transit system like New York City, or
An area that was very late to shelter.
"The numbers out of Louisiana are very telling, they are significant," added Makary.
"They are telling us now that there are 39 deaths per 100,000 people compared to 19 in New York. That’s double. Louisiana has double the death rate and that’s because they did not do the sheltering until late. [Gov. John Bel Edwards issued the order on March 22. It took effect March 24.]
"So I think we’re learning a lot, and I’m worried about cities like Atlanta that went into sheltering just 5 days ago. It may be that late sheltering is one of the most ominous signs of the peak having a bad impact."
Update April 7
In his morning press briefing, New York Gov. Andrew Cuomo announced that his state saw the largest amount of deaths on April 6: 731 deaths, up from 599 on Sunday, bringing the total to 5,489.
The Louisiana Department of Health reports that 70 people died Monday, bringing the total to 582, fourth highest after New York, New Jersey and Michigan. In Georgia, 75 people died on Monday, according to the Atlanta Journal-Constitution.
As the public health expert on the White House Coronavirus Task Force, Dr. Deborah Birx, told Americans on March 31 upon the president's decision to extend his Coronavirus Guidelines for 30 days, success in "flattening the curve" comes down to behavior, regardless of where one lives.
Related in Planetizen:
N.Y.C. Density and Spread of Coronavirus, March 31, 2020
Bay Area Ordered to Shelter in Place, March 17, 2020
Hat tip to Pat Carstensen.
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