(TNS) — Gov. Gavin Newsom's abrupt move to lift stay-at-home orders — allowing outdoor dining and other business activities to resume — represents a gamble that California can avoid another deadly coronavirus surge in the coming months despite a slow, frustrating rollout of the vaccine and the looming threat of more contagious strains of the virus taking hold across the state.
After a catastrophic fall-and-winter surge left about 20,000 dead, California is rapidly bending the curve as new cases fall and hospitalizations decline. COVID-19 hospitalizations began to fall about 2½ weeks ago, and much of this progress can be attributed to residents changing their behavior by avoiding travel, staying at home more and following the new rules.
The question now is whether California can keep cases down even as activities such as dining, cosmetology and travel pick up.
Lifting the stay-at-home order should be a boost to some restaurant owners and other merchants whose businesses have been battered by cycles of closure since the pandemic began and who placed enormous pressure on the governor to ease restrictions as campaigns gather signatures to recall him from office. But experts said it would not take a lot for the situation to spiral out of control again.
UC San Francisco epidemiologist Dr. Kirsten Bibbins-Domingo said lifting the order can work if the public — and businesses — follow the rules and show intense caution. This is more essential than ever, she said, because so much is still unknown about these new strains, which adds a new level of uncertainty to fighting the virus.
"Everything hinges on the behaviors we adopt. If we adopt behaviors where everyone is masking, everyone is keeping to distancing, that all of the rules the governor has in place are enforced, I think there's a possibility for us to resume some of these activities," Bibbins-Domingo said. "It's not an outrageous idea. This is not an outrageous policy."
Newsom, in announcing the changes Monday, also struck a cautious note but said he believed the conditions had improved enough to try it out.
"We're seeing a flattening of the curve. Everything that should be up is up; everything that should be down is down — case rates, positivity rates, hospitalizations, ICUs. Testing is starting to go back up, as well as vaccination rates in this state," he said.
The shift took some officials and others by surprise, coming just a few weeks after California found itself the American epicenter of the coronavirus with hospitals overflowing, ambulance patients facing as much as a 17-hour wait to get into emergency rooms, hospital morgues overwhelmed and funeral homes forced to turn families away.
UC Berkeley epidemiologist Dr. John Swartzberg said he feared lifting the stay-at-home order was "premature" because the cases, while declining, remain very high. He said it might make more sense to wait a few weeks until cases go down further and California can begin reopening with a lower baseline.
He noted that after last year's spring and summer surges, California failed to bring its case numbers to a low level before reopening. That meant that when the next surge hit, it became even bigger than the one before it, he said.
"It's like we're climbing this mountain. We go two steps up and we just take one step back, and we take two steps up from there and one step back and we keep just having more cases," he said. "We're doing a lot better than we were doing 2½ weeks ago, but we're doing terrible compared to three months ago. We need to knock these cases down so as we get more and more people vaccinated, we'll get to a safer environment much more quickly."
The autumn-and-winter stay-at-home order was unpopular in many corners, with some politicians saying it went too far and restaurant owners suing in an effort to bring back outdoor dining. Critics questioned whether there was enough evidence to show outdoor dining was a significant spreader of the coronavirus. But there is evidence the order changed behavior and helped slow the spread.
A calculation by the L.A. County Department of Health Services found that the transmission rate of the virus began to climb in the region in the weeks before Halloween and accelerated until late November, when it reached a peak of 1.2, meaning on average every person infected with the virus was infecting 1.2 other people — a recipe for a dramatic worsening of the pandemic.
It was also in late November that L.A. County became the first in the state in the autumn to shut down outdoor restaurant dining, and a few days later became the first again in the state to issue a stay-at-home order that once again banned almost all private gatherings and instituted tighter capacity limits on stores. The county's model suggests that was the time period when the transmission rate began to fall, and by late December fell below 1, meaning that every infected person on average was infecting fewer than one other person.
"I think that the early action taken by L.A. County as cases began to rise has blunted the magnitude of this tsunami that we experienced. It would have been even worse had some of these measures not been taken early on," said Dr. Robert Kim-Farley, medical epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health, and a former health official with L.A. County.
It would end up taking roughly two months for the effects of L.A. County's health orders to convincingly begin reducing hospitalizations and offering officials confidence to begin reopening businesses. That's similar to the amount of time it took for the summer's business restrictions to have a similar impact.
"It takes time from when you initiate a control measure to when you actually see the effects of having that control measure in place. It's like trying to steer a large supertanker ship. When you turn the rudder, it takes a long time before the ship begins to move," Kim-Farley said.
Epidemiologists said it's essential health officials keep focused on at least two mutant strains of the coronavirus in California.
One of them, the B.1.1.7 variant first identified in Britain, is believed to be more transmissible and, according to new data, may be possibly more deadly, and has been detected in L.A., San Diego and San Bernardino counties.
A homegrown mutant strain in California, B.1.426, has also spread quite rapidly in recent weeks and officials are investigating whether it's partly responsible for California's devastating surge.
This should give the public pause, Bibbins-Domingo said. "If you take a long view of the pandemic, we actually need to reiterate more — not less — how much we need to be doing the types of things that are not fun for everybody, but have become the mainstay of policy until we get everyone vaccinated."
Under Newsom's changes, all counties will return to the colored tier system that assigns local risk levels based on case numbers and rates of positive test results for coronavirus infections.
Most areas will be classified under the "widespread" risk tier, which permits hair and nail salons to offer limited services indoors but restricts many other nonessential indoor business operations, such as gyms and movie theaters.
"Today, we can lay claim to starting to see some real light at the end of the tunnel as it relates to case numbers," Newsom said.
Hours later, Los Angeles County officials said they plan to take advantage of the relaxed restrictions — allowing for the immediate reopening of personal care services and outdoor dining at restaurants later this week. Additionally, hotels and motels can again be booked for nonessential travel and leisure.
But conditions in hospitals remained crowded, according to L.A. County health officials who have watched as COVID-19 ripped through communities since Halloween, a time period that has resulted in more than 8,000 dead out of a cumulative total of 15,000.
"We're anxious, as is everyone, to move forward" with reopenings, county Public Health Director Barbara Ferrer said during a briefing Monday.
But, she stressed, "this all depends on all of us" and, if the county's coronavirus situation starts deteriorating again, "we'll be in the horrible position of once again needing to backtrack."
Los Angeles Mayor Eric Garcetti said Monday morning that his administration learned of the governor's move "as quickly and as suddenly as the public."
Garcetti said coronavirus infections seem to be slowing in the L.A. region, but remain extremely high.
"Still very high historically," he said. "Still numbers that are six to seven times more hospitalizations than what we had just a month and a half ago, but the right trend."
Garcetti said in a statement Monday night that the city would follow the county's rules, including allowing outdoor restaurant dining to resume Friday.
Other counties from San Francisco to Orange said they hoped to get restaurants open for outdoor dining soon.
Orange County Supervisor Don Wagner, a frequent vocal critic of the state's pandemic response and of Newsom, said rescinding the stay-at-home order was "a step in the right direction, but I've also learned during the course of COVID that this governor is very erratic. Who knows what will get him to change his mind again?"
"It's a long time coming," Wagner added Monday. "It was an unnecessary step when he shut us down. It's a necessary step for him to open us up. Let's just not pretend there's a lot of science that he's revealed behind his decision."
For all the concerns about how the changes will affect the spread of the coronavirus, the end of the stay-at-home order represents a life preserver for restaurants, which have been brought to the brink of financial collapse. While indoor dining is still considered too unsafe, many eateries invested in building elaborate outdoor dining areas that have sat empty since the stay-at-home order.
"This is a huge step forward, and it's a big relief for everyone in this industry," said JC Clow, the founder and managing partner of the Winery Restaurant Group, which has two locations in Orange County and one in San Diego County.
Clow closed outdoor dining at his three locations for about a week when California began imposing regional stay-at-home orders the week of Dec. 6. It was a huge blow to staffers who depended on the restaurant for a steady paycheck and income from gratuities. He started getting daily phone calls from staff members who were pleading for help, he said, with some on the brink of homelessness.
"As those personal stories started coming in, we couldn't just sit on our hands and do nothing," he said. "A lot of these people have been with us since Day One, and when you hear those heartfelt cries for help, we just couldn't turn the other cheek. We had to do what we could while still being safe, so we reopened outdoor dining."
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