SAN FRANCISCO — California has been ahead of the rest of America in confronting the coronavirus pandemic, locking down its citizens early and avoiding, so far, the worst-case scenarios predicted for infections and deaths.
But as the national conversation begins to shift to reopening and President Trump beats the drum of economic revival, California’s extremely cautious approach toward the virus is a measure of how complicated it will be to restart the country.
“We’re not going to flip the switch and suddenly have the economy return to what it was and everyone come out of their homes simultaneously,” Mayor Eric Garcetti of Los Angeles said in an interview. “People’s physical interactions, people’s spatial understandings, people’s risk-taking will come slowly.”
As America’s premier gateway to China, California was, early in the pandemic, seen as one of the most vulnerable to the spread of the virus. In January close to 600 direct flights from China carrying around 150,000 people landed in the state, more than twice as many as landed in New York.
But two and a half months after the first cases were detected in Southern California, scientists are scrambling to explain the California conundrum: The state, despite its large, globe-traveling population, ranks 30th in the nation in coronavirus deaths per capita and has a fraction of the mortality rate that New York and New Jersey have suffered. As of Monday, San Francisco had recorded 15 deaths.
Much remains unknown about the coronavirus, and experts are still trying to understand why it is affecting some areas more than others. But figuring out why it has spread much less intensely in America’s largest state than initially feared will be important in planning next steps, experts say.
As it has with so many other policies, California went its own way on confronting the virus. In moving toward recovery its leaders are inching forward, having repeatedly said that success can quickly turn to failure.
How the nation’s largest economy calibrates the reopening will have huge ramifications for the rest of the country, providing examples of what works, and what doesn’t, especially given limits on testing capacity.
Gov. Gavin Newsom was scheduled on Tuesday to lay out a strategy for a coordinated and gradual approach to lifting some of the shelter-in-place orders, one that he said would be based on facts and science, phrasing that amounted to a veiled rebuke of the Trump administration.
The reasons for the early promising signs in California are numerous, experts say. The state was the first to implement stay-at-home measures, and even before the orders came down, Californians were beginning to keep their distance from one another, while New Yorkers were still packing bars and restaurants.
Other factors include a work-from-home culture at many companies, spurred by the tech industry; a dry and sunny February that brought people away from crowded spaces and into the outdoors; and even the fact that the San Francisco 49ers lost the Super Bowl, avoiding a crowded victory parade.
California’s deep experience confronting natural disasters has also helped it address the pandemic. Not only does the state have a vast government machinery in place to handle disasters, but its populace has experience following orders at a time of calamity.
A number of experts are advancing another explanation, too: features that have long been viewed as liabilities — the state’s solitary car culture and traffic-jammed freeways, a dearth of public transportation and sprawling suburban neighborhoods — may have been protective.
“Life in California is much more spread out,” said Eleazar Eskin, chair of the department of computational medicine at the University of California, Los Angeles. “Single-family homes compared with apartment buildings, work spaces that are less packed and even seating in restaurants that is more spacious.”
Many scientific studies have found a correlation between population density and the spread of flu and other infectious diseases, something that may exist for the coronavirus as well.
Moritz Kraemer, a scholar at Oxford University, conducted a study with 12 other scientists across the world that relies on data from China. The study, which has not yet completed peer review, shows that more crowded areas had both higher per-capita coronavirus infections and more prolonged epidemics.
“The more space you have, the less probability there is for transmission,” said Professor Kraemer, who is also leading a team of researchers in mapping the global spread of the virus.
But California still has numerous weak points, and experts stress that density is only one of many factors in the spread of a disease that is still poorly understood.
Nursing homes and other settings where people congregate have been hit hard. The authorities discovered 91 cases at a single homeless shelter in San Francisco.
Jeffrey Shaman, a professor of environmental health sciences at Columbia University, where he has been deeply involved in modeling the spread of the disease, said it was likely that some aspects of West Coast culture helped dampen the early spread of the virus. But that does not argue, he said, for car congestion as a cure-all.
Some experts like George Rutherford, a professor of epidemiology at the University of California, San Francisco, put more emphasis on early government action in mitigating the spread of the virus. Dr. Rutherford said the nation’s first stay-at-home orders by officials in the San Francisco Bay Area, led by the Santa Clara chief health officer, Dr. Sara Cody, were crucial.
“That’s where the credit belongs,” Dr. Rutherford said.
Dr. Rutherford pointed out that his commute on mass transit in the Bay Area resembled one in New York City more than in Los Angeles.
“I easily come within 6 feet of 200 people a day,” he said.
Yet even in San Francisco, the nation’s second-densest major city, cars are much more common than in New York. San Francisco has one vehicle for every two people, compared with New York where the ratio is one to four, according to data from the Department of Motor Vehicles.
Experts say understanding the dynamics of spread will be crucial for the next phases of the pandemic, as the authorities look for ways to open up the economy while avoiding a wide-scale and deadly second wave of the disease.
Mr. Garcetti, the Los Angeles mayor, has been guided by history, spending his nights and weekends studying how California cities responded to the 1918 flu pandemic. One of his key takeaways is that acting too soon to reopen could be disastrous, citing a second wave of infections in 1918 that proved more deadly than the first.
In 1918, “L.A. acted quickly and kept with it,” he said. In contrast, San Francisco, he said, “had also done really well but then came out of it too quick, and had a second spike in the short term, which killed a lot of people.”
Epidemiologists say transmission dynamics will differ by state, city and neighborhood.
In a push to better understand the scope of people’s interactions, Dr. Eskin is leading a survey effort in California and beyond. The survey asks what symptoms the participant has experienced, if any, and the locations of the supermarkets and pharmacies where he or she goes.
“We want to give the public health authorities the data that they need for them to make decisions on when they should let people go back to work or the kids go back to school,” Dr. Eskin said.
But even as California officials consider data that shows the outbreak here is far less intense than initially feared, they are being cautious in predicting a loosening of restrictions anytime soon.
Mr. Garcetti, for instance, has been touting the idea of using wide-scale testing to determine who is immune, and then allowing them to resume some measure of normal life.
“The idea of folks having an immunity passport, or something that allows them to be able to work, certainly would accelerate for me our economic recovery and my ability as mayor to lift the orders for some people,” he said recently.
But that plan would require wide-scale testing, which California does not have.
An immunity passport, Mr. Garcetti said, is “still a while off.”
Adam Nagourney contributed reporting from Los Angeles and Matt Richtel from San Francisco.
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