How California went from model student to pandemic problem child

SAN FRANCISCO — California was long the nation's shining star on the coronavirus, heralded by national media and White House advisers as an example of how other states could beat the disease. The state was so confident in April that it sent hundreds of ventilators to the East Coast.

Now, the Democratic state joins Republican-dominated Florida, Texas and Arizona as America's problem children, with new cases skyrocketing and leaders seemingly caught flat-footed as the spread grows beyond their control. California has seen a 70 percent increase in daily new cases over the past two weeks, while hospitalizations have shot up 51 percent.

Gov. Gavin Newsom on Wednesday took his biggest step yet to reverse California's reopening, ordering 19 hard-hit counties to close indoor dining, movie theaters, bars, wine tasting rooms and bowling alleys for three weeks. The moves affect seven out of every 10 residents, including most of Southern California.

"The bottom line is the spread of this virus continues at a rate that is particularly concerning," Newsom said Wednesday.

Disease experts, public health officials and even state leaders themselves say they had too much faith that residents would continue social distancing in bars, restaurants and backyards. Epidemiologists are now wondering if California was too eager to reopen its economy in a state with the nation's largest, most diverse population of nearly 40 million people.

The state, with the fifth-largest economy in the world, offers a large-scale preview of what states across the country may face in coming weeks as they reckon with a virus that just won’t slow down. California serves as a microcosm of all of the problems cropping up around the nation: an older, more vulnerable population; outbreaks in prisons and nursing homes; cooped-up residents flocking to beaches, restaurants and bars overrun by young people; and a high incidence of infection among essential workers, often living in congregant housing.

State and health officials underestimated how much reopening "became the starting bell for a lot of people beginning to ignore the kinds of public health maneuvers that they had followed earlier," said Bob Wachter, chair of the medicine department at the University of California, San Francisco medical school.

“If you dodge the bullet the first time through, the virus is just sitting there waiting for you to get cocky," he added.

Newsom initially laid out a slow, phased-in reopening process that started in May with retail pick-up, offices and manufacturing, all with social distancing. He then allowed restaurant dining and in-store retail to resume later that month. Facing litigation and pressure from the White House, Newsom allowed church services to start with limitations.

By June, however, Newsom opened the floodgates to other sectors. In the next stage came hair salons and barber shops. Then bars and gyms, followed by nail salons and tattoo parlors. Simultaneously, protesters were hitting the streets throughout California — though officials have insisted that demonstrations did not lead to outbreaks — while residents were increasingly tired of quarantining without seeing friends and family.

“Once the reopening process starts, there’s enormous political pressure to accelerate it to include everything,” said Tom Inglesby, director of the Center for Health Security at Johns Hopkins Bloomberg School of Public Health.

The governor has insisted that he did not allow California to reopen on a broad scale, putting that responsibility — and blame, perhaps — on officials in the state's 58 counties. He says he only told counties "how" they could open, not "when." Still, by issuing guidelines for each sector, his administration gave a tacit green light to counties where residents had been clamoring for a return to normalcy.

By and large, Southern California has experienced Covid-19 in a different way than Northern California, with Los Angeles and its vast suburbs to the east among the hardest hit. California's top five counties by case count are Los Angeles, Riverside, San Diego, Orange and San Bernardino.

Meanwhile, Imperial County on the southern border, east of San Diego, is the state's biggest concern with a positive test rate of 23 percent, far higher than the nearly 6 percent statewide figure. The rural county ran out of hospital beds weeks ago, sending more than 500 patients elsewhere in the state.

Despite having more cases, Southern California was among the loudest in the reopening chorus. San Diego officials implored Newsom to loosen restrictions. Orange County cities threatened legal action against Newsom when he shut down their beaches in late April. Riverside County supervisors overrode their health officer's desire to move slower.

The state’s agriculturally rich Central Valley has also emerged as a hot spot, with outbreaks at nursing homes and in the fields as well as at meat-packing and other food-processing facilities. Most inland counties considered their early coronavirus efforts a success and reopened sectors in conjunction with the state's timeline.

In contrast, the San Francisco Bay Area took a more conservative tack from the start. Santa Clara County was the first in the nation to shut down large gatherings — including professional sports — and was soon joined by San Francisco. Then, six Bay Area counties imposed the nation's strictest rules days before Newsom imposed the nation's first statewide stay-at-home order.

Their approach proved successful — and they have likewise been more conservative than other counties in reopening their economy. As the state's problems grew more severe, San Francisco delayed opening museums, zoos, hair salons and bars last week, while Contra Costa, Alameda and Marin have also slowed their reopening plans.

A handful of critics thought Newsom was reopening too soon — chief among them Sara Cody, the Santa Clara public health officer credited with initiating the early coronavirus shutdown. In late May, as the governor allowed church services and haircuts to resume, Cody told her county supervisors that the pace was "concerning."

“The state modifications are being made without a real understanding of the consequences of what the last move has been, and with the possible serious effects for health and possible serious risks or an exponential growth in cases," she said.

Still, the Bay Area didn't avoid the recent growth in cases. Two Bay Area counties — Contra Costa and Santa Clara — landed on the state's watch list of 19 that must now close or keep shuttered the range of indoor venues.

Some of the hard-hit states on the East Coast — New York, New Jersey, Massachusetts — have been slower to reopen after experiencing a surge at levels still unseen in California. Their infection curves are now calm compared to those in other states.

For now, at least, the key appears to be reducing social interactions.

“That doesn’t mean having to go back to shelter-in-place throughout the state, but it does mean we’ve been reopening too quickly,” Inglesby said.

Even if Newsom ratchets down social activity, behavioral change may remain elusive. "I've thought he's done a pretty good job and he's stayed pretty close to the data," said Steven Goodman, an epidemiologist at Stanford University. "What he says and how people behave are not exactly the same thing."

Goodman also pointed to the influence of President Donald Trump's refusal to take the pandemic seriously. "There's no way to get the collective body of society to do things it doesn't want to do if you don't have consistent and persistent messaging from the top," he said. "California is not a country, and it exists in the United States where there are all sorts of other signals from the top that the actions we want people to take are just suggestions, they're just not mandatory."

To much of the nation, California's emergence on the list of problem states is surprising not just because of its early success, but also because the recent surge has largely been framed as a red state issue. Nearly all of the current hard-hit states have Republican governors who prioritized economic concerns and were criticized for not taking the disease as seriously as other leaders.

The divide between Republicans and Democrats when it comes to social distancing and mask wearing plays a role, but doesn't explain everything, said Matthew Gentzkow, a Stanford University economics professor leading a group of researchers in tracking partisanship in response to the Covid-19 pandemic.

“The idea that political differences would somehow protect California because we have all these Democrats staying home and being careful, I don’t think that can be drawn from the research,” Gentzkow said. “The behavior of Democrats and Republicans haven’t been so different that it would insulate California.”

Through mid-June, Newsom defended the state's reopening as viable because of the precautions in place and the state's large hospital capacity. He noted that California's early actions bought time for the state to stock up on personal protective equipment, such as 150 million N95 masks the state is purchasing from a just-certified manufacturer, BYD. He also took comfort in the state's positive test rate remaining stable around 4.5 percent.

But within the past two weeks, the governor has shifted course. As a first step, he issued a statewide mask order for most public settings on June 18, stressing that wearing face coverings was essential if Californians wanted to keep the economy open and control the virus spread.

Days later, he reinstituted daily press briefings after largely foregoing them during the reopening process. He repeatedly emphasized that residents need to socially distance, wash their hands and wear masks as new cases soared. On Sunday, he ordered bars closed in seven California counties in his first sector closure since the reopening.

Over time, Newsom shifted to a more pluralistic view of decision-making, repeatedly emphasizing that the counties now controlled their own fate. California political expert David McCuan described the administration’s message to counties as “tired, unclear, uncoordinated, disjointed.”

McCuan, a political science professor at Sonoma State University, called Newsom’s mask mandate “late in the game” and said Sunday's bar closures on a handful of troubled counties was the least he could do to take some action.

“This is where he doesn’t want to go too far too fast. He wants to have the hammer ready to go but … he doesn't want to be that heavy handed,” he said.

Despite the growing worry, Cyrus Shahpar, a director at Resolve to Save Lives, a nonprofit that combats global epidemics, said California’s numbers aren’t spiking as dramatically as Texas, Florida and Arizona on a per capita basis — which offers hope for the Golden State to right the course.

“California is starting to move in that direction with hospitalization rates and positivity rates over the last 14 days, but we’re not there yet,” Shahpar, an epidemiologist who lives in the Bay Area. “The problem is that we have a lot more people that will become infected in terms of the number, but not the rate.”

While California’s sheer size and heterogeneity pose challenges, Shahpar noted that more of the state's residents have embraced wearing masks and adhering to public health restrictions than in Texas, Florida and Arizona. He said the state also benefits from more consistent messaging from local and state leaders.

It's possible that California is acting in time to prevent an out-of-control spiral.

“If California can learn from those other states and start tightening the dial earlier, that will have benefits in terms of the overall impact,” he said.