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California installed strict shelter-in-place orders in mid-March. Experts say this significantly contained COVID-19 spread early on. Getty Images
  • California is looking at plans to slowly lift its COVID-19 shelter-in-place orders.
  • The state has had fewer COVID-19 cases and deaths than other states.
  • Experts say California’s decision to implement stay-at-home orders early on has been a big factor in its success in battling the outbreak.
  • They add that California’s healthcare system was also in a better position to respond to the crisis.

California, the first state to issue stay-at-home orders to reduce the spread of COVID-19, is now mulling a framework for getting people back to their jobs and lives.

While Gov. Gavin Newsom declined to outline precise dates and methodologies for relaxing shelter-in-place orders, he said this week that any decisions would be led by “science and public health, not politics… so that we can ultimately transition to herd immunity and that vaccine.”

Newsom is collaborating with the governors of Oregon and Washington in a joint effort to coordinate reopening their economies and help prevent additional spread of the virus.

California has become something of a star among big states with population-dense cities for its aggressive approach to COVID-19.

California, with a population of nearly 40 million, has recorded more than 24,000 confirmed cases of COVID-19 and over 820 deaths.

Nearby Washington state, which had the first recorded U.S. case of the virus in January 2020, has also managed to flatten its curve after an initial spike of COVID-19 cases.

The state has reported nearly 11,000 cases and more than 550 deaths with a population of more than 7 million people.

New York, by contrast, leads the nation in confirmed COVID-19 cases with more than 220,000 cases and over 11,000 deaths with a population of around 20 million.

New York issued stay-at-home orders on March 22, a few days after California instituted its restrictions.

A mix of factors — including early action, better healthcare systems, and a little bit of luck — likely account for California and other states’ successes compared to those that are still struggling, experts say.

“Primary care has historically been stronger on the West Coast than in the tri-state area, so understandably concerned populations likely have an easier time contacting and seeing the primary care doctors who know them best and can help keep them healthy, happy, and [at] home during the COVID-19 pandemic,” Dr. Say Salomon, the national medical director of acute and post-acute care at ChenMed, a primary care provider for seniors, told Healthline.

“Social distancing and stay-at-home orders appear to have started more quickly on the West Coast, and population densities are significantly different,” he said.

Dr. David Witt, a regional healthcare epidemiologist at Kaiser Permanente Northern California, agreed.

“One of the most important things to underscore is that California and Washington are experiencing something different than the rest of the country because of its early mitigation efforts,” Witt told Healthline.

“Because of the early decision issued in the 6-county Bay Area on March 16th — followed by similar California and Washington state orders on March 19th and March 23rd, respectively — we’re seeing a leveling off of cases in hospitals and outpatient settings,” he said. “This means that in some places, such as Seattle and the San Francisco Bay Area, we are managing to slow the spread of the virus.”

Experts were hesitant to get into details on how programs to slow COVID-19 can work, but they said there are some tried-and-true measures for success.

“It’s still too early to know with certainty the effectiveness of various public health and healthcare measures on infection and death rates by state,” said Jennifer Prah Ruger, PhD, a professor of health equity, economics, and policy as well as the founder of the Health Equity and Policy Lab (HEPL) at the University of Pennsylvania.

“But early information suggests that California has acted quickly, early, and proactively [while] Washington acted quickly with social distancing measures,” she told Healthline. “Seattle is also a less densely populated city than New York City, San Francisco, or Los Angeles, but future studies will offer data regarding casual mechanisms.”

Other factors that experts noted could affect COVID-19 containment included differences in overall population density and ethnic makeup, as well as different mutations of the viruses depending on the country of origin of initial cases (from Europe or Asia).

Where an initial outbreak occurs can also be a factor.

An outbreak that starts on a cruise ship, for instance, is potentially easier to isolate than one that starts in the middle of a major city.

“Washington was relatively fortunate that its first big COVID-19 outbreak was in a nursing home, prompting a quick containment and social distancing strategy that has yielded clear dividends,” Dr. Daniel McCarter, the national director of primary care advancement at ChenMed, told Healthline.

Then there’s the matter of a muffed play or two in the Super Bowl preventing a mass gathering that could have spread the virus at a key moment.

“There is an additional element of luck associated with California’s success in flattening the curve. The 49ers’ loss in the Super Bowl this year meant there wasn’t a big celebratory parade in San Francisco,” Dr. Nate Favini, the medical lead of Forward, a preventive primary care practice, told Healthline.

“If there was, it could have been an equivalent to New Orleans holding Mardi Gras, and we would likely have seen many more cases in the Bay Area as a result,” he said.

California is far from the only state to be considering relaxing stay-at-home restrictions that were instituted to help halt the progress and “flatten the curve” of the new coronavirus that’s ground the nation to a standstill.

Many state leaders have announced emerging plans to gradually reopen in the coming months.

Some states have never issued stay-at-home orders at all.

In South Dakota, where no shelter-in-place orders have been issued, a meatpacking plant in Sioux Falls has now become one of the largest COVID-19 hot spots in the country.

“It’s unfortunate to see that there are still some states that don’t have any form of stay-at-home order in place because this will hamper our ability to fight the virus as a country,” Favini said.

“I’d expect to see spikes in cases in places where people aren’t practicing social distancing,” he added. “It’s clear that stay-at-home orders have saved thousands of lives. And, that acting early really matters.”

But all of this is happening in an America that has more than 650,000 confirmed cases of COVID-19, more than 3 times that of Spain, the country with the next highest number of cases, and nearly 8 times that of China, where the virus was originally discovered.

Experts say that this means without a deliberate, cautious, and science-led approach to relaxing shelter-in-place orders, we’re likely to see COVID-19 cases surge again — perhaps coinciding with the height of the flu season.

“Premature relaxation of interventions… might lead to transmissibility exceeding 1 again — i.e. a second wave of infections,” scientists writing in The Lancet stated.

Newsom seemed to acknowledge this dynamic, likening California’s burgeoning approach to that of a dimmer switch slowly turning the lights back on.

The approach, he said, is to contain the virus “into suppression, ultimately on our way to herd immunity, and ultimately to a vaccine.”

In the meantime, other states seeking to follow California’s lead should be extra vigilant, Witt said.

“Everyone needs to double down on the social distancing and shelter in place,” he said. “As we can see from the decline in cases in California, Washington, and Oregon, that decision to move early and take it seriously has made all the difference.”

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