New York is turning the tide on COVID-19. What California must learn from the Empire State
California this week surged ahead of New York as the state with the most total cases of COVID-19 — a dubious title that prompts what would have seemed a silly question two months ago:
Is New York now handling the virus better than California?
The two states clearly are going in the opposite direction. As of Wednesday, more than 415,000 Californians have tested positive for the virus. That’s slightly more than in New York, a state that was devastated in March and April by the pandemic. New York still has more total infections per capita because its population (about 19.5 million) is half the size of California (about 40 million).
During March and April, Golden State officials repeatedly cited California’s seeming ability to avoid the catastrophe that overwhelmed New York hospitals.
Now, though, only 1% of New Yorkers tested for the virus in recent weeks are infected, while in California, the positive test rate has ratcheted up beyond 7%. And California’s hospitalization numbers are hitting new highs on a daily basis, while New York state this week reported the lowest number of new hospital admissions in four months, since mid-March.
The ultimate answer to how well each state has fared during the pandemic is likely months and perhaps years away. For now, it’s clear the virus has chosen very different paths through the two states. And it likely has unfinished business in both states.
New York native Robert Wachter, now chairman of the Department of Medicine at the University of California, San Francisco, said he expects a fall surge in New York and California as well. The question is how well the public and leaders in each state are ready for it.
‘New Yorkers are afraid of this virus’
While New York suffered a devastating early blow before it was ready to react, that experience prompted the state to issue tougher shut-down orders than most states, and it appears to have caused New York residents to take the virus more seriously than many in California.
“New Yorkers are afraid of this virus in a way other states aren’t. People in New York City knew people who were in the hospital and dying,” said Dr. Melissa Marx of Johns Hopkins University Bloomberg School of Public Health in Baltimore.
New Yorkers would hear ambulance sirens at night in March and April and new what is was about, Wachter of UCSF said. They saw refrigerated overflows morgues outside of hospitals.
Fearful that the virus surge nationally could seep back into New York, state officials recently reached beyond their borders to launch a national advertising campaign last week called “Mask Up America.”
The chart below shows how New York’s experience with death has been far more impactful than in California, where the Newsom administration still struggles to persuade people to wear masks in public and avoid indoor family gatherings and parties.
California’s early lockdown helped, but ...
UC Irvine epidemiologist Andrew Noymer said California ran into its own, very different problem than New York this spring. California locked down hard early with a March stay-at-home order, and was fortunate that the virus hadn’t already gotten the type of fast foothold it did in New York.
While that helped keep the infection numbers low for months, it prompted cabin fever among many residents who didn’t see much of a health threat in their communities, and that in turn prompted many county leaders to push the state to allow massive businesses reopenings faster than it now appears was advisable.
Speaking to reporters on Tuesday, California Secretary of Health and Human Services Dr. Mark Ghaly said that reopening was viewed by some residents as a “green light” to try to resume a pre-COVID-19 normal life.
Now, California is desperately retrenching from it May and June reopenings. “I don’t envy the governor’s choices in California,” Irvine epidemiologist Noymer said. “The American public has shown zero resolve for shelter in place.”
Wachter of UCSF said the recent surge in California was expected, but he is disappointed by the size of it. “We let our guard down,” he said. He said the state got lucky in March that it didn’t face the tsunami that New York did. He is feeling more optimistic this week, saying politicians and residents generally are responding well, and said he thinks California is back on track to flattening the spread.
California spared NY’s deaths
Measured by deaths, the tale of the two states is dramatically different. New York has suffered nearly 33,000 deaths. California, in notable contrast, has suffered 8,000.
Hospitals in New York City, an epicenter for travelers, were overwhelmed at a time when U.S. healthcare professionals knew little about the virus and were struggling to figure out how to treat the sick. At the time, ventilators were considered an important tool, and the antiviral drug remdesivir had not yet been approved for use by the federal Food and Drug Administration.
In the months since, hospitals in California and elsewhere have had a chance to prepare — and to learn from the New York experience. Subsequent medical studies have found that critically ill virus patients often improve better when placed on therapeutic drugs than on ventilators. Hospitals are now using dexamethasone and convalescent plasma as well as remdesivir, UCSF doctor Wachter said.
David Lubarsky, head of UC Davis Health, which runs a major medical center in Sacramento, said more judicious ventilator use was an important lesson learned.
“In the beginning of this, especially in New York, everybody had a breathing tube and a mechanical ventilator and that apparently made worse the lung inflammation, and now we know that’s not the way to go about it,” he said. “We really changed our treatments.”
Testing failures in California
Testing and contact tracing have been considered a key, and in that sense, New York appears to have done a better job than California.
California, as of this week, has conducted 6.5 million tests, the most of any state. New York has conducted the second-most, 5.2 million. But a lot more people live in California than New York or any other state. Viewed by percentage, up to 16% of Californians may have been tested, whereas New York has tested up to 26% of its residents.
In fact, despite months for the federal government and labs to prepare, the lack of testing material nationally in recent weeks has is hindering California’s ability to stay on top of the spread of the virus. Other states are experiencing the same problem, national health experts say.
People who think they may have the virus now find themselves having to wait a week to get a test appointment, then waiting a week to get the results. By that time, if they did not choose to self-quarantine, they will likely have infected others.
It’s one reason, California health officials say, infection numbers are on the rise. Another is that counties do not have enough contact tracers to quickly identify COVID-19 clusters in their communities before they spread.
That is short-circuiting the basic virus fight of testing, contacting and quarantining, said Amesh Adalja, a scholar who focuses on pandemic preparedness at the Johns Hopkins University Center for Health Security.
In that sense, some of the extra time California got that New York didn’t is arguably wasted.
This story was originally published July 22, 2020 at 3:54 PM with the headline "New York is turning the tide on COVID-19. What California must learn from the Empire State."