But our response to a different natural disaster – coronavirus – is individually and often divisive, revealing differences in risk perception, governance, and equity as vast as the Golden State.
Experts say that six months after the state’s order to stay strict, this response speaks to our remarkable success against the virus, as well as recent failures. It also sheds light on why viral prevalence is so high.
“Every day, 40 million people make 20 personal decisions,” said Dr. San Francisco, president of UC San Francisco’s Department of Medicine. Bob Wachter said.
The case counts and said, “We are seeing a difference in those decisions,” he said.
From the beginning, COVID-19 is a complex threat, invisible and intangible. Humans are wired to respond to immediate threats, such as the earth beneath our homes. But vigilance is hard to maintain – especially in the form of closure, initially intended to be brief, dragged on.
From late April to late June, the state’s seven-day average for daily deaths was below 100 – but reached 145 by August. 6. The average of seven days has reached 88 by Friday.
If we need another lockdown this winter, Andrew Irheimer of UC Irvine fears, the public may be reluctant to follow. We locked ourselves up for months. Some of us had a personal brush with death. Now, patience has worn thin.
Back in March, seeing the devastation of China, we set out. The state’s quick and integrated lockdown gave us a similar fate.
“California deserves credit for working collectively and with the utmost care at the onset of the epidemic,” UC San Francisco’s president of epidemiology and biology, Dr. Kirsten Bibbins-Domingo said. “We acted quickly, we acted decisively.”
New York’s Makeshift Morgue, Californians were surprised to see them engaged.
“The response was overwhelming” This is serious. it’s scary. I am going to believe the experts. I am going to believe the figures. Although, it is difficult personally and financially, I am still going to do the right thing. ‘
what happened next?
Some places, like the Bay Area, used the time to stock up on PPE, prepare hospital beds, expand testing, build clinics, and start educational campaigns. By the first week of March, our global tech companies sent employees home. Only essential workers were expected to move out.
There is a deep trust in public health in the region, which is born out of the tragic AIDS epidemic. Similarly, we believe in data, the foundation of so many Silicon Valley technologies. Our accomplished digerati find it easy to work remotely.
This has resulted in a change in the behavior of the cultural herds of the Bay Area. Just as yoga is stylish and non-smoking, wearing a mask has become de rigeur. Social distance is expected, not asked.
In the mental juggling of cost versus benefit, such sacrifices may seem simple.
But this is not everyone’s experience. While an earthquake is a shared trauma, a virus – with no symptoms in particular – is an intangible threat, affecting different people in different ways. While it is clear about endangered bridges or crushed school warehouses, it is hard to imagine the lethality of a family barbecue.
COVID-19 cases and death rates are also disproportionately high in some people, such as Latino, many of them “essential workers” in low-income neighborhoods. And the worst part of the epidemic has shifted to agricultural areas, which counts among the highest per capita cases in the state.
As the week drags on into months, our reactions to the rules reopen, inspired by personal leadership, local leadership, cultural influences, education, race, marital status, mixed messages and real-world experiences.
And what seemed like a moment of triumph in March quickly resumed in May and early June. Summer’s weekly death almost doubled. The devastating Loma Prieta earthquake killed 63 people; Every day, a small virus claims far more.
UCSF’s Dr. The problem, said George Rutherford, is that the state delegated responsibility to the counties, and what had become a unified response fell apart.
“Eighty-eight counties did their job,” Wachter agreed. Bibbins-Domingo said: “This was where we saw the biggest upswing in the gains we made.”
And many counties did not make good use of those precious months.
Meanwhile, local politicians pressured the county’s health officials to ease restrictions on occupational businesses and ban residents.
Orange County reversed its rules about mandatory masks on June 11. In Meredd County, the huge poultry plant at Foster Farms was also ordered to close after an outbreak on August 27, with employees receiving emails instructing them to work. Around the state, churches have disregarded county and state orders to limit indoor services.
Clearly, cases have increased.
Such decentralization of authority only works when local authorities have strong guidance and support, said Philip Cohen, professor of sociology at the University of Maryland at College Park.
In more rural areas, he said, “simply do not have the infrastructure, personnel, experience or resources to deal with the epidemic.”
California’s fragmented approach violates one of the cardinal principles of risk communication in an emergency: “deliver a clear and consistent message by trusted messengers,” said Lori Peake, director of the Center for Natural Hazards at the University of Colorado at Boulder.
Instead, the messages were mixed, and confusing. Masks were useless, then necessary. Viruses can kill you, or do nothing. Children are safe, except occasionally; Schools are dangerous, depends. And messengers were politicized: Republicans said the threat was exaggerated, killing jobs and underestimating the president. Democrats warned of disaster, urging more spending.
In the beginning, we had a clear goal: Do not dominate hospitals. But that shifted, said Dr. Rajiv Bhatia, a clinical assistant professor of primary care and population health at Stanford.
“You can’t fight anything without a goal and a measure,” he said.
For example, in early times, state officials considered hospitalization rates to determine whether we were controlling the virus, but this metric is not included in the state’s new surveillance system.
Experts say that this confusion makes it easier for us to be called “information avoidance” – which puts our head in the sand.
“This is a rational response to unpleasant information,” said economist Plamen Nikolov at Binghamton, State University of New York, which is studying the epidemic’s responses.
Without accurate information, we can reduce the risk accurately, he said. Furthermore, humans are terrible at understanding exponential growth – failing to save enough for retirement, for example – so we underestimate the rapid arrival of the virus.
According to Nikolov’s research, other symptoms also affect our response. Women, Democrats, married people, and college graduates are more likely to be masked and socially spaced.
If Stanford’s Bhatia said that messaging works best, it is targeted at the most vulnerable populations.
And it should be appropriate and “actionable”, Peak added. Without much money, she said, security is difficult for people in small crowded apartments who work on essential jobs.
Unlike people in parts of the world suffering from malaria and other fatal infections, some are opposed to California health directives. Nearly one-third of the newly-infected people in affluent Los Angeles County refused to speak with the county disease investigator – or disappear.
Effective disaster response calls for both “top down” and “bottom up” efforts, working in tandem and harmony, Peake said. This is not happening.
“I am still thankful that we came together in March to come together at a tight shelter. I think we prevented a lot of deaths and grief as a result, ”Santa Clara County Health Officer Dr. Said Sarah Cody, who helped lead the country’s first regional shutdown.
“After that, it has become increasingly more complicated,” she said. “We no longer have a common vision of what COVID is and what it means … and what we all have to do together.”