Pandemic Progress Report: California, May 15

In my final Endgame post (#5) I introduced Tomas Pueyo’s idea of “the dance.” All across the US, we are starting the dance, which is the time between reopening and the end of the pandemic (a vaccine, treatment, or herd immunity). During the dance we must find the least costly, least inconvenient set of restrictions (non-pharmaceutical interventions or NPIs) that will keep SARS-CoV-2 infections from growing exponentially. Because different countries, different states, and different counties within states are all trying different things, I hope in a month or so we’ll have data on what works and what doesn’t. California is opening more slowly than many other states, so we will get the benefit of their experience.

Now is the perfect season to practice our dance. Whether or not summer will inhibit the spread of COVID-19 remains to be seen. We do know, however, that influenza will largely disappear for the next several months. That allows some breathing room in our hospitals, and a greater margin for error in our containment effort.

As I watch things unfold here in California, I am reminded of the quote from Prussian General Helmuth von Moltke: No battle plan ever survives contact with the enemy.

Our governor has a plan, the California Pandemic Roadmap with four stages, carefully plotted criteria, and benchmarks. While the plan provides a framework, messy reality has forced the governor to be flexible. That messy reality includes people’s growing impatience, as well as the idealism of some of the benchmarks (like zero COVID-19 deaths for 14 days in an entire county, no matter how populous).

I sense that the plan began with the goal of much tighter containment than what Americans will actually tolerate. I think we are inadvertently sliding into the Strategy C I talked about in this post. By Strategy C I mean that instead of going for maximum containment (like they did in Wuhan, for example), we should tolerate a low level of infections in the community in order to slowly increase herd immunity. How low? Low enough to keep the hospitals comfortable, but not to eliminate all infections.

As states open up, the responsibility for containing the pandemic falls to the citizens. Regardless of what your state or county rules are, each of us has a responsibility to apply the NPIs that make sense for our situation. We must not think “freedom” means we’re free to live without regard for the well-being of our community. Wear a face mask in public to protect others. Find ways to improve safety in your workplace. Continue to stay six feet away from people, wash your hands, disinfect surfaces, work from home if possible, etc. I’m optimistic that Californians will do this, and we’ll be able to dance for a long time.

I’ve had some questions about relaxing ALL restrictions on healthy young people (say, under age 35) because of the extremely low probability that this virus will kill them (see data from New York City above) so they can build herd immunity. I think this is a good justification to reopen schools and higher education, but beyond that I see no reason to make special exceptions for the young and low-risk. Really, as we start to have options to leave our homes again, those options are intended for lower risk people. Those at high risk for COVID-19 should continue to shelter in place when possible.

Amy Rogers, MD, PhD, is a Harvard-educated scientist, novelist, journalist, and educator. Learn more about Amy’s science thriller novels, or download a free ebook on the scientific backstory of SARS-CoV-2 and emerging infections, at AmyRogers.com.

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