'Eerily quiet': How California's early action against COVID-19 delayed the surge at hospitals

Dr. Jahan Fahimi unzips the plastic inner entrance to a mobileisolated care unit set upina hospital parking lot.If you live in San Francisco and come down with COVID-19, this is where you might end up.

But look around the mobile unit, even the University of CaliforniaSan Francisco Health hospital itself, says the emergency care physician.

"It's eerily quiet in our emergency room and in the hospital," he says. "Most of us would have expected that the surge would already be here. And it hasn't yet come."

Since the pandemic began,many California hospitalshavebeen preparing for a massiveinflux of COVID-19patients the dreaded surge. However, evidence is mounting that California's early action including the first statewide stay-at-home order in the U.S. may have helped slow the spread of the virus and temporarily relievepressure onhospitals.

At one point, several weeks ago, about half of the patients at one San Francisco-area hospital had either tested positive for COVID-19 or were possible cases, saysDr. Stephen Parodi, an executive with the PermanenteMedical Group,which oversees more than 30 California hospitals.

Since then, he says,the rate of hospitalizations has stabilized.

"We saw within about three to four days of implementing the stay-at-home orders, a levelling off."

According to the COVIDTracking Project, a collaboration of volunteer scientists, journalists and engineerswho track and collate COVID-19-related data,in the first week of March, the states of New York and California had about the same number of coronavirus cases.Now, New York has about eighttimes as many cases as California, and close to 10 times as many deaths.

WhileNew York issued its stay-at-home order only a day after California,several California jurisdictionshad already enacted their own orders several days earlierand shut their schools long before New York did.

"That's when we really started seeing a dropping and levelling off of the cases," saysParodi.

They have additionallyprohibitedmost residential and commercial construction, closeddog parks and playgrounds and bannedplay with a ball except with familyrules that havebeen strictly enforced. Local authorities are also turning people away at many beaches, which some other states, such as Georgia, have been loathto do.

"You look outside, it looks like Christmas Day on the streets; there'snobody's walking around,"says Dr. George Rutherford, a professor of epidemiologyat theBerkeley School of Public Health.

And because the public has largely heeded the early injunctions, theyhave beenmore effective, he says.

"Think of it as like a paper cutter coming down on viral transmission. It's the most draconian weapon we have at our disposal in public health."

WATCH /Dr. Jahan Fahimishows how his hospital in San Francisco is preparing for a surge of COVID-19 patients:

Preparing for the Surge

4 years ago

Duration 0:49

Dr. Jahan Fahimi, an emergency physician at UCSF Health in San Francisco, shows CBC News the inside of a mobile isolated-care unit set up to deal with a potential surge of COVID-19 patients.

Last week, theSeattle-basedInstitutefor Health Metrics and Evaluation (IHME)publisheda state-by-state projection of COVID-19deaths in the U.S. overthe next fourmonths. The report suggests California's early and aggressive distancing measures are paying off.

"The data is telling us that they are working and they are effective at reducing the number of mortality and reducing the demand on our hospitals as well,"says Ali Mokdad, a professor at the IHME.

The states like California and Washingtonthat implemented physical distancing early had fewer deaths than what was projected, Mokdad says.

"We were really disappointed when many states delayed these measures."

As of Wednesday evening, governors in eight states hadyetto issue statewide stay-at-home orders:Arkansas, Iowa, Oklahoma, Nebraska, North Dakota, South Dakota, Utah, and Wyoming.

Missed opportunity

Nicholas Jewell, a professor of epidemiology at theUniversity of California, Berkeley, says many states lost an important opportunity. When measures aren't taken, the number of infections grows exponentially, so two weeks of lead time on physical distancing couldreduce the number of deaths by 80 to 90 per cent, he says.

The time to enact stringent physical distancing measuresis when many people think"it's too early and you're overreacting," he says.

"It's a real mistake to wait until you think, 'Well, now we have a problem. We need to start doing something about it.' You're already really too late."

Several other factors are likely helping to slow the spread in California.

Dr. Fahimisays high-tech workers in Silicon Valley were among the first to stay at home.

"A lot of the companies were very proactive about sending their workforce home and doing work remotely even before the shelter-in-placeorders were placed," Fahimi says.

As far as testing goes, after an initial lagthat left California behind other states, it has now greatly ramped up its system.

Gov.Gavin Newsomcreated a task force that he says will boost testing fivefold by the end of the month. AndLos Angeles MayorEric Garcetti announced Monday evening that any L.A. County resident who has symptoms can get tested by applying online.

Experts say testing is key tounderstandinginfection patterns, which makes it easier toslow the virus's spread.

On Tuesday, Garcettialso mandated that all customers and employeesin essential businesses that are allowed to remain open must wear face coverings.

The worst is still to come

The state is now so well stocked with equipment it issending 500 of its ventilators to other states that need them more urgently.

The flattening of the curvehas bought the state aresource more valuable than masks or ventilators: time.

"So that when the surge actually does come, we are much better prepared than we would have been otherwise," Fahimi says.

There's plenty of cause for optimism, buteach of the experts who spoke with CBC Newshad a different way of issuing the same warning: the worst is still to come.

"We don't know how big the surge will be," Fahimi says. "We just know that one is going to come."

Prisons, health-care facilities, large populations of homeless people, they're all "dry tinder lying around," says Rutherford. "And if you get a spark on it, they will ignite."

Dr. Robert Kim-Farley is an epidemiology professor at UCLA, as well as a formerofficial with the U.S. Centersfor Disease Control. He cautions against premature optimism. He says there are asterisks when comparing the current situation in California's biggest cities and the nightmare unfolding in New York.

For example, he says, compared to New York City, Los Angeles County is a much less dense metropolitan area.And in this case, L.A.'s oft-criticized urban sprawl and dependence on getting around in cars rather than public transit may have helped with physical distancing,he says.

Kim-Farley also acknowledges that California's early scramble for medical and protectiveequipment wasat least partially due to decisions made years ago.

The budget for building and maintaining stockpiles was slashed by the state's former governor during the last recession. The materials, he says, were either sold off or given away because they couldn't be maintained.

Kim-Farley says he hopes this experience has taught the state a lesson.

"That just because we're going to have financial difficultiesdoesn't mean that we shouldn't bepaying what's necessary for an insurance policyof having strong, robust stockpiles just for these types of things, when we have a pandemic."

Rutherford, a former medical resident at Toronto's Hospital for Sick Children,says it's vital that experts, policymakers and the publicunderstand what happened during the outbreak and what was effective in dealing with it.

Society must watch and learn, and, hopefully, remember, he says, "forwhen the next epidemic comes along 100 years from now."