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The Nooner for Wednesday, April 8, 2020, presented by SYASL Partners
Thank you who chipped in to pay my rent with the new Square button last night. Trust me, I'm not being dramatic on that. If you did so anonymously and wanted to also get an ATCpro subscription (there were a couple over $49.99), email me with the last four digits of the card you used. For "donations," I don't get an email address unlike with the subscription link.
Again, thank you all, the less I worry about rent, etc., the more hours I can put in to the words below.
I'm guessing today will be another two-Nooner day. I was up at 5, it is now 11:25, and I haven't even looked at the newspapers yet. So, I'll be watching the press conferences and following the news and see if there are any newsworthy developments or things I am missing anything from my work this morning.
GUN VIOLENCE HITS ASSEMBLY FAMILY: The office of Assembly member Mike Gipson (D-Carson) reports that his son and son's fianceé were among four shot on Sunday around 4pm. According to a release, Devon Gipson and Jennifer Salazar were visiting his mother's house in South Los Angeles when they went for a walk to a neighborhood store. Devon was hit in the back, Jennifer was hit in the leg, one other was shot, and there was one fatality. Devon was admitted and underwent surgery for a fractured rib and punctured lung, while Jennifer was treated and released. Devon is a father and works full-time for Mattel, Inc. in El Segundo, according to the release.
MODEL UPDATE: Overnight, the widely used University of Washington model was updated and from a macro sense, it is good for the United States, as the death rate is now forecasted at 60,415 as physical distancing truly flattens the curve. While flattening the curve may not reduce the aggregate number of people who will be infected, it reduces the demand on the health care system, reducing the number of fatalities from an overwhelmed one that lacks the capacity and supplies to treat all needing care. Because of that, it reduces the number of health care providers and first responders who become ill themselves.
That's what happened in Italy, Spain, and the greater New York City metropolitan area.
If you're a Nooner Newbie, I wrote about this model for California on Monday, so let's look at how the overnight run changes the situation in California. Before I get into these numbers, it is essential to remember that the UW model assumes full social distancing through the month of May. On Monday, I wrote about "herd immunity," the phenomenon when sufficient people have been exposed and had the virus either symptomatically or asymptomatically, and thus have antibodies that repel the virus. In absence of a vaccine, this is the natural way to stop the spread. I'll write more about this after the numbers.
California's numbers (parenthetical data are changes from Sunday overnight model):
Let's look at the latest and Monday.
April 8 (click to enlarge):
April 5 (click to enlarge):
You've undoubtedly heard the phrase "flatten the curve," but this is what the experts are talking about. Make sure you look at the dates on the X-axis, as the way the chart displays in comparing the two makes the older chart appear earlier than the new one. Really, they are about the same, with a change in peak resource need one day earlier under the latest.
If you look a the curve, it's hard to discern the actual change that yields the difference in the numerical results. It would be more apparent if not for the y-axis, which is high because California is well prepared with hospital beds, which is the solid magenta line at the top. What it does show is that even modest changes can lead to significantly different results. If the model holds, that's a 10% reduction in projected deaths.
That doesn't mean it's going to be easy, even under this model that provides optimism. As I write this around 5:30am, there have been 446 reported deaths in California (the updated number will be at the top of this item, which I'll update last at my Nooner deadline--you can do the math if I don't update this graf at 11:30am). Therefore, we're still talking about 1,165 more deaths from COVID-19 in California by August 4. To put that into context, 63 people died in the 1989 Loma Prieta earthquake, there were around 60 fatalities in the 1994 Northridge earthquake, and 85 people lost their lives in the deadliest wildfire in California's history -- the Camp Fire in Butte County two years ago.
For those jumping to an overall conclusion, it's not all rainbows and unicorns. The latest model run actually finds higher total deaths for New York and New Jersey, where while it appears that things are getting better, the health system is still overwhelmed.
What does this mean for the public health orders that have us largely cooped up?
Of all the questions I get in my physically isolated inbox, the question is when I think public health experts will advise political leaders that it is safe to go back to a semblance of normality. The questions have ranged from electeds to family members whose businesses have been impacted.
Obviously, I am no expert. But I do know generally what they are looking for.
Under current scientific protocols and regulatory processes, there won't be a widely available vaccine until 2021, maybe second quarter at the earliest. While tests (both active COVID-19 and antibody serology) may be fast-tracked, there is a big difference between confirming the validity of a diagnostic test and evaluating both the effectiveness and safety of a drug, including a vaccine. It takes time and there are plentiful drugs and vaccines over the years that have looked promising only to be shown as dangerous or not effective when administered at a phase III trial.
The substitute to a vaccine is "herd immunity." This is when enough people have symptomatically or asymptomatically had the virus and developed antibodies such that the virus can no longer easily find a host with which to spread. I'll repeat what I wrote on Monday:
Think of it as one of those "America Ninja Warrior" games where contestants have to jump among small posts in water that are increasingly spread further apart. At some point, even the best contestant can't jump from one to another. That's the same situation as with the virus. Experts think that's 6 feet, the length that droplets of water can travel from a sneeze. Even if an infected person has a monster sneeze with three people around them within 6 feet, if those three people have antibodies, the virus is unlikely to spread. The science may sound complicated and the "rules" for social isolation arbitrary, but it's actually pretty basic.
That creates the pickle.
Californians are doing a great job following stay at home orders and social distancing. That's slowing the spread. I was out walking around the park yesterday to slow the spread of the sense of Jello throughout my body. There were a few people BBQing in the park and a group of guys was back with their constructed outside gym including a rowing machine and full-on free weights, but generally speaking for a beautiful spring day with offices empty around Sacramento, the park's human population was sparse.
The challenge is that the more effective we are with physical isolation, the fewer people contract the virus, recover, and develop antibodies to limit its spread. Statistically, it is still true that the vast majority of folks who contract COVID-19 will range from being asymptomatic to having the equivalent of a really bad flu that takes time but is recoverable without medical intervention.
Until there is a widely proven pharmaceutical intervention to control the virus among those infected, the only solutions are (1) cross our fingers that COVID-19 behaves like the flu with warmer weather, (2) herd immunity, or (3) vaccine.
Warmer weather may provide some hope as COVID-19 is more prevalent in the northern hemisphere than in the southern. However, Florida has a higher rate per 1,000 of both cases and deaths than California. Then again, Florida has tested nearly twice as many people relative to California and also has an older population more susceptible to a fatal result from the virus. Other data from the southern hemisphere is also problematic because there is less commercial and leisure travel with Asia and Europe, which clearly led to the virus' spread in the United States.
So, let's assume that April 13 is indeed the peak resource date (knowing that the model will change with each run between now and five days hence). If we reopened California for business as unusual on May 3, what would happen?
Nobody knows -- at least from all I can tell from absorbing all the information that is out there.
Back to our three factors, in order of certainty this time.
1) Vaccine: We know that we won't have a proven vaccine until next year at the earliest.
2) Weather: While we stilll have no idea as to how it affects the spread of this particular virus, we know that weather likely won't be measurably different three weeks from now. It's forecast to be 69 and sunny in Sacramento today, 56 and rainy in Los Angeles, and 62 with thunderstorms in Sandy Eggo.
3) Herd immunity: Barring a therapeutic treatment or relying on one of the two above factors, this is what the experts are looking for.
We're back to our America Ninja Warrior example. If we know that we've spaced out the possible viral hosts sufficiently through enough people having antibodies, we can go back to business. Trust me, I am not a media person like on teevee who thrives on covering this and I'm feeling the financial pinch like many of you. This time last April, I had $450/week coming in just on classifieds, while I'm at $75/week right now. There is little hiring and obviously no events. I'd much rather be covering bill and budget hearings in the Legislature, the May 12 special elections in CA25 (Santa Clarita-Palmdale) and SD28 (Temecula-Blythe), and the November elections. But it is what it is.
Serological testing has begun for antibodies. Stanford has tested in Santa Clara and are awaiting "imminent" approval by the FDA. UCSF is also reportedly working on a test and other institutions across the country have been approved. But, we won't know the degree of "herd immunity" until there are representative samples both geographically and demographically throughout California. That takes an FDA-approved test and the test-result processing capacity in laboratories already overburdened with COVID-19 virus testing itself.
I have neither how long that will take nor what the threshold of share of population being immune that for this particular virus would be qualified as "herd immune." And, results will be different among California regions based on COVID-19 prevalence. It may seem odd but is simple if you think about it -- the hardest hit areas (e.g. Santa Clara) may be the first to be identified as having herd immunity. Those where there have been the fewest cases likely have the smallest share of the population with antibodies.
Do we open up county-by-county? Is the threshold for immunity 50% or 70% of the population, both numbers I have heard from experts? It varies by historical studies of different viruses.
Each day the economy is largely closed costs individuals as well as the state and local government money. We all want to see it opened as soon as possible. We're facing billions in budget reductions in California over the next eighteen months at least and that will hit health and human services and will likely lead to more illness and perhaps death. If we open too quickly, the virus regains a foothold and leads to death.
There are no easy answers. Hopefully the serological tests for antibodies can be rolled out quickly. Can enough be practically be performed on a representative basis by the end of April in a state of 40 million people to assess herd immunity? I don't know. Would the results indicate herd immunity? Nobody knows. How would returning to "normal" before the end of May change the model? Nobody knows.
At what point do the potential costs of returning to normal outweigh the costs of staying at home? During this Holy Week for many, I'll just say that the last question is between you and your God.
In a new CNN poll conducted by SSRS, 37% of respondents nationwide are comfortable returning to normal after April 30, while 60% are not.
To be honest, those results surprised me.
There's another factor that may affect results such as that. If you're a parent knowing that school is closed for the rest of the year and are being paid to work at home or receiving unemployment plus a promised federal check, you may be content not being required to go to the office.
Anyway, I don't envy the job of political leaders, from county health officers (quasi-political) to Governor Newsom in deciding when to give the "All Clear" or variation thereof. They don't teach this in school.
COVID-19 and the November election: For the Public Policy Institute of California, Eric McGhee has a blog post on how COVID-19 changes California's November 3 general election.
COVID-19 will move elections across the state closer to [the Voters Choice Act] model. Governor Newsom has mandated something like this for the special elections coming in April and May. Though this is a realistic path forward, it is not without obstacles. Preparation time is short. And the risk of infection will alter the siting and staffing of in-person options, even in experienced counties.
Furthermore, initial positive experiences in vote center counties may not translate to the rest of the state. A chaotic transition could create unforeseen problems that prompt some to throw up their hands and not vote at all. Young people and voters of color are more likely to use in-person voting, so great care must be taken to ensure they receive news of the change, trust that the change is being done fairly, and have options besides VBM if they want them.
Fortunately, California is well positioned here, too. Organizations like the Future of California Elections have helped make the state a national model for robust communication between election administrators and stakeholders.
The task is daunting, but we have little choice. Our best hope for a safe and fair election is to expand vote from home options as much as possible. The question is not whether to do it, but to recognize the challenges and work to mitigate them as much as possible.
BALLOT UPDATE: With the deadline to count ballots extended to 4/24, there are 67,748 ballots remaining among eight counties.
cakeday and classifieds after the jump...
CAKEDAY: Happy birthday to Rene Aguilera, Wayne Johnson, Emanuel Patrascu, Matt Shupe, and Paul Woods!