As San Francisco Imposed Coronavirus Shelter-In-Place Rules, Los Angeles Waited

The coronavirus is surging in Los Angeles as the county emerges as the new epicenter of the virus in California — whereas in San Francisco, numbers are slowing, a payoff that officials say is because of the Bay Area’s fast action to impose aggressive restrictions on residents.

In mid-March, as Los Angeles Mayor Eric Garcetti watched case numbers climb in his city, he ordered all bars and nightclubs that don’t serve food to be closed, as well as movie theaters, fitness centers, arcades, bowling alleys and performance venues. Restaurants couldn’t allow dine-in service.

But Garcetti said a shelter-in-place order wasn’t “imminent.” People were still permitted to gather, though not in large groups.

That was March 15. Los Angeles County had 94 cases of COVID-19, the illness caused by the new coronavirus, more than twice as many as San Francisco’s 43. On March 16, San Francisco joined six Bay Area counties to announce strong protections, including requiring residents to shelter in place, effective the next day. Los Angeles County waited three days to announce a similar order. During that time, Los Angeles’ cases more than doubled, to 231. San Francisco’s rose by a smaller 63%, to 70.

A look at the coronavirus outbreak in the two major counties offers additional evidence that early intervention played a key role in slowing the rate of infection in San Francisco.

“The intensity in the increasing number of cases will probably depend on when the shelter-in-place order and lockdown got started,” said Lee Riley, a professor of epidemiology and infectious diseases at UC Berkeley. “If you start these restrictions late, then the rate of infection is going to be faster than the places where they started earlier.”

Experts warn that due to the lack of testing in California, the data that is available don’t paint a full picture of the crisis in San Francisco and Los Angeles counties. The coronavirus testing backlog in California is around 13,000, Gov. Gavin Newsom said Saturday. The backlogged tests are from patients who have submitted lab samples but are waiting for results. Test results can sometimes take up to 12 days.

California has struggled with test shortages that have prevented many people from getting tested at all, as well as slow processing times. Because of the testing shortages, it’s difficult to understand the full scope of the problem, said John Swartzberg, a UC Berkeley infectious disease expert.

“We are just not capturing enough people to have a good enough denominator,” he said. “We’ve done an inadequate amount of testing to see who is infected and how many people are infected. That is because we haven’t had enough testing available to us.”

Cases increased slowly in both counties. At one point, Los Angeles County and much smaller San Francisco, which is both a city and county, were neck and neck. Los Angeles reported its first case of COVID-19 on Jan. 26. San Francisco reported its first two cases on March 5. And on March 10, the counties had the same number of cases: 17.

But since announcing its shelter-in-place rules on March 16, San Francisco has seen a slower rate of increase than has Los Angeles.

Los Angeles’ cases have risen more than 48 times, while San Francisco’s have gone up about 10 times.

Los Angeles County, with about 10 million people, will naturally have more cases than San Francisco, where fewer than a million live. But the rate of increase in Los Angeles County could indicate a flareup, similar to the one seen in New Orleans over the past month, Swartzberg said.

New Orleans received criticism for holding its Mardi Gras celebration, which can draw more than 1 million people, on Feb. 26. The first case in Louisiana was announced less than two weeks after Fat Tuesday celebrations, and the number has since skyrocketed. On Sunday, Lousiana reported 13,010 cases and 477 deaths.

“Instead of the virus just spreading uniformly throughout society, it seems to flare up in different places and in different times,” Swartzberg said. “I would watch carefully the data we have in Los Angeles, because … what that is going to show is that Los Angeles could be a place that it is going to flare up.”

Flare-ups can occur during public gatherings, said Nicholas Jewell, a professor of biostatistics at UC Berkeley. Los Angeles held its annual LA Marathon on March 8, drawing 20,000 registered runners. That day, the county had 14 confirmed cases. Two weeks later, it was 409.

The increase in infections from Los Angeles and San Francisco counties since mid-March probably shows the number of people infected before the shelter-in-place orders, Jewell said. Next week will be key to seeing how effective the directives were.

If the rates of infection continue to increase at staggering rates, then that means Los Angeles County could still be in the “growth phase” of the epidemic wave, often called the curve, said Shannon Bennett, chief of science at the California Academy of Sciences in San Francisco.

As of Sunday, Los Angeles County had reported 5,940 positive cases and 132 deaths. The rate of reported infections increased by 12.6% from the previous day. San Francisco had 568 cases and eight deaths, with reported infections up 7.4% Sunday.

“That’s the big question. Where are we on the epidemic wave?” Bennett said. “It looks like in San Francisco, we are starting to level off. We are still seeing new cases, but not as high a rate as prior days. So that could reflect that we are further along on the epidemic curve than other parts of California.”

 

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