Now that we’ve “celebrated” the first anniversary of COVID-19 in California, it’s a good time to take stock of the state’s response.
From the beginning, the Golden State has taken an aggressive stance toward the epidemic, including imposing the earliest shelter-in-place order in the nation; ceasing in-person schooling for the vast majority of public-school kids; shuttering churches, parks, and playgrounds; mandating masks, with hefty fines for violators; and forcing the closure of “non-essential” businesses that cannot operate using distancing technologies, such as videoconferencing. Even Disneyland has been closed since March 2020. In short, California has followed one of the strictest lockdowns in the country.
Though the state’s response received high marks in July from the “covidian” high priesthood, including Dr. Anthony Fauci, the state has seen exploding coronavirus cases and deaths. Through March 28, 2021, 8.9 percent of all Californians have been identified as COVID cases—3.6 million cases. Since most infections are not recognized as cases, a much larger fraction of the population has been infected with COVID. Through March 29 this year, nearly 57,800 people have died in California with COVID.
To put these numbers in perspective, it helps to have a comparison state that has followed a very different policy. For that, we should consider Florida, which partially lifted its lockdown in May 2020 and then further relaxed restrictions in September (based in part on focused protection ideas advocated by us).
In sharp contrast to California, in Florida most schools and universities have been open for in-person instruction since the fall, normal human activities—sports, church going, visits to the park—occur with regularity, and businesses have been open for in-person activities. Local ordinances can recommend masks and social distancing and impose indoor-capacity limitations but cannot mandate closures, as is the case in California. Disneyworld has been open since July. At the same time, Florida increased testing and protection within its nursing homes to reduce the risk of COVID among its most vulnerable residents.
The Florida policy has drawn sharp criticism from Fauci, who said it “opened up too quickly” in July. However, the infection control results to date look remarkably similar to California’s, and in some ways better. Through March 28, 9.5 percent of Floridians have been identified as COVID cases. Once we account for the fact that Florida has one of the oldest populations in the country and California has one of the youngest, the death rates with COVID through March 28 are lower in Florida than in California. In fact, the COVID death rate for the under-65 population and the over-65 population are both lower in Florida than in California.
Some think of lockdowns as the only possible way to protect the population from exposure to COVID risk. In reality, the lockdowns in California and elsewhere have served to protect only a portion of the population—the rich.
Data from Los Angeles County, where a large fraction of COVID cases in California has happened, put this fact in stark relief. Through March 28, in the wealthiest parts of LA county (those with less than 10 percent of households in poverty), the age-adjusted death rate with COVID-19 was 119 people per 100,000 population. As we look in poorer and poorer areas, the death rate mounts: areas with more than 30 percent of households in poverty have faced a death rate of 394 people per 100,000—a death rate more than three times higher. Hispanics in LA have borne the worst of the pandemic, with a death rate of 338 per 100,000. By contrast, Black, Asian, and White residents have experienced 188, 143, and 119 deaths per 100,000, respectively. The California lockdowns are a form of trickle-down epidemiology. In Florida, by contrast, there is little difference among races in COVID-related death rates throughout the epidemic, with the Black and Hispanic populations dying at lower rates than the White population.
While anyone can get infected, there is more than a thousandfold difference in COVID-19 mortality between the oldest and youngest. According to a report by analysts at the University of Southern California, a strategy that prioritizes the elderly for the first vaccinations would result in a 70 percent increase in the number of lives saved, even with the same number of doses distributed. From the beginning of the epidemic, mathematical epidemiologists have touted the benefits of protecting the vulnerable to reduce COVID-related deaths. While the vaccine is a scarce resource, vulnerable populations should receive it first.
Through December and January, California failed to rapidly distribute the vaccine to the elderly, who are at the highest mortality risk after infection. Governor Newsom did not make the vaccine available to the elderly until January 13, and California ranked dead last in the country in the pace of vaccine distribution in late January. One of the authors’ 80-year old mother, who lives in LA County and does not drive, was directed to a vaccination site at Dodger Stadium, 30 miles away, for inoculation and only received her first dose during the third week of February. By contrast, Florida offered the vaccine to every single resident and staffer in the state’s nursing homes, as well as in hundreds of assisted-living facilities, by the end of January. Though California has eventually caught up, it lagged behind Florida in its vaccine rollout through the crucial early winter months.
That California and Florida have had similar COVID outcomes despite disparate policies would matter less if the lockdowns were costless. However, this is very far from the case. The harms of the lockdowns are manifold and devastating wherever they have been implemented, including plummeting childhood vaccination, worsened cardiovascular disease outcomes, less cancer screening early in the epidemic, and deteriorating mental health, to name a few. According to a CDC estimate, one in four young adults in the United States seriously considered suicide, as reported this past June. For children, the cessation of in-person schooling since spring 2020 has led to severe learning losses, with adverse consequences projected throughout affected students’ life spans.
On January 25, Governor Newsom lifted the statewide shelter-in-place order he had imposed on California in early December. This order returned the state to the regional color-coded lockdown regime that had been in place before the even more draconian shelter-in-place order. While this will permit some businesses to operate again, most state public schools remain closed to in-person instruction. As of March 28, California ranks last in the United States in access to in-person instruction for K–12 students. The lockdowns of varying stringency in place since March 2020 have evidently failed to protect Californians—especially poor Californians—from COVID and have inflicted enormous harm.
It is far past time to try a better strategy.
Dr. Jay Bhattacharya, MD, PhD, is a professor of medicine at Stanford University. Dr. Martin Kulldorff, PhD, is a professor of medicine at Harvard University.