Is L.A. County Prepared for a Coronavirus Surge?

After months of lockdown, the doors of Los Angeles County, the California epicenter of the COVID-19 pandemic, are reopening fast. Too fast for some.

At the end of May, L.A. County’s churches, retail stores, beauty salons and dine-in restaurants received the green light from the state to resume business. As California eyed Phase 3 of its reopening, thousands spilled out into the county’s streets in response to the death of George Floyd in Minneapolis, many of them without masks, creating an environment ideal for spreading the virus. Last Friday, gyms and other recreational venues welcomed back the public with restrictions.
 

“It makes little sense to press forward in bringing things
‘back to normal’ when things are not normal.”

— Prof. John Swartzberg, infectious disease expert

 
The latest numbers reveal some worrying trends. The transmission rate—the number of people to whom an infected person transmits the virus—appeared last week to be climbing once again. On June 11 the county recorded the highest one-day jump in cases since the pandemic began. And while the rate of COVID-related deaths doesn’t appear to be on the uptick, health experts warn that the possible impacts from the protests have yet to be broadly felt due to the virus’s incubation period.

Given the confluence of recent events, the county should put “the brakes” on its steps to reopen, warned John Swartzberg, a clinical professor emeritus at the University of California, Berkeley, and infectious disease expert. “It makes little sense to press forward in bringing things ‘back to normal’ when things are not normal.”

And so, exactly what are L.A. County’s contingency plans in the event of a surge of infections? Some public health experts have raised serious questions over the county’s preparedness to protect its most vulnerable communities hit hardest by the epidemic, including small business owners—questions the county appears unable to answer at the moment.

Communities of color continue to die of the virus at significantly higher rates than whites, for example. And nursing homes account for nearly half of county COVID-19 deaths. At a recent press briefing, county health officials acknowledged these disparities, and detailed ongoing efforts to address them, including increased testing and outreach programs. “We need to do more,” admitted Christina Ghaly, the department’s Health Services director.
 

The available information from the L.A. County Dept. of Public Health appears short on specific actions
to be taken if infections continue to spike.

 
Still, Dr. Michael Wasserman, chairperson for the California Association of Long Term Care Medicine Education Committee, is skeptical of the county’s overall preparedness to address the problems facing nursing homes if there is a significant uptick in infections: “They ‘say’ they’re prepared, but that doesn’t make it so.”

“Where’s their contingency plan?”

Capital & Main sent the L.A. County Department of Public Health (LAC DPH) a detailed set of questions. The department responded with the following statement on June 3:

Public Health is assessing the activities allowed by the Order on an ongoing basis through metrics and surveillance tools to identify concerning situations or surges in COVID-19 cases, hospitalizations and deaths and to determine the appropriate next actions. The metrics that are available online are the same metrics we are using to evaluate trends as a whole. A surge wouldn’t necessarily call for a reclosing. Depending on the situation, severity and potential its causes, a freeze in reopening and additional limitations or modification at businesses already reopened could also be appropriate. The situation and the actions recommended to address it would be discussed with the Board of Supervisors as these situations are identified.

The county has released other details. To win Sacramento’s approval for the last round of business reopenings, it had to demonstrate that it has mastered a number of important metrics, including that it has adequate testing capabilities, along with hospital and containment capacity. On June 8 the county published a 12-page plan to contain the virus as L.A. continues to reopen.

Also Read “Death Trap: L.A.’s Nursing Homes and COVID-19”

But the available information appears short on specific actions to be taken if infections continue to spike. County officials claim that’s for good reason. “The thresholds and guidelines we are setting now may also have to change so we can be responsive to the changing needs and demands of the times,” L.A. County Supervisor Mark Ridley-Thomas explained in a statement.

According, however, to a retired LAC DPH senior manager who requested anonymity, the contingency plans as outlined not only lack important details but fail to address serious flaws in the department’s response to the first wave of infections, such as community specific problems associated with public health care access and follow-up treatments.

“I don’t think they’re prepared any more than they were before,” warned the retired senior manager, who added that, given the “limited” number of precautions in place, health officials appear to be “tacitly accepting the fact” that the virus is going to “burn” through the population, possibly resulting in unnecessary deaths. “This is such a vicious virus.”

A detailed contingency plan would help ensure swift decisions that are public and health data-driven rather than politically motivated, said another former senior public health official, speaking on condition of anonymity. A Columbia School of Public Health study showed that if the U.S. had issued a national emergency a week earlier than it did, some 36,000 lives would have been saved. If issued two weeks earlier, it would have led to some 54,000 saved lives.
 

The nexus between poverty and race is well established in L.A.,
as are its  vast implications.

 
“This goes to the question: Did we intervene early enough in those populations that were most at risk? I don’t believe we did,” said the former senior public health official. “Where’s their contingency plan so when they do reopen, they can respond to events that occur, and know how to respond? That is what appears to be missing here.”

At the end of April, the county published a report detailing how its poorest, most disadvantaged residents were disproportionately impacted by COVID-19, and outlined a multipart strategy to address these problems. But some question the overall efficacy of these measures. As of June 5, nonwhite death rates remained significantly higher than for whites, explained LAC DPH’s director, Dr. Barbara Ferrer. For African-Americans, it’s more than double.

“Whatever you think you’re doing to protect low-income people, you need to do more,” said Martha Dina Argüello, executive director of the L.A. chapter of Physicians for Social Responsibility.

The nexus between poverty and race is well established in L.A., as are its  vast implications. People of color and the poor in California are exposed to substantially higher levels of air pollution, for example, which can both help cause and contribute to the sorts of underlying health conditions that make people susceptible to the disease. “There’s so much inequality and so much inequity, sometimes it’s unimaginable,” said Argüello.

According to Dr. Noah Marco, chief medical officer at the Los Angeles Jewish Home in the San Fernando Valley, his organization’s facilities are in “better shape” to handle the crisis than they once were, but he remains concerned about broad ongoing testing deficiencies in nursing homes. Indeed, health officials have acknowledged “unnecessary” testing delays.
 

It’s unclear, should infections or deaths rise too high, what precise measures the county might take with the business community.

 
“The county is opening up and deploying more tests to the community when they have not even completed testing of all long-term care facilities,” wrote Marco in an email. “I still do not understand the logic that L.A. County Health Department is using to prioritize its limited resources.”

“It just takes one gathering”

Business owners are watching infection rates closely. One threshold for reopening is for the county to show fewer than 25 new cases per 100,000 residents over the prior two-week period. Over the past 14 days, there have been 173.6 new cases per 100,000 residents.

It’s unclear, should infections or deaths rise too high, what specific measures the county might take with the business community. Harmeet Dhillon, a San Francisco-based attorney who has represented various business interests in COVID-19 related litigation against the state, warned that the measures L.A. County took during the first wave disproportionately helped chain grocery stores and pharmacies, and big-box retailers, at the expense of small business owners. “It’s totally discriminatory nonsense,” she said.

Fred Jones, legal counsel and lobbyist for the Professional Beauty Federation of California, warned of an ongoing lack of “clarity” surrounding the county’s decision-making, and said that if the county’s “unconstitutional” business closures are extended or reapplied once again, it might lead to some of his constituents “providing their services underground.”

Poverty has a “direct correlation” with unhealthiness, Jones added. “If we drive businesses and individual sole-proprietor booth renters into poverty, that’s going to have direct health implications for them.”

According to Rosey Ibarra, owner of Social Salon Suites, a Glendale-based company, the rules and guidelines provided by the county for reopening have been at times “contradictory” and vague, and she said she remains “in the dark” about how a sharp uptick in infections might impact her directly. If the county did shutter her business again, she added, “I don’t see us surviving past that.”

It’s not only business owners who are frustrated with the clarity of the county’s crisis messaging. Some health experts have also voiced concern that county officials weren’t louder in warning protesters of the risks of spreading the virus among populations already hit hard by COVID-19. Ferrer said at the June 5 briefing, for example, that 86 percent of the nursing home residents and staff who tested positive were asymptomatic or pre-symptomatic.

“It just takes one gathering where one person who is infected transmitting to a group,” said Dr. Loren Miller, an investigator for the Lundquist Institute, a biomedical research facility that specializes in infectious diseases. When people let their guard down, he said, “that’s when transmissions can occur.”

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