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--:-- Sean Rameswaram: The pandemic is going from bad to worse in the United States. The White House appears to be at war with Fauci and the CDC. The CDC appears to be at war with itself. We're hovering around 60,000 new reported cases a day. The governor of Oklahoma just tested positive for COVID. Hospitals are filling up. States are shutting down. July is starting to feel like March. Things are so bad now that even places that did a good job initially look to be in bad shape. Case in point, California.
--:-- Sean Rameswaram: On today's show, we're going to explain how the Golden State went from shiny example on a hill to cautionary tale. Dr. Robert Wachter from the University of California in San Francisco is going to do a lot of the legwork.
--:-- Sean Rameswaram: Well, it begins probably like everyone else's journey. We saw what was happening in China in January, and California is so interconnected with China. I think we knew there was every reason to believe that we were going to get hammered. Big, diverse, lots of travel with Asia, lots of travel connecting us with Europe. I mean, sort of the mood that you know when earthquakes can hit, but except we never know that. My metaphor was I was standing on a beach waiting for the tsunami and I could see the peak of the waves over the horizon.
--:-- Sean Rameswaram: And that's, there was no good reason to think that California was not going to be the state that was most hammered by this. And then I think an interesting thing happened in late February, early March. There was a notice in the news that Google and Twitter and Salesforce and Facebook, really the big tech companies in the Bay Area, were all telling their workers to stay at home.
--:-- Sean Rameswaram: We know that Facebook, Google, LinkedIn, those are three major tech companies. They are now strongly recommending their employees work from home. Facebook is also scrapping all barrier events and telling workers to cancel all business travel. And I remember seeing that and I said, that's kind of interesting because, you know, we were worried about it and we thought it could, the pandemic could be bad. But when it's over there, there's always this feeling like, you know, maybe it's not going to hit us so badly.
--:-- Sean Rameswaram: We've seen scares before. They don't always play out. But then you say, all right, Google's telling people to stay home. Google has an international footprint. They're smarter than I am. They have all the data in the universe. When they're telling people to stay home, this must be serious stuff.
--:-- Sean Rameswaram: The Bay Area went to lockdown on March 16th, and the state of California did on March 19th. What it means, people cannot leave their homes here for at least a month, except for essentials. Grocery stores, banks, pharmacies, food delivery services will all keep operating. And there are exceptions for emergency services, even the media.
--:-- Sean Rameswaram: It was aggressive, it was early, and they guessed right. It was sort of a remarkable feeling where it was kind of like we were bracing for the tsunami and we're seeing little wavelets that are going up to our mid-knees, but we're not seeing anything like what they're seeing in New York.
--:-- Sean Rameswaram: What was it specifically that prevented California from seeing huge surges early on? Was it that people stayed at home? Was it that the virus never actually ended up spreading that much in the outset?
--:-- Dr. Robert Wachter: I think you had four things that worked in California. You had these corporate leaders acting early and aggressively. You had political leaders acting early and aggressively. And I think quite courageously, you had the people listening, taking it seriously, doing the right thing without a whole lot of blowback. And the fourth thing is luck.
--:-- Dr. Robert Wachter: If California had had New York's per capita death rate over the first three months, that would have been that would have amounted to 55,000 more deaths in California. So the fact that California people said to me sometimes, did we waste March, April and May by doing so well if we're going to get hit now? And the answer is, first of all, no, because you'd rather be hit now than than hit in March. Our capacity is better now. We built up hospital capacity, testing, contact tracing. We have a couple of medicines that are modestly effective.
--:-- Dr. Robert Wachter: So, you know, a delay is better than nothing. But the other thing is, you know, California did so remarkably well in those first few months that if we'd had the same deaths per population as New York, that would have been almost 60,000 additional deaths.
--:-- Sean Rameswaram: It feels like the narrative begins to shift in May. There's drama over the beaches. There's a ban on going to some beaches. People push back. Was it a mistake to sort of pivot towards reopening in May?
--:-- Dr. Robert Wachter: To me, perfectly reasonable to begin opening up in May. But the hope was that as we opened, people would continue to act well. People would continue to say this is a real threat We have to take it super seriously
--:-- Dr. Robert Wachter: And I think that where we now got it wrong where people began to feel like the fact that we're opening means we're out of the woods. Look at us, how wonderful we are, how great we did, a lot of self-congratulations, a little bit of, oh, that's terrible what happened in New York. We're lucky it never happened to us, and it's not going to happen to us.
--:-- Sean Rameswaram: The virus couldn't care less that you had a great March, April, and up till mid-May. The virus is just waiting for an opportunity to pounce. And starting in mid-May, and particularly in early June, we gave it that opportunity.
--:-- Sean Rameswaram: What was the result? Well, the result was we began to see a spike in cases. Lo and behold, I mean, a lot of this is very predictable and very mathematical. It's like, OK, you know, now there's an increase in cases. What's going to happen next? Well, in a week or so, you're going to start seeing an increase in hospitalizations.
--:-- Sean Rameswaram: And then we started seeing an increase in hospitalizations. And well, well, you know, more more cases, some more hospitalizations. But maybe it's not so bad because these are all young, healthy people who are who are not following the rules and they're not going to get that sick. We won't see deaths.
--:-- Sean Rameswaram: And then, lo and behold, you begin starting to see begin to start to see increases in deaths. And we also have a grim number here from California. 149 people died of the coronavirus today here in the state. That is the highest daily death toll that we have seen since the pandemic began here.
--:-- Sean Rameswaram: The deaths are still lagging behind the cases and the hospitalizations. But if you look at what's happened in Florida and Arizona and Texas, they had the same lag and now they're seeing significant spikes in deaths.
--:-- Sean Rameswaram: It's patchy. It's not equal throughout all of California. You saw certain counties have big surges, whereas other counties, including San Francisco, where I live, were mellower.
--:-- Sean Rameswaram: But the other thing we came to recognize is the state is very interconnected. So there's a huge surge in a county, a relatively rural county called Imperial County, down on the Mexican border that has mostly to do with cross-border traffic, people coming back and forth across from Mexico.
--:-- Sean Rameswaram: And you might say, well, that's 600 miles away from San Francisco. Well, it turns out they overwhelmed their hospital and their ICU capacity very quickly. Those patients got transferred to hospitals in San Diego and Los Angeles, and actually, believe it or not, some of them in San Francisco.
--:-- Sean Rameswaram: So there are no walls here. If you start seeing outbreaks in one part of the state, that's going to metastasize to other parts of the state, and that's what we've begun to see.
--:-- Sean Rameswaram: How is California's leadership responding? What's Governor Gavin Newsom doing now?
--:-- Dr. Robert Wachter: Well, starting about two weeks ago, he began getting increasingly stern. And interesting sort of watching the kind of stern dad thing.
--:-- Dr. Robert Wachter: I don't mean to be patronizing or paternalistic about all of this. I'm just working with local health officials, dealing with the data, the science, trying to mitigate as we were so successful mitigating the spread of this disease by tempering that growth of the curve in the beginning.
--:-- Dr. Robert Wachter: We need to do that again. We will do that again. And it's really going to be up to each and every one of you.
--:-- Sean Rameswaram: Then you started seeing public service announcements about masks and things like that. So do your part. Don't let COVID win. Wear a mask. Just do it. Just do it.
--:-- Sean Rameswaram: It was cute. But I think one of the things that has struck me is, you know, my instinct is we need influencers to get people to do the right thing. And so, you know, to me, it's like, let's get Springsteen with a mask. Let's get Tom Hanks with a mask.
--:-- Sean Rameswaram: And then I realized, you know, I'm a 62-year-old guy. I don't have any idea who an influencer is for a 25-year-old. You know, they're all people I'm quite confident I've never heard of.
--:-- Sean Rameswaram: Tom Hanks is cross-generational. Oh, okay. That's comforting to hear. Wear a mask, wash your hands, social distance. If you can't do that, I don't have much respect for you.
--:-- Sean Rameswaram: So Hanks is on board. Governor Newsom is getting more stern. What happens next? What happens this week?
--:-- Sean Rameswaram: This week on Monday, he took the about 30 counties that represent about 70 percent of the population of California and backed them down in terms of what is what they're allowed to keep open.
--:-- Sean Rameswaram: And for all of California, he closed things like indoor dining and bars. And so, you know, it was a significant step backwards, not quite to full lockdown, not quite to shelter in place, but much more where we were in early May.
--:-- Sean Rameswaram: Not on open economy or off shutdown, but a dimmer switch looking at conditions throughout the nation's most populous state as they present themselves, as those trend lines become points of concern before they invariably become headlines.
--:-- Sean Rameswaram: You know, people talk about the surge in California and kind of put surges in one bucket and say California, it's almost California, Texas, Arizona, Florida, which is not entirely accurate.
--:-- Sean Rameswaram: Because if you look at the surge in California, it's about a little less than half of what they're seeing in Texas and almost about a third of what they're seeing in Florida and Arizona.
--:-- Sean Rameswaram: So it's not nearly as disastrous. We're not seeing hospitals that are overrun yet the way they are in Houston and in Miami and certain parts of Florida.
--:-- Sean Rameswaram: But it's enough that I think responsible governance is to say that we're going in the wrong direction. The ground rules here all along where we open up and we see how it goes And if it going badly we go backwards And that precisely what he doing
--:-- Sean Rameswaram: And we got to figure out how to make this work If people can follow the rules and the standards to keep everybody healthy then we're going to have to keep the economy shut down more than any of us would like to.
--:-- Sean Rameswaram: Do you think it'll work? I do. I, you know, I think what California proved in March, April and early May is that as a state, the people and the government are capable of acting well.
--:-- Sean Rameswaram: And I what I believe and I and maybe this I hope this may be a little bit of wishful thinking, but what I believe is that we've had our come to Jesus moment now.
--:-- Sean Rameswaram: And if everybody plays well and wears masks and keeps their distance, then I think we're in a good position to get this under control in the next two or three weeks and then begin to open up more slowly.
--:-- Sean Rameswaram: But, you know, one of the things about this virus is it just constantly surprises us. More with Dr. Wachter after a quick break on Today Explained.
--:-- Sean Rameswaram: Thank you.
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--:-- Sean Rameswaram: Dr. Wachter, you mentioned that the spikes in California aren't as bad as the ones in places like Arizona, Texas, Florida. What sets California apart from those states other than, you know, sort of avoiding this situation back in March?
--:-- Dr. Robert Wachter: I think probably the biggest thing is the politics. You know, it is wherever you live on the political spectrum, blue to red, it is clear that Democratic governors and Democratic states have tended to take the virus more seriously and have tended to take the need for relatively strict public health measures more seriously and kind of believed in the whole thing.
--:-- Dr. Robert Wachter: California sort of makes that explanation a little bit more nuanced and says that that's probably a little bit what's going on, but probably more of what's going on is the states that got hammered early tended to be big coastal states that had a lot of international travel, New York first among them.
--:-- Dr. Robert Wachter: And the states that are getting hammered now are the states that didn't get hammered the first time. Rather than a political issue, it's more a matter of complacency. If you survived for three months and did well, the normal human condition is to say, this is not that big a deal.
--:-- Dr. Robert Wachter: I want my former life back and I'm going to go back to it, particularly if I'm young and I see myself as being relatively not too vulnerable to the disease.
--:-- Sean Rameswaram: When you look at these other states like Texas or Arizona and Florida and compare their politics to California, what do you see as the most sort of jarring differences in the approach to this right now?
--:-- Dr. Robert Wachter: It's hard to pin it on one thing. I mean, if you're a person in Arizona, you got a message early on that this is not serious, that we have to save the economy.
--:-- Dr. Robert Wachter: I want to encourage people to get out and about, to take a loved one to dinner, to go retail shopping. If you don't have an underlying health condition, it's safe out there. We are in phase one. A lot of these rules are from, you know, pointy-headed intellectuals, and it's not happening to us, and it's not going to happen to us, that masks are for sissies.
--:-- Sean Rameswaram: Wearing a face mask as I greet presidents, prime ministers, dictators, kings, queens, I don't know, somehow I don't see it for myself. I just don't. Maybe I'll change my mind.
--:-- Sean Rameswaram: If you hear that message from anybody who wouldn't embrace that, it's like, of course, that's what I want. I mean, the fact that we set this up as this sort of duality of you're either in favor of the public health or you're in favor of the economy is so wrongheaded.
--:-- Sean Rameswaram: And I think we're seeing that now. If the virus is not under control, the economy is in the tank. A friend of mine the other day said to me, you know, the virus is a great teacher.
--:-- Sean Rameswaram: And I said, yes, but. And the but was, I said, fire is a great teacher. You stick your finger on the stove, it hurts like hell. You're going to pull it out and you're never going to do that again.
--:-- Sean Rameswaram: The virus isn't a great teacher because you can act badly for a while, get away with it and say, oh, you know, I was right. The governor was right. Fauci's wrong. You know, all these people are getting hysterical or is something about what happened in New York that's particular to New York.
--:-- Sean Rameswaram: And then you know I acted what they what they say is badly you know for the last month And I been fine and everybody I know is fine I don know anybody who died of this thing You know it whether you say it a hoax or it just overrated whatever it is
--:-- Sean Rameswaram: And to me, I've likened this a little bit to a Vegas casino that, you know, you can win a few hands and you think, you know, look, I'm better than the house. Well, you're not better than the house. And if you play enough hands, the house wins.
--:-- Sean Rameswaram: And the house here is the virus. And so, you know, we will look back on this in the history books and look at the behavior, the political behavior and the behavior of the people in places like Texas and Arizona and Florida and say, you know, they all acted badly.
--:-- Sean Rameswaram: But in many ways, their bad behavior was reinforced for two or three months, which is a lot of reinforcement to say, look, I'm doing what they all, all the experts say, I shouldn't do this. I'm doing it and I'm doing fine. And then that all works until, you know, until you hit the iceberg.
--:-- Sean Rameswaram: And that's what's happening now. Right. Yeah, we hit the iceberg. And as the ship sinks, we're still fighting over whether we need to wear life jackets. Somehow this is still an us versus them fight in the United States.
--:-- Sean Rameswaram: It's nuanced. It's like, yes, of course, we want the virus tamped down to the degree possible. And we want to open up the economy to the degree possible. And that is a razor's edge kind of set of decisions.
--:-- Sean Rameswaram: But the best we can do is go with the evidence and make the best decisions we can. And the fact that the attempts to bring Fauci down now are fascinating.
--:-- Sean Rameswaram: In a stunning development, some administration officials are treating him like a political rival, releasing what they say is a list of questionable statements by Dr. Fauci, even though many of them were taken out of context or widely accepted in the early days of the pandemic.
--:-- Sean Rameswaram: Because you can go back in February and March and see things that people said, experts said, that have turned out to be wrong, including things that I said, because we've learned more.
--:-- Sean Rameswaram: So it's one thing to evolve with the science. And I think masks are a great example where the science was not super clear in March. We didn't know about super spreaders. We didn't know about asymptomatic cases and transmission.
--:-- Sean Rameswaram: There's a whole bunch of things we didn't know. So you can always go back and look at the statements of people, you know, and say, look, Fauci said that in February. Fauci said it because that was the best science at the time.
--:-- Sean Rameswaram: But, you know, science has to evolve. Politics often doesn't. And once you see this through a political lens, you're in grave danger of making very bad decisions.
--:-- Sean Rameswaram: And you may get away with it for a while. And I think that's what's happened in some of these states. They got away with it for a while. They came to believe that, you know, it was the right call and they are paying the price now.
--:-- Sean Rameswaram: And that's why it's going to be fascinating to see whether they're able to turn it around. You know, can the leaders change their messaging without feeling like they're doing themselves massive political damage?
--:-- Sean Rameswaram: You know, my own bias is the political damage of being responsible for thousands and thousands of deaths is probably worse than the political damage of saying, I'm sorry, I had it wrong a few months ago, but now we understand the right thing to do.
--:-- Sean Rameswaram: Yeah, that's my bias, too. I wonder, as a medical professional who surely encounters medical professionals abroad, are a lot of them shaking their heads and asking you what the heck is going on in the United States?
--:-- Dr. Robert Wachter: Oh, absolutely. Florida now has more cases than Europe. And, you know, they were all hit quite badly a few months ago, but they quickly got their acts together.
--:-- Dr. Robert Wachter: And, you know, there are a lot of people in other countries that shake their heads at the United States independent of COVID. There's so many reasons now. This is just one more thing.
--:-- Dr. Robert Wachter: But it's one more thing that sort of, you know, that strongly overlaps with the reasons they were shaking their head. It turns out that the United States is uniquely bad at fighting a pandemic.
--:-- Sean Rameswaram: Now, it shouldn't be, you know, you think about some of the natural advantages that we've squandered here. You know, the CDC is a world-class organization. Our ability to ramp up manufacturing for things like PPE or new drugs or vaccines, you know, our scientific enterprise, is unparalleled.
--:-- Sean Rameswaram: But pandemics are tests of everything. They test your science. They test your society. They test your politics. They test your resolve. They test the ability to move from a society that tends to be very individually based to one in which people are going to be willing to accept rules that are imposed on them and standards that are imposed by other people.
--:-- Sean Rameswaram: And the fact that we're so partisan and so individualistic and that there are so many people among us who see anything that's coming from some central authority as something that they immediately have antibodies to puts us in a pretty bad position.
--:-- Sean Rameswaram: And then, you know, all of those things are magnified in the current era. So we couldn't have been less well prepared to handle this in a good way.
--:-- Sean Rameswaram: And I think, unfortunately, sadly, it's playing out. And at a cost of, you know, at the end, there will be hundreds of thousands of people that will have died that really didn't need to.
--:-- Sean Rameswaram: Dr. Robert Wachter is a professor and the chair of the Department of Medicine at the University of California in San Francisco. I'm Sean Ramas-Vurham. It's Today Explained.
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--:-- Sean Rameswaram: You can find us on Apple Podcasts, Spotify, or wherever you get your podcasts. Today Explained is a Vox production. Our producer is Elizabeth Zhang. Our editor is Alex Wineman. Our engineer is Paul Robert Mounsey.
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