First came reports of a deadly virus spreading quickly in China, then evacuation flights and two-week quarantines on a military base in Fairfield, then an outbreak on a cruise ship that had departed from San Francisco and, by late February, a small but growing number of cases of coronavirus in the Bay Area. Within weeks, 300 people had tested positive locally, and five had died.
There was no end in sight, and the path forward was unclear.
That’s when public officials in six Bay Area counties, who had been taking incremental steps to slow the virus’ spread, made the dramatic and unprecedented decision to order nearly 7 million residents to stay at home. Other counties followed, and on March 19, the state issued a stay-home order — making California first in the nation to enact such a measure.
Now, a month later, those orders remain in place but the Bay Area and California are in a much different place. More than 6,000 people have tested positive for coronavirus and nearly 200 have died, but the curve was relatively flat — meaning the rate of new cases and deaths did not climb as quickly and as high as many feared. That feat, widely credited to the quick action to close businesses and send people home, helped keep hospitals from being overwhelmed but also caused extensive job losses and financial distress.
Now officials are talking about when and how we can begin, slowly, to emerge.
“Everyone else thought we were overreacting,” said Warner Greene, a senior investigator with the Gladstone Institutes, a biomedical research organization. “The Bay Area has done exceedingly well. They didn’t flatten the curve, they crushed the curve, and we are all benefactors of that.”
Still, so much isn’t known: How many people have been infected? What percentage of people are asymptomatic? Why do some people get sicker than others? And perhaps now most important of all: When will it be safe to reopen society?
The virus isn’t going away, for now, and the task of politicians and health care professionals is to determine when kids can safely return to school, adults can go back to work and what treatment is best for those who will fall ill.
What happened? The almost complete shutdown of the Bay Area occurred in increments as the cases climbed, and began weeks before the shelter-in-place orders came. With every passing day, a new order was issued — each more radical than the one before — and residents were faced with a new reality.
On Feb. 10, Santa Clara County declared a local emergency. At the time, the county had confirmed that two residents tested positive after returning from Wuhan, China. On Feb. 25, San Francisco declared a state of emergency, even though the county didn’t have any confirmed cases. On March 11, San Francisco banned public gatherings with 1,000 people, essentially halting Warriors games and other events at Chase Center. Two days later, schools throughout the Bay Area announced closures for at least a month.
The Bay Area shelter-in-place order came on March 16. On April 7, six Bay Area counties announced school closures through the end of the academic year.
Sometimes the public directives changed midstream, as scientists and doctors learned more about the virus.
For weeks public health authorities said the coronavirus risk to most people was extremely low. Then, they learned that it was circulating in U.S. communities and before long, asymptomatic people became a great concern. In February, people were told they shouldn’t wear masks; starting this weekend, everyone in the Bay Area must wear a face covering under certain circumstances in public.
Public health experts say California’s incremental steps in addressing the coronavirus pandemic were deliberate and followed an existing playbook to reduce panic.
“If you were to start from mid-March saying school is going to be closed for the rest of the year and we may consider reopening society sometime in June, I don’t know that people would be very receptive to that. That might cause a little bit more hysteria,” said Jahan Fahimi, an emergency physician at UCSF Medical Center. “It’s a thoughtful way of rolling this out, gathering data along the way.”
What did we learn? Aggressive social distancing works. As a result of the order, the number of confirmed coronavirus patients in intensive care units in the nine Bay Area counties dropped by 10% on Friday compared with a week earlier. The total number of hospitalized patients was 405, down 11% from a week earlier.
“We are very clear on the principles we need to apply,” said Dr. Matt Willis, Marin County’s health officer. “We know how this disease is transmitted and we know what’s worked. We learned that, from a community standpoint, if we limit the number of interactions where the virus is transmitted, we limit incidents and we prevent surges, because that is what’s happened.”
If some restrictions are lifted, the likelihood of transmission will increase, Willis added. That’s why Bay Area counties and the governor are now building a framework to put in place for reopening society. Maintaining a 6-foot distance from others, frequent hand-washing and covering faces are key if parts of the order are lifted.
Nursing homes, jails and homeless populations are still the most at-risk, despite the order. An ongoing challenge will be how to address outbreaks at these facilities, Willis said.
Homeless residents and people in long-term care facilities make up 10% of all cases.
Despite its many successes, the shelter-in-place order has had a profound impact on the economy. During the past month, nearly 3 million Californians filed for unemployment benefits.
“We recognize that there is significant social harm in the shelter-in-place order as it is, because of its impact on the economy, on education and especially on people with limited means,” Willis said.
What we don’t know: Widespread data on the virus is still unavailable. The medical community is continuing to debate how the virus is transmitted, for how long people are infectious and why some people never develop symptoms. And it’s still unclear how the virus will behave in warmer weather, Fahimi said.
“Traditionally, coronaviruses in general, we do see that they tend to peak when other respiratory illnesses peak in the fall and winter,” he said. “But this virus is very different than a lot of other viruses that we’ve seen, so it may behave differently. We don’t quite know what that is going to look like.”
It also remains unclear whether those who have contracted the virus can develop antibodies to it and whether that can protect them from future infection. Will antibodies give people immunity? These are the questions that scientists are trying to answer now, Fahimi said.
It’s likely that once someone contracts the virus, they have some form of immunity, said Bela Matyas, the Solano County health officer. The limited data that does exist hasn’t shown evidence that people are contracting the virus more than once, he said.
“The ones who have been hospitalized and we’ve tested, they are not coming back,” he said. “There is so little certainty with what we are dealing with, we have to do the best we can to … draw conclusions from the limited data that are available.”
Experts say the focus needs to be on developing antiviral treatments and ultimately, a vaccine. Those antiviral treatments will allow doctors and nurses to treat patients before their condition worsens and they end up in the ICU, said George Rutherford, a UCSF infectious disease specialist.
“If we were able to find people early and treat them, that would be big,” Rutherford said. “That’s what we do for strep throat. We find people, we treat them and they don’t get scarlet fever.”
That treatment could occur in different phases, Rutherford said.
The first phase would be to treat people who are exposed before the infection takes hold. If people are infected, then they would be treated for the virus before it does any serious damage. And finally, once people are in the ICU, they can be treated before their immune system withers away, Rutherford said.
What we need to do: Gov. Gavin Newsom announced a “road map to recovery” with six requirements that must be met before basic activities can resume, including widespread testing so the state can isolate and quarantine people who contract the virus. Mass gatherings might be canceled until the state reaches “herd immunity,” Newsom said.
Experts say that testing needs to be expanded before restrictions can be lifted.
“We will have to test, test, test,” Greene said. “Find it and isolate that person and potentially quarantine contacts.”
Mark Ghaly, state health and human services secretary, said Wednesday that California has the technological capacity to do 94,000 coronavirus tests per day, though only a fraction of that is occurring now. Newsom said Thursday that the state is trying to scale up to 25,000 daily tests.
Another medical breakthrough that seems out of reach for now: a vaccine.
“I don’t think we are going to be able to really get back to the normal that we are used to until we have a vaccine probably,” said Dr. Maria Raven, the head of the Department of Emergency Medicine at UCSF.
That might mean continued use of face coverings while in public, social distancing in restaurants, no major public gatherings or sporting events. It could also mean a longer shift to using telehealth and telemedicine options, as well as working remotely, Raven added.
“We will get control of this virus,” said Greene, of the Gladstone Institutes. “Now the question is when is the next one coming?”
Sarah Ravani is a San Francisco Chronicle staff writer. Email: sravani@sfchronicle.com Twitter: @SarRavani
