SAN FRANCISCO — How will California get back to normal amid the coronavirus outbreak?
There will be no getting back to normal anytime soon, with the new coronavirus unlikely to ever be completely eradicated, and a vaccine 12 months to 18 months away under the most optimistic scenario.
Certainly, society will be opened back up eventually. But the process is likely going to be slow and methodical — guarding against new outbreaks in an effort to prevent a resurgence even worse than what California is experiencing now, but also focusing on starting to reopen the economy.
Depending on various models, the peak in cases in California could come anytime between mid-April and the end of May.
California has not been hit as hard as hot spots such as New York. But officials remain cautious.
Los Angeles County health officials warned Friday that the region needs to significantly increase social distancing to slow the spread of the novel coronavirus and that stay-at-home restrictions could remain into the summer.
Even with the dramatic social distancing the county is now seeing, officials forecast that up to 30% of residents could be infected by mid-summer without more behavioral changes. And abandoning the stay-at-home order now could mean that hospitals would be swamped with severely sick people by mid-May.
Gradual relaxation of stay-at-home orders
Rather, experts both in California and nationally talk about a gradual relaxation of elements of the stay-at-home order — an intermediate step that should not be skipped until an effective vaccine is available.
“Is it wearing masks? Probably. Is it continuing to restrict large gatherings? Yeah, probably,” said Dr. George Rutherford, epidemiologist and infectious diseases expert at UC San Francisco. “Is it continuing to have older people stay home more than they would otherwise? Yeah, probably.”
“When we return to work, do we all go back on the same day, or do we stagger that?” Rutherford asked.
Perhaps factories use staggered shifts to avoid too many workers mixing with each other. Maybe manufacturing and construction are opened up first, Rutherford said, and then, a bit later, nonessential retail stores, and then some time after that, restaurants.
“If you’re going to open the bars, you’re going to have to take out every other stool — I mean, I don’t know what the governor is going to decide,” Rutherford speculated. “And then maybe everybody who can telecommute would just sit tight for a while.”
As restrictions are eased, officials will need to monitor cases to see if coronavirus cases start to flare up dramatically again.
Looking for a decline in cases in national hot spots
Experts say national progress needs to be made in reducing coronavirus cases.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has repeatedly said the public should be expecting a gradual peeling back of stay-at-home orders.
“When you say get back to normal, you’re really talking about a really clear indication that those areas — like New York City, like New Orleans, like Detroit — that have big outbreaks with peaks, have not only stabilized in the number of new cases and hospitalizations, but have actually turned the corner and are starting to come down,” Fauci said in an interview with The Journal podcast that aired last week.
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Socially distanced bikers and walkers, against a backdrop of the Queen Mary, make their way along pedestrian and beach bike path on the first day that Long Beach reopened the path on Monday May 11, 2020. The city of Long Beach eased a few of its public health restrictions, allowing under certain guidelines the reopening of pedestrian and beach bike paths, tennis centers and courts. Beach bathrooms are also reopening, but the parking lots and beaches still remain closed. (Genaro Molina/Los Angeles Times)
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Traffic remains light on the southbound 110 Freeway headed toward downtown Los Angeles on April 28. (Robert Gauthier / Los Angeles Times)
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Dominique Barrett, center, known as “King Vader” to his 2.4 million TikTok followers, prepares to shoot a video on April 30 in Glendora. (Dania Maxwell / Los Angeles Times)
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Cody Purcell of Redondo Beach rides a wave, glowing from the bioluminescence, in Hermosa Beach, CA, after midnight Friday morning, May 8. (Jay L. Clendenin/Los Angeles Times)
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Friends play spikeball, a game perfect for social distancing on an open but restricted San Buenaventura State Beach. (Brian van der Brug / Los Angeles Times)
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The majority of golfers are wearing masks while hitting balls on the driving range at Van Buren Executive Golf Course in Riverside. (Gina Ferazzi / Los Angeles Times)
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Beaches including Harbor Cove Beach were open but beachgoers were not supposed to be sitting on the sand. (Brian van der Brug / Los Angeles Times)
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Tango instructor Yelizaveta Nersesova leads a Zoom tango event from her Los Angeles home April 27 that brought together hundreds of dancers from around the world. (Jason Armond / Los Angeles Times)
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Grocery store workers, joined by United Food and Commercial Workers International Union Local 770 representatives and community members, hold a rally in support of strict social distancing on May 1 at a Ralphs store in Hollywood where 19 employees have tested positive for COVID-19. (Kent Nishimura / Los Angeles Times)
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Mostly masked commuters keep their distance from one another on a Metro bus in downtown Los Angeles on April 29. (Gabriella Angotti-Jones / Los Angeles Times)
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Gregory Kuhl, 69, heads home after a shopping trip in Hollywood on April 28. Big cracks in the street, cars parked in driveways blocking sidewalks and uneven pavement levels make navigating his route difficult. (Dania Maxwell / Los Angeles Times)
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Tenants and their supporters from across Los Angeles gather at city hall to call on L.A. Mayor Eric Garcetti, the L.A. City Council and California Gov. Gavin Newsom to cancel rent and mortgage payments during the COVID-19 crisis. (Luis Sinco / Los Angeles Times)
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Aerial view of over 100 vehicles lined up at the West Valley COVID-19 testing center at Warner Center in Woodland Hills. (Brian van der Brug / Los Angeles Times)
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Senior Mason Wise, left, helps his sister, Mackenzie, a sophomore, clean out her PE locker at El Camino Real Charter High School in Woodland Hills. School officials were allowing no more than five students at a time on campus to take home their belongings. (Brian van der Brug / Los Angeles Times)
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Shuttered storefront businesses in the garment district of Los Angeles. California’s unemployment rate has skyrocketed since the statewide coronavirus shutdown took effect. (Luis Sinco / Los Angeles Times)
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Healthcare workers celebrate as Claudia Martinez is discharged from the ICU after she recovered from COVID-19 at Scripps Mercy Hospital in Chula Vista. (Marcus Yam / Los Angeles Times)
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Carson residents Kaeli Burks, 3, left, and her cousin Bailey Watson, 5, look out the window of their car after their mothers helped them with self-testing at a new drive-up testing site for COVID-19 in Carson. Free COVID-19 testing is available to all city residents thanks to a partnership between the city and US Health Fairs. (Genaro Molina / Los Angeles Times)
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Norm and Tracy Kahn enjoy eating dinner outside on a small cafe table sitting in blue chairs on their side yard during the coronavirus pandemic on April 27 in Riverside. “During this pandemic, eating outside offers us an opportunity to change surrounding and appreciate the calmness of being outdoors among trees, scents from nature and the sounds of birds,” she said. Also adding, “Mixing up where we eat puts variety into our days and takes away the sameness of feeling trapped at home.” (Gina Ferazzi / Los Angeles Times)
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Ronald Reagan UCLA Medical Center nurses carry supplies outside the hospital. (Robert Gauthier / Los Angeles Times)
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Tom Sean Foley pauses on a walk with his kids, Cathelen Claire, “C.C.,” 3, and Timothy Joseph, 4, to take a photo in front of the “Love Wall,” mural by artist Curtis Kulig, outside of Smashbox Studios in Culver City. (Jay L. Clendenin / Los Angeles Times)
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Protesters stand along Mission Blvd. in Pacific Beach during A Day of Liberty rally on April 26. The protesters were against the government shutdown due to the coronavirus. (K.C. Alfred / San Diego Union-Tribune)
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People make orders at a food truck along Shoreline Avenue in Long Beach. (Luis Sinco / Los Angeles Times)
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Medical staff, wearing protective gear, work inside a COVID-19 isolation area inside the emergency department at Los Angeles County-USC Medical Center in Los Angeles, where patients with the virus are being treated. (Mel Melcon / Los Angeles Times)
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Neighbors practice social distancing while enjoying the nice weather near The Strand in Hermosa Beach. (Gabriella Angotti-Jones / Los Angeles Times)
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Counter-protesters attend a protest to call on state and local officials to reopen the economy in downtown Los Angeles. (Christina House / Los Angeles Times)
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A group of protesters cheer on cars during a vehicle caravan protest to call on state and local officials to reopen the economy in downtown Los Angeles. (Christina House / Los Angeles Times)
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Cedar Mountain Post Acute Rehabilitation staff member Navi Cavaltera waters a flower pot put up by the community to show their support for the nursing staff of the facility in Yucaipa. Eighteen of 20 coronavirus-related deaths in Yucaipa were residents of the skilled nursing facility. (Irfan Khan / Los Angeles Times)
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A pedestrian wearing a protective mask passes a mural on a store on Melrose Avenue in the Fairfax district of Los Angeles. (Allen J. Schaben / Los Angeles Times)
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Jonte Florence, a freestyle dancer, does a handstand on a mostly empty Hollywood Walk of Fame. Florence said he normally performs for hundreds of tourists along the busy street. (Allen J. Schaben / Los Angeles Times)
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The Tyrannosaurus rex overlooking the intersection of Hollywood Boulevard and Highland Avenue wears a protective mask while practicing social distancing. (Allen J. Schaben / Los Angeles Times)
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Businesses are shuttered and pedestrians are few and far between on Hollywood Boulevard. (Allen J. Schaben / Los Angeles Times)
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Daniel Rogerson wears a vintage military gas mask while riding a bike along the beach path in Santa Monica, which is closed to enforce social distancing because of the coronavirus pandemic. (Luis Sinco / Los Angeles Times)
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A face mask seller in colorful dress appears to be part of a mural behind a bus stop on Soto Street in Los Angeles. (Irfan Khan / Los Angeles Times)
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Life around Cesar E. Chavez Boulevard and Soto Street has slowed down as California officials extended stay-at-home orders into May and residents entered Easter weekend with unprecedented limits on their movements. (Irfan Khan / Los Angeles Times)
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UC Irvine Medical Center health care workers return their gratitude as about 25 Orange County first responder vehicles participate in a drive-by parade of gratitude as they battle COVID-19 at the hospital. (Allen J. Schaben / Los Angeles Times)
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Billy Budd, 55, of Hollywood, walks along Hollywood Boulevard with a protective face covering. Budd is a scenic artist for movies and television who is currently out of work due to the coronavirus outbreak. (Mel Melcon / Los Angeles Times)
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Stuart Reyes and his sister, Stephanie, sell masks for $5 each on the 3000 block of West Century Boulevard in Inglewood. Stuart Reyes said he is selling masks to support his mother. (Irfan Khan / Los Angeles Times)
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A jogger runs on a closed trail past dozens of pieces of caution tape, torn off by hikers and mountain bikers at El Escorpion Canyon Park in West Hills. (Brian van der Brug / Los Angeles Times)
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Alex Herron and nurse Mercy Pineda at a blood drive sponsored by USC athletics and the American Red Cross at USC’s Galen Center. (Genaro Molina / Los Angeles Times)
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Los Angeles City Hall displays blue lights to show support for healthcare workers and first responders. (Gary Coronado / Los Angeles Times)
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After being indoors for several days because of rainy weather and coronavirus stay-at-home orders, Olivia Jacobs, 4, and her mom, Cia Jacobs, enjoy a warm and sunny afternoon making chalk drawings on the sidewalk in front of their home in West Hills. (Brian van der Brug / Los Angeles Times)
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An Oceanview Plaza security guard sports a whimsical mask while on patrol. (Robert Gauthier / Los Angeles Times)
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Jacob De Wilde, left, and Lesli Lytle load a car with food during a food distribution organized to mark Good Friday. (Irfan Khan / Los Angeles Times)
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As a late season storm continues to make its way across the Southland, a young basketball player dribbles along an alley through an Elysian Park neighborhood in Los Angeles. (Kent Nishimura / Los Angeles Times)
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People are silhouetted in a window of an apartment building in Hollywood, where a stay-at-home order remains in effect to help curb the spread of the coronavirus. (Luis Sinco / Los Angeles Times)
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The Wilshire Grand Center display blue lights and a heart to show support for healthcare workers and first responders. (Gary Coronado / Los Angeles Times)
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Women wear masks as they stroll along Highland Avenue in Hollywood. Wearing masks while outdoors is mandatory in the city of Los Angeles. (Luis Sinco / Los Angeles Times)
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Patients are removed from Magnolia Rehabilitation and Nursing Center after 39 tested positive for the coronavirus and nursing staff was not showing up to work. (Gina Ferazzi / Los Angeles Times)
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A specimen is turned in at the new mobile testing site for people with symptoms of the coronavirus at Charles R. Drew University of Medicine and Science in South Los Angeles. (Christina House / Los Angeles Times)
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Hippie Kitchen in Los Angeles hands out food, water and toiletries to homeless people and residents of skid row. Additionally, masks were offered to help reduce the spread of the coronavirus. (Myung J. Chun / Los Angeles Times)
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Nurses pose for a fun photo during a break in drive-through public testing for the coronavirus at Arrowhead Regional Medical Center in Colton. (Irfan Khan / Los Angeles Times)
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A woman shows a notice from her doctor that allows her to obtain a test for coronavirus at a new drive-up testing site in a parking lot at the South Bay Galleria in Redondo Beach. (Genaro Molina / Los Angeles Times)
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A person who wishes to remain anonymous strikes from her car to support McDonald’s employees who are demanding the company cover healthcare costs of any worker or immediate family member who gets sick from COVID-19 in Los Angeles. (Dania Maxwell / Los Angeles Times)
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Cassidy Roosen, with Beach Cities Health District, holds up a sign that says, “We’re All in This Together,” while waiting to direct cars at a drive-through, appointment-only coronavirus testing location at the South Bay Galleria in Redondo Beach. (Jay L. Clendenin / Los Angeles Times)
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Grace Carter, 15, of Riverside, practices a dance routine at home after dance classes and school were canceled. She has to use the Zoom app on her iPhone to practice with her dance group. “It’s hard,” she said. “My bedroom is a smaller space. I miss all my friends at the studio.” (Gina Ferazzi / Los Angeles Times)
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A man works from his home in Long Beach. (Marcus Yam / Los Angeles Times)
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A San Bernardino County healthcare worker takes a sample at a coronavirus drive-through testing site at the county fairgrounds in Victorville. (Irfan Khan / Los Angeles Times)
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A Metro general service employee disinfects a bench in Boyle Heights. (Gary Coronado / Los Angeles Times)
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A runner jogs past the Pottery Barn in Pasadena. Some businesses in the area have boarded up their stores. (Al Seib / Los Angeles Times)
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Raquel Lezama and daughter Monica Ramos collect meals for their family at Manual Arts High School. Lezama was laid off from her $17.76-an-hour job at a Beverly Hills hotel. (Al Seib / Los Angeles Times)
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The Iron City Tavern in San Pedro tries an incentive to lure takeout customers. (Carolyn Cole / Los Angeles Times)
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Healthcare workers gather outside UCLA Ronald Reagan Medical Center to call for further action from the federal government in response to the COVID-19 outbreak. (Robert Gauthier / Los Angeles Times)
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Kristen Edgerle, of Victorville, collects information from a blood donor before drawing blood at The Richard Nixon Presidential Library blood drive during the coronavirus pandemic in Yorba Linda. (Jason Armond / Los Angeles Times)
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Shauna Jin, of Los Angeles, with her dog, Bodhi, practices social distancing with John Kiss, of Los Angeles, at the entrance of Runyon Canyon Park in Los Angeles. (Gary Coronado / Los Angeles Times)
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A lending library had some additional useful items, including a roll of toilet paper and cans of beans and corn, in a Hermosa Beach neighborhood. (Jay L. Clendenin / Los Angeles Times)
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Protesters drive by the Getty House, the home of L.A. Mayor Eric Garcetti, in Hancock Park. Tenant advocates are demanding a total moratorium on evictions during the coronavirus crisis. (Wally Skalij / Los Angeles Times)
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Venice residents Emily Berry and Gavin Kelley take a break at Venice Beach. Berry, a cocktail waitress at Enterprise Fish Co., lost her job due to the coronavirus outbreak. Kelley, a manager at a performing arts school with a focus on music, said that he still has a job and that classes at the school will resume online this coming Monday. (Mel Melcon / Los Angeles Times)
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The JW Marriott at L.A. Live is sharing a message of hope with red lights in 34 windows, creating a 19-story display on the hotel’s north side. (Gary Coronado / Los Angeles Times)
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Juan Diaz Jr., a lifelong Dodgers fan, prays that the season will start by May in front of Dodger Stadium on what would have been opening day. (Mel Melcon / Los Angeles Times)
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Hayley, CEO and founder of Love My Neighbor Foundation, right, dances with Crystal Armster, 51, while she and her colleagues continue to feed the homeless on skid row amid the pandemic. (Genaro Molina / Los Angeles Times)
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A masked passenger on a Metro bus in downtown Los Angeles. (Wally Skalij / Los Angeles Times)
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Dede Oneal waits for a coronavirus test at the Crenshaw Christian Center in South Los Angeles. (Genaro Molina / Los Angeles Times)
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A man in a mask passes a closed restaurant along Spring Street in downtown Los Angeles. (Wally Skalij / Los Angeles Times)
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Artist Corie Mattie paints a mural on the side of a pop-up store as a man takes a picture in West Hollywood. (Wally Skalij / Los Angeles Times)
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Medical assistant Zoila Villalta works with Rosie Boston, 32, of Glendale, who is donating blood for her first time at L.A. Care Health Plan downtown. (Al Seib / Los Angeles Times)
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A couple wait for a bus outside the Petersen Automotive Museum in Los Angeles. (Luis Sinco / Los Angeles Times)
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With all Los Angeles schools closed until further notice, LAUSD buses sit idle in Gardena. (Brian van der Brug / Los Angeles Times)
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A lone traveler makes his way to catch a flight in Tom Bradley International Terminal. (Genaro Molina / Los Angeles Times)
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Denise Young looks on as her daughter, Allison, 9, a fourth-grader at EARThS (Environmental Academy of Research Technology and Earth Sciences) Magnet School in Newbury Park, receives a Chromebook. (Mel Melcon / Los Angeles Times)
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Hollywood Boulevard is devoid of the usual crowds. (Brian van der Brug / Los Angeles Times)
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Michael Ray, 11, plays before a movie at the Paramount Drive-In. (Wally Skalij / Los Angeles Times)
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Isabella Leader, 15, counts how many flags have been left for World War II veteran Lt. Col. Sam Sachs who was celebrating his 105th birthday at the Mom & Dad’s House, an assisted living facility, in Lakewood. Lt. Col. Sachs appealed to the public for birthday cards after the coronavirus pandemic forced the cancellation of a big celebration and wound up receiving thousands, including a letter and photo from President Trump. (Genaro Molina / Los Angeles Times)
“And history with other countries tell us that once you turn that corner and come down, the decline is pretty steep,” Fauci said. “I don’t think that you need to get down to zero before you can start contemplating gradually relieving some of the restrictions. It isn’t like a light switch, on and off.”
One idea might be having a 50-seat restaurant only seating a maximum of 25 diners, he said. “Bottom line is, it’s going to be gradual. It’s not going to be all or none.”
And some changes might be permanent, he said, adding: “I don’t think we ever should ever shake hands ever again, to be honest with you.”
On Sunday, Fauci said the New York City metro area last week suffered a terrible week of death, but also began to see a flattening of hospitalizations. “It’s starting to turn the corner.”
Once a sharp decline is seen, “then you can start thinking about how we can keep it that way and prevent it from resurging — when you’re starting to think about a gradual reentry of some sort of normality, some rolling reentry,” Fauci told CNN. “So you’re trying to balance two things: You want to make sure you don’t do something prematurely and precipitously. But at the same time, you pay attention to the need to try and get back to normal.”
No sports games until Thanksgiving, at the earliest?
Some local officials in California have suggested ongoing restrictions lasting toward the end of the year. The top administrator for Santa Clara County — home to the San Francisco 49ers, San Jose Sharks and Stanford University — said at a meeting of the Board of Supervisors last Tuesday that he suspected sports games wouldn’t be held until Thanksgiving at the earliest.
On Thursday, he doubled down on his comments. “Even if we do well here in Santa Clara [County], if you have a big event that attracts thousands of people from all over the nation, you run the risk of reinfecting everyone,” Dr. Jeffrey Smith, the Santa Clara County executive officer told KPIX-TV.
“In my opinion, it’s unlikely that the shelter-in-place [order] will be lifted at least until the late fall, because we don’t have a national shelter-in-place program,” Smith said in an interview aired Thursday night.
A longer-term coronavirus strategy lasting at least through the end of the year is something other nations are realizing is unavoidable.
Singapore was once lauded for keeping the coronavirus under control, but a wave of new cases, brought by travelers returning home, forced the dense city-state at the beginning of April to order schools and nonessential businesses to close for at least a month.
Officials in Singapore now say they need sustainable measures to slow down the virus that can last through the end of the year.
Returning to containment
Infectious disease experts say easing out of stay-at-home orders will require four developments: a dramatic reduction in virus transmission; lots of testing capacity; plenty of hospital space; and robust local resources to aggressively investigate new infections to isolate the infected and quarantine close contacts who might get sick, a practice called contact tracing.
“Otherwise, what’s going to happen is we will end up in a situation which I would call a smoldering epidemic, in the sense that we will be having cases with us, kind of like seasonal influenza — it may wax and wane,” said Dr. Robert Kim-Farley, medical epidemiologist and infectious diseases expert at the UCLA Fielding School of Public Health.
San Francisco’s director of public health, Dr. Grant Colfax, has likened the current coronavirus outbreak as a wildfire sweeping across the city. The goal is to reduce the number of new cases so much that new cases are seen more like smaller spot fires, which can be identified and contained before getting out of control.
Keeping disease levels low in the coming weeks and months will also give scientists and doctors more time to identify life-saving drugs that need time to be identified.
“I think within the next few weeks, we’re going to have some good knowledge about what those look like based upon clinical, randomized controlled trials,” Kim-Farley said.
Boosting the investigation of new cases
Already, Rutherford is working on a project aimed at dramatically increasing San Francisco’s capability to do contact tracing, which involves investigators asking infected patients where they were when they got infected — typically five days before developing symptoms. They’d also ask where the patients were while infectious, which probably starts one or two days before symptoms became apparent.
Rutherford’s UC San Francisco team of about three dozen people — who normally work on projects focused on Asia and Africa — will assist in the effort. And the goal is to “get a bunch of medical students and the city librarians to come in” and help boost staffing, he said.
So instead of roughly 10 disease investigation specialists working on this contact tracing effort, soon, there could be 100 people working on it for San Francisco, work that is done mainly by telephone.
Adding on undergraduate students — for instance, those interested in public health at San Francisco State — could dramatically help expand the manpower. A big need will be investigators who can speak Spanish. “So you get 600 undergraduates as opposed to 100 medical students, we can work on it,” he said.
