California Announces Statewide 'Stay at Home' Order

California Gov. Gavin Newsom on Thursday ordered the state's 40 million residents to stay at home, restricting non-essential movements to control the spread of the coronavirus that threatens to overwhelm the state's medical system.



“This is a moment we need to make tough decisions,” Newsom said. "We need to recognize reality.”
His move came after counties and communities covering about half the state's population already had issued similar orders.

People may still leave their homes for walks and exercise and for essential needs such as food and medical care. Restaurant meals can still be delivered to homes.



Newsom earlier in the day asked the president to deploy a U.S. Navy medical ship to help the state expand its medical capacity and warned that more than half of California's residents could contract the new coronavirus.

Newsom asked President Donald Trump to send the USNS Mercy Hospital Ship to the port of Los Angeles for use through Sept. 1, in a letter dated Wednesday. California has disproportionately aided people returning to the U.S. from foreign countries and needs the ship to help “decompress” its health care delivery system as infection rates climb, Newsom wrote. The ship is based in San Diego.

He said infection rates are doubling every four days in some parts of the state and issued the dire prediction that 56% of California's population could contract the virus over the next eight weeks.



His spokesman later confirmed that number does not take into account aggressive mitigation efforts underway across the state. Many large counties had already been issuing shelter-in-place orders aimed at keeping Californians confined to their homes and Newsom had directed the closure of bars, gyms and other gathering spaces statewide.

“This projection shows why it’s so critical that Californians take action to slow the spread of the disease — and those mitigation efforts aren’t taken into account in this projection,” spokesman Nathan Click said in an emailed statement.

Newsom's letter to Trump said 25.5 million people could be infected. But the state's population is estimated to be just shy of 40 million, meaning 56% of the population would be closer to 22.4 million people. The governor's office did not respond to questions about his calculation or offer a prediction that considers efforts to stop the spread of the infection.

Total case tallies
Much of the attention on data tracking the coronavirus has centered on charts and maps showing the total number of cases reported so far from around the world. As the source of the outbreak, for example, China has reported more than 80,000 confirmed cases so far, the most of any country.

In the U.S., New York state has recently reported the largest number of cases – more than 11,000 as of March 21. That was nearly half of all U.S. coronavirus cases reported by that date in the Johns Hopkins database. New York state independently reported more than 15,000 confirmed cases on Sunday.



Cumulative case counts don’t account for how many patients have recovered. They also don’t account for lags in reporting cases and differences in reporting methods.

“When people get sick especially in the context of a new outbreak, it takes a while to move them through the detection pipeline and the diagnostic pipeline,” said Dr. Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. “So just because we saw a big influx in cases today, it doesn’t mean those people got sick today, but they probably got sick recently.”

Incomplete data
Cases can also be removed from the cumulative total if they are later found to have been incorrectly diagnosed.

So far, the available data on confirmed cases is also severely limited because it only accounts for cases that have been reported. These counts don’t include the unknown number of people who weren’t sick enough to go to a doctor or clinic, or who weren’t tested because there were not enough test kits available.

The result is that the number of cases reported daily provides an incomplete picture of the outbreak at any moment in time.



Still, researchers say that even incomplete data is critical to the task of controlling the spread of the illness. The hope is that widespread “social distancing” can “flatten the curve” tracking the spread of the pandemic - from the steep rise in the initial phases to a more gradual increase as efforts to contain the outbreak take effect.

Delaying the spread of the virus can mean the difference between delivering care to all those patients who need it and overwhelming local or national health-care systems.



Quick intervention
Countries that appear to have contained the outbreak have taken aggressive measures to test widely and isolate those found to have the most serious cases, according to Rivers.

In China and South Korea, she said, this policy of “case based intervention” centered on isolating and treating infected patients quickly to limit the spread of the illness. The impact of those measures can be seen in the the flattening of growth in the number of reported cases for those two countries, where the outbreak first began to spread widely.

In the short term, the rapid increase in the distribution of coronavirus test kits in the U.S. will likely accelerate the pace of reported and confirmed cases.



At a White House press briefing last week, Dr. Deborah Birx cautioned that the rapid increase testing will likely skew the case counts until those tests are more widely available. “We will see the number of people diagnosed dramatically increase over the next four to five days,” she told reporters. “It will be five to six days’ worth of tests being run in 24 to 48 hours. So our curves will not be stable until sometime next week.”

That’s one reason the confirmed case counts have taken an alarming jump in New York state in recent days, after the state dramatically increased the availability of test kits.



New York Gov. Andrew Cuomo told reporters last week that the expanded testing represents an “exponential increase of what we have done.”

“What happens when the testing capacity increases, the number of positives increase by definition,” he said.