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Why the LA COVID-19 case spreads

Los Angeles is paying attention to disasters.

A large number of COVID-19 patients have begun to flood into hospitals and may soon force doctors to ration. The number of available beds in the intensive care unit quickly dropped to zero because health care providers begged people not to go to the emergency room unless it was a matter of life and death.

A doctor at the Los Angeles County Public Hospital said last week: “Ambulances hovered around the hospital for several hours, trying to find a bed that can open the bed so they can breathe heavily for severely ill COVID patients.” “We are actually entangled by a thread.”


And there is no sign of relaxation. If Christmas travel and social gatherings promote the further spread of the virus, it is expected that the number of COVID-19 patients in hospitals will increase by January or later.

The mayor of Los Angeles, Eric Garcetti, said in an interview that if another craze occurs in a few weeks, “it will lead to a clear view of the people in the New York corridor in northern Italy.” On this edge.”

The severe situation has caused chaos and depression on the island of Angelenos. Many people are wondering whether the sacrifices made in the past nine months are fruitless. Los Angeles County, an early adopter of masks, quickly established orders for standby at home in March and November. Until this point, the rate of coronavirus cases and COVID-19 deaths has been relatively low.

So what went wrong?

Interviews with 31 epidemiologists, health experts and government officials provided clues: Los Angeles is more vulnerable to extreme crises than other parts of the country.

Fatigue, the trio of winter weather and holiday travel have also caused more coronaviruses to spread here and become a kind of fire.

The popular image of Los Angeles is the mansion on the hillside, the sprawl of the city and the gathering of car drivers in the car, which obscures the dirty reality. With a population of over 10 million, Los Angeles County has a high rate of poverty and homelessness, a large number of basic workers, and is some of the densest communities in the United States.

“There is no big and complex city like Los Angeles. The nearest city may be New York. We have seen everything that happened in New York.” said Dr. Kirsten Bibbins-Domingo, an epidemiologist at the University of California, San Francisco.

Experts also attributed the Los Angeles issue to issues that may be inconsistent or arbitrary on the rules, as well as a patchwork of chaotic policies throughout Southern California. In addition, the county is investigating whether part of the blame should be attributed to the more infectious strain of the virus circulating in the UK.

According to epidemiologists, Los Angeles took the right measures in most cases, and fortunately, it managed to contain the crisis for several months.

“Now, this luck is exhausted,” Gasetti said.

November surge

The surge in coronavirus cases that began in early November has attracted attention from Los Angeles County officials.

By the week of Thanksgiving, 4,000 people tested positive every day, which was the county’s record at the time. Barbara Ferrer, Director of Public Health of Los Angeles County, believes this number may have reached its peak.

Then Thanksgiving came.

“We realized,’Oh my God. She said: “Each of us is traveling, just like thousands of people are traveling. “At that time we were really scared, because we only knew in the core that we would step into the wave above the wave. “

Los Angeles County currently has an average of 14,000 new coronavirus cases every day.

The coronavirus took off throughout California in November, which was the peak start expected a few months ago. This progress reflects the situation of the American flu pandemic in 1918, when the autumn peak was five times that of the spring.

It is believed that the coronavirus will thrive in cold, dry weather, so it is easier to spread at this time of the year. The short few days in winter may also prompt people to spend more time indoors, where the virus can easily spread.

Experts say that until November, California avoided large-scale outbreaks in other parts of the country, so once the virus starts to spread more, the state will have a greater proportion of the population vulnerable. In addition, because they did not witness the early disasters, Californians may have a false belief that the pandemic can be controlled.

San Francisco Director of Public Health, Dr. Grant Colfax (Grant Colfax) said: “People will feel tired.” “It has been a long 10 months, I think people are beginning to relax their vigilance because we are in relatively good condition. “

High “social vulnerability” score

After the increase in traffic in the fall, Los Angeles faces unique challenges.

Los Angeles County has a large manufacturing sector and the two largest ports in the United States. People in these industries live in close quarters that can promote the spread of the virus. Los Angeles factories (individual outbreaks have infected more than 400 people) have been the main driver of the entire pandemic.

Los Angeles County also has high “Social vulnerability” score According to calculations by the US Centers for Disease Control and Prevention (US Centers for Disease Control and Prevention), this indicator can measure the severity of a natural disaster or disease outbreak in an area based on factors such as natural income, education, and housing conditions. The county’s score is worse than anywhere in the Bay Area or neighboring Ventura and Orange counties, which suggests that it will always be more difficult for Los Angeles to bear the COVID-19 surge without causing fatal consequences.

Gasetti said: “This is where you live: Los Angeles has the dual characteristics of poverty and population density, which makes viruses like this spread faster and more destructive.”

Los Angeles’ expensive housing market has also hurt the area. Density measures how many people live in a geographic area, and another indicator is called “crowding,” which tracks how many people live in a house. Each room (excluding bathroom) has more than one occupant and is considered overcrowded.

But in Los Angeles, it is common for four, five or more working-class families to share expensive one-bedroom apartments.

According to 2019 data from the US Census Bureau, Los Angeles has the highest overcrowding rate among the 25 largest metropolitan areas in the United States. 11% of homes in Los Angeles are considered overcrowded, while only 6% in New York and the Bay Area.

An analysis was published in the June issue of the Journal of the American Medical Association. Studies have found that the incidence of coronavirus is not affected by the poverty rate or the density of nearby residents, but it increases significantly with the increase in overcrowding. Crowded houses may have nowhere to isolate infected persons to prevent others from getting sick.

Dr. George Rutherford, an epidemiologist at the University of California, San Francisco, said: “The more people infected, the denser the population and the more connections.”

Ferrer said that in a county as large as Los Angeles, this spread has become “exponential growth,” and every newly infected person is likely to infect others. Currently, it is estimated that 1 out of 95 people in the county are infected with the coronavirus.

“I don’t think people are listening”

Ferrer is now committed to breaking the transmission cycle. Her department banned dining in outdoor restaurants, and state officials issued regional home stay orders throughout the holiday period. But she knows that she has lost some public trust in recent months.

In the spring, “I drive to work every day, there will be two cars on the road, no one is outside. And we absolutely do not have that opportunity this time,” Ferrell said. “I think people don’t listen much.”

Ferrer said the opposition from local elected officials in recent months has eroded compliance with regulations. Two members of the county board of supervisors, Kathryn Barger and Janice Hahn, condemned the Department of Public Health for promoting outdoor dining bans. The other three directors and Garcetti support public health officials.

Ferrer said: “Once we feel that there is no unity, that is, not all of us speak in one voice, it will cause another kind of confusion, and in some cases a lot of resistance.” It’s a disaster.”

According to Google’s “COVID-19 Community Mobility Report,” officials in San Francisco reported that every day new cases of the corona virus began to stabilize, and visits to retail and entertainment venues fell by 55% compared to the baseline. In Los Angeles County, they only fell by 24%.

Some experts suggest that the decline in Los Angeles’ compliance with public health guidelines may be due to excessively strict rules that distrust the public who once met the standards. The recent controversial closure of playgrounds (and later closure) and the ban on small outdoor gatherings, while indoor retail companies remain open, have led to criticism that the decision was made for economic rather than public health considerations.

Leo Beletsky, a professor of health sciences at Northeastern University, said: “It’s a very low-risk activity to party outside wearing a mask, so it’s wrong to restrict this behavior.” “In many cases, , Did not strictly tailor the restrictions based on the evidence, and did not clearly communicate the restrictions, which opened the door to misinformation.”

Ferrer and other experts defended the reinstatement of the ban on most gatherings, noting that it is clear that when people do not mix, new infections decrease. She admits, however, that this is a complicated message to explain that activities that were considered feasible a few months ago are no longer safe due to the large number of people who are sick.

Ferrer said that in general, the rules established throughout the pandemic have helped Los Angeles a lot, and many experts agree with this view.

She said that although the number of cases in Los Angeles is astronomical, it is partly due to extensive testing that makes it difficult to compare the area with other parts of the United States. In terms of cumulative mortality, the likelihood of being tested is less affected. Los Angeles County has 93 deaths from COVID-19 per 100,000 people, which is fewer than 134 in Illinois, 121 in Arizona and 103 in Florida. . If Los Angeles County were a state, the death rate would rank 28th.

The death toll in Los Angeles is still far from the New York disaster in the spring. The total number of COVID-19 deaths reported in New York City is nearly 25,000, compared to 9,400 in Los Angeles County.

But Ferrer knew this would change soon. The sound of police sirens became the soundtrack for holiday weekends in parts of Los Angeles, as hospitals were crowded with COVID-19 patients. Early data showed that last week’s trip rate was high, which indicates that a catastrophic and even worse proliferation of locomotives is coming.

Governor Gavin Newsom (Gavin Newsom) has ordered 5,000 body bags, most of which are dedicated to Los Angeles County.

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