We all know the question everyone is asking: When is this nightmare going to be over?
Over the course of the past few weeks, I have been insistently discussing this with state and local officials. After asking the tough questions and deciphering the information, I wanted to share with the public what I have discovered as clearly as possible.
A lot of the discussion is around “predictive modeling.”’ These ‘models’ are being used to estimate how many cases we will have and when the spread of the virus will peak. These estimates are important because they are being used to make decisions of how best to bolster our health facilities and how restrictive the stay at home orders should be.
The problem is that the models are really best estimates and they differ greatly depending upon assumptions and inputs made. For instance, the University of Washington IHME model shows that California will have a need for 470 ICU beds statewide. This estimate is well below our current capacity of ICU beds, which is a good thing. This model also shows cases of coronavirus peaking this week, and then declining.
However, state modeling done by the CA Department of Public Health (CDPH) is projecting a much greater number of ICU beds needed through the month of May. But their range is also all over the map. For instance, for Butte County the 25th quartile of the modeling shows 18 ICU beds needed – and the 75th quartile shows a need for 407 ICU beds! The median number of beds needed is 99. The difference in the “range” of this model is so wide as to almost tell us nothing. To make things even more convoluted, the state says this model will continue to change.
Some respected public health doctors say that we should be looking closer at what is actually happening on the ground. These include Dr. Jeffrey Klausner, an epidemiology specialist at the UCLA Fielding School of Public Health and Dr. Rajiv Bhatia, a physician and health scientist who earned his MD at the Stanford University School of Medicine. They say it would be better to base decisions using real time trends in hospitalization data, rather than predictive modeling.
I can tell you that as of Friday, there are no confirmed COVID-19 patients in an ICU bed in the six-county Assembly District I represent. Acute hospital admissions are down about 40 percent at Rideout in Marysville. The Enloe daily census is hovering around 135, which is far below normal. These figures also call into question the accuracy of the state’s modeling projections.
I agree there is risk to opening up too early, but there is also risk of opening too late. It is not a “safe” bet to stay locked down. In addition to the economic havoc, there are increases in cases of domestic violence, child abuse, suicide, etc. Lost jobs and poverty are linked to health declines, drug addiction, and death.
Then there is the impact to health care. Many doctors have had to close down their regular practices. Hospitals have cut themselves to only essential emergency medical services. This has cost them millions of dollars in revenue. They will not be able to sustain this hit for a long period of time. Our rural hospitals are especially struggling and may not recover. And we cannot get through this crisis without a sustainable healthcare network.
There remains no consensus in the public health world for how exactly we should open up our economy.
Dr. Klausner and Dr. Bhatia have recommended opening up rural areas like ours that have a low number of cases and hospitalizations. Their strategy would ramp up restrictions only if we see higher hospitalization rates or if testing indicates a spread of the virus. The Governor and CDPH appear to favor a slower phased process of opening up.
No matter what, the implications of this pandemic and our response will be with us for years to come. So it’s important that we get this right.
Bottom line: we need a reasoned, scientific approach to opening up that balances the real public health threats on both sides of the stay at home orders. In order to do that, we need to be making decisions with good data.
Assemblyman James Gallagher represents the 3rd Assembly District, which encompasses all of Glenn, Sutter, Tehama and Yuba counties, as well as portions of Butte and Colusa counties.