Gov. Newsom names six goals that must be met to lift California coronavirus order

SACRAMENTO - Gov. Gavin Newsom says California needs to increase testing, protect high-risk residents from infection and expand hospital capacity before the state can begin to modify the unprecedented stay-at-home order he imposed one month ago and gradually return to a sense of normalcy.

“I want you to know it's not, it will not be, a permanent state,” Newsom said of the restrictions put in place to fight the spread of coronavirus. “We recognize the consequences of the stay-at-home orders have a profound impact on the economy, your personal household budget, your personal prospects around your future.”

The governor broadly described the steps his administration expected to take in the weeks and months ahead to protect the public and gauge how long the order should remain in place, underscoring a transition in the fight against the virus in recent days as California and other states map out plans to ease restrictions.

Six key factors

The new parameters Newsom outlined Tuesday suggested the state must meet a high bar before walking back the order. The administration highlighted six key indicators for altering his stay-home mandate: the ability to closely monitor and track potential cases; prevent infection of high-risk people; prepare hospitals to handle surges; develop therapeutics to meet demand; ensure schools, businesses and child care facilities can support social distancing; and develop guidelines for when to ask Californians to stay home again if necessary.

The Democratic governor and officials in his administration say their strategy to slow the spread of the virus is working, pointing to relatively low growth in COVID-19 hospitalizations as evidence that staying home and social distancing are preventing a surge of infections.

But that success comes with a cost.

More than 2.3 million Californians filed for unemployment benefits in the last month as businesses closed their doors due to state mandates, and the economy continues to unravel. Some students lost access to free and reduced-cost meals when schools shuttered, and many have not participated in virtual learning. The governor's strategy of distancing residents can also lead to social isolation and increased health risks for the elderly and vulnerable populations including stress-induced heart attacks, suicide, drug and alcohol abuse and lack of access to care for other unrelated illnesses.

Despite his attempts to quell a sense of uncertainty, Newsom had not yet provided a timeline before Tuesday for when the state's nearly 40 million Californians can expect to return to work - or move about freely. And to those struggling to make ends meet, that's the question they want answered most.

“When are the restrictions going to be lifted?” asked Miguel Tot, who was laid off from his job as a manager of a downtown Los Angeles restaurant on March 16. “There's no timetable on that so I have no idea, you know, when normality is going to come back.”

The 34-year-old said he and his wife have enough money saved to buy groceries, pay rent and bills and provide for their two young children for about two months. Despite having no health insurance, Tot said he began looking for a new job late last month in anticipation of that safety net running out and with no sense of when the order will end.

Looking ahead

The governor has predicted a peak in COVID-19 cases to begin in May and said last week that hospitalizations continue to fall below expectations.

As chief executive, Newsom has the power to call off the statewide order, but individual counties can keep their own orders in place. Newsom announced a pact Monday to work with his counterparts in Oregon and Washington to develop a regional strategy to reduce restrictions on residents in the coming months.

“The most important thing for leaders is to be honest and be honest about what we don't know,” said Daniel Zingale, a former aide to Newsom who retired earlier this year. “If it comes to a point where we do know more, then tell them.”

Lisa Berkman, a professor of public policy and epidemiology at the Harvard University T.H. Chan School of Public Health, agrees that offering false hope won't help struggling Californians or anyone else.

“It's not helpful to give an end date if we don't know an end date,” Berkman said. “I don't think that any governor should be saying that we're going to end this in three, four or five weeks when it's completely unknown. You don't want to end this until you see a leveling out of the curve. You don't want to end it early and have an uprising in cases.”

Berkman's work is focused on the health effects of public and workplace policies. People who are socially isolated have a higher risk of mortality, including dying of cardiovascular disease, infectious diseases and a number of other causes, she said.

She said orders across the country have exposed socioeconomic inequality in disadvantaged communities, and she stressed the importance of reducing isolation by expanding internet access, introducing government programs to help at-risk residents and calling and checking on elders.

Newsom said earlier this month that Google would donate 100,000 mobile hot spots to provide free and unlimited high-speed Internet for the remainder of the school year, but it's unclear which communities will receive that benefit.

Berkman and other academic experts support Newsom's call for the state to expand its testing beyond sick patients to attempt to ascertain the percentage of the population that is infected, or to determine how many people previously contracted the disease and have immunity.

Newsom has said antibody blood tests are “critical in terms of our capacity to make a determination about community spread and about immunity.”

Tests a bellwether

Diana Dooley, a chief of staff to former Gov. Jerry Brown, said the lack of access to tests has prevented California and other states from accurately determining how long to keep the order in place.

“The whole issue of how much it's out there will drive the fundamental question of when could it end,” she said.

The governor has said testing broader samples of the public throughout the state, and not just people exhibiting COVID-19 symptoms, will help officials determine when to lift the restrictions.

For now, that kind of testing is occurring only at the local level or at universities. Los Angeles County, for example, began testing the blood of 1,000 randomly selected residents last week to see whether they have or previously had COVID-19.

Dooley called statewide random blood sample tests “a bit of an academic wish” given that California still doesn't have enough tests for sick patients.

Mark Ghaly, secretary of the state's Health and Human Services agency, said last week that the state is prioritizing traditional diagnostic tests for patients suspected of having COVID-19 and expanding access to those tests to hospital workers, low-income Californians and communities of color.

A Newsom administration official said the state expects to begin statewide antibody tests in the next few weeks, an undertaking supported by the scientific community.

“Right now it takes away from testing people who could be potentially ill, and that's a horrible decision to make, but in the long run as a public health scientist, I would say we learn a lot from surveillance,” Berkman said. “It's one of the bedrocks that we have. It's how we first identify early cases. It's how we learn how people survive or not, who is vulnerable or more resistant. Without some kind of a random sample, we can't learn any of that.”

Dooley expects the state to allow businesses that are predisposed to social distancing, such as hair salons or certain retail stores, to reopen first before gradually expanding to other types of facilities.

Others suggest restrictions on large gatherings, staggered work shifts, more telecommuting, half-empty restaurants and, perhaps, the end of the handshake will become part of what Newsom has described as the “new normal” in the next several months.

With access to basic necessities such as water, heat and food, Berkman remains hopeful that Americans can endure stay-at-home orders for as long as it takes. The “we're all in this together” message repeated by Newsom and other leaders across the country also helps people cope with the new conditions and feel a sense of connection with others across the world, she said.

“As Americans, we have rarely been called upon to do something for the public good,” Berkman said. “It's not just to protect our own risk; it's to help protect everybody. It's a rare collective action, and if people understand they are forsaking their comforts and joys and the way they normally behave to really curb something that is for the good of the country and the world, there's a lot of joy in that.”