Death tolls in California and Louisiana hint at the urgency to 'flatten the curve'

In the past week, California has seen its number of deaths slowing down, while the tally in Louisiana has accelerated.
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People wait to get in a grocery store in West Hollywood on Tuesday, March 31, 2020, as Californians are under orders to stay home.Valerie Macon / AFP - Getty Images

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By Andrew W. Lehren and Emily R. Siegel

In California and Louisiana, two of the states hardest hit by the coronavirus, the difference of a handful of days is starting to show just how important social distancing has been to limiting the spread of the pandemic.

On March 23, Louisiana surpassed California in total dead from the coronavirus even though California has more than eight times as many residents. That gap continues to widen.

The two states have instituted increasingly restrictive measures and are among the 23 states with stay-at-home orders. Both states are led by Democratic governors who have earned praise from President Donald Trump for their response to the crisis.

The disease is still spreading in both states, and the number of new cases and deaths reported each day is still climbing. But California is closer to "flattening the curve" — meaning slowing the pace, so that the number of new cases and deaths each day stops accelerating, then is no higher than the day before (or "flat"), and then, ultimately, lower day by day.

In the past week, California has seen its rate of daily increase in total deaths slow down, while the increase in daily deaths in Louisiana has accelerated.

Experts say the difference in death tolls indicates just how crucial it has been for states to enact strict orders to limit personal contact. Health care professionals and epidemiologists have stressed that it is crucial to slow the spread so that the sick do not overwhelm the capacity of local health care resources.

"California has been serious about this, social distancing and shutting down the entire state for commercial activity," said Dr. Joseph Fair, a virologist and epidemiologist based in New Orleans and an NBC News contributor. "You haven't had that in Louisiana."

A New Orleans police officer ensures people maintain social distancing by remaining six feet apart, as meals are distributed at the Lantern Light Ministry at the Rebuild Center in New Orleans on March 31, 2020.Kathleen Flynn / Reuters

The pandemic is expected to peak about 18 days later in California than in Louisiana, a sign that the curve is flatter in the former, according to projections from University of Washington researchers. Louisiana is expected to peak April 10, but California not until April 28, according to their estimates.

As the pandemic struck, California Gov. Gavin Newsom asked on March 15 for the state's restaurants and bars to shutter. Many obeyed the request. Disneyland was already closed. Schools were boarded up. The state had restricted large gatherings of more than 250 people.

But at a time when the virus's extent is uncertain because of the nation's testing shortage, there was one inescapable fact: Six people had already died in California.

The next day, March 16, six of the nine counties that form San Francisco's Bay Area issued the nation's first aggressive shelter-in-place order. Then, on March 19, Newsom issued a statewide stay-at-home order closing nonessential businesses and banning public gatherings, considered among the most strict in the nation.

The state's death toll had tripled to 18.

While the number of dead has continued to climb, the rate of daily increase has slowed. California reported 150 additional deaths on Tuesday, a 13 percent increase in total daily deaths from Monday. Louisiana reported 239, an increase of 23 percent in the same time period.

"California, because they jumped on a little bit earlier, maybe they did a better job," said Drew Harris, a public health assistant professor at Thomas Jefferson University College of Population Health in Philadelphia. "There is essentially some evidence of flattening the curve."

That does not mean the state is by any means seeing the disease abating, but it is a positive sign.

In Louisiana, Gov. John Bel Edwards ordered casinos, movie theaters and bars to close on March 16, and prohibited gatherings of more than 50 people.

At that point, two people had died in the state.

As in California, Louisiana's schools had already been closed and a ban on gatherings of more than 250 people were already in place. But during the St. Patrick's Day celebration weekend, throngs had packed New Orleans' Bourbon Street, and police were brought in to disperse revelers. The city had already celebrated its traditional raucous Mardi Gras festival in late February.

While California was instituting stay-at-home orders, Louisiana would not follow until the late afternoon of March 23.

On that same day, Louisiana for the first time eclipsed California in total deaths, with 34 dead versus 27.

A popular evangelical pastor, who had already defied Edwards' restrictions on large gatherings with a Sunday service busing in more than 1,000 parishioners, responded the next day to the new stay-at-home order by bringing together hundreds for a Tuesday service.

Since Edwards issued stay-at-home restrictions, the total number of deaths has more than tripled to 119 deaths as of March 27.

"Whatever happened, what you're seeing in deaths is really a snapshot of a transmission that occurred weeks earlier," Harris said. "When you look at a chart like this, you're just seeing a little snapshot. You don't know what the curve will ultimately become."

Elsewhere in the world, South Korea seems to have successfully flattened the curve of COVID-19 for now. The number of new cases per day has already peaked, and the rate of deaths and new cases is now constant, or flat.

What remains to be seen is how well different states fare in the U.S. as they implement different rules at different times.

For Louisiana, Harris said: "It could be the curve [will reach] its peak, and then the next couple of days it drops off. That's one possibility. Or it could continue to go up for Louisiana, which is very scary."