LOS ANGELES — In Los Angeles County, 10 people on average test positive for the coronavirus every minute. Every six minutes, someone dies from Covid-19, according to county public health data.
The startling figures come as Los Angeles became the first county in the nation to record 1 million confirmed coronavirus cases since the start of the pandemic.
According to county public health officials, roughly 1,003,923 people in L.A. have been infected with the virus and more than 13,000 people have died. The numbers are equally sobering across the state. California has nearly 2.9 million confirmed coronavirus cases and more than 31,000 deaths, according to NBC News counts. A more contagious variant of the virus has also been detected in the region.
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Epidemiologists and elected officials are confronted with an uncomfortable question as L.A.’s Covid-19 crisis metastasizes: How did Los Angeles become the center of the pandemic?
“L.A. is a pretty large, complex county with factors like overcrowding, poverty and a large essential workforce,” said Dr. Kirsten Bibbins-Domingo, an epidemiologist at the University of California San Francisco. “Those things came together at a time in the pandemic where we also see a lot of fatigue and the lessening of adherence to the basic things one has to do to stay safe, like wearing a mask.”
In many ways, Los Angeles was uniquely vulnerable to the crisis.
Pandemic fatigue set in as cooler weather and shorter days approached, making outdoor activities less inviting even in a region known for its temperate climate. This coupled with holiday travel, gatherings and a large essential workforce, with many members living in crowded or dense housing, created a confluence of problems.
"At least the way this virus is transmitting, you don’t need to have Hell's Kitchen-type of urban density," said Dr. George Rutherford, also an epidemiologist at the University of California San Francisco. "Los Angeles has small family housing with lots of people in them. It’s hard to be a gardener working from home."
The convergence of environmental factors continues to confound public health officials, who have repeatedly warned that the next few weeks could be the worst of the pandemic as the post-holiday surge continues.
On Monday, county public officials issued new recommendations for essential workers and people who run essential errands to wear masks inside their own homes to avoid infecting loved ones, especially those with high-risk factors.
"One of the more heartbreaking conversations that our health care workers share is ... when children apologize to their parents and grandparents for bringing Covid into their homes, for getting them sick," Hilda Solis, chair of the Los Angeles County Board of Supervisors, said during a news conference on Tuesday. "These apologies are just some of the last words that loved ones will ever hear as they die alone."
According to county public health officials, the recent surge started at the beginning of November shortly after private gatherings were permitted, personal care services reopened, the Dodgers won the World Series and Halloween weekend.
Less than a month later, the county was forced to reintroduce restrictions first enacted in the spring, including ending outdoor dining, limiting the number of people allowed inside essential businesses and prohibiting multiple households from gathering, indoors or outdoors. A modified stay-at-home order was issued around Thanksgiving, but by then cases were already increasing exponentially.
“Once you get behind the eight ball, it's hard to put the genie back in the bottle,” Bibbins-Domingo said. “That’s the situation you don’t want to be in.”
Yet that is the scenario currently playing out across much of Southern California, where hospitals remain overwhelmed with Covid-19 patients. According to Los Angeles County's public health director, Dr. Barbara Ferrer, L.A. has experienced a 1,000 percent increase in Covid-19 cases since Nov. 1.
“Everyone should keep in mind that community transmission rates are so high that you run the risk of an exposure whenever you leave your home,” she said during a news conference last week. “Assume that this deadly invisible virus is everywhere, looking for a willing host.”
But nearly a year into the pandemic, fatigue appears to be everywhere.
Mixed messages from elected leaders has only worsened the feeling of fatigue, experts say, starting with the federal government’s early downplaying of the coronavirus and trickling down to the state and city levels where opinions on what should remain open and what should stay closed can vary widely.
“The federal government has to own the message confusion and the resistance it breeds,” Rutherford said.
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Experts also point to confusion and frustration stemming from strict stay-at-home orders that were issued early in the pandemic when California had relatively low coronavirus cases. Unlike New York City, which shut down after cases skyrocketed, Los Angeles pre-emptively closed many businesses and limited outdoor activities before experiencing any such surge, causing some residents and local leaders to question the efficacy of restrictions.
“You have to think about the psychology behind this,” Bibbins-Domingo said. “When you saw the devastation that New York experienced early on, it’s easier to implement hard-nosed public health strategies. It’s a much harder thing to do 10 months in when people are tired.”
Despite the deadly surge, protesters took to the streets this month, marching through grocery stores and shopping malls calling for the reopening of California’s economy and encouraging people to defy the state’s mask mandate.
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Some of the resistance came in the wake of elected leaders flouting the very rules they sought to impose. Gov. Gavin Newsom and San Francisco Mayor London Breed, both Democrats, were pictured dining last year at an upscale wine country restaurant, while House Speaker Nancy Pelosi was seen getting a haircut even though many salons remained closed throughout the state.
The backlash was swift up and down California.
Small-business owners protested stay-at-home orders and a recall effort against Newsom quickly gained traction. In Orange and Riverside counties, sheriff's departments indicated that stay-at-home enforcement wouldn't be prioritized after restrictions went into place while some restaurants in San Diego and Los Angeles have been openly defying stay-at-home orders for weeks.
Perhaps the biggest hurdle in lowering transmission rates, Bibbins-Domingo said, is convincing people that their actions can save lives.
"If we cannot accept and understand how our fates are tied together, we will not get back to normal," she said.