What a stay-at-home order means for preventing hospitals from getting overwhelmed by COVID-19 patients
Eight months after California experienced its first shutdown, Governor Gavin Newson has issued a limited stay-at-home order, scheduled to take effect Saturday, Nov. 21.
All non-essential work and gatherings must conclude from 10 p.m. to 5 a.m. in counties in the purple tier, which includes Los Angeles County.
The restrictions will last for one month, but will they be enough to slow the transmission of COVID-19? Or are we looking at a return to the stricter emergency orders of March?
The rationale for a stay-at-home order largely depends on factors like hospital capacity and our ability to address the pandemic medically, says Annabelle De St. Maurice, MD, MPH, co-chief infection prevention officer for UCLA Health.
Decreasing transmission would give hospitals near capacity some breathing room by lowering the number of patients coming in with severe symptoms that require beds and, in the worst cases, ventilators.
If the current restrictions don’t do enough to lower transmission, and hospitals become overwhelmed, then a stricter stay-at-home order may be necessary.
“What we know about shutdowns is that they reduce transmission because people are required to stay home, so there are less opportunities to gather in public sites for socialization,” Dr. De St. Maurice says. “There's evidence that states that have shut down, have seen transmission decrease.”
In addition to paying attention to the numbers of hospitalizations and deaths, there are other factors that determine whether a county or state will experience another shutdown. We must also consider the availability of personal protective equipment (PPE) and COVID-19 testing, and the ability to conduct contact tracing, says Timothy F. Brewer, MD, MPH, professor of Medicine and Epidemiology at the UCLA Health.
“Restrictive shutdowns are not a standard public health intervention,” Dr. Brewer says. “They should be reserved for times when regular interventions have failed to stop substantial disease spread or deaths in the community.”
According to studies from California's original shelter-in-place order, it could take up to three weeks to see the effects of a shutdown on reducing transmission and deaths, he says. “It is hard to know how extensive the restrictions need to be.”
Judith Currier, MD, chief of the division of infectious diseases at the David Geffen School of Medicine at UCLA, acknowledges that though our national strategy on vaccine development and therapeutics have been clear, the acceptance of public health messaging has been more challenging.
Dr. Currier reminds us that there are things that each of us can do to restrict opportunities to transmit the virus – wearing masks, washing hands, staying six feet apart and avoiding mixing with people outside our households during the upcoming holiday season.
“The hard part is that not everybody has the option to stay home,” she says of some L.A. residents who must continue going into workplaces.
Preventing large gatherings, particularly indoors, will decrease spread and prevent deaths and reduce the need for large-scale shutdowns, says James D. Cherry, MD, MSC, Distinguished Research Professor of Pediatrics at the David Geffen School of Medicine at UCLA.
“In 1918, wearing masks and social distancing reduced the spread of influenza. The same is true today for COVID-19.”
If stricter stay-at-home orders do become necessary, Dr. Cherry says they should be as local as possible to prevent further outbreaks.
“Rural areas may not need to shut down if the case load is low and the population masks and social distances,” he says. “Tight areas like Los Angeles may need to pretty much shut down.”