So, What Is California Doing Right?

My own takeaway from yesterday's post is that, faced with a COVID surge as bad as has taken place anywhere, California somehow turned things around in a way that few other jurisdictions have. The question of why has been pestering me for some time. I was originally gonig to post on some Canadian craziness that a visitor sent me, but I found a discussion in an LA County health department press release we received in an e-mail that goes some distance to help me understand what's happened here.

One direction my thinking had been taking was that, indeed, California vaccination policy had been aimed from the start at vaccinating the most vulnerable populations, where the outbreaks were most severe. My original sense was that this was just politcal correctness, but on reflection, while it was politically correct, it was also just good project strategy: fix the problem where it's both easiest and most visible. The press release indicates that this was in fact what the county did:

Public Health is tracking outbreaks where many people have been vaccinated at healthcare settings, skilled nursing facilities, and other long-term care and residential settings. When the surge began in late October and early November, outbreaks at long-term care facilities, skyrocketed 1,300% from 13 outbreaks the week of October 25 to 189 outbreaks the week of December 6. Skilled nursing facilities experienced a 234% increase in outbreaks during the surge, from 26 outbreaks the week of October 25 to 87 outbreaks the week of December 6 outbreaks. Healthcare settings also saw more outbreaks during the surge, from 13 outbreaks in late October to 31 outbreaks in early December.

When the Pfizer and Moderna vaccines were approved for emergency use in mid-December, the County prioritized staff and residents at long-term care facilities and frontline healthcare workers as the first to receive the vaccine. Once Public Health began administering the vaccine, outbreaks at these settings plummeted, with outbreaks at long-term care and residential settings dropping from 189 outbreaks in early December to just 7 outbreaks in mid-February. Outbreaks at skilled nursing facilities also dropped significantly, from 87 outbreaks in early December to only 10 outbreaks in mid-February. Outbreaks at health care facilities dropped from 31 in early December to 1 by mid-February.

This data provides a real-life example of the power of the current vaccines; while outbreaks do decrease with less community transmission, the magnitude of these declines most likely indicates that vaccines provide significant protection against transmission even in very high-risk settings.

Just looking at the curve in the chart I posted yesterday, we see that LA County's reversal began in mid-January. The health department account above shows they had data that supported the impression given in news accounts, that the outbreaks were worst in elder and long-term care facilities. There would have been a combination of people with compromised immune systems in close quarters, with care staff in a position where they would transmit infections, whether they themselves had symptoms or not.

These populations were a very large percentage of infections, hospitalizations, and deaths, and in fact, they were the 500-pound gorilla that drove the statistics.. If you attack a problem like this first, you change the statistics very quickly. In a normal project management world, this is called "going after the low-hanging fruit". (I would be criticized by bosses for doing this when I worked for a living. They'd say, "This just looks like you're fixing the problem, but you aren't. You're just going after the low-hanging fruit.")

Up to today, I'd been thinking that the peak of the COVID curve in mid-January was the result of factors other than the vaccine, but here, LA County has been saying for the past couple of days that in the real world, the vaccine has been extremely effective, and giving even small amounts of it to the most vulnerable population in mid-December had a dramatic effect within weeks. This is simply one more example of a fairly well-known project management strategy and an indication that if professionals know what the low-hanging fruit is, things can change quickly.

This is borne out by the current map of California counties by color-coded COVID tier (click on the image for a larger copy). What is remarkable is that counties like Los Angeles and Alameda, which includes Oakland, that had been among the worst-hit thoroughout 2020, have reversed course and are now in the less restrictive "orange" tier. The vaccination map shows the most effort took place in LA County, but vaccination has clearly improved the situation in both the south and the counties around San Francisco Bay.

This anwers my question of what California did right. I'm still wondering what New York, Canada, Germany, and other places are doing wrong, if it's so clearly possible to get things right. But this leaves out a separate question of why some jurisdictions like Sweden and Florida weren't hit as hard throughout the pandemic, and I'm still working on that one.