Yesterday Matt Peebles posted a well-reasoned and thought-provoking essay on the topic of population density as it relates to the COVID-19 crisis. He invited us to draw our own conclusions regarding the question of local control over mitigation measures. My conclusion, as you’ll see, is an extremely qualified “yes.”
For the reasons that Matt stated, the emphasis on deaths is sound. In fact, “excess deaths” is even better, because not all COVID-19 deaths are diagnosed as such. All across the world, the spike in deaths this spring against the 10-year average is dramatic. But a closer look shows that some of the spike isn’t attributed to COVID-19, when logically nearly all of it should be (and maybe even some of what lies below the 10-year average, because deaths attributed to things like car accidents have dropped).
Matt’s analysis is missing one important element that applies directly to us: Time lag. The case load blows up in high-density areas first, owing to both higher density and higher connectivity to the outside world. But that shouldn’t lead to a sense of complacency in low-density areas. As the per-capita caseload and death rates have crested and dropped in urban areas, it’s tended to start climbing in more rural areas.
Here is a fascinating website created by the Dartmouth Atlas of Heath Care. The maps are divided into Hospital Referral Regions—each polygon captures the area served by the closest major hospital. Hey! NorCal is doing better than any area in the country! Of 306 HRRs, the Chico HRR has the lowest COVID-19 rate in the nation. Redding HRR ranks 9th lowest.
But wait. Scroll down and look at the “Average Daily Growth Rate of COVID-19 Cases, Last Seven Days” map. The HRRs that currently show the highest growth rates are rural areas right down the spine of the nation, in the mostly rural Midwest. The growth rates in those low-density areas right now are far higher than on the West and East coasts—higher even than NYC. That’s lag time. The urbanized coasts got it first, but low density only goes so far to shelter you in the long run.
I had a brief online exchange about this topic with a guy who I consider one of the smartest guys in town—easily smarter than me. He’s fairly conservative, I’m fairly liberal (neither of us hair-on-fire types, though I often play one on ANC out of orneriness). I give a lot of the credit for NorCal’s lowest-in-nation COVID-19 HRR rates to the extreme efforts of Californians at large—and for us, those living in the Bay Area-Sacramento-Tahoe axis. To a great degree, I think we owe our current blue-sky status to their diligence. (Anyone who thinks we locked down as tightly as they did a month ago is kidding themselves.)
When I suggested this, the conservative guy attributed our success to luck—twice. Granted, he didn’t dismiss my credit-giving directly, but I kinda took it that way. The scientist in me says it’s hard to put a number on luck, but stochastic variation is a thing—it very well might be that we’ve been somewhat lucky. We’re probably both right to a degree. Still, I think Californians deserve to pat themselves on the back for the measurable efforts we’ve taken. Alas, as we all know, giving credit to those south of us has political ramifications.
Bottom line: I’m fine experimenting with opening up in this part of NorCal. As I mentioned to the conservative acquaintance above, there’s no better place in the country to do that. We have an apparent low case load, growing testing capacity, and moderate population density and connectivity—those latter factors are important, because our results would be meaningful. Who cares if an empty quarter of North Dakota opens up and nothing happens? But if we open up, it should be done with extreme caution and rigorous testing.
Here’s the million-dollar question: Do we have the local culture and leadership to pull off step-wise opening up with caution and careful observation? Do we have the political smarts to present opening up as a controlled experiment? Or will we insist on marching on our own junk: blustering about our God-given rights, babbling about hoaxes and conspiracies, and pulling the trigger before we have buy-in from Sacramento?