The community I grew up in in California purposefully threw rallies and went out of their way to rebel against every single restriction. I keep this in mind when people say California's restrictions didn't work.

Edit: This was in Orange County CA, not rural. And when I say "rallies" I'm talking thousands of people, not small gatherings.

Still, the vast majority of cases in California have been in the metropolitan areas that have also had the strongest restrictions.

> Still, the vast majority of cases in California have been in the metropolitan areas that have also had the strongest restrictions.

So are the vast majority of people, and greater population density makes it harder to control the spread of communicable disease. So you’d expect, all other things being equal, not only thr vast majority of cases but the highest per capita cases to be in the metro areas.

But, actually, the highest per capita infections (both total and current) were mostly in rural, not metropolitan, counties.

>the highest per capita infections (both total and current) were mostly in rural, not metropolitan, counties.

Can you please cite your sources for this claim? I just did the math using the numbers of infections[0] and the county populations[1] and it doesn't really seem to match up with your claim at all.

There are 58 counties in California.

San Bernardino, LA, and Riverside counties are numbers 4, 5, 6 respectively for highest cases per capita and all have populations above 2.2 million.

Of the bottom 10 counties in cases per capita, only 2 have a population larger than 100k (SF, Humboldt)

[0] https://usafacts.org/visualizations/coronavirus-covid-19-spr...

[1] https://worldpopulationreview.com/us-counties/states/ca

Except these surrounding towns act as virus reservoirs for the large cities. That limits the effectiveness of restrictions. The “become COVID-19 carriers to own the libs” strategy kinda worked.

The vast majority of cases will basically always be in big cities because that's where the most people live. We'd need per-capita data for it to be a useful comparison.

It's out there. It's also not hard to take raw data and divide by the population size which is publicly available for all counties and cities.

SF fared a lot better than LA, which was a lot looser with restrictions...

Of course SF has a good hospital coverage, displaced a lot of poorer residents. Thus fewer people working high-risk jobs in SF actually end up counted in SF's stats.

But I don't think that SF's 62 deaths/100k (compared to e.g. 240 for LA and 232 for Miami) is solely explained by that, and that the tighter (and more adhered to) restrictions did play a role.

Without the poorly considered relaxations in Oct/Nov, despite clear indicators for a worsening situation, it'd have ended up better...

The restrictions were almost never enforced, and only occasionally against businesses. Individuals only got arrested when they did something dumb like refusing to leave a business when refusing to wear a mask. The “lockdown” was a joke: people either chose to follow it or did not. People traveled a hundred miles or so to get haircuts in less restrictive counties of California. So it’s not really fair to compare counties when regions were crossed so often.

No SF had stronger restrictions with high adherence and had much lower per capita case and death rates. It’s hard to say how much of that is causal though (SF has temperate humid weather and a large white collar workforce that could afford to stay home that could have helped independent of lockdown).

Assymptomatic carriers have been observed to carry the virus and spread it to those around them for periods that range between a few weeks up to a couple of months.

https://www.thelancet.com/journals/lanepe/article/PIIS2666-7...

All it takes is a single spreader moving from outside of the metro area to negate the effect of the lockdown, specially if a considerable portion of the population is quite militant in their refusal to follow even the most basic health and safety precautions.

Just in case anyone thinks this was confined to rural areas it was not.

I had to go do business in LA specifically around Manhattan Beach and Inglewood, and the folks that live there were taking me to strip malls where all the businesses looked closed but we're all actually open.

They just had their windows covered. I'm talking about an MMA gym next to a hair salon next to an Ethiopian restaurant.

Yeah, the speakeasy gym thing was all across SoCal if not further. Probably given the low compliance we should have left gyms open officially.

It sounds like the restrictions didn't work at all in that community.

You can’t assert this without confirming that zero restrictions would have led to the same number or fewer deaths.

What I meant is that restrictions are ineffective if they are ignored, not that they literally had no effect.

According to a study in PNAS, shelter-in-place policies in the US did not work: https://www.pnas.org/content/118/15/e2019706118

Another study in Eur J Clin Inv had similar findings comparing countries: https://onlinelibrary.wiley.com/doi/10.1111/eci.13484

COVID went wild basically everywhere. There were a few strong exceptions: China (apparently), Australia, New Zealand and some others. What these had in common was very strict police enforcement, which led to some dramatic scenes like people getting welded into their houses in China, or houses in Australia getting broken into by police on suspicion of too many people gathering.

In my _opinion_, lockdowns didn't work elsewhere because most cases are not from casual public transmission in places like stores, restaurants etc. Rather, events like kickbacks, dinner parties, and practices like in-home workers (nannies, cleaners etc) continued throughout the pandemic, or resumed shortly after the original March 2020 shockwave. While strident police enforcement of physical distancing could eliminate cases, and seemed to in a few places, the half measures used by most of the world did little-to-nothing positive while being an economic and cultural disaster.

Personally, I never caught COVID and rarely socialized during the pandemic. All the cases I heard of stemmed from the kind of thing I mention above: private dinner parties, nannies and so forth, rather than casual public transmission.

You, or any individual may have taken social distancing seriously but it's clear many or most did not, including people on both political "sides", up to and including governors, members of congress etc.

Here in Japan they've never really had lockdown. Restaurants have remained open the entire time, just asked to close at 8pm. I could/can walk by them at 7pm and see them full of people talking and eating without masks. I was invited by Japanese friends the entire time (didn't go) and would see them posting pictures of their restaurant dinner gatherings on Facebook.

Further, as a comparison, Tokyo Metro has 38 million people, California has 38 million people. Tokyo Metro has ~6500 people per square mile, California has 240 per square mile. Tokyo Metro had and still has people commuting in very crowded trains every weekday. California mostly people drive cars. California closed restaurants. Tokyo Metro never closed restaurants.

Yes, Tokyo is going through a "spike" right now but compared to California it's still tiny. Compare Tokyo Metro's current "spike" (~2k people per day) with any of California's spikes at 40k per day, 20x more.

Some people will claim testing but that doesn't fit the facts either. Deaths from COVID in Tokyo Metro. California 62k death, Tokyo Metro, 2k dead. And, if you believe the attribution of death by COVID is bad then all you have to do is look at the death rate from all causes and see that Japan is doing much better than the USA

https://ourworldindata.org/grapher/excess-mortality-raw-deat...

I have no idea what Japan did right or got lucky with. Various speculations abound. Japanese don't shake hands, hug and kiss friends. Japanese may be commonly taking some medicine for unrelated things that happens to provide protection. Japanese might have more people with genetic immunity. Japanese mask compliance might be higher. Japanese aren't obese (I'm sure there's some other non-obese country they can be compared to). Japanese have a different diet (not sure what other countries have similar diets)

I recognize that even with restaurants open it's possible just the various other factors are/were enough to keep R low enough.... I really have no clue. Personally I mostly stayed locked up. I live alone. Saw less than 1 person a month in person, usually an outdoor walk with masks on.

This is super interesting. My entirely unqualified gut reaction is that this is cultural- that Japanese people take infectious disease seriously and test+quarantine after experiencing symptoms or traveling at all, having already handled SARS outbreaks before, and many Americans are still debating whether the pandemic is real, and that behavioral difference is enough. I don’t know how to test that. But it could also just be as simple as Americans being less healthy.

On the other hand Japan has an older median age than most other countries. We know that age is a crucial risk factor for COVID-19 so on that basis they should have had a higher death toll, but didn't.

My guess is that the low obesity rate is the critical factor, but that remains somewhat speculative.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430889/

People discuss the range of social <-> lockdown techniques as if they're generically effective or not, when really I think think the effectiveness of the same strategies varies vs how high the current community state of infection is, as well as a hysteresis of what level of infection you're coming from.

If you can act earlier, maintain a external boundary, and maintain a low enough level to trace then I think you can stay in a very good state with minimal inconveniences. But once the infection rate has passed a certain level, more stringent strategies are needed to get back to the same low state.

What you're saying is consistent with my hypothesis. Ie that casual public transmission on subways and in restaurants is low. Rather, it's "behind closed doors", at extended private gatherings, via domestic workers and so on. Those are the only such cases I have direct knowledge of (California USA). It could be that Japanese don't gather as much, or have chosen to skip it during pandemic.

You might be right. I don't think that fits with seeing restaurants open and unmasked (since you need it off to eat and drink) but maybe the sum total of meeting in person is still much lower than "behind closed doors". The news (when I used to watch it) certainly highlighted that going to hostess club had a few spreader events like where 80% of the people in the club got COVID. I don't know how common that was, I just know it was in the news last may/june (don't watch the news much)

A lot of your observations make sense. My speculation would be:

A) Japan has a more temperate climate

B) Japan is an island and was pretty strict about locking down travel and forcing everyone entering the country to quarantine for 14 days

C) Japanese culture seems to promote very rigid adherence to rules and proper social etiquette.

The strictness of the enforcement in China has been overstated in the media. Strict, but not that strict. Source: here during the Chinese lockdown, have compared notes with those in other cities.

In the UK (which has pretty good test capacity) the infection rate slightly lags the lockdown restrictions as you would expect from a working policy, so I think it can be successful.

The closing of schools in California (vs open in Florida since last fall) was a very distinct difference in both policy and actual behavior. It seems not to have had a dramatic effect on outcomes.

At least in hindsight, the closing of schools might have been a huge mistake.

Some canadian provinces are still closing down schools at the moment.

Why? Sincere question. Is there science to back it up or is it just fear of making a wrong decision?

Sincerely, I don't know. Almost all of the at risk population here has had at least a first shot. But the situation in Ontario has been pretty bad the past few weeks.

But I don't follow the science closely enough. I hope they're making the right call, because it's really hard on the kids. I'm just glad my own little guy is not of school age yet, and in fact is young enough to be mostly oblivious to the whole thing.

Conveniently skipping over the occupied ICUs. How do you not know that our medical system was overwhelmed or that the rise in cases only reversed after we shut down schools both times in the last 4 months?

Surely that wasn’t the only tightened restriction or change in behavior during the case surge, though?

There are a lot of confounding variables in these analyses. It’s going to take years to tease them apart, and we may never truly know for certain in some cases.

Perhaps, but do you lock everything down mid-spike when you know the current rate will lead to extreme triage measures within two weeks, or do you wait two weeks to act and start rejecting patients as they continue to flood in?

"the rise in cases only reversed after we shut down schools both times" implies a causal relationship, though, while ignoring the other mitigations that went into effect.

The point is not "is it wise to take precautions"; that's obvious. The point is we don't necessarily have great data on which precautions work better than others because they're largely all being put into effect at the same time.

> point is we don't necessarily have great data on which precautions work better than others

We actually do, though, and it's preventing close contact of non-household members and preventing sharing enclosed spaces with non-household members for long periods of time.

People spread the virus before they even know they're sick, and a subset of sick people either need to go to work despite being sick, or they just don't care.

Again, all those restrictions were typically implemented at the same time - distancing, capacity limits, masking, etc.

It's going to take time and years of research to tease out things like "did closing schools specifically help".

I just haven't been following the news that closely, especially for Ontario (I'm not in ON). No intent to "conveniently" hide information, though thanks for clarifying.

I don’t know why no one is saying this, but Ontario’s ICU numbers skyrocketed to 900 at the peak just a few weeks ago. We’re only down to 700 occupied beds now and normal medical procedures are still paused because of the enormous ICU load.

It wasn’t until we closed schools that the trend reversed.

People are so quick to blame fear without actually looking at the data

> It wasn’t until we closed schools that the trend reversed.

The other way to think about it is that it wasn’t until things got bad that people got cautious.

Kind of how people take homeopathic drugs when they are sickest.

Is the data conclusive? I try to look at the data, but it seems like a mixed bag when it comes to school closures.

I don't know if we can conclusively say what specific action needs to be taken other than halt contact. We were on an extremely bad path, and I don't know what else could have been done since we had little vaccine supply at that time.

They have vaccine shortages. The issue is the teachers, not the kids.

Are schools a major source of transmission for teachers and staff?

Yes. Workplaces with lots of contact always are.

In Nov-Feb, I was losing 40-60 employees a week to infection or quarantine. Mostly people in essential IT support positions

My sons school was open most of the year, but shutdown for a month due to teacher quarantines.

Schools are different than a business setting. Young children have less chance of getting it and less of spreading it. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp....

You just contradicted the website you linked, I'm confused.

> Hospitalization rates in children are significantly lower than hospitalization rates in adults with COVID-19, suggesting that children may have less severe illness from COVID-19 compared to adults.

Less severe response to it, not "less chance of getting it." And then just two lines later:

> Recent evidence suggests that compared to adults, children likely have similar viral loads in their nasopharynx,7 similar secondary infections rates, and can spread the virus to others

I don't know how you arrived at your opinion here.

The population of humans in schools includes many adults.

Yeah because it appears to have helped reverse cases both in January and this month.

You mean cases started to drop after everyone stopped traveling for Christmas and vaccines started to hit meaningful numbers?

Who knows. The alternative was not closing schools while cases were increasing exponentially. Is that a theory we should be testing when we've already paused elective medical procedures due to the wave of COVID patients?

I said "in hindsight", meaning that we don't fault the decisions at the time. I think now is when we begin (without blame) to start evaluating what worked and what didn't.

Unfortunately, some of the things done were disruptive, and if they were also ineffective, that will lead to blame. But our mission should be honesty first, and have faith that reasonable people can accept that the best decisions were taken with the information available at the time.

Did it actually help, or was that just coincidental?

The alternative was not closing schools while cases and incoming patients were increasing exponentially. Is that a theory we should be testing when we've already paused elective medical procedures due to the already high numbers of people in the hospital?

Education is essential so yes that is a hypothesis we should be testing.

I'm not sure you understand the consequences of an overwhelmed medical system.

Regardless, school is being done online. Kids that needed laptops got them.

> Regardless, school is being done online. Kids that needed laptops got them.

Right, I forgot University of Phoenix regularly matches their in-person counterparts in terms of quality. Keep telling yourself that teachers who were never trained to do remote teaching are anywhere near the same effectiveness as before. You ever dissect something virtually? Somethings can simply not be learned through a screen. Physical education, dealing when your crush looks at you in the eye, literally anything "hands-on" like swinging a hammer at a nail, the of useful skills that can only be developed in the presence of another human are tremendous. Funnily, most of the useful things learned at school for most people are not the curriculum and it is these things that are missing.

We can have this discussion if the situation carries on through this year. I agree a lot of places have had suboptimal schooling, some better than others, but I'd rather save lives and hold off on dissecting animals for a year.

It was a huge mistake in foresight as well. Many of us were highly vocal against school closings.

San Francisco had some of the heaviest lockdowns in the country, yet 100 miles east in Modesto the mayor actively defied the statewide lockdowns. California is a big state.

Low income / essential workers & overcrowded homes are a far more significant factor that often go unmentioned when people try to compare the outcomes between state & municipal public health interventions. This was observed well before the winter surge. https://calmatters.org/projects/overcrowded-housing-californ...

How do you isolate when there's more members than actual rooms in the home & only one one restroom?