Sunday, June 14, 2020

Coronavirus in Utah: The First Three Months

Three months ago, when my university campus and so much more of Utah shut down due to the pandemic, I was hopeful.

For one thing, we were lucky. On March 12 the number of known COVID-19 cases in Utah stood at only four, out of 1500 nationally. The initial onslaught in the U.S. had mainly hit the coasts, giving Utah more time to prepare.

Also, Governor Herbert and other state officials were taking the virus seriously. They shut down the public schools, university campuses, and other large gatherings more quickly than I had thought possible. The state was putting out good public information on how to stop the virus’s spread, and efforts to ramp up testing were well underway.

Meanwhile, the Church of Jesus Christ of Latter Day Saints shut down its large gatherings with equally stunning abruptness. In doing so it not only prevented untold numbers of superspreader events on Sundays, but also sent a clear message to its two million Utah members that they had a responsibility to protect themselves and their neighbors.

Exponential growth

Then, while I scrambled to teach my classes online, I watched the numbers climb.

Of course they would climb. The experiences in China and elsewhere had taught us that the virus was highly contagious and could spread unnoticed, with an incubation time of about a week before symptoms appeared. Even then, many victims had mild enough symptoms that they mistook COVID-19 for a common cold or flu. And testing, in Utah in mid-March, was available only to those with the most severe symptoms.

But even knowing all this, and even being familiar with the mathematics of exponential growth, I found it morbidly breathtaking to watch the number of known cases in Utah grow to more than 1000 by the beginning of April—doubling eight times in only 20 days. (Some of this growth was due to actual spread of the virus over time, while some was due to the expansion of testing.)

And then, also predictably, the exponential growth stopped. It stopped because of the shutdowns enacted in mid-March, plus a testing capacity that by early April exceeded 2000 per day, plus the tireless contact tracing carried out by the heroes at Utah’s health departments. The rate of newly confirmed COVID-19 cases in Utah stabilized at about 150 per day. While the virus was raging out of control in many parts of the U.S., Utah had flattened the curve!

And there was even more cause for hope. On April 2 state officials and the Silicon Slopes folks announced a program of even more testing, to not just flatten but “crush the curve.” By mid-April Utah was testing about 4000 people per day, and I eagerly watched for when the daily case numbers would begin to drop.

The long plateau

But the drop never happened. April came to an end, along with my spring semester classes. As the weeks of May went by, the rate of new cases held steady. Tragically, Utah’s coronavirus death toll rose steadily as well, reaching 100 by Memorial Day.

Why weren’t we crushing the curve? Health department officials know the answer to this question in detail, because they’ve interviewed nearly every known victim and traced the sources of most infections. Those details are confidential, so the rest of us can only piece together a partial answer from statistical data and news reports. But the broad picture seems pretty clear.

You see, the virus arrived in Utah by infecting cruise passengers, ski vacationers, and other travelers. These people were mostly white and well-off, like Utah’s elected officials and health department administrators. So understandably, these officials targeted their response to white, well-off people like the early victims and themselves.

If you thought you might be infected, they told you to contact your primary health-care provider. They set up test sites in suburban neighborhoods, for drive-through access. They put out information mostly in English, through media channels that white and well-off people use.

But by early April, it was no longer us white, well-off people who were most at risk. Most of us were able to do our office jobs from home, avoiding nearly all human contact. Our homes also tend to be spacious enough that we can isolate ourselves from family members if necessary.

Meanwhile, the virus continued to spread in places where isolation was difficult or impossible: nursing homes, homeless shelters, meatpacking plants, and the more crowded home environments of lower-income Utahns. Many of the people at risk had no primary health-care provider to call. Many couldn’t get to a drive-through testing center. Many weren’t tuned in to the government’s information channels. Many were immigrants who understood little English.

Of course our public officials knew about these risks from the start, and they’ve made well-intended efforts to better target at-risk populations. Many of these efforts have been successful. When I look at that long plateau through April and May on the chart of new case numbers, I see it as a succession of dozens of overlapping local outbreaks among a wide variety of at-risk communities, with health officials rushing in to put out each fire as soon as they learn about it.

What I don’t see, unfortunately, is enough effort by health officials to prevent these local outbreaks among at-risk populations from happening in the first place. I’ve read almost nothing about testing at-risk workers in locations where there isn’t yet a known outbreak, or about inspecting workplaces and punishing employers who don’t maintain safe working conditions, or even about publicly disclosing the specific locations of known outbreaks. Perhaps there’s some of this going on in Utah (and again I’m not in a position to know most of the details), but it’s obviously not enough.

A new surge

We know it’s not enough because we haven’t crushed the curve. And now, since late May, the curve is again rising. The number of new cases reported each day has again doubled, to more than 300. On a per-capita basis we’re now reporting more new cases than all but five of the other states.

And we’ve just witnessed Utah’s biggest outbreak so far: 800 new cases reported in the Bear River district over the last 16 days, when the district had previously been averaging only three new reported cases per day. Nearly all of these 800 new cases seem to be tied to the JBS meatpacking plant in Hyrum, where most of the employees are immigrants from Latin America, Asia, and Africa.

An outbreak of that size does not develop in just 16 days: it must have been in progress for several weeks before the authorities became aware of it. And yet it seems they were completely unaware until approximately May 29, when they reported the first big jump in positive test results.

I know only one way to describe this kind of blindness on the part of public officials: institutional racism.

As if to underscore this description, right in the midst of this outbreak the all-white Cache County Council voted to petition the state to go to “green” status, removing most of the remaining measures to protect public health.

The sad irony is that if public officials had done more to address the threats to Utah’s disadvantaged populations back in April and May, they would have crushed the curve by now and we probably could take most of the state to “green” status. More importantly, we could have saved many lives, and we could be confident that reopening schools and universities in the fall won’t put undue numbers of students, teachers, and their families at risk. But with new cases being discovered at a rate of 300 per day, I fear that the contact tracers won’t be able to keep up, and the only way to prevent another period of exponential growth may be a return to “orange” or even “red” status.

Let me hasten to add that I’m not a big advocate of draconian population-wide restrictions as the main way to control the virus, so long as the case load remains low enough for testing and contact tracing to keep up. What we need (as far as I can determine as an amateur outsider who merely reads news reports) are more efforts focused on high-risk populations and high-risk workplaces. Utah’s white and well-off public officials need to work harder to understand these risks and develop more aggressive ways to prevent outbreaks. And Utah’s white and well-off voters need to understand that their personal situations during this pandemic are very different from those of the workers who are keeping food on their tables.

Update, 17 June 2020

On the same day that I posted this armchair analysis, the Salt Lake Tribune published an in-depth article with plenty of real reporting on how “Utah wasn’t prepared to reach out to its Hispanic residents when the virus struck.” This article also mentions a challenge that I hesitated to speculate about: “Another fear Hispanics harbor, particularly those who are undocumented, is that information they give while at a testing site could be sent to immigration officials.”

And today (three days later), the Trib has a summary of some very troubling comments from state epidemiologist Dr. Angela Dunn to a legislative committee: Utah is already at the point where contact tracing is falling behind, due to the high rate of new infections and the large number of contacts that must be traced for each infected person. “As long as that’s going on, it’s not realistic to focus restrictions only on specific ‘hotspots.’”

The Tribune is providing free public access to its fantastic reporting on the pandemic, but someone has to pay for all this work. Please, if you can, sign up for a subscription to the nonprofit Salt Lake Tribune.