Please read or reread my previous statements below to get a better understanding of where we find ourselves today and actions you can take to protect yourselves and your family.  

The third modification of the shelter in place order is being made on 6/1/20.  These modifications are being made in attempt to strike a balance. They are an attempt to find a way to increase the immunity of the population (in public health terms, this is called “herd immunity”) slowly and methodically, while minimizing premature death, with equity in mind, while not overloading the healthcare system, and minimizing economic damage. Many of these considerations work in opposite directions. Of important note, the macroeconomic concerns are also working somewhat in opposition to the microeconomic ones.  These modifications are not being made because it is safe to be out and about. The virus continues to circulate in our community, and the increase in interactions among people that these modifications allow is likely to spread the virus at a higher rate. Whether these modifications allow the virus to spread out of control, as we saw in February and March and resulted in the first Shelter in Place order, is yet to be seen. The risk of exposure to COVID-19 looms large for all of us. The public and open businesses need to fully do their part to minimize transmission of the virus.

As the governmental public health measures and restrictions imposed during to the first wave of this pandemic are slowly easing, the power to control the spread of the virus is moving to you, the individual, and you, the community.  You get to decide what future you want.  Your collective behavior will determine our destiny.  If enough people, businesses, or organizations in the community do not follow the protective recommendations, the virus may spread with abandon.  Our best estimate of the Re (the effective reproductive number) after the first Shelter in Place order was 0.9, down from between 3 and 4 in the weeks prior to that.  Anything above 1 is not good, and the higher it gets above 1, the worse it is in an exponential manner.  After the several rounds of loosening of restrictions, it is now estimated at 1.3.  That means without everyone doing their part, and maintaining an Re closer to 1, the virus is set to explode again.  That scenario benefits no one.

We are already seeing an upward trend in hospitalizations with the modifications that have already been made.  This means the virus is likely now circulating at higher levels than before.

While we will certainly recover, the world will look different in the future.  If you are feeling on edge, out of sorts, a bit unhinged, these feelings are completely normal.  We are certainly in the midst of the biggest disaster of our lives.  Pandemics destroy human made systems.  Pandemics damage the economy in many ways, but primarily through demand suppression.  Pandemics threaten all manner of stability.  Pandemics unearth hidden strifes and conflicts that we thought were long buried.  Pandemics are a spark that can, if not carefully managed, cause a global conflagration.   The profound economic shock of this pandemic will be larger than the Great Depression.  (For those of you who believe that the public health restrictions caused the economic shock, evidence suggests otherwise.  Fear plus mass death (which we, very fortunately, did not experience here most likely because of the public’s compliance with the restrictions) causes far greater and longer lasting demand suppression than fear alone).  The pandemic came on with great speed, like a natural disaster such as an earthquake or a massive hurricane.  It has caused the largest change in consumer behavior ever measured.  It will cause a larger mass reallocation of labor than occurred in World War II.  Many people understand this, try to be good citizens and follow the recommendations.  For some, it is too much to bear and they are in deep denial.  There are some who are experiencing direct and deep economic harm due to the restrictions put into place to slow the pandemic.  To those folks, I would say, I’m trying to ease restrictions as fast as I can without being reckless.  And then there are some people who don’t understand, some who think Darwinian concepts should rule the day, some who have completely different views on how the world works, and some who simply don’t care.  These people are very frustrating to people who care about their responsibility to others.  Since it is always tricky to try to influence other’s behavior, the best you can do is to do the right things to protect yourself, your family, and those you care about. If you have any worry at all about the virus and its effect on you, your family, friends, colleagues, neighbors, or others, you should know, it is not completely safe to be out, it is even less safe to attend gatherings of any size.  If you are at risk from serious complications of the virus, you should continue to take all measures to ensure your safety.

Scott Morrow, MD, MPH, MBA
San Mateo County Health Officer