Isolation, Loss, And Heroism: 5 Years Of COVID-19 In LA

LOS ANGELES, CA — Exactly five years ago, California was plunged into crisis as the novel coronavirus, as it was then known, began infecting people in the Golden State and threatened countless lives and livelihoods.

On March 19, 2020, Gov. Gavin Newsom issued the unprecedented stay-home order directing all but essential workers to stay-home. The order came just a few days after a prominent global study forecast a COVID-19 death toll topping 2.2 million people in the United States. The stunning report prompted shutdowns across the nation.

Suddenly, the vibrant streets, the classrooms, the beaches, the jammed freeways of Los Angeles were eerily empty. Hospitals and morgues prepared to be overrun and scrambled for ventilators and protective gear. Americans feared a deadly outbreak for which there was no known cure. Together and alone, we waited.

COVID-19 Pandemic Los Angeles Shutdown In Photos: 5 Years Later

Since then, at least 1 in 280 or more than 36,000 Los Angeles County residents have died from COVID-19. Nearly a third of those deaths occurred in that first year before the first vaccine was released. Thirty-three children have died from Covd-19 countywide.

Overall, more than 1.2 million Americans are confirmed to have died from the disease. It's a number believed to be a significant undercount. As recently as February roughly 1,000 Americans per week were dying from the disease.

There is no real way to quantify the number of lives saved under the stay-home orders and the sacrifices Angelenos made for one another. It is clear that the toll was not evenly felt. People living in low-income Los Angeles neighborhoods and people of color — two groups that disproportionately made up the ranks of essential workers — died at the highest rates. In Los Angeles County, Latinos died of COVID-19 at twice the rate of whites.

Overall, there have been more than 3.7 million laboratory-confirmed cases of the coronavirus in Los Angeles County, and throughout the pandemic, Los Angeles County Public Health Director Barbara Ferrer has helmed the county's response.

Ferrer spoke with Patch about those challenging early days of the pandemic - the uncertainty, the heartache, the threats to her life, what she wished we had done differently and how prepared Los Angeles County is for the next health crisis. To this day, the scars of the pandemic, the memory of the first child to die of COVID-19 in Los Angeles County, still brings her to tears.

This conversation has been edited for length and clarity.

Question: Could you tell me if you recall what you were thinking when the first case of COVID 19 was confirmed in Los Angeles. Do you recall that case?

It was a traveler who didn't live in Los Angeles, and there was a lot of scrambling, because it involved the person coming into the airport. It involved getting that person transported. That person was traveling with some family members. So it was also making sure we had appropriate housing for those family members who, of course, needed to isolate to make sure that they too weren't infectious or weren't going to go ahead and develop COVID 19, and this was back in January, which was when cases were really among travelers. A lot less was known about transmission. In particular, there were assumptions being made that there was no community transmission happening in the United States yet.

The big issue was on how were we going to be able to appropriately screen people, particularly traveling from China to make sure that they weren't inadvertently infected with the virus, and then coming into places like LA and able to transmit it. Our understanding at that point was also that people who were infected were very likely to be symptomatic. We went many weeks thinking that the vast majority of people infected were symptomatic, when, in fact, that wasn't true either.

My memory of that was that this was going to be a virus potentially limited to travelers, and if we did a good job, it would be contained in a way that really might not create a vast threat to our communities.

The first things we really concentrated on were good screenings and a lot of contact tracing.

Q: Do you recall the fate of that first case?

That person is fine, that person fully recovered. The family members were not infected, and, yeah, they were all fine.

Q: When did it first dawn on you that shutdowns would be a likelihood, and when you were issuing orders at the county level, what was going through your mind?

I'll preface this, that 38,000 people died in LA County over the course of the pandemic, and 1.2 million people died in the United States. I think 8 million people died across the world, and these are likely all undercounts. In those first few months, it became clear how dangerous this virus was and how easily it could be transmitted and how we had no tools, really, for containment. We didn't have a vaccine, we didn't have therapeutics, and we didn't have testing, easily accessible testing.

So, with very limited testing, spread becomes easy, and with no therapeutics, the fact that it can cause severe illness is definitely going to play out as well, and there was no vaccine that could either prevent transmission or prevent severe illness for those who were infected. I think pretty quickly, once we saw how quickly there was community transmission — once we saw that it was happening and happening rapidly, I think we all knew that the only way to prevent a lot of devastation was going to be to limit people's exposure to each other.

We didn't have any other tools, so you have to then go to distancing, social distancing, space, masking — tools that really help prevent transmission. I think at the forefront, at the time, was this could be so deadly and was transmitted so easily that we really needed to keep people away from each other as much as possible, and limit people working together, being together to family units and to essential workers.

It was very clear that it was a deadly virus. It was also very clear early on that the virus was going to have the ability to mutate, which, I think added a lot of worry around how effective immunity might be — immunity from getting sick if the virus was going to be mutating frequently.

Q: What is it like for you when you hear people say, 'well, these were draconian measures'?

I like to look at the data. There was a lot of surveying that was done. USC had a survey. I think UCLA had a survey. So one thing was, initially, there was only a very small minority of people that didn't want to do the shutdown. Everybody was pretty scared, and most people were scared enough to recognize that we didn't have enough information to have other containment strategies.

I think the frustration started in May, when it became apparent that this wasn't going away quickly. We never shut down most things. I just want to say the busses ran. All manufacturing plants remained open, for the most part. Stores, grocery stores remained open. Pharmacies remained open. Our electricity, our water, so much remained open. So I also want just do a little bit of a reality check that lots of things that were absolutely necessary for us to continue our lives were, in fact, still open.

But I think what people really felt the hardest was the closure of things like restaurants, bars, entertainment, schools and retail, what was called non-essential retail, gyms. So I think everybody was fine when it seemed like, you know, we're going to do this for a few weeks...the virus is going to go away, and the threat is going to go away. I think when people realized this was going to take much more time, and was going to continue to be dangerous for so many people until we had more tools (widespread testing, therapeutics, a vaccine), we were going to need to stay apart, except for essential activities. I think that's when people became alarmed and wondered if that was the best approach.

Those people were always in the minority. For the entire time we had masking orders in place, data shows that 70 to 80% of people wore their masks most of the time. The entire time that there were, in fact, closures at schools and, that was time-limited —actually was less than a year — the majority of parents did not want their kids to go to school. So yes, there were a significant number of people who, starting in May, really felt that they wanted the right to make their own decisions about what they wanted to do or not do to take care of themselves and their families. That was always a small minority of people. They got a lot of attention. They were very vocal, but it was never the majority here and I think that gets misconstrued around what is it that people really cared about.

I think the majority of people really got that this is an infectious disease and your actions have an impact on other people, not just other people, but other people you don't know. If you don't wear your mask and you have COVID 19, and you're not worried because you're relatively healthy, and you're willing to take that risk, but you now inadvertently spread it to someone who is compromised, older, very young, or in poor health, and they become infected with COVID and they die, you've now by your actions contributed to both the spread of the infection and bad outcomes for other people. I think most people got that, and most people really understood, 'I'm wearing my mask, not just for me, but to protect other people.'

You know, I, I wish I could say that everyone shared that sentiment: we're very interconnected, and my actions actually affect your health. When I look back, I wish we had done a better job explaining the importance of understanding the impact of your actions on other people and on the broader good for the community. But I do think the vast majority of people heard us, understood us and got that there was a lot of risk, particularly that first year.

Were you surprised by the widespread willingness to make sacrifices for the health of the greater good?

No. My takeaway from five years of pandemic living is that so many people were like heroes every single day. So many people took care of other people. So many people were kind to other people. So many people went out of their way to make sure that other people were okay. And sadly, a large number of people experienced tremendous loss, loss of life and loss of livelihood, and still understood the imperative to go forward with this notion that we're going to be here together, taking care of each other.

I look back, and what I remember is incredible acts of courage, kindness and this willingness to take care of each other. And I really worry a little bit about that reality being clouded. Because yes, there were people that hated the masks. They feel, to this day, that that violated their rights and the right to decide what their children should do, but that wasn't the majority of the people. The majority of people understand we're interconnected. I don't get to decide when I'm going to stop at a red light. I don't get to decide when I'm going to stop at a stop sign. We follow some rules that allow us to protect each other, traffic safety rules, public health safety rules, those are rules we follow because we're taking care of each other all of the time. That's the compact we make because we live in communities.

Q: Are there any particular COVID cases or stories that stand out in your memory?

I think you know the heartbreak of people dying by themselves. Sorry, I think it's hard to talk about. It was so contagious. There was so much worry. People died alone. It was hard to visit people in nursing homes. I've talked to people who lost 10 family members.

Our first child death —there's a lot of sadness there. I do remember that I knew that I was waiting for confirmation of a child death. We did media every day, and I remember it was hard. It was hard that day, knowing that we had a child who died.

Q: People were looking to you for reassurance and direction, but then, as you mentioned, kind of May and later, there was a hostility, and they definitely directed the slings and arrows at the health departments. And I know in other counties, health directors quit. A lot of them faced threats. What was it like for you at that time? Why did you decide to keep coming out on TV almost every day, and were you receiving threats as well?

I think everyone knows that we received and I received significant threats. And I had to have security. There were some very, very angry people. I think angry and scared, to be honest. Some of it was the fear of the impact. You know, I think once it became clear this pandemic wasn't ending quickly, I think folks realized, it wasn't just lives, it was livelihoods.

Sadly, people felt like there was a choice that needed to get made, and in some ways, it was a false dichotomy. You either have to set policies that ensure that people are going to be protected, or you're going to set policies to ensure that people are going to have their livelihoods, you know? I think in one of the richest countries in the world that's a false choice.

We should be able to protect our health and our safety, and there should be a safety net so people don't lose their livelihood. One of the lessons, for me, from the pandemic, is we need to work really, really hard to make sure that that social safety net is there. People shouldn't be choosing, as they had to, 'Should I isolate for 10 days and not go to work? Or should I go to work because if I don't go to work, I don't get a paycheck?'

We should never have people have to make that choice. We should have a social safety net that says, 'Don't choose between health, not only your health, but the health of everybody else, and your paycheck.'

I think that made people super angry and I understood that anger. I mean, I wish it hadn't been directed in such a violent way towards me or towards other people who worked at the Department of Public Health or other people who were across the country trying to do their best to save lives, but I certainly understood where it was coming from.

There was really important work to be done. I wasn't going to leave. Everybody here was working literally around the clock that first year, and we needed to be able to work together as a team. So, and I'm Puerto Rican, I'm not easily intimidated, to be honest. It was unfortunate, and it was costly having to have security.

Q: Is there anything you would have done differently?

There are two areas where I wish we had initially been able to take some additional steps. One is protecting workers. These are startling numbers, but if you look at mortality rates, for example, over the course of the pandemic, blacks and Latinos and Latinas, but Latinos and Latinas in particular have somewhere between one and a half and two and a half times the death rate of white residents in LA County.

People who lived in our neighborhoods with the lowest income levels were also three times more likely to die over the course of the pandemic than people who lived in our wealthiest neighborhoods. This is not by chance. This is because many of those folks were the essential workers. They had lots more exposures. They went to work, they worked in factories. They worked in plants. They worked at grocery stores. They were not teleworking from home, and they didn't limit their exposures.

So I wish we had done more initially, around protecting workers. I wish we had more requirements at work sites, been very deliberate about making sure that that people were masking, that there was distancing, and to offer testing to essential workers. I just look back on those first six months, and I wish we had been able to focus more attention and more resources on those workers who were still working.

The other group I wish we had been able to do more for initially, was protecting the most vulnerable people who were in our skilled nursing facilities. If you still look at our data, the one place where there still are outbreaks are at skilled nursing facilities. It is so easy for infectious diseases to move through a facility.

Knowing what we know now about how vulnerable older people are to this virus, how easily it was spreading...we did not appreciate asymptomatic spread. So we were screening workers, but there were so many people who were spreading the virus who were, in fact, asymptomatic. We should have done a lot more on making sure people were wearing respirator masks really early on and very quickly, going to a containment strategy at those skilled nursing facilities.

Q: Do you think these lessons have us better positioned right now for the next pandemic?

Absolutely. I think, locally, we're well positioned. We did an extensive after-action review. We brought in an outside consulting group to help with that. I didn't want us to have our blinders on. I wanted other people to look at it, and they interviewed hundreds of people across the county and we implemented almost every single recommendation. For those that we haven't fully implemented, we're working on them.

I think at the local level, we're doing great. I will say a pandemic is not a local event. And I was very heartened by the previous administration's emphasis on understanding and strengthening the role of CDC, in particular, and working closely with the WHO. With this new administration, I think we need to make the case that no pandemic is local and that we really rely on good information and good data sharing. You could just look at the Ebola outbreak and you know we need to work together. Infectious diseases do not respect boundaries and not in a global economy.

So, we can be very well prepared locally, but information-sharing strategies for containment, those need to be global strategies. We need to be able to vaccinate people in all parts of the world, not just in our country, if we're going to contain a deadly virus.