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California

California’s Fragmented Mental Health System is Struggling and Broken

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Breakdown: California’s mental health system, explained

by Jocelyn Wiener for CalMatters

CALIFORNIA — Mental health advocates have long described California’s fragmented mental health system with words like “struggling” and “broken.”

Evidence of its consequences can be found in our jails and prisons, our hospitals and clinics, our schools and colleges. The problem touches those living in comfortable middle class suburbs, remote rural towns, and on the streets of the state’s biggest cities.

In January 2018, a year before he was elected governor, Gavin Newsom laid out his concerns: “Our system of mental health care in California falls short, not for lack of funding.

We’ve done the right thing in this state: Thanks to the vision of Sacramento Mayor Darrell Steinberg, we passed a millionaire’s tax in 2004 that now funnels more than $2 billion a year into services.

We fall short because we lack the bold leadership and strategic vision necessary to bring the most advanced forms of care to scale across the state. We lack the political will necessary to elevate brain illness as a top-tier priority.”

The Legislature in recent years has tried to respond. Some efforts, such as the court-ordered treatment programs allowed by Laura’s Law, have been controversial. Proponents say such measures are necessary to get people into treatment; disability advocates worry that they curtail people’s individual liberties without addressing widespread shortages of housing and community-based services.

With fresh attention on mental health, advocates are hoping California embraces humane and effective ways of averting some problems and solving others.

Who’s affected?

Directly or indirectly, mental illnesses touch the lives of almost everyone in the state. The afflictions include:

  • severe bipolar disorder, characterized by dramatic swings between mania and depression
  • schizophrenia, which can involve symptoms such as delusions and hallucinations
  • severe major depression, characterized by persistent sadness and disinterest

These mental illnesses, and others, can impede people’s ability to function and carry out the normal activities of daily life. They are often compounded by stigma, making it hard for people to talk openly about their experiences.

Problems emerging early

About three quarters of serious mental illnesses first appear before the age of 25. This makes children and adolescents particularly vulnerable, especially if early symptoms go untreated. One out of every six California adults experienced at least four potentially traumatic adverse events during childhood—abuse, neglect or domestic violence among them. This greatly increases their risk of depression, anxiety, suicide and post traumatic stress disorder.

Over the past decade, the state saw hospitalizations for mental health emergencies spike more than 40 percent among young people.

Even as a growing percentage of adolescents reported experiencing depression in recent years, less than a third reported receiving treatment.

Too often, these young people live in communities that have few options to care for them. Programs that target early psychosis, for example, can be very effective—but only if they’re available.

“If you have a child or a teen in trouble, there are vast areas of the state where there is no appropriate help,” says Carmela Coyle, CEO of the California Hospital Association.© 2019

Suicide rates are climbing

Suicides have increased dramatically, reflecting a national trend. More than 4,300 Californians died by suicide in 2017, a 52 percent increase from 2001.

The problem was particularly pronounced for the young: Suicides among adolescents aged 15 to 19 increased 63 percent.

Like so many other mental health issues, suicide rates vary a great deal in different parts of the state—and are especially acute in some rural Northern counties, where mental health services are in particularly short supply. Trinity County, in the state’s far north, lost an average of 34 residents per 100,000 to suicide, more than four times the rate in Los Angeles County.© 2019

Substance abuse is interwoven with mental illness

Some people living with serious mental illness simultaneously experience alcohol and drug use disorders, complicating diagnosis and treatment.

A third of adults who received county mental health services for serious mental illnesses had a co-occurring substance use disorder. The stakes for these individuals are especially high: People with drug or alcohol use disorders are almost six times more likely to attempt suicide than those without.

In this, too, geography matters a great deal. Lake County, for example, has an overdose death rate nearly nine times that of San Bernardino County.

People struggle to get help

A statewide poll shows that the top health issue Californians want their governor and Legislature to address is making sure treatment is available for people with mental health problems: 88 percent called it extremely or very important.

Yet most Californians think there’s not enough mental health care available in the state—especially if they’ve tried to get it.

In recent decades, the state and federal governments have passed laws requiring insurance companies to provide patients with equal levels of care for physical and mental illnesses. It’s called “parity.”

Passing such laws is one thing, enforcing them is another. While most insurers no longer limit the number of visits to providers or charge higher co-pays, pre-authorization requirements and determinations of “medical necessity” can still act as barriers to care.© 2019

Timeline: How we got here

Jails and prisons have become default psychiatric institutions

The largest psychiatric institutions in the state and nation are not hospitals—they are jails and prisons. Far more people in California with mental illness are behind bars than in hospital beds. Over 30 percent of California prisoners currently receive treatment for a serious mental disorder, an increase of 150 percent in nearly two decades.

“We’re going to end up with an incarceration system that’s mainly dealing with people that have serious mental health problems,” said Democratic state Sen. Jim Beall of San Jose. “It’s our own fault, in a way, for not having a good mental health system.”

Mental health courts provide one possible response to this crisis. Public defenders, prosecutors, judges and social service providers work together to connect certain defendants with services and treatment, with a goal of keeping them out of jail.

Judge Stephen Manley started one of the nation’s first such courts in Santa Clara County more than two decades ago. The model has expanded around California, but still serves only serve a fraction of the need.

“Everyone wants to tell me, ‘It’s so complex, we can’t solve it,’” he said. “And I say, ‘No, you can. Get together and figure out what you can do.’”

Inmates with mental illness can wait months to get into a state hospital

Another marker of the mental health crisis confronting the criminal justice system: growing numbers of inmates are waiting for state hospital beds, sometimes for months at a time. In the past five years, the number of California inmates deemed incompetent to stand trial and ordered sent to state hospitals increased 60 percent. Judges refer defendants to a state hospital when doctors determine the accused are unable to understand legal proceedings or cooperate with their attorneys.

But the result has been a backlog. Over the same period, the number of Californians deemed incompetent to stand trial and awaiting placement has soared 139 percent.

A few decades ago, fewer than half of state hospital patients came from the criminal justice system. Today, more than 90 percent do.

“That is a sad state of affairs in our society, that only when you get locked up does it become a priority to get you treatment,” said Los Angeles District Attorney Jackie Lacey.

Burgeoning numbers of mentally ill people on the streets

About a third of homeless people have serious mental illness, according to the Treatment Advocacy Center. With California’s homeless population nearing 130,000, that means an estimated 43,000 suffer from serious mental illness.

Sacramento Mayor Darrell Steinberg, a former state senate leader appointed by Gov. Gavin Newsom to lead a new commission on homelessness and supportive housing, calls the problem “horrendous.” Steinberg co-authored the Mental Health Services Act, a tax on millionaires intended to help address this issue.

“There’s nothing worse than seeing this increase in the numbers of people on our streets, many of whom are sick and who want to get off the street” he said.

As tent encampments proliferate, efforts to address this issue are gaining traction. In 2018 voters passed the No Place Like Home Act, allowing the state to borrow $2 billion to increase the supply of permanent supportive housing, which pairs affordable housing with mental health services.© 2019

Disappearing board-and-care homes

Licensed board-and-cares are closing at a rapid clip. There is no reliable statewide data tracking the facilities, which provide food, laundry and medication help and often serve as a safety net for people with serious mental illness who can’t live independently. But since 2012, San Francisco has lost more than a third of licensed residential facilities that serve people under 60, and more than a quarter of those serving older clients. Los Angeles has lost more than 200 beds for low-income people with serious mental illness in the past year.

As housing values soar and minimum-wage increases drive up staffing costs, government-set reimbursement rates have remained stagnant. The homes receive $1058—just under $35 a day—from tenants to pay for housing, 24-hour-care and three daily meals.

Advocates say the state needs to collect better data—and significantly increase reimbursement rates—if it hopes to save the remaining facilities.

“If legislators don’t get onto this, we’re in big trouble,” said Lisa Kodmur, who is contracting with Los Angeles County on the issue. “We will see more homelessness, more incarceration, more institutionalization, more people living on the streets.”© 2019

Emergency rooms feel the pinch

People in psychiatric crisis increasingly are landing in the state’s emergency rooms again and again. But not only do emergency rooms often lack space for these patients—they’re also not good environments for them.

“If you’re a paranoid schizophrenic, being in the ER is the worst place” says Carmela Coyle, CEO of the California Hospital Association.

Yet people in psychiatric crisis often wind up in the ER because they’re not getting treated elsewhere.

“Practically speaking, the emergency rooms of hospitals and jails are where people are taken for treatment, which is all wrong,” says Judge Stephen Manley, who started one of the nation’s first mental health courts in Santa Clara County more than 20 years ago. “The emergency room has no room for them and jails do not have expertise.”© 2019

Psychiatric hospital beds in decline

For those experiencing a psychiatric emergency that requires a hospital stay, beds can be hard to come by. Since 1995, California has lost nearly 30 percent of its acute care psychiatric hospital beds. Having to travel long distances can make it hard for families to visit a patient and can also make it more difficult for hospitals to plan for safe discharge.

Almost half of counties had no adult acute psychiatric beds, and the vast majority had no psychiatric beds for children, as of 2015.

For adolescents, the picture is even worse. The state has only eight juvenile psychiatric beds for every 100,000 minors.

The lack of community treatment

When people in psychiatric crisis land in emergency rooms and jails, it’s frequently because because they can’t get treatment in the community—even when they ask for it.

California lags behind the rest of the country: 37 percent of Californian adults with mental illness received mental health services during the past year, compared to a national average of almost 43 percent.

It’s a problem even for those who have been so sick that they were hospitalized: Among those who have Medi-Cal, close to a quarter of children, and more than a third of adults, weren’t able to access outpatient services within a month of being discharged from a hospital.

Privately insured people face barriers to treatment, too. California patients in 2015 were more than seven times as likely to get treatment for mental health and addiction from providers outside their insurance plan’s network as patients who were seeking medical or surgical care.© 2019

Where are the mental health providers?

One big reason people can’t get care: California doesn’t have enough mental health providers. This can lead to long wait times, or long travel distances, for people trying to get treatment.

Depending on where you live, there might be a lot of mental health professionals—or virtually none. Such shortages are especially hard on people living in rural areas, those insured by Medi-Cal, and children and adolescents.

The Bay Area has more than 70 psychologists per 100,000 people; the San Joaquin Valley has less than 16.

But even in areas that have a lot of providers, many refuse to accept insurance. A study in The Journal of The American Medical Association reported that only 55 percent of psychiatrists accept insurance—compared to an average for all health care professionals of 89 percent.

The problem is expected to get worse as the mental health workforce ages. Of special concern: Close to half of psychiatrists and more than a third of psychologists in the state are older than 60, and many will retire or reduce their hours in coming years.

On-campus counselors are in short supply

Demand for mental health counseling is going way up on college campuses—and there aren’t enough counselors to meet the need.

Nationally, the number of students seeking help on college campuses grew five times faster than enrollment, according to the Center for Collegiate Mental Health consortium. Depression and anxiety were their chief complaints.

Many of the state’s colleges and universities fail to meet the standard of one counselor per 1,000 to 1,500 students. As of 2018, the community college system had more than 7,000 students for each counselor, California State University had more than 2,000 students per counselor, and the University of California had about 1,100 students per counselor.

The success of the Mental Services Act—and some concerns

One of the most dramatic changes to the state mental health system came in 2004, when voters passed Proposition 63, the Mental Health Services Act. The 1% tax on millionaires has brought about $2 billion a year of new revenue into the system.

report issued last year about the effectiveness of the money in Los Angeles County showed that it is making a difference there, both by providing prevention and early intervention services for young people who hadn’t previously accessed them, and by improving outcomes for people with serious mental illness involved with expanded full-service partnership programs.

But some aspects of the law have continued to prove controversial over the years—including tracking how counties are (or are not) spending the money. Most recently, an audit showed that the California Department of Health Care Services allowed county mental health departments to accrue $231 million in funds by the end of the 2015-16, money which should have either been spent or returned to the states.© 2019

The conservatorship debate

Conservatorship laws in California are tangled in a web of philosophical, legal and ethical questions. What is the government’s responsibility to care for people with serious mental illnesses who say they don’t want treatment? How should the right to liberty be balanced against the need for care?

For years, legislators have talked about amending long-standing conservatorship laws. Last year, out of several legislative proposals, only one ended up passing, and it was expected to affect relatively few people.

At the core of this debate is a law signed more than a half-century ago by then-Gov. Ronald Reagan. The Lanterman-Petris-Short Act ended the inappropriate and often indefinite institutionalization of people with mental illnesses and developmental disabilities, and provided them with legal protections, including limiting involuntary holds to 72 hours.

Those who want to revise it say it can prevent very sick people from getting the help they need. Defenders of current law say people with mental illness need better care and support from society, not intrusions on their civil liberties. If the state wants to help those with serious mental health issues, they say, it should address the housing crisis and struggling community mental health systems.

Mental health legislation to watch: 2019

SB 10 (Sen. Jim Beall, D-San Jose) would establish a state certification process for peer providers—including family members, caretakers and people recovering from addiction or mental illness—who can then help guide others.

SB 11 (Beall) would strengthen enforcement of state and federal mental health parity laws, requiring health insurers to report annually to the state about their compliance with those laws. The information would be publicly available. Update: In May this bill was quietly, effectively killed for the 2019 session. 

SB 12 (Beall) would authorize creation of at least 100 drop-in centers to meet youths’ mental health needs.

SB 744 (Sen. Anna Caballero, D-Salinas) would streamline the local approval process and limit environmental challenges to prevent “Not In My Back Yard” opposition to supportive housing projects funded by the No Place Like Home bond measure passed last fall.

SB 331 (Sen. Melissa Hurtado, D-Sanger) would require counties to create and implement a suicide-specific strategic plan, especially for teenagers. Update: In August this bill was held up in the Assembly Appropriations Committee.

AB 890 (Assemblyman Jim Wood, D-Healdsburg) would allow nurse practitioners to diagnose and prescribe without supervision. Update: This bill stalled out in the spring of 2019, having never made it to the Assembly floor for a vote.

AB 565 (Assemblyman Brian Maienschein, D-San Diego) would forgive student loans for providers entering the public mental health workforce. Update: The Assembly passed this bill in 2019, but it ran aground in the Senate Appropriations Committee.

AB 50 (Assemblyman Ash Kalra, D-San Jose) would expand the state’s assisted living waiver program, which uses Medi-Cal funds to allow vulnerable people to stay in board-and-cares instead of nursing homes. The program is currently authorized to serve fewer than 6,000 people. This would broaden the program to serve more than 18,000. Update: This Assembly also passed this bill in 2019, but it was held back by the Senate Appropriations Committee.

AB 1766 (Assemblyman Richard Bloom, D-Santa Monica) would require the state to maintain data on board-and-care residents to better understand their needs.

The new governor

Gov. Gavin Newsom has labeled improving the mental health system a personal priority. Here’s what he told CALmatters in the spring of 2018:

On the January of his inauguration, he released a proposed budget including:

  • Early detection and treatment of early stage psychosis: $25 million
  • Screening for Adverse Childhood Experiences, which have been strongly linked with physical and mental illness: $45 million
  • Mental health counseling at University of California campuses: $5.3 million
  • Programs to expand the mental health workforce: $50 million
  • Training law enforcement on de-escalating encounters with people in psychiatric crisis: $20 million
  • Shelters and permanent supportive housing for homeless people with serious mental illness: $500 million
  • Expand “whole-person care” programs to offer intensive services to people with serious mental illness: $100 million

Newsom announced in late April his plans to soon name a mental health czar, who would be in charge of guiding state mental health policy.

CalMatters event: “If you think the system works, you’re dead wrong”

A physician, an advocate, a public health specialist, a suicide-attempt survivor and a California state lawmaker gathered in downtown Sacramento today to offer their diagnosis of the state’s mental health system.

The consensus was summed up by Sen. Jim Beall: “We need to start from scratch.”

“I haven’t heard a lot of cheerleaders for the status quo,” said Beall, a Democrat from San Jose and the author of several bills that would expand access to mental health treatment. “If you think the system works, you’re dead wrong.”

The panel discussion, hosted by CALmatters and the California Health Care Foundation, builds off an ongoing CALmatters reporting project by Jocelyn Wiener and Byrhonda Lyons on the state’s fragmented, sometimes fatally dysfunctional mental health system.

Who are falling through the cracks? What is the state doing right? And where can policymakers improve?

Wiener put those questions to the panel, and then asked them to share solutions. Despite their array of professional and personal backgrounds, everyone agreed that the state is repeatedly failing to ensure quality care to those who suffer from mental illness.

Where to call for help

If you or someone you know is having thoughts of suicide, there is help available. Call the National Suicide Prevention Lifeline 1-800-273-8255 (TALK) for resources and support. Free, confidential, available 24/7.

Text “HOME” to the Crisis Text Line—741-741—to reach a trained crisis counselor. Free, confidential, available 24/7. More information and resources are here.

Consumers experiencing access issues, or other issues with their health plans, can reach the state Department of Managed Health Care Help Center at 1-888-466-2219 or online here.

Not only do a sixth of Californians experience some mental illness, but 1 out of every 24 have a mental illness so serious it becomes difficult for them to function in daily life.

Left untreated, these illnesses don’t only impact quality of life, they also impact survival: On average, Americans with serious mental illnesses have life expectancies 25 years shorter than the general population, in part due to untreated physical health conditions.

This explainer and other parts of our continuing “Breakdown” series are supported by the California Health Care Foundation.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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California

COVID-19 and California’s Housing Crisis: Issues to Watch

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A hand-sanitizing station at a homeless encampment near Oakland city hall. Photo by Anne Wernikoff for CalMatters View Comments

by Matt Levin for CalMatters

CALIFORNIA — As the pandemic forces millions of Californians to adjust to a new reality, the words “housing crisis” provoke previously unthinkable questions: How to shelter in place without a home?

How to self-isolate in an overcrowded apartment? Less than two weeks ago, Gov. Gavin Newsom and California lawmakers were in the throes of tackling the twin issues voters considered the state’s most urgent concerns: the more than 150,000 Californians without a home and the state’s sky-high housing costs.

Legislators were introducing controversial bills to make it easier for developers to build more housing, hoping to ease the crippling shortage economists say have made rents and home prices among the most expensive in the country.

Newsom and local governments were about to square off over how to spend $1 billion in proposed help for the unhoused.

That feels like eons ago. As the COVID-19 pandemic forces millions of Californians to adjust to a new reality, the state’s “housing crisis” already means something different, provoking previously unthinkable questions: 

How do you shelter in place without a home? How do you self-isolate in an overcrowded apartment? How far would a $1,000 stimulus check from the federal government go toward my rent or mortgage payment? 

Here are five rapidly evolving housing issues to watch in the next few weeks, months and, yes, years. 

Issue 1: The state’s housing crisis makes it harder to respond to COVID-19

First, there’s the obvious: how to protect the more than 150,000 homeless Californians from contracting and spreading the virus. 

It’s worth reiterating here that the counts you’re hearing from state officials — 108,000 people sleeping outdoors, 43,000 in shelters — are major underestimates. Not only are those numbers more than a year old, but counting the homeless is an inherently unscientific and imprecise snapshot in time. That means more emergency housing units, money and supplies will be needed than what the official stats might indicate.  

It’s also worth reiterating that other states don’t have to worry as much about this vulnerable population as California, which has the highest number of homeless residents in the country and by far the most living outdoors. Many of those homeless are seniors who have chronic health conditions and are particularly susceptible to COVID-19. 

But there are other dimensions of the housing crisis that are making it tougher for public health authorities here to manage the pandemic. Mostly because it’s so expensive to live here, California is the worst state in the country when it comes to overcrowded housing. 

That presents complications for millions of Californians instructed to stay indoors, especially if a household member is showing symptoms of COVID-19. The Centers for Disease Control and Prevention has recommended that someone who is symptomatic should self-isolate in a “sick room” with a separate bathroom. That may not be an option. 

While the virus presents the most pressing public health risk, researchers are also concerned about the long-term physical and health effects of overcrowding if schools and workplaces remain closed for extended periods. 

“On a daily basis, people are experiencing the crowdedness of their homes for longer periods of time throughout the day,’ said Claudia Solari, who researches housing overcrowding at the Urban Institute. “That kind of longer exposure could be a problem.” 

Solari’s research finds overcrowding can be linked to physical and behavioral problems in children. 

Issue 2: Housing the unhoused amid a pandemic takes an extraordinary — and extraordinarily complicated — effort 

Newsom and local governments have announced unprecedented efforts to get people living outside to move indoors. 

The state released $100 million to local governments for emergency shelter housing, with more likely on the way; purchased more than 1,300 trailers from the Federal Emergency Management Agency to isolate homeless people who are symptomatic; and offered to negotiate leases with more 950 hotels on behalf of counties to get more people off the streets. Two hotels have already been secured in Oakland, providing 393 rooms.

The city of Los Angeles, with the largest homeless population in the state, announced today it would convert 42 city recreation centers to emergency shelters to create 6,000 new beds. 

But as sweeping as many of these actions have been, including many long sought by advocates, the task ahead is daunting and raises tough questions for public health experts and providers of services for the homeless.

“Health and healthcare are impossible to do with homelessness, they’re incompatible,” said Dr. Margot Kushel, a UCSF homelessness researcher.

Kushel points to several difficult-to-manage scenarios that may play out in coming weeks: How to discharge someone from a hospital if they don’t have a home in which to self-isolate? How to immediately house people with substance-abuse disorders without risking their health (an alcoholic could die if immediately cut off from alcohol, for example)? What to do with an encampment if someone starts coughing and running a fever? 

That last question could be especially problematic. Kushel pushes back against the notion that large-scale sweeps may be necessary, arguing that dispersing an encampment would be an even larger public health risk. But she worries that contagion could be a pretext for governments to sweep people off the streets, especially for the Trump administration, which has threatened such action before. 

State models show that 60,000 people who are homeless could be infected by the virus, with up to 20% needing hospitalization. 

Issue 3: Renters and mortgage-holders need lots of help

“I think it’s a huge number,”said Carol Galante, director of the Terner Center for Housing Innovation at UC Berkeley. 

Galante was a high-ranking official in the Department of Housing and Urban Development from 2009 to 2014, as the Obama administration wrestled with the Great Recession. 

Galante said she could easily see this crisis become worse for renters and homeowners with mortgages unless bolder action is taken by the federal and state governments — especially for Californians. 

One simple example: the $1,000 stimulus check some federal lawmakers are pushing for all Americans. That could pretty much cover your rent for the average one-bedroom apartment in Phoenix or Dallas or Atlanta. It would cover less than half of what a one-bedroom costs in San Francisco. 

“I keep thinking of all the people whose incomes have just gone to zero,” said Galante. “Hairdressers, waiters, waitresses — they can’t pay their rent.” 

Newsom has received a flood of criticism from tenant-rights groups for not doing enough to prevent evictions in the wake of the pandemic. An executive order the governor issued this week simply allows local governments to impose an eviction moratorium — if they want to. In places that have imposed a moratorium, renters would have to demonstrate financial harm from the coronavirus crisis to avoid eviction. 

The Trump administration announced a moratorium on foreclosures and evictions for federally backed mortgages on single-family homes. That would not apply to the vast majority of renters. 

Issue 4: Rents and home prices may dip, but that’s not necessarily good news 

Economists are saying the country is likely already in recession, and only the depth and breadth of a downturn are uncertain at this point. The worst-case scenarios — 20% unemployment, widespread layoffs over a prolonged period — are terrifying. Early indications are that jobless claims are reaching record levels already. 

In most recessions, home prices and rents decline alongside falling incomes and wages. If a COVID-19-induced downturn is brief and the economy rebounds like President Trump has predicted, rents and home prices might only dip temporarily. But the possibility of a prolonged drop in housing costs is real. 

Some might see a paradoxical benefit for Californians. Wasn’t the root of the “housing crisis” the fact that rents were too damn high? If housing prices drop, won’t more people be able to buy a house?  

Not really. 

A rapid decline in rents and home values might be beneficial to Californians who can keep steady incomes and stable jobs. But for lower-income earners, especially in the service sector, rents will not drop as fast as their incomes. The state will be more unaffordable, not less. 

Issue 5: If momentum for new home building dries up, trouble lies ahead

If California does enter a prolonged recession, its political leaders may want to look back to the 2010’s for a lesson in what policymakers shouldn’t do. 

While the rest of the economy picked up steam after the Great Recession, homebuilding did not — particularly in places like the Bay Area, which saw an explosion in high-wage jobs. Meanwhile, the state only incrementally replaced funding for government-subsidized low-income housing programs it had slashed during the downturn. 

The result? The housing crisis we were living in before COVID-19 hit: sky-high rents, declining homeownership, widespread gentrification and displacement and rising homelessness. 

Galante, the former HUD official, fears that policymakers may make the same mistakes, just as things like affordable housing funding and zoning reform were finally at the top of the agenda. 

“I think we need to be preparing and thinking about that recovery today, and part of that means doing the hard things,” she said. 

Those hard things? Spending more on low-income housing even if state coffers start to bleed, and reducing the regulations developers face when trying to build. 

Matt Levin is the data and housing writer for CALmatters. His work entails distilling complex policy topics into easily digestible charts.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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Half of Californians Could get Coronavirus, Newsom Warns Trump

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The USNS Mercy, a Navy hospital ship is seen docked at Naval Base San Diego Wednesday, March 18, 2020, in San Diego.

by Judy Linn for CalMatters

In a dramatic and unprecedented move, California issued a mandatory, statewide shelter-in-place order on Thursday after Gov. Gavin Newsom warned 56% of Californians — 25.5 million people — could be infected with coronavirus in the next two months.

The governor’s executive order means the most populous state in the nation will effectively shut down non-essential services — altering daily life for 40 million residents for the indefinite future. It allows Californians to continue to go outside to get food or medicine, to walk their dogs, to care for relatives and friends, to get health care, but generally, the directive is to stay at home. 

LET’S NOT REGRET. LET’S NOT DREAM OF REGRETTING, GO BACK AND SAY, ‘WELL, YOU KNOW WHAT, WE COULDA, WOULDA, SHOULDA.’ NOT WHEN THE DATA ALL POINTS TO WHERE I THINK MOST OF US KNOW WE’RE GOING.” — GOV. GAVIN NEWSOM

The order is legally enforceable, meaning disobeying can result in a misdemeanor with up to $1,000 in fines or six months imprisonment, although Newsom said social pressures will likely be enough to encourage people not to gather in the middle of a public health crisis.

Newsom said he made the difficult decision based on modeling by state health officers and new data related to infection rates in the state. Similar shelter-in-place directives were already being used by a number of Northern California counties and the governor had previously asked seniors to stay home, but Thursday’s action now applies to everyone.

“Let’s bend the curve together,” the governor said in a livestream, referring to the effort to slow the spread of COVID-19 to prevent health facilities from being overwhelmed by patients. “Let’s not regret. Let’s not dream of regretting, go back and say, ‘Well, you know what, we coulda, woulda, shoulda.’ Not when the data all points to where I think most of us know we’re going.” 

The directive was the culmination of swiftly escalating restriction in the face of an even more swiftly escalating peril. In just two weeks, Californians saw social gatherings limited first to 250 people, then only to the young and healthy, then locally outlawed in the Bay Area and some other counties. Sports events were canceled. Disneyland shut down for only the third time in history. Then millions of students were sent home from schools and colleges. Bars were told to issue their last call and restaurant seats emptied out. 

It is unclear for the moment when normalcy will return, and Newsom’s executive order was much broader than many of shelter-in-place orders imposed earlier in the week by some cities and counties. What will remain open are the bare essentials: gas stations, pharmacies, grocery stores, banks and laundromats. Restaurants can offer take-out and delivery. About 500 members of the National Guard will be deployed for humanitarian work to help distribute food.

The governor said social media companies such as NextDoor will begin to provide informational kits to check in on neighbors and loved ones. AmeriCorps and the California Conservation Corps will also ramp up outreach to fight isolation, he said.

“One-pagers so you know what kinds of things you need at home to protect yourself, those that are socially isolated, our seniors struggling with loneliness, as much or more than anything else to make sure we reach out, maybe call five people a day, just check in on them,” Newsom said.  

Newsom said his decision wasn’t made lightly. Rather, it came after weeks of effort in collaboration with the Centers for Disease Control and Prevention to model the spread of the novel coronavirus in California, according to Health & Human Services Secretary Mark Ghaly. 

“And we are very glad we had built that model,” Ghaly said. “It’s put us in a great position with our partners across the state to be prepared for what we are starting to see, which are hospitals with many patients, and patients who are in the ICU and having outcomes that we’ve seen in other countries.” 

Earlier in the day, the governor said he had warned President Donald Trump that more than half of Californians — 25.5 million people — could be infected with coronavirus over the next two months as he sought at least $1 billion in federal aid from congressional leaders.

“If we change our behaviors, that inventory will come down,” Newsom said. “If we meet this moment, we can truly bend the curve to reduce the need to surge, to reduce the need to have to go out and to cobble all those assets together.”

In a letter dated Wednesday, California’s governor requested White House assistance to deploy the USNS Mercy hospital ship to Los Angeles as health officials project the state will fall short of hospital beds needed to handle a surge in COVID-19 cases. In the last 24 hours, the state reported 126 new cases, a 21% increase, and the rate is doubling every four days in some areas. 

“We project that roughly 56 percent of our population — 25.5 million people — will be infected with the virus over an eight week period,” Newsom wrote. 

Newsom also sent a separate letter to the leaders of the U.S. Senate and House of Representatives seeking at least $1 billion in federal funds to support California’s response to the pandemic. The money, he said, is needed to purchase and set up health care facilities that the state projects it will need to treat a flood of patients. This includes using state-run hospitals, mobile hospitals and retrofitting hotels and motels.

The governor also asked for additional congressional support to help families and low-income households cope with the crisis by extending unemployment insurance, increase reimbursement for Medi-Cal, the state’s Medicaid program, suspend work requirements for food stamps as families go hungry and allocate more funding for nutrition programs for children and seniors. 

Newsom also called for loans for small businesses and technology and broadband funding for school districts with high concentrations of families in poverty as schools scramble to adapt to online learning or studying at home.  

State health officials estimate that California hospitals have the capacity to handle a surge of about 10,000 people. However, some models project the state could need twice that, closer to 20,000 extra hospital beds. 

He announced a series of steps being taken to bridge that gap. They include ramping up hospital beds by leasing motels and hotels, borrowing university dorms, staving off hospital closures and asking the federal government for two mobile hospitals in addition to the naval hospital ship.

He announced Seton Medical Center in Daly City, which had been slated for closure by Verity Health Systems, would continue operating and said a second hospital in Southern California would be named on Friday.    

While government officials are conferring with pharmaceutical companies such as Gilead in seeking treatments, Newsom said he “was pleased” to see Tesla’s CEO Elon Musk tweet about the possibility of producing ventilators. Musk said Tesla’s cars contain sophisticated ventilation systems and SpaceX, his spaceflight company, makes life support systems.

“Ventilators are not difficult, but cannot be produced instantly,” Musk replied.

In Newsom’s letter to the president, the governor asked that the naval hospital ship be deployed to Los Angeles because it will free up beds at existing hospitals and health facilities to respond to acute care needs, such as heart attacks and strokes or car accidents. 

Newsom sought to strike a chord with the president’s hometown.

“The population density in the Los Angeles Region is similar to New York City, (and) will be disproportionately impacted by the number of COVID-19 cases,” Newsom wrote.

Judy Linn covers state finances, workforce and economic issues for CalMatters. CalMatters reporter Rachel Becker contributed to this report.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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Ask an Expert: Are California’s Coronavirus Projections Solid?

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Kaiser Permanente Registered Nurse Rosa Aceves conducts a COVID-19 test at a drive up testing location at the Kaiser Permanente Fremont Medical Center in Fremont on March 11, 2020. Photo by Doug Oakley courtesy of Kaiser Permanente View Comments

by Rachel Becker for CalMatters

Gov. Gavin Newsom has said more than half the state could become infected by the novel coronavirus. To make sense of the state’s numbers, CalMatters’ Rachel Becker spoke with Lee Riley, a professor of epidemiology and infectious diseases at the UC Berkeley School of Public Health and chair of the division of infectious diseases and vaccinology.

State models project that more than half of the state could become infected with the novel coronavirus over the next two months, a threat to 22.5 million people that has prompted a statewide order from California Gov. Gavin Newsom to shelter in place except for essential activities.

coronavirus epidemiologist Lee Riley
Lee Riley, professor of infectious diseases at the UC Berkeley School of Public Health

The California Department of Public Health reports that California’s case count has climbed, as of Saturday, to 1,223 confirmed cases and 23 deaths — certainly an underestimate because of limited testing. Reports from across the state indicate that tests are being reserved for the sickest and most vulnerable because of a shortage in testing supplies that followed a slow federal rollout of tests hampered by technical flaws. 

So far, about 25,200 tests have been conducted in California’s commercial, private, and public health laboratories. But nearly 12,700 of those results are still pending — leaving California in a data limbo, without a clear sense for how the epidemic is evolving. 

CalMatters spoke with Lee Riley, a professor of epidemiology and infectious diseases at the UC Berkeley School of Public Health and chair of the division of infectious diseases and vaccinology, to make sense of the numbers. 

Why is the novel coronavirus spreading so far, and so fast? 

We don’t really know why this is happening. But one of the observations being made in China, where they have a lot of experiences now, is that the virus seems to be able to transmit even before someone becomes symptomatic

And then even after an infected person recovers from the illness, they continue to shed the virus up to two weeks to even 20 days. So there’s more opportunity for an infected person to transmit. That’s why I think so many other people get infected — because there’s many more days of infectious period for a person to contract the virus. That may be one of the reasons that it’s spreading so quickly.

I don’t have enough information about the source of the data that the governor is using to make any real comments. It’s not disclosed how those numbers were derived. The projection was probably made on not having the control measures that we currently have [such as Thursday’s shelter in place order]. If we didn’t do anything, then yes, certainly, we could have millions of people getting infected.

But we are doing things. And, I don’t know how people are behaving, but the fact that we’re not seeing the explosive increase in the number of deaths tells me that, number one, the healthcare providers are really doing a good job preventing deaths, and that measures that are being taken right now are working, at some level. 

“THE VIRUS SEEMS TO BE ABLE TO TRANSMIT EVEN BEFORE SOMEONE BECOMES SYMPTOMATIC. AND THEN EVEN AFTER AN INFECTED PERSON RECOVERS FROM THE ILLNESS, THEY CONTINUE TO SHED THE VIRUS UP TO TWO WEEKS TO EVEN 20 DAYS.”

How are the testing delays and shortages affecting those numbers?

One caveat is that these numbers that we’re getting may be somewhat delayed because as you know, the testing is increasing in number, and so there’s a real backlog of the tests. We don’t really know exactly what’s happening now. The numbers that we’re seeing are based on the tests that were done several days ago, and they’re just coming up because [at] a lot of the testing services, there’s a huge backlog right now. 

We don’t know which direction this is going to go. We may see a continued increase, a huge bump in the next several days, but that just means the results are just coming in. 

The governor’s projections that 56% of Californians might become infected, and that 20% might get sick enough to require hospitalization — can you put those numbers into context? Have we ever seen anything like it before?

If that’s true, that would be unprecedented. We always talk about the 1918 influenza epidemic, right? Even compared to that, this would be far greater in terms of the number. Mind you, when we talk about this level of infection, that doesn’t mean that all those people are going to have severe disease. 

The governor’s estimates are that maybe 20% will have disease severe enough to need hospitalization. That would still be a lot of hospitalizations, and that would overwhelm the healthcare infrastructure in California. 

What do you think of the state’s shelter in place directive — can it slow the spread of the epidemic? 

I think so. That is really, probably, the best strategy at this point, short of vaccines or other modalities. That’s what we really need to be doing. 

In Wuhan, in the province of Hubei, which is a large province in China with more people than California, they certainly didn’t have millions of infected people. The epidemic was put under control in about three months. So if we compare what happened in China to what’s happening in California, there’s a huge difference in terms of the projections that have been made. 

Although, one thing that should be stressed is that in China they had much more draconian control measures. They not only restricted international travel — people coming in to China or going out — but also intra-country travel. And so that may have also helped. The U.S. is a big country, and so far, and the U.S. hasn’t restricted intra-country travel, and even within California, we’re not really restricting travel between cities — although that’s probably going to happen anyways because people are being asked to stay in their homes. 

What do you think the future holds?

At some point, we need to start thinking about what we are going to do next year. Is the same thing going to happen again next year? If so, are we going to keep doing the same every year? We don’t know, and I think that’s important. More research needs to be done to really understand about the structure of this virus to see if this is a virus that’s going to become seasonal, or endemic [meaning it’s always around], or disappear, like the first SARS. So those are some of the issues we really need to start thinking about, and start planning for next year, and be prepared for next year. 


Rachel Becker is a reporter with a background in scientific research.

This article is produced as part of WeHo Daily’s partnership with CalMatters, a nonpartisan, nonprofit journalism venture committed to explaining how California’s state Capitol works and why it matters.

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