Saturday, November 14, 2020

Deputy Health Officer Warns County Seeing 'Unprecedented Growth' of COVID-19, Will Likely See Increased Restrictions

Posted By on Sat, Nov 14, 2020 at 10:27 AM

click to enlarge Humboldt County Deputy Health Officer Josh Ennis. - SUBMITTED
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  • Humboldt County Deputy Health Officer Josh Ennis.

Just hours before Humboldt County announced it had confirmed the most COVID-19 cases in a single week since step pandemic began, Deputy Health Officer Josh Ennis sat down to answer questions from the media and issued a dire warning. The county is seeing "unprecedented growth" with the virus that, if it continues, threatens to overwhelm the local healthcare system and Public Health's efforts to  identify and isolate the virus to prevent further spread.

And while Ennis stopped short of predicting the county would be moved out of the state's "minimal" — or yellow — risk tier when the state updates its data Tuesday, he made clear he feels that due to a lag between on-the-ground conditions and the data the state is looking at, waiting two to three weeks for state intervention may be "too late."

"I think that it is very likely that we as a county will be moved into a more restrictive tier," Ennis said.

Perhaps most concerning about local conditions, Ennis said, is that the spike in numbers hasn't been driven by a large case cluster but lots of small ones that are seemingly unconnected. When the county last saw a significant spike in virus activity, it was driven by several chains of transmission, with most new positives being linked to a known case. This time, he said, most new cases are classified as travel related — meaning the person traveled outside the county and returned with the virus — or community transmission, meaning the person did not travel outside the county or come into contact with a known case, leaving contact investigators to believe they acquired the virus from an unknown source in the local community. Either way, each confirmed case represents a new chain of transmission in the local community, increasing the risk for exponential spread and stretching the capacity of contact investigators.
"It's so different this time around," Ennis said. "More than half the cases are due to travel or community transmission, each one of those represents a new case that has no relation to any of the ongoing investigations. That to me is much more concerning than anything we've seen in the past, so any argument to potentially stay in the yellow at this point, I think does not have legs to stand upon."

As the Journal reported this week, Humboldt retained its “minimal” COVID risk status Tuesday, according to the data released under California’s “Blueprint for a Safer Economy," which was updated based on data for the week ending Oct. 31. For that week, Humboldt had an adjusted case rate of 2.0 — which the state describes as a seven-day average of daily new COVID-19 cases per 100,000 residents — and a test-positivity rate of 1 percent.

But for the week ending Nov. 7, the county averaged 3.6 new cases per 100,000 residents with a test-positivity rate of 1.8 percent — numbers that would place it solidly in the state's "moderate" risk tier if they persisted for consecutive weeks. This week, the county averaged 5.6 daily cases per 100,000 residents with a test-positivity rate of 2.7 percent, which would push the county into the state's "substantial" risk tier, forcing bars to close and restaurants, gyms and other businesses to significantly curtail indoor operations.

The Journal emailed all five Humboldt County supervisors and Sheriff William Honsal on Friday asking if — given the escalating numbers — they think the county should proactively implement further COVID restrictions regardless of what action the state might take or when it might take it. Only Supervisor Mike Wilson had responded by the time this article posted. (If others respond, we'll update this post accordingly.)

Wilson said these are "significant decisions" and that he tries to make it a practice not to jump out ahead of processes in place or county health officials.
"However, I will say that considering the trends, I believe it would be very prudent for local businesses to be prepared to move to a more restrictive tier sooner rather than later," Wilson said. "Flexibility is key. I would also ask that families and friends be extra vigilant about masking, distancing and hand washing and limit the size and frequency of any gatherings, especially as we move into the holiday season. ... Our community has shown we can control the spread of this virus and I believe we can reverse the current trend if we work together."

Ennis similarly urged local residents to exercise caution and restraint as the holiday season approaches at a time when the county and country are seeing "unprecedented rates" of disease growth that "is truly stretching healthcare systems."

"This is about social responsibility to some degree and, so I'm asking folks, now is the time to really question if you should be bringing people together and whether the travel that you're pursuing in the future is really worth taking the risk of overwhelming our own local healthcare capacity," he said.

A state database shows that Humboldt County currently has three confirmed COVID-positive patients hospitalized locally, with another four suspected to have the disease. Answering a question about healthcare capacity, Ennis said there currently is sufficient capacity but residents need to remember Humboldt County's healthcare system is "somewhat of an island" and that hospitalizations generally trail some weeks behind case numbers.

"We have four hospitals across the county and the next hospitals are quite a ways away," he said. "We have to work hard to make sure we can take care of our own because when we see a surge in hospitalized cases, it's very likely that the normal receiving hospitals around us are going to be in similar scenarios. So we really need to work hard to make sure we can manage whatever happens here locally."

Ennis also noted that cases "are starting to intersect" with local health care workers, which impacts the system's ability to staff beds and patients.
Throughout his media availability, Ennis underscored the point that current conditions in Humboldt County are unlike anything seen locally to date.

"This is truly different this time," he said. "It is spread out across many different sectors, many different settings. We have no one large cluster that's driving these numbers. It is very different."

See the full transcript of Ennis' Nov. 13 media availability copied below:

Good afternoon, thank you for being with us today, would you like to start by addressing the community?

Yeah I'd like to take this opportunity to talk a little bit about where we're at and how the tier framework might be able to adapt to certain situations.

So right now across the state, as well as our own county, we're seeing unprecedented growth. The volume is of concern but even more than that is the acceleration, so how quickly that volume has taken off. Just two weeks ago we had far fewer cases, on the order of very low single digits per day, and now we have days where we're consistently in the double digits.

The tier system looks at a couple different things, but one of them that many people can understand, is the case rate, so how many new cases per 100,000 people we see every day. The state looks at that every Tuesday and they're looking at data that's 17 to 10 days old, okay so there is a substantial lag in the period of time that they're looking at, and on top of that, they are looking at that data and looking for increases spanning two consecutive weeks. So really movement within the state's tier framework is two-and-a-half, three weeks later, so naturally you can see if we've sped up dramatically during that lag period time, intervention is coming really way too late.

So to bring it back home to our own county, the acceleration has been quite dramatic, this prior week we saw that we stayed within the yellow tear by the skin of our teeth and come next week that could look very different when the state looks at our metrics. I'd also like to mention that within all this framework, within all the guidances, the state has allowed the county the opportunity to exercise some amount of local control, to be more restrictive than the state, and that is something that many folks outside of our own county, in local health jurisdictions, as well as folks even within the state, are discussing given the very concerning trends with acceleration of the cases as well as the volume and what we're seeing happen across the entire nation that is beginning to threaten some of the health care systems in in many of these other states.

Thank you. We'll get into questions from the media. The Redheaded Blackbelt asks, "Reader-submitted question: Because of the discomfort with the swab test, why is the county not using the spit tube process used by major league baseball and other sports? does this have something to do with the cost of the test?"

First I'll just I'll clarify that there are two different type of nasal tests that are commonly used in our county. One is the nasopharyngeal swab or NP swab for short and this is the very deep nasal swab. There are some sites such as the Optum Serve site that is a state contracted entity that has their own decision making and so we cannot determine what type of swap they use.

The county, on the other hand, where we can exercise more control or make recommendations to local organizations, has adopted the position of recommending that an anterior nare swab can be used, this is the very front of the nose, it is far more comfortable than that very deep nasal swab. And that is the one that we have generally supported, it's the one that we accept and compliance with it is far more acceptable than the deep nasal swab. Now for the spit test, the jury was still out very early on, it seems that it is proving to be reliable enough that you can probably use it. Now the FDA issues emergency use authorization for these different testing platforms with very specific restrictions to what what type of specimen collection it can be, and I can say that amongst all the testing platforms we have in the county none of them have FDA emergency use authorization for use with saliva, so from a very practical standpoint we can't use those specimens quite yet, that could change in the future but we do we don't have permission at this time from the FDA.

Thank you. The Redheaded Blackbelt asks, "As the holiday season ramps up large gatherings are normal. Can you describe the process that happens if someone calls into the COVID Joint Information Center at 707-441-5000 with a concern about a large gathering they know is being planned?"

So our JIC is still receiving concerns and complaints about this and I'll remind folks that this is forwarded on to the appropriate jurisdiction for which they're received. Ultimately I'm gonna again ask that we maintain some amount of social responsibility here, that people in light of what's happening across the country, in our county, really question if they need to bring multiple households together, especially across state lines, in a time when we're seeing unprecedented rates of growth of disease that is truly stretching health care systems. So again this is about social responsibility to some degree and so I'm asking folks, now is the time to really question if you should be bringing people together and whether the travel that that you're pursuing in the future, is really worth taking the risk of overwhelming our own local health care capacity.

Thank you. KMUD News asks, "What are the chances Humboldt will be required to phase back down into greater restrictions again? Can you predict if and when that could happen?"

I cannot predict it, because throughout the coarse of tracing as well as a case investigation we learn more and more information and it changes something we call the episode date. So cases may fall into one reporting week and then they may get moved into another reporting week and so for that reason, we can only produce best estimates of the data that the state is going to be producing and looking at come each Tuesday. That being said, with what we're seeing across the state, is that many counties are being moved into more restrictive tiers. Just last week many of the Northern California counties were in the yellow. This week almost all of them are at least in the orange and some in even more restrictive tiers. I think that it is very likely that we as a county will be moved into more restrictive tier.

Again I'll note though, that the lag is very significant between what the state framework requires and what we're actually seeing on the ground. If we had our original alert level system we likely would move well in advance of the state requiring that movement because three weeks late, it is really too late to be intervening.

Thank you. KMUD News asks, "What symptoms are common in patients who more recently tested positive? Has the colder weather altered how COVID-19 affects people?"

The symptoms of COVID-19 span a huge spectrum, asymptomatic at one end, fever, cough, headache, body aches at the at the other end requiring oxygen, ICU level care. I'd encourage you to go on our website and you can actually see what percentage of symptoms folks within Humboldt County have had. Now I will point out that there is one symptom in particular that seems to be fairly specific to this and that's loss of sense of smell and taste.

Now I'll use this question as an opportunity to ask people if you are symptomatic, if you have new symptoms that are abnormal that are on that list, you need to act on that, please seek out a test and stay at home until you get those test results. We are seeing far too many people who seek a test at least a week in the symptoms, it takes a few days to get results, and now we've lost our opportunity to break that chain of transmission. So please, if you're having new symptoms, believe that they're symptoms, stay at home, get a test and help us to break the chain of transmission.

Thank you. The Senior News asks, "Public health officials in the Bay Area are recommending two-week quarantines for people who travel outside their home county once they return. Is that also the recommendation for Humboldt? And what about people traveling into Humboldt from places with higher infection rates, whether another California county or out of state? Should those people self quarantine when they get here?"

So we are actively revising our own travel guidance and we have yet to release the new travel guidance but I'll go ahead and say it here. If people travel out of county, if they travel out of state, if they're bringing people from out of state, we recommend the safest option as a 14-day quarantine. I said this up front, but I'll say it again. Half of all our new cases are being driven by travel and in most cases it's travel out of the state.

If we look at community transmission as well, that is starting to tick up as well, and so it's really folks who don't know that they're actually infected or don't know that they've been exposed, they're picking it up in places that we're not capable of following through contact tracing, and that is the biggest concern to me. So really ask yourself if you should bring households together, ask yourself if you really need to travel right now. We're seeing unprecedented levels of disease across the entire country.

Thank you. The Times-Standard asks, "How many contact tracers does the county currently employ? What is the maximum number of cases the entire tracing team could track in a single day? What daily challenges face the tracing team? How would you describe the public's willingness to cooperate with tracers?"

Giving an exact number to our contact tracers is difficult because we have a number of folks who volunteer for the position, they come in and out of availability, and so I think I could generalize and say that it's on the order of low to mid-teens at any given time. Above these tracers though you should keep in mind that we have investigators, these are all public health nurses and they typically have a couple tracers underneath them, above them we have what we call task force leaders, they're capable of doing any amount of investigation and tracing as well, and so we have a fairly large operation at this point. It's hard to pinpoint the maximum number of cases that we could track at any one given time and it's because 50, if they're all related to community transmission and they're all individual cases that aren't related to one another, is very different than 50 that are entirely related to a single cluster. And so it's really difficult to give a number.

I will tell you though that the current volume is a challenge at this time. We are staying on top of it but if case growth continues at the pace it is we may have to consider dramatically reorganizing how we do things. And we are not alone in this, other counties have done this in a very different way and they have pulled back months ago and but make no question of it, the reason we've done so well is because we've been supporting intensive investigation and tracing up until this point.

Thank you. The Times-Standard asks, "Would you recommend Georgia Tech's COVID risk assessment tool to the public? Do you think the website offers help for people looking to determine risk factors and holding gatherings with the holiday season approaching?"

This risk assessment tool is I think a fantastic resource. I think what you need to know though is that it, just like our own state's tier framework, has a significant lag. It's pulling data that's made available publicly which tends to have quite a bit of a lag to it.

I think when we're talking about the idea of gatherings during the holidays, people need to know that almost the entire nation has significant burden of disease, we are seeing it tick up faster than it ever has before, and this is now our third wave and this is far more concerning than the prior two when it comes to looking at Humboldt County alone.

So I'd really encourage you to think about whether you should bring those folks from out of the county, from out of state, and whether it is worth taking that risk right now. It is very likely at this point that people coming from elsewhere by virtue of where they live or the convenience of travel may have been exposed to COVID-19 and they may not know it when they first show up.

Thank you. The North Coast News asks, "With a huge increase in COVID-19 cases this week, how close are we to falling back into the orange tier?"

I think I spoke to this earlier somewhat, the case rate is certainly very concerning and I think it's very likely that our numbers will fall well within that range, but again because episode dates move, I don't know that we can say for certain at this time.

Thank you. The North Coast News asks, "If we were to have a large influx in cases what is the emergency room capacity locally how many cases could the county handle at once before our system would become overwhelmed?"

Looking at emergency room capacity is is probably not where we should be looking for talking about health care capacity, but the essence of this question is talking about the health care system.

Our health care system is somewhat of an island here. We have four hospitals across the county and the next nearest are quite a ways away. We've looked at how many beds we have across the four facilities, we've looked at the ICU beds, the ventilator capacity, and we know that because we're an island, we have to work hard to make sure we can take care of our own, because when we see a surge in hospitalized cases, it's very likely that the normal receiving hospitals around us are going to be in similar scenarios. So we really need to work hard to make sure we can manage whatever happens here locally.

We're paying very close attention to this right now. I would say that our hospital system is well prepared because we've had many months to prepare for this and what we are seeing as one of the biggest risks here is our health care workforce capacity. We have enough disease within the community that they are, cases are starting to intersect with some of our health care workers and that is going to impact our ability to be able to grow the number of beds, ICU beds and vented patients that we can take care of at any one time.

Thank you. The North Coast News asks, "Do you think the announcement of the vaccine this week led to a decreased caution around preventative safety measures because people were feeling more hopeful?"

I'm not really sure that the vaccine contributed in large part to the decreased caution, I think people are very tired of the pandemic. I think that this has been ongoing with changes in behavior for weeks, and so I would speculate that it had little to do with it. I'll remind everyone that the vaccine does not have an expected launch date, it's going to be in extremely short supply for weeks if not months, so I think that it had very little to do with this.

Thank you. The North Coast News asks, "What do you have to say to the community about the holiday season with this new increase in cases we are seeing?"

I've spoken about this in several other questions, I spoke about it up front, again ask yourself if you should really be bringing together several different households from different areas. We're seeing that as contributing to driving increases and right now the most concerning features how quickly the growth is occurring. So
I know we're asking for a lot but really ask yourself if now is the time to be doing that.

Thank you. The North Coast Journal asks, "It seems the virus is currently moving faster in Humboldt County than the tier system engineered by the state to slow its spread. Do you expect Humboldt County to be moved into the orange tier by the state Tuesday and is there a chance it could skip orange and be moved into red due to what seems to be markedly increased virus activity?"

I've spoken about the tier system and how there is some uncertainty going into the date that they make the tier level assessment.

For that reason I can't say that we are definitely going to be in one tier versus the other. I've already said that I do expect that in the near future we will land more restrictive tiers. In regards to particular colors again it really relies upon the case rates, I only have estimates at this time so I would not be able to give more detail than that.

Thank you. The North Coast Journal asks, "Based on what you are seeing regarding virus activity locally do you think there are any arguments to be made that mitigating factors support keeping Humboldt County in the yellow tier moving forward?"

I've mentioned that we barely eked by, staying in the yellow tier this past week, clearly there's been a dramatic uptick in the number of cases. Because it's so different this time around, because like I said, more than half the cases are due to travel or community transmission, each one of those represents a new case that has no relation to any of the ongoing investigations.

That to me is much more concerning than anything we've seen in the past, and so any argument to potentially stay in the yellow at this point, I think does not have legs to stand upon.

Thank you. The North Coast Journal asks, "Because of the lag between on the ground conditions and the state triggers for tighter restrictions, are there circumstances you think should prompt counties to proactively implement restrictions beyond what's under the state's framework?"

So I think I've answered this to some degree, there's a significant lag to this state's tiered framework. It's unable to adapt quite as quickly. Our own county alert level assessment tool prior to adopting the states probably would have seen movement prior then, so yes I think there are circumstances which warrant consideration of moving in advance of the state requiring it.

Thank you. The North Coast Journal asks, "Currently what's the state of hospital capacity locally? The state database shows two local COVID-19 hospitalizations with another two suspected. But taking into account all non-COVID-19 hospitalizations as well, is Humboldt County prepared for a potential spike in hospitalizations should one follow this recent increase in cases?"

I'm unsure when the COVID-19 hospitalization data was accessed or pulled, but we have seen at least two more hospitalizations that we reported out yesterday and I'd like to remind folks that we will not see hospitalizations increase for at least two weeks prior to the spike in case counts. And so there's going to be a lag there.

As I've mentioned already the hospital system is healthy at this point but we do not have the capacity across the county to absorb a huge increase. We would be reliant upon house hospitals around us to some degree if we had a dramatic increase in cases.

I don't want to alarm anyone. We have looked at the supplies that are required for caring for the sickest of the sick, that includes ICU vents, sorry ICU beds as well as vents, and we are well within the ability to continue to care for the sick, but if the current trend continues on the order of weeks, just looking at the percentages of people who end up getting sick, who end up in the hospital, that could start to threaten the health care system capacity at some
point in the future.

Thank you. The North Coast Journal asks, "You mentioned Tuesday that our current increase in cases is unlike what we saw in August because that spike was largely attributable to a handful of large case clusters linked to gatherings or travel, while current conditions are seeing many small clusters of cases. How many unlinked chains of transmission or unlinked virus clusters has Humboldt County identified over the past 14 days?"

So to give you a better idea of this I can go back to that number that I've already mentioned, the the number of either travel or travel related or community transmission cases, is around 55 percent. To put that in context, if we look back several months, we have not had a number anywhere near that great for at least since very early on in the pandemic. Now keep in mind that very early on in pandemic our numbers were very low, they're nothing like the volume now. Now that might give you a sense that this is truly different this time, it is spread out across many different sectors, many different settings, we have no one large cluster that's driving these numbers, it is very different this time.

Thank you. The North Coast Journal asks, "While test results from the Humboldt County public health laboratory seem to be reported at a consistent flow, it seems there is great variation in how results are reported from corporate laboratories. Can you discuss generally how the county is notified of these results? Do they come in large batches or a steady stream? What is the current lag time between a sample being taken and a result returned? How much variation are you seeing in that lag time?"

When a test is performed in a commercial lab there are a few different ways that we at Public Health can be notified. For Optum Serve we've worked a parallel reporting system that's more direct to us but its fallback is CalREDIE and then for most of these other labs such as say CVS or PALCO pharmacy, we generally receive results through CalREDIE, so that's kind of the backstop reporting system.

Sometimes we'll notice that there are true data dumps within that system. We may get a flurry of new positives that aren't really commensurate with the pace of testing, meaning that they're all concentrated in a short period of time, but they may span you know several days over which those specimens were collected. Currently there's there's a big range, it's between two days and seven days after collection the specimen that we're receiving the results. In general, it's been about three days and as of yesterday you know many of the specimens were right at that mark, about 72 hours later that we find out about it.

Thank you and thank you for your time this afternoon.

Thank you.
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Thadeus Greenson

Thadeus Greenson is the news editor of the North Coast Journal.

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