Crossroads 

Humboldt County's Joint Information Center had planned to close for the county holiday on July 3, a move that would save overtime expenses and give most of its employees three consecutive days off for the first time since the COVID-19 pandemic breached the Redwood Curtain. Then came the test results.

The number of local cases had already been spiking over the course of a couple weeks when the latest batch of results came in on the eve of the holiday weekend with six new confirmed cases — a single-day tally eclipsed on just three occasions since the county began reporting test results March 16. Officials gathered a few staff members and put together a brief press release to make the public aware of the results and note that roughly a quarter of the county's cases to that point had been recorded over the previous two weeks. About a week earlier, having watched California's caseload balloon in alarming fashion with thousands of new cases reported on a daily basis mirroring a national trend, Humboldt County Health Officer Teresa Frankovich issued a pleading message to the community warning the county was at a "crossroads." She added a couple of quotes to the July 3 press release urging residents to behave responsibly over the holiday weekend and to put community over revelry and the temptation to gather with friends and family.

"This (recent case spike) has been driven largely by residents gathering and visiting between households both locally and while traveling, as well as by illness occurring in the cannabis industry workforce," she said in the release. "In order to avoid having Humboldt County become yet one more COVID-19 hotspot in the state, prevention is key. It is still within our power to change the course of this pandemic."

Did local residents heed the warning? We won't know for at least a few weeks, and that's one of things about this virus and current testing capacity that confounds health officials trying to get the public to exercise restraint and caution. It's often said COVID-19 test results are just a snapshot in time — just a measure of whether someone is infected at the moment they are tested, giving no indication whether they'd previously been sick or would catch the virus in the future. What's talked about less is the fact that the results are a snapshot back in time, giving more insight into conditions two or or three weeks ago than the current state of things. That's because the virus' incubation period is believed to extend up to 14 days and — as infection rates spike throughout the state and country — national testing laboratories are facing increasing backlogs and slowing the turnaround times for results to a week or more.

The best local example of this delay came when, five days after Frankovich issued a shelter-in-place order confining residents to their homes except for essential outings, Public Health confirmed two new cases on March 24, kicking off a streak that would ultimately see 48 cases confirmed over a 15-day period. That spike was followed by a lengthy lull as the impacts of shelter in place finally began to show up in the testing data, with just five cases confirmed over the ensuing month.

Speaking to the Humboldt County Board of Supervisors on July 7, Frankovich said it takes at least two weeks for test results to begin reflecting a surge in virus transmission but she believes it's generally longer than that.

"Much of what we're seeing now dates back to around Memorial Day — I think that's when people started emerging. COVID can circulate in small numbers really sneakily," she said, before turning her attention to when the conduct of local residents over the July 4 weekend might be reflected in test results. "It may take six, even 10 weeks before we see the full impact."

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Clusters

As Humboldt County's COVID-19 case count continues to rise — five confirmed cases July 6 and five more as the Journal went to press July 7, bringing the countywide tally to 154 — officials are gaining a better understanding of how it is circulating. Highly infectious indoors, COVID-19 moves in household clusters, said Deputy Public Health Officer Josh Ennis. Someone will bring the virus home, and soon it will have infected everyone within a household.

"This disease travels in clusters," he said during a July 2 media availability. "Something like 80 percent of all cases are in household, where people share indoor spaces for prolonged periods of time. But all it takes is one of those people to have contact with someone in a different household and all of a sudden it jumps from one household to another entire household."

While the current case spike that has seen 46 cases confirmed locally since June 19 coincides with sectors of local businesses being cleared to re-open in modified capacities, Frankovich has repeatedly said contact investigations have traced infections back to social gatherings — family members or friends from different households getting together for barbecues, birthday parties or other events. In some cases, she said, travel has been involved, with someone carrying the virus into Humboldt County for a visit with a local household or a local traveling somewhere else, contracting the virus and bringing it back to their household. But gatherings are the nexus that connects one household cluster to another.

When asked by a reporter in a recent media availability about direct flights between the local airport and Los Angeles resuming July 6, Frankovich's responded that travel has long been a concern of health officials but quickly noted that far more people enter and leave Humboldt County by car than plane. Then she offered what seemed a cold truth for people looking to blame local infection rates on outside forces.

"To date, the drivers of travel-acquired infections in our community have been our own residents leaving and coming back to the area. It hasn't been tourism," she said.

Later addressing the board, Frankovich offered: "The moral of the story right now is, as much as we want to, it's not the time to be traveling. We also can't be socializing with other households and certainly not indoors."

But the further Humboldt County residents emerge from the spirit of shelter in place, the more officials warn of the potential for mass spread events that expose large groups of people to the virus before sending them back to their households. Speaking to the board, Frankovich and Sheriff William Honsal both said they've received reports of weddings and private parties planned in the near future, some with hundreds of guests invited. Frankovich explained that such events are incredibly dangerous at this point because they could quickly overwhelm local capacity to isolate the virus.

Contact investigations — in which trained Public Health investigators work backward from a confirmed case to identify everyone a person has had contact with since becoming infectious and putting them in quarantine before they can unwittingly spread the virus to others — have been crucial in limiting COVID's spread locally, officials say. But a scenario that sees a high number of people exposed at once — say 100 at a wedding — could quickly overwhelm Public Health's capacity to find and isolate those carrying the virus, leading to a period of unchecked spread or a shutdown.

"Gatherings like that are really not allowed under state orders or local orders," Frankovich said. "I just want to remind people about that."

'Hugely Problematic'

When Humboldt County's OptumServe testing site opened to the public in May, it was heralded as a great success as the first such site to open in the state. The site allows locals experiencing mild or no COVID-19 symptoms to schedule an appointment to have a sample taken, which is then sent to a corporate laboratory for processing.

Initially, those labs were turning around tests results within 48 to 72 hours. But as caseloads have spiked throughout the state and country in recent weeks, and testing has ramped up, the laboratories have become overwhelmed, causing supply chain shortages and testing backlogs. Describing the situation as "hugely problematic," Frankovich said it now sometimes takes the labs up to eight days to report the results from samples taken in Humboldt County.

"Nobody wants to find out six days after they were tested that they are positive," she said, later telling the board it's "really imperative that we find some other (testing) solutions."

The slow turnaround times for a positive test greatly hamper contact tracing investigations and increase the chances for spreading the virus, she explained. After all, if it takes eight days to get a positive result instead of two, that's six days' worth of potential contacts investigators have to track down and interview, which adds up quickly when spread over dozens of cases.

During the July 7 board meeting, First District Supervisor Rex Bohn suggested the county's new dashboard display the number of active cases — not just the total recorded to date. While the total — 149 at the time of the meeting — seemed like bad news, he suggested the number of active cases — 13 — could be seen as more positive.

"I'm kind of trying to put a little bit of positives out there," he said.

But Frankovich responded that the low number of active cases, when gauged against the spike in positive cases reported recently, isn't really a good sign. Instead, she said, it speaks to the testing delays and the fact that the county is currently identifying cases after people have already been sick for some time, meaning they may "recover" sooner but have also potentially been spreading the virus longer.

"The earlier we are able to identify cases, the more active are active," she said. "In general, I would rather have our active case list higher because it would suggest we are catching cases earlier."

Kids and Schools

When looking through the dashboard of COVID-19 case data, there is one area in which Humboldt County seems a clear outlier: infection rates among children.

Children under the age of 18 make up just 7 percent of confirmed COVID-19 cases nationally and just 8 percent statewide. But 12 percent of Humboldt County's cases have been confirmed in people under the age of 19. (It's unclear why the county went with 19 and under as opposed to 18 and under.)

Frankovich said it's been a bit of a mystery how much COVID-19 is circulating through child populations. While 58 children have died nationally of COVID-19, data and numerous studies have so far indicated children are much less likely to become critically ill with the disease and more likely to experience minor or no symptoms. Especially in the United States, that means they have been much less likely to get tested, so she suspects the lower national and state numbers simply reflect that not many children have been tested. But Humboldt County, she said, has been conducting contact investigations and had the capacity to test entire households from the beginning, to which she attributed the higher rate in the under-19 population.

"The vast majority of these cases, perhaps all of them, have been contacts of known cases," she said. "So they've come to testing and identification because we are making a really concerted effort to test even those without symptoms in households of people who are identified as cases. I think that really, in our population, explains why we're seeing that higher number in that age group."

What exactly that means remains unclear. While to date children have been much less likely to get seriously ill, the long-term impacts of the new disease are unclear. While initially thought to be solely a respiratory disease, there's a growing body of evidence to suggest it's much more than that and, in some cases, attacks the kidneys, brain, heart and liver. It has also been confirmed to lead to a rare life-threatening inflammatory syndrome in children, leading to hospitalizations with wide ranging symptoms that include swelling, rashes, fever and abdominal pain. But confirmed cases of children hospitalized with COVID-19 remain rare — California had seen just 143 of them as the Journal went to press. But how children contribute to the spread of the virus and remains largely unclear.

Frankovich told the board July 6 she's been in ongoing discussions with local school districts for weeks now about how they might be able to re-open in the fall under guidelines released by the California Department of Public Health, the state Department of Education and even the American Academy of Pediatrics.

"Everyone's goal is getting kids back in school," she said.

But nobody's quite sure what that will look like. To some extent it will depend on conditions in the greater community, as Frankovich intoned when she warned that a lack of personal responsibility now — whether it be socializing outside the household unit or traveling — could imperil schools' ability to open in the fall. But it will also depend on Humboldt's dozens of schools coming up with site specific plans to have students on campus next year in a way that's safe for them, their families and school staffs.

According to the Humboldt County Office of Education, no local districts have yet publicly committed to a plan of what instruction will look like in the fall. Instead, they are trying to proactively plan for three options: entirely distance learning, entirely in-person instruction or a hybrid model. Tentative hybrid plans have included the possibility of splitting classes into two separate schedules to limit the number of children in a classroom at one time, whether that means some students attending in-person class in the morning and others the afternoon, or students attending school on different days. And individual districts are working to determine whether they can come up with plans that conform to state guidelines, which include everything from screening students before they step onto campus to maintaining social distancing in classrooms.

Humboldt County Office of Education spokesperson Jenny Bowen said HCOE is working with local districts as they plan to implement one of three options in the fall.

"There are still unknowns and we have no way of determining what the fall will really look like," she wrote in an email to the Journal.

'Personal Responsibility'

On July 1, Gov. Gavin Newsom announced that counties in California that land on a statewide monitoring list for three days or more will need to step back from reopening sectors of the economy, shuttering bars and movie theaters, and forcing restaurants to close to dine-in customers, among other things. It's an action the state has taken with 19 counties so far.

The monitoring list aims to track when cases are growing out of control in a given county, with increased rates of hospitalizations that threaten hospital capacity. Humboldt County has yet to make the list for even a single day, though Frankovich told supervisors that the rate of recent case growth could get us there in time. Currently, healthcare capacity isn't threatened but in a small community with a limited number of intensive care unit beds, that could change quickly, and the health officer cautioned it's important for people to understand the pattern of the virus: First comes a spike in confirmed cases, then an increase in hospitalizations and, finally, a rise in death tolls.

Stressing that she feels Humboldt County is on the precipice — at a "crossroads," as she put it — she stressed the need for personal responsibility going forward, saying people need to stick to their households and when they do go out, mask up, wash their hands and maintain 6 feet of physical distancing. Everyone is tiring of sheltering in place, she said, and we all want to visit family and friends. But that's what drives this virus, she said, noting that the more the virus spreads, the greater the chances of it hitting those most at risk.

"There is no doubt in my mind that a lot of what is driving our increases going forward is gatherings," she said. "As much as I hate to say it, we really, really need people to limit those gatherings outside their household unit. It won't be forever but it's important now. ... While the large gatherings are particularly problematic and worrisome to the community, what we're seeing right now are a lot of smaller gatherings. It's 10 to 20 people at birthday parties, barbecues and things like that, each of those generating additional cases and quarantined people who are exposed. We just really need to limit these activities right now.

"It should be your household unit and you outdoors doing all the things we love, just not with other families right now."