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Red Alert 

Pushed into an elevated risk tier as the holidays approach, Humboldt sits at a crossroads

click to enlarge Humboldt County Public Health Laboratory staff Paula Moon (left) and Alyssa McCloud catalog incoming samples for COVID-19 testing.

Courtesy of Public Health

Humboldt County Public Health Laboratory staff Paula Moon (left) and Alyssa McCloud catalog incoming samples for COVID-19 testing.

It was late last month when Humboldt County Deputy Health Officer Josh Ennis noticed the trend and started trying to raise public alarm. At a glance, Humboldt County's COVID-19 case numbers looked good. Not only were case counts decreasing sharply — going from 155 in August to 124 in September to 59 in October — but test positivity rates, or the percentage of COVID-19 tests that came back positive, remained low as well, even as larger swaths of businesses were re-opening. After some weeks of narrowly skating by, Humboldt County was sitting solidly in the state's yellow, or "minimal," risk tier, one of only a handful of counties to enjoy the least restrictive restrictions in the state.

The thing that troubled Ennis was that while the rate of cases the county was confirming was falling, it was not seeing a commensurate drop in hospitalizations. That was either a statistical anomaly or an indication that the virus spread was continuing apace locally, just going undetected.

"When we looked at our hospitalizations ... we felt there was more asymptomatic spread based on the hospitalization census numbers," Ennis said at a media availability earlier this month.

When Ennis sat down a couple of weeks later, on Nov. 13, to again answer questions from the media, it was clear Humboldt County was in trouble. By then, Public Health had already confirmed 87 cases in November, putting it on pace to shatter the county's single-month case record, and just recorded 53 cases for the week, the most in a seven-day span locally since the pandemic began.

Ennis made clear the county was seeing "unprecedented growth," but quickly added that the circumstances underlying those numbers made them all the more concerning. Instead of the large case clusters spawned by large gatherings that had driven Humboldt's case count upward in August, contact investigators were finding small clusters — a few cases here, and a few there — that were seemingly unconnected, driven by travel and spread from unknown sources within the community.

"That to me is much more concerning than anything we've seen in the past," Ennis said. "It's just so different this time around because ... more than half the cases are due to travel or community transmission, and each one of those represents a new case that has no relation to any of the ongoing investigations."

Three days later — on Nov. 16 — Gov. Gavin Newsom used an emergency provision to break from his "reopening blueprint" and announced a sweeping escalation of restrictions throughout the state, with 40 counties being moved into more restrictive tiers in an effort to control spread of the virus, which had begun to surge exponentially in some regions. For Humboldt County, that meant being moved from the state's "minimal" risk yellow tier directly into the "substantial" risk red tier, skipping the state's orange tier entirely and ushering in a new wave of restrictions on local businesses. Later that day, Humboldt County Public Health announced it had confirmed 29 new COVID-19 cases over the weekend, tying a single-day reporting record, with a test-positivity rate of 3.5 percent.

In her report to the board of supervisors the following morning, County Health Officer Teresa Frankovich noted the virus is surging in a third wave that's enveloping most of the country, including California, just as the holidays approach. Ninety-one percent of California's population has already been put in the state's "widespread" risk, or purple, tier, she said, adding that she wouldn't be surprised to see the entire state fall in that category in the coming weeks.

"Right now," Frankovich said, "we're at risk to move into purple, for sure."

While to some Humboldt County's jump from yellow to red may have seemed abrupt, it wasn't to those paying close attention. The state's tiered reporting system largely hinges on two metrics to gauge the spread of COVID-19 cases in a given county — a seven-day average of new cases confirmed per day, per 100,000 in population and the percentage of COVID-19 tests that come back positive over the same period. But the system was also designed to operate with a lag so it wouldn't be overly reactionary, whipping businesses from one set of regulations to another based on a momentary upturn or downturn, or some statistical anomaly.

As such, the data the state was looking at to assign counties to its four risk tiers lagged more than a week behind what local officials were seeing. So when the state announced Nov. 10 that Humboldt County would remain in the yellow tier with a case rate of two cases per day per 100,000 residents and a test positivity rate of 1 percent, that was based on data for the week ending Oct. 31. In real time, things were looking far more dire. For the week ending Nov. 7, the county averaged 3.6 new daily cases per 100,000 residents with a test positivity rate of 1.8 percent, which would have placed the county solidly in the "moderate risk tier." Things grew worse the next week, when the county averaged 5.6 daily cases per 100,000 residents with a test positivity rate of 2.7 percent — numbers that would have qualified for the red tier.

But looking at the numbers statewide, which included a record 10,000 new cases confirmed in the state on Nov. 15, Newsom took emergency action Nov. 16 — one day ahead of the state's scheduled reclassifications. With case numbers and hospitalizations surging throughout the state, he said it had become apparent that emergency action was required and a shift, at least temporarily, to making tier assignments in real time, as they're needed.

"Across every age group, every demographic, we're seeing cases increase and positivity rates increase," Newsom said, adding that conditions are so alarming he was considering implementing some kind of statewide curfew in the coming days. "This is simply the fastest increase California has seen since the beginning of the pandemic."

The new red-tier classification will have reverberating impacts on Humboldt County businesses. Most significantly, bars, breweries and distilleries will have to close entirely. Wineries and family entertainment centers — like miniature golf and bowling allies — will have to cease all indoor operations. Office spaces that are deemed non-essential will have to operate remotely.

"Everything else," Frankovich said, "will pretty much see a reduction in capacity."

Retail stores and shopping centers will now have to operate at 50-percent capacity, while places of worship, movie theaters and indoor restaurants will have to limit capacity to 25 percent. Gyms and fitness centers will only be allowed to operate at 10 percent of capacity. Hair and nail salons, as well as other "personal care services," meanwhile, are allowed to continue operations as approved in their workplace safety plans.

click to enlarge Humboldt County Public Health Laboratory Manager Jeremy Corrigan and microbiologist Annayal Yikum in the lab. - COURTESY OF PUBLIC HEALTH
  • Courtesy of Public Health
  • Humboldt County Public Health Laboratory Manager Jeremy Corrigan and microbiologist Annayal Yikum in the lab.
Frankovich explained that while early in the pandemic there were some cases of large-scale spreading events at salons in other areas, prevention measures like masking, distancing, limiting occupancy and disinfectant routines have proven very effective and these types of business are allowed to continue operating even in the state's most restrictive tier.

Throughout the state, some officials have questioned the rationale of the tiered system and its restrictions on businesses, noting that health officers have largely decried travel and social gatherings — everything from dinner parties and Halloween festivities to backyard barbecues and birthday parties — as primary drivers in transmissions. If that's the case, then why crack down on the business community, they ask. But others argue that the tiered system makes sense, as officials have more control over what happens in the public sector than they do in private homes and every bit helps. Plus, a study by Stanford and Northwestern universities last week used cellphone data tracking 98 million people's movements to learn that many infections happened at "super-spreader" sites, including some restaurants and fitness centers, bolstering the argument that occupancy caps are an effective tool.

During her Nov. 17 briefing of the board of supervisors, Frankovich indicated she believes there has been a degree of workplace spread in Humboldt County, positing that part of the reason the county has seen an increase in COVID-19 rates in adults aged 20 to 30 is that they are more likely to fill jobs in the "frontline workforce."

"Partly, it's just exposure," she said.

At one point in the supervisors meeting, Third District Supervisor Mike Wilson seemed to ponder whether the county and local agencies could be doing more to protect that frontline workforce, recounting his recent trip to a burrito shop where he found two young male customers weren't wearing masks and being a "little bit jerky about it." Wilson said the sole employee in the front of the house, a young woman, seemed to feel threatened and reluctant to ask them to mask up or leave. He asked Sheriff William Honsal if the county could be doing more.

Honsal responded that the first step is businesses and their employees really need "to be comfortable having those conversations" and need to say, "No mask, no service."

"If they're not comfortable with it, then really they shouldn't be working that cash register or that job," Honsal said, also taking the opportunity to note it's a misdemeanor offense to not wear a facial covering in an indoor public setting, or one where 6 feet of physical distance can't be maintained at all times.

Honsal then added that the goal is "voluntarily compliance" and employees need to ask customers to mask up and then, if they refuse, call law enforcement.

"Businesses should confront those people," the sheriff said. "If they don't leave, then call the police or sheriff and allow us to have a conversation with those people."

The sheriff also took a moment to make a plea directly to the anti-maskers who believe the facial covering mandate is misguided, infringing on their civil liberties or both.

"If we value our community, then I think we should do everything we possibly can to reduce risk to our community," Honsal said. "Your decision not to wear a facial covering could affect our businesses, our schools, our churches — everything you hold dear could be impacted by your decision not to wear a mask."

At one point in the meeting, First District Supervisor Rex Bohn wondered aloud whether some people just feel invincible or think the virus is just the flu and doesn't pose a substantial risk, before urging them to "listen to the scientists and experts."

"It's not the flu," Frankovich said, pointing out that much is not yet known about the long-term effects of COVID-19 infection, which have been preliminary linked to cardiovascular, respiratory, renal and neurological issues. "We don't know as much as we're going to know about the virus, but the one thing we know about the flu is that if you get it and you survive it, you're fine. We can't say the same with COVID."

There's simply no question that COVID-19 is surging throughout the county, state and country at a terrible time. The weather is turning colder throughout much of the country — and wetter in Humboldt — making it harder for people to gather outdoors and tempting them to do so inside, which studies have repeatedly shown to be much more dangerous as the virus is airborne and can linger for hours in enclosed spaces.

"COVID likes the indoors," California Health and Human Services Secretary Mark Ghaly said at the state's Nov. 16 press conference on the new tier restrictions, adding that sitting across a dining table from someone unmasked while eating and drinking is a moment of "high transmission risk."

The spike also comes as the holiday season — traditionally the single largest stretch of travel and multi-household gatherings of the year — rapidly approaches.

For weeks, if not months, Frankovich and Ennis have warned residents that travel and social gatherings are the primary drivers of infections in Humboldt County. When it comes to travel, they said many local cases have been tied to both people and families traveling outside the local area to visit friends and relatives and returning with the virus, as well as local households welcoming out-of-area guests who unwittingly bring the virus with them. And despite repeated warnings throughout the pandemic, Frankovich told the board Nov. 17 that people continue to gather socially with people outside their households.

"It's a significant risk," she said. "We've had instances with dinner parties in a home where most of the individuals at that dinner become ill."

In a video released to the community Nov. 16, explaining what Humboldt's move to the state's red tier means, Frankovich ended with a plea.

"If we want to be able to keep our schools operational and keep our business community operational, we have to stop gathering, and that's a particularly difficult challenge at the holiday season, but it's essential to protect our families and our community," she said. "I'm really asking for everyone's cooperation in this — our holidays this year need to be just our households. That's where the celebration occurs. We can Zoom. We can call. We can have other forms of communication, but we simply cannot be gathering multiple households indoors."

During his Nov. 13 media availability, Ennis issued a similar plea, explaining that local healthcare capacity is currently sufficient to handle the rising COVID-19 caseload but is "stretching" with a trajectory that is scary and cannot continue. He cautioned that Humboldt County is "somewhat of an island" when it comes to healthcare and that hospitalizations generally trail some weeks behind rises in 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."

And that means slowing the rate of spread and flattening the curve, Frankovich told the board, explaining that the goal is simply to keep hospitals from being inundated with so many cases at once that it imperils healthcare workers and makes care unattainable for non-COVID patients. If the current rate of infections continues, both Ennis and Frankovich expressed grave concern that contact investigators will be unable to keep up with efforts to identify and isolate case clusters, leading to even more exponential growth, which would then overwhelm the system.

The county is at a critical juncture, both said. The good news is that there's no mystery what needs to be done. People need to stay home as much as possible, refrain from gathering socially with people outside their households, wear facial coverings when in public and practice physical distancing at all times. And they need to wash their hands.

"The tools work," Frankovich said. "We know that. We just have to use them."

Thadeus Greenson (he-him) is the Journal's news editor. Reach him at 442-1400, extension 321, or [email protected]. Follow him on Twitter @thadeusgreenson.

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Thadeus Greenson

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

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