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Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith Friday April 17, 2020 How Do We “Keep A Lid On”* COVID-19? *Definition of “keep a lid on”: to control (something), to keep (something) from becoming worse Current status: That is the topic of the day. Alpine County has been fortunate so far. We have only had one laboratory confirmed case of COVID-19, who was never hospitalized, and is now recovered. All of the residents who have been tested are negative, with no tests pending. None of our healthcare workers, including first responders, have become ill. All our surrounding counties – Calaveras, Amador, El Dorado, Douglas, and Mono – have had gradually increasing numbers of cases, but I would not consider any of them “hot spots”. California now has over 26,000 cases, over 900 deaths, and over 3,000 cases in healthcare workers. There are a number of “hot spots”, specifically Los Angeles and over 100 nursing homes among others. Guidelines: What can we do to keep Alpine County healthy? This week, both Governor Newsom and President Trump have released guidelines for planners at the federal, state, and local levels to begin the process of loosening the strict social distancing measures that have been implemented, which are not sustainable for the long run. All of them emphasis a phased rational approach, but do not dictate timelines. Statistical models attempting to forecast the future are changing every day in response to new data. Decreasing numbers of new cases and hospitalizations are reason for cautious optimism, with emphasis on the word “cautious”. Gov Newsom outlines 6 critical indicators: before-modifying-the-stay-at-home-order-and-other-covid-19-interventions/ President Trump: Public Health Brief Richard O. Johnson, M.D., MPH Nichole Williamson Public Health Officer HHS Director Office: [PHONE REDACTED], Ext 249 Office: [PHONE REDACTED] e-mail: [EMAIL REDACTED] 24/7/365 Emergency Contact Numbers Dr. Johnson’s cell: (760) 914-0496 Dispatch: [PHONE REDACTED], Ext 330 ---PAGE BREAK--- Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith Let’s highlight some of the key issues: 1. healthcare system capacity All planning includes the need for our healthcare system to be able to handle projected surges of illness. Clinics and hospitals have developed the ability to greatly expand their capacity in terms of space and beds, but that also requires equipment such as ventilators. The most valuable asset is staff, and even with the use of personal protective equipment (PPE), many have become ill as they serve on the frontlines. We can become creative and increase the supply of PPE with 3D printers, but in Alpine County we do not have replacements for EMS, fire, law, or clinic staff if they are exposed and need to be quarantined for 2 weeks or become ill and need to be isolated. Up to this point, our nearby hospitals have fortunately not experienced a surge of COVID- 19 patients. 2. case finding and contact tracing The key to preventing or limiting community transmission with a virus such as COVID-19 is aggressively searching for any potential cases. If that person is identified early and can be isolated, then vigorous contact tracing can be carried out by public health staff. This enables contacts to be identified and quarantined. These measures will limit the possibility of any further spread in the community. 3. testing There are two main tests for coronavirus, and they have different purposes. The favored tool to diagnose active COVID-19 infections is the polymerase chain reaction, or PCR, test. It uses a cotton swab to collect samples from the nose, which are then examined for the virus’ genetic markers. These tests are in high demand and are generally reserved for the most severely ill patients. While PCR tests can identify the sick, they are unable to detect if someone once had COVID-19 and subsequently recovered. The test that can check for past exposure to the virus is the serology test, which searches for coronavirus-related antibodies in the blood. Knowing who previously has been exposed lets health officials determine the breadth of infection in the wider community, establish who may be immune and help guide public policy on lifting restrictions. This is the concept of herd immunity, described here: 19/articles/achieving-herd-immunity-with-covid19.html Thus far, testing in California has been sluggish. As of Tuesday, April 14, about 215,000 people in California had been through a standard PCR test. With state population of 40 million, that works out to about 5,385 tests per million people. That’s quite a bit lower than the rate for the U.S. as a whole — 9,157 tests per million, according to public data compiled by Worldometers. And the U.S. lags woefully behind dozens of other nations, including Iceland (106,490 tests per million residents), Bahrain (40,762 tests per million), Switzerland (22,993 per million), Germany (15,730 per million) and even Russia (9,593 per million), according to the data. In Alpine County, we are currently able to offer the PCR test to determine if you are currently infected. We are exploring serological testing for surveillance purposes, in order to better understand how many individuals have ---PAGE BREAK--- Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith experienced infection with no or minimal As of this week, the FDA has issued Emergency Use Authorizations (EUA) for 3 testing kits. We will continue to examine our options as kits are approved and available. 4. treatment There are many trials underway, with some encouraging results. A Remdesivir trial shows promise, whereas experience points out significant risk of cardiac side effects. 5. vaccine Again, much work being done, with small numbers of humans being vaccinated. This is still at least 12-18 months away. The incredible desire to have an effective vaccine soon needs to be tempered with the need for safety. See the 1976 swine flu experience: 1976-swine-flu-outbreak With these key issues in mind, we have 3 options: The first is to drop all protective measures and let the virus have its way with us. That is unacceptable, as more than 500,000 Californians would die. A second option would be to continue as we are. However, that is not sustainable for us as a society. Therefore, we consider the third, which involves a phased rational relaxation of the physical distancing measures which we have taken based on data. Difficult decisions will need to be made in terms of timing, indicators that need to be in place, triggers for action, and allowance of local or regional approaches. I want to emphasize that this will be a long slog over the next few years, with periods of relaxation alternating with periods of increased restrictions whenever there is a significant surge in new cases. I would expect increased “compliance fatigue” as time goes on, with more resistance to measures imposed on the individual in the name of protecting the community. In Alpine County, we have already begun this process, and will have more definitive information and decisions in the coming weeks. Examples of decisions that will need to be made: - When and how to re-open workplaces to those workers who have been working at home or laid off/furloughed - When to reopen restaurants, bars, pools, campgrounds, fishing season, museums, libraries, schools, daycare, hotels, motels, short-term rentals, and all other commercial businesses, and under what conditions/restrictions - When to permit large events/activities, such as bike races, concerts, summer camps, etc. Let’s be honest. The biggest risk for Alpine County is travel. And I don’t mean just visitors coming into the county from areas with COVID-19 activity, but also residents traveling to areas with COVID-19 activity and bringing it back with them. Certainly, there are types of travel to avoid, such as cruise ships. Very possibly large concert ---PAGE BREAK--- Alpine County Health Department, 75-B Diamond Valley Rd., Markleeville, CA 96120 Alpine County Board of Supervisors, Phone: (530) 694-2281 District 1: Donald M. Jardine, District 2: Ron Hames, District 3: Katherine Rakow, District 4: Terry Woodrow, District 5: David Griffith venues and sporting events will be radically different in the coming months. Between those large gatherings and total isolation, there are many other places and events where careful planning will allow things to happen, albeit with modifications, such as camping, weddings, family reunions, summer vacations, etc. As we plan together over the next weeks, let us keep in mind the importance of staying mentally well and socially connected in addition to staying physically well. Here are some resources to look at for you and your family as we “Stay Together While Staying Apart”. Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak: Stress and Coping: ncov%2Fprepare%2Fmanaging-stress- anxiety.html?utm_campaign=20200416_cvd_prv_gal&utm_content=english&utm_medium=email&utm_source =govdelivery The California Surgeon General’s Playbook: Stress Relief During COVID-19 offers stress management information, specific “stress busting” strategies that can be used at home, and a self-care template for adults. The California Surgeon General’s Playbook: Stress Relief for Caregivers and Kids During COVID-19 offers information on stress management for kids, specific “stress busting” strategies, and a self-care template for kids. Automated texting for COVID-19 information is active in Alpine County. Text "covid19" "covid" "coronavirus" or "corona" to 211-211. Alpine County Warm Line: [PHONE REDACTED]