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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: January Riddle, District 2: Ron Hames, District 3: Irvin Jim, District 4: Terry Woodrow, District 5: David Griffith Friday January 8, 2021 Musings* from Your Public Health Officer *musing: a noun, meaning a period of reflection or thought On January 6, 2020, I wrote this: Latest Outbreak!! This is unfolding right now – but has the makings of a great (or tragic) scenario for a pan (pandemic) flu exercise someday – the progression and ending still is not written! Throw in international travel, and human-to- human transmission, and a fatality rate of 1-2%, and it becomes a 1918 flu pandemic all over again. Probably no vaccine. We already have troops moving like in 1918, and God knows what else coming down the pike this year!” That was written and sent out to our Public Health staff in Alpine County before the first laboratory confirmed case in the US, and more than 3 weeks before the WHO declared COVID-19 an outbreak of international concern. In February 2020, the US still only had 15 confirmed cases, but in March, COVID-19 hit the US with a vengeance. I hope you will indulge me as I reflect on this past year, where we are as we begin 2021, and what we need to do as we face an uncertain future. “We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line.” – Atul Gawande “Bad times have a scientific value. These are occasions a good learner would not miss.” – Ralph Waldo Emerson The Past: Who would have thought that candidates for the “words of the year” would include vaccination, herd immunity, mRNA, ventilator, travel ban, face covering, superspreader, elbow greeting, fist bump, zooming, social distancing, flatten the curve, N95, mutation, and Operation Warp Speed. 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 Number Dispatch: [PHONE REDACTED], Ext 330 Warm Line: [PHONE REDACTED] ---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: January Riddle, District 2: Ron Hames, District 3: Irvin Jim, District 4: Terry Woodrow, District 5: David Griffith Yes, a lot has changed, and we still have a lot to learn, but we have a short memory. The 1918 flu killed 195,000 Americans in the month of October 1918 alone, when the population of the US was less than a third of what it is now. Ultimately, it killed an estimated 675,000 Americans, and more than 50 million people worldwide. In some respects, that was a very different world; in other respects, nothing has changed. In 1918, the police chief in Fresno made it clear that he had “no desire to interfere with anyone’s freedom or fun”, but almost in the same breath stated that not ‘assembling indoors would do much toward checking the further spread of this epidemic that is causing so much sickness and death”. That was 1918 – not 2020. In the fall of 1918, the city of San Francisco struggled with a fierce debate: Should citizens be made to wear masks? They passed a mask law, backed up with fines and prison time, with strong resistance. People called the masks uncomfortable, and an impingement on their freedom. Hundreds were arrested, but when the law expired on Nov 21st, people threw their masks in the streets and celebrated. A surge of new cases followed, and in opposition to further laws being proposed, the Anti-Mask League was formed. The Public Health Director stated: “The dollar sign is exalted above the health sign”. Has anything changed in the last 100 years? Yes, we have learned a lot, but have forgotten tremendous lessons also. Masks, also known as face coverings, do work to protect the wearer and those nearby around them. Surges of cases were the result of changes in the behavior of individuals much more than they were the passing of new laws, orders or mandates from the federal, state, or local authorities. Compliance with guidance to wear masks, to practice social distancing, and to minimize gatherings, especially indoors, has been shown to reduce the numbers of new cases. Evidence in the Southern Hemisphere shows that these behaviors have also significantly limited cases of seasonal influenza, and this also appears to be the case for us this winter so far. Flu is almost non-existent – not because of a great vaccine, but because of the behavior of individuals. The Present: We are currently in a time of deep crisis with the current surge in new cases, hospitalizations, and deaths, and anticipated additional surge as a result of activities over the holidays: - The US is now averaging over 200,000 cases per day, and almost 20,000 deaths per week, with total deaths now well over 300,000. - In California, much of the state is in crisis mode, with hospitals especially in Southern California close to implementing plans to ration care for those with the least chance of survival. - New therapeutic modalities have improved the survival rates of those sick enough to be hospitalized, and medications are now available to even prevent the need for hospitalization in some mild or moderate cases. ---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: January Riddle, District 2: Ron Hames, District 3: Irvin Jim, District 4: Terry Woodrow, District 5: David Griffith - In Alpine County, we are part of the Greater Sacramento Region, with a staffed ICU capacity at the lowest level it has ever been and therefore fall under the state’s Regional Stay-at-Home Order for the foreseeable future. About COVID-19 restrictions - Coronavirus COVID-19 Response (ca.gov) - We struggle with balancing our efforts to minimize the economic impact of businesses and to maximize the health and safety of our residents and workers. - Vaccination has become available in limited quantities so far, allowing us to reach out to those who fall in Phase 1a and 1b. This is a miraculous achievement after less than a year of development and testing, with vaccines that are both safe and effective. ACPHB-Lets-Stick-It-1321 (alpinecountyca.gov) - Our staff is currently working far beyond expectations in answering the “call to duty”, performing testing, case investigations, contact tracing, and now vaccinations all at the same time. The Future: The two key words in my mind as we look forward are GRATITUDE and HOPE. Gratitude for: - Most residents and businesses are following guidelines to wear masks, practice social distancing frequent handwashing, and minimizing gatherings, especially indoors. - Most businesses are willing to comply with the restrictions imposed by the Regional Order. - Most residents are being gracious and patient with our staff as we struggle under the weight of the extra demands being placed on us in response to the multiple simultaneous tasks. I ask you to remember something that most of you know as parents and dog owners – it takes 10 expressions of affirmation to undo the emotional wounds from negative verbal interaction. - At the risk of leaving someone out, I am grateful: for the brilliant scientists who made the vaccines possible; for the doctors, respiratory therapists, and especially the bedside nurses, who’ve defied their exhaustion, fear, and heartbreak to save lives and comfort the dying at huge risk to their own health and that of their families; the first responders including EMS, fire, and law enforcement; the post office and delivery folks; teachers and school staff who devote themselves to our young citizens who are the future; grocery store and food services workers who’ve risked their lives to keep us fed and supplied and the country functioning; and all other frontline and essential workers. Join me in saying “THANK YOU” WHENEVER YOU HAVE THE OPPORTUNITY! Hope: - Testing and treatment are rapidly improving. - Effective and safe vaccines are becoming more available. We expect these advances to begin the long-awaited decrease in cases, hospitalizations, and deaths, with a resulting ability to re-open businesses and allow life to slowly and carefully return to some semblance of normal. Getting there will not depend on actions at the federal, state, or local government level. It will depend on the actions of businesses and individuals practicing good behaviors as we continue to emphasize. Final word: If you and your loved ones can stay healthy a few months longer, you are all much likelier to survive the disease – or to avoid contracting it entirely. Please stay the course, and don’t let your guard down!