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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 Monday, March 9, 2020, 10 AM Coronavirus Update: Alpine County Has No Identified Cases – Yet! Contents (A long document, but please read the sections you are interested in): - What We Know - What We Don’t Know - What We Are Doing - What We Recommend That You Do - Guidance for Parents, Children, and Schools - Guidance for Mass Gatherings/Events - For Updated Information (links) What We Know – easy to spread, high risk of death for the elderly – we do not have it under control: - No cases of COVID-19 infection have been identified and reported in Alpine County, or the surrounding areas including South Lake Tahoe (El Dorado County), Douglas County and Carson City in Nevada, Amador and Calaveras Counties in California. - In the USA, >500 cases have been identified in more than 30 states, with at least 21 fatalities. This includes 114 cases in California, and 2 in Washoe County (Reno). In Northern California, cases have been reported in Placer County (one death) and all counties west along I-80 including San Francisco. Santa Clara County (San Jose) has been especially hard hit. - COVID-19 cases have been identified in over 100 countries in addition to China, with hot spots in South Korea, Iran, and Italy. Egypt may soon be included in this list. Travel on cruises appears to be a high-risk choice, especially for the elderly and those with underlying medical problems. - The general population is at low risk. Increased risk exists for persons who have recently traveled to the above areas within the last 14 days, healthcare workers, and anyone in close contact with an identified case. 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 - It has become clear that there is community person-to-person transmission in some areas, with each case on average expected to infect 2-3 other persons. The usual spread is via droplets from coughing or sneezing, usually within 6 feet of an infected person. - The incubation period (time from exposure to becoming infected) may be up to 14 days, with 5 days being typical. - Fatalities have occurred in the older population, especially in those with chronic medical conditions such as heart or lung disease, diabetes, and high blood pressure. The risk of death approximately doubles for every 10 years a person is older than 60 years of age. An informed guess of the fatality rate is around 2-3% of infected persons but may be as high as 15% for elderly with underlying medical conditions. - Estimates are that 80% of those who become infected have no or are only mildly ill and do not seek medical care. Children do not appear to get infected very often, and when they do, the illness is generally mild. I am not aware of any deaths in a person under the age of 10 years. - There is no vaccine, and even with furious efforts to make one, it will be many months before a vaccine is deployed for the general population. What We Don’t Know – how bad will it get, and when: - We do not know how long viral particles can present a risk for infection on contaminated surfaces. - Although we believe persons are contagious for some time prior to becoming ill, we do not know for how long. - We do not know how long persons might be contagious after developing - We do not know if infected persons without are contagious. - Although we know this virus is easily spread, we do not know how many people will become infected or die, and when a peak in this wave will occur. China, South Korea, Iran, and Italy are ahead of us in the evolution of spread and will have something to teach us. - What We Are Doing in The Face of All This Uncertainty: - The health and well-being of everyone in our community (residents and visitors) is our top priority. - The Alpine County Health Department has opened its Department Operations Center and is meeting and communicating on a regular basis. We are available 24/7 to utilize our expertise and resources to respond to this rapidly evolving situation. - We are monitoring all related information and events – locally, regionally, state, federal, and internationally. ---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 - We are participating in the development of guidance documents for public health departments, health care facilities (clinics), EMS, schools, and the public in coordination with other local Health Officers, the California Department of Public Health, the EMS Authority, the Department of Healthcare Services, and the Governor’s Office of Emergency Services. All affected personnel will be informed as guidance evolves. - We have met or had contact with our first responders (law and fire), healthcare personnel (clinic), and ski areas (Kirkwood and Bear Valley) to provide guidance on how to protect the health of their personnel and guests during encounters with persons who might be infected. - We have inventoried our personal protective equipment and supplies for testing and found them to be sufficient for the anticipated usage. We have mechanisms in place for requesting additional equipment and supplies if necessary. - We have communicated updates to the Board of Supervisors and to the public and will continue to reach out as the situation changes. What We Recommend That You Do/Don’t Do – prepare, be cautious, DON’T PANIC - We need to recognize that there is discomfort and fear with all this uncertainty about the future. Take a deep breath and put it in perspective – there have been millions of cases of the flu in the US this winter even though we have a vaccine, with over 18,000 deaths, including >100 deaths in children. Prevention: - In order to minimize your risk of becoming infected, we recommend that you reconsider going to any of the “hot areas”, including cruises, especially if you are over the age of 60 and with chronic medical conditions. - For you French and Italians – no kissing!! For the rest of us, no hugs! A fist or elbow bump rather than a handshake or a high five has been shown to transmit 5-10 times less germs. - For those with underlying medical conditions, we recommend: o avoid non-essential travel. o Having an up-to-date supply of essential medications (for diabetes, high blood pressure, etc.), medical supplies, household items and groceries. o Avoid crowds - If you fly, use wipes to clean the armrests and tray in front of you, which typically carries more germs than the bathroom! - There is no recommendation to use facemasks if you are not sick. They should only be worn by those who are sick to help prevent the spread if they must be out in public, which should be rare. ---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 - I have seen a recommendation for seniors to “stay home”! However, my caution is this. Seniors are already at risk for social isolation and loneliness under the best of circumstances. There is no reason why they cannot be enjoying the outdoors. Sunshine and exercise and a good night’s sleep and good food are great stimulants for your physical and mental well-being! If you have a family member or a neighbor who is a senior living alone, please make it your responsibility to check in on them frequently. - If you look out for or care for a friend, family member, neighbor, co-worker, have a back up plan in case you get sick. - Practice the oft repeated common-sense advice: o Wash your hands frequently with soap and water for at least 20 seconds. Try one of these tunes: trnd/index.html?utm_source=CNN+Five+Things&utm_campaign=c13ccdc164- EMAIL_CAMPAIGN_2020_03_09_02_50&utm_medium=email&utm_term=0_6da287d761- c13ccdc164-96259537 o If you cannot wash, and you can find some hand sanitizer (>60% alcohol), use it until you have access to soap and water. o Avoid touching your eyes, nose, or mouth with unwashed hands (difficult!!). o Avoid close contact with persons who are sick. o Stay home from school or work if you are sick. - Recommendations for environmental cleaning include increased frequency, but not the use of other disinfectants than what you would normally use on your kitchen counters and bathrooms. DO not mix products together! Here is a list of approved and effective products: What should you do if you think you are sick with COVID-19? o Your risk is considered “Medium” if you have been to a “hot zone” or an area with community spread, you are a healthcare worker, or you have been in close contact with a known case. o Avoid contact with other persons. o DO NOT GO TO A CLINIC OR URGENT CARE OR EMERGENCY ROOM WITHOUT CALLING FIRST. ---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 o Call your healthcare provider before seeking medical care so they can work with us to do a risk assessment and protect their personnel and facilities from potential exposure and closure and quarantine. o There has been lots of conflicting information about testing. Although you may have heard it said that testing is available for anyone free of charge, testing will not be done unless authorized by your healthcare provider in coordination with the Health Officer. Priorities for testing are persons with (in descending order): • Healthcare workers with exposure • Close contacts of confirmed cases • Persons hospitalized with pneumonia and no other explanation • Elderly persons with underlying medical conditions • Elderly persons without underlying medical conditions • Persons in congregate settings (long term care facility, shelter, jail, homeless • Travelers from “hot areas” o Think flu – if you have a mild case without prolonged fever, shortness of breath, or dehydration, you are likely to stay at home and treat yourself with medication to treat your fever, fluids, and rest. If you are mildly ill, do not show up and request testing! Advice for Parents, Students, and Schools According to Gov. Newsom, it is not a question of “if” but ”when” some California schools will face closure. This has already happened in the Sacramento area. School districts are preparing for these scenarios so that parents and children can plan for what would happen if a local school faced closure. A guidance document for schools was sent on March 7th to school administration from the California Department of Education and the California Department of Public Health. It encourages schools to work with local public health in various scenarios to prevent or limit the spread of COVID-19 by alternating group activities or closing school for a period of time. Children do not typically get very ill with COVID-19, and they get sick less frequently. However, we do not know if children are efficient spreaders of infection for COVID-19 like they are for seasonal influenza, which would then in turn pose a threat to the older folks such as grandparents with underlying medical conditions. Recognizing the tremendous stress that this would present to families, we will work closely with schools to minimize the risk of school closure happening. Our goal is to minimize the impact of any actions, while at the same time protecting the health of students, staff, families, and the community. ---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 Advice for mass gatherings/events On March 7th, the California Department of Public Health sent guidance to “Public Event Organizers” covering mass gatherings and events. Some events may include persons traveling from multiple communities already experiencing infections. Also included are religious services, where large numbers of people are within arms length of each other. Not included are the typical office environment and stores. If there is no evidence of community transmission (our current status in Alpine County), agencies, organizations, and event organizers should develop plans to modify, cancel, or postpone an event so that attendees, workers, and the local community are protected from the introduction of infection into new communities. Once there is evidence of community transmission, organizers should consider modifying, canceling, or postponing non- essential events. If events are primarily for or attended by older adults and people with underlying medical conditions at higher risk for severe illness and death, organizers should seriously consider cancellation. Public Health will seek to work with all organizations, agencies, and event organizers to tailor recommendations specific to Alpine County for each event based on what is currently happening or anticipated to happen in Alpine County. For updated information, go to: Alpine County Health Department: California Department of Public Health (CDPH): Centers for Disease Control and Prevention (CDC):