Humboldt County May Not Be Able To Keep Up With Community Spread Case Investigations as Recommended by WHO and Governor Newsom

While the Humboldt County Health Department mobilizes to trace and track people recently exposed to COVID-19 in the community, the World Health Organization is emphasizing the effectiveness of widespread testing as a preventative and control measure against the highly infectious respiratory virus.  According to the World Health Organization (WHO), more testing results brings in more data, which makes the virus spread easier to identify and suppress.  

With the current number of confirmed coronavirus cases at 44 in Humboldt County, and more results pending daily, many people are interested in knowing how far the virus has extended into our rural area.  It has become increasingly clear in recent days that the Redwood Curtain cannot shelter Humboldt County from an encroaching pandemic. 

As California Governor Gavin Newsom noted this week, testing in the state has not been up to par, and in an effort to advance extensive testing as a state-wide goal, he has requested increasing test availability “exponentially” in order to more accurately trace the spread of Coronavirus.  In Humboldt County, testing for community level transmission cases has become an issue following a handful of confirmed cases of Covid-19 without a traceable source. Currently, there are 600 test kits in Humboldt, with about 50 available per day.  

The North Coast is frequently faced with logistical challenges in healthcare, but this will require an entirely new level of coordination for North Coast officials.  As Humboldt County residents bear witness to the unfolding local emergency, local health officials may have to for several reasons suspend community spread investigations before it is ideal, even though maintaining the case investigations would help to suppress the outbreak.  The WHO ‘suppression measures’ laid out as a strategy for stopping the spread of the virus are costly for a small health department to maintain, but have been proven successful.  

Regardless of logistical challenges, the virtues of increased testing and subsequent case investigation as a control measure against the spread of the virus was a topic of overwhelming concern, at the Friday, March 27 WHO press conference. Dr Michael J. Ryan of the World Health Organization addressed the online media and said,  “If you know where the virus is, you can break the chain. If you know who has the virus, if you know who the contacts are, you can break it, if you have that knowledge.” 

Dr. Ryan was urging nations and municipalities to increase testing efforts as much as possible to stem the pandemic at a press conference in late March, stating, “Having a larger number means ‘I know where the virus is better’.”  

Screenshot of WHO March 27 live press conference, Dr. Michael J. Ryan.

Some community members are anxious to know when COVID-19 test kits will be more widely available locally to people who have symptoms, or to people who suspect that they have been exposed. The Center for Disease Control initial criteria to be tested—high risk travel and known exposure to someone who has the disease–kept roughly 80% of cases that have what would be considered mild to moderate symptoms, as well as asymptomatic individuals from getting the test. (Here is the current criteria.)  

The World Health Organization (WHO) has been urging increased measures of medical surveillance in combating the pandemic spread.  As numbers of people infected with Covid-19 across the world continue to rise, the WHO addressed concerns regarding effective suppression strategies, putting the most emphasis on widespread availability of testing. This is considered a best practice, proven effective in countries like South Korea, Iceland, Japan, and Taiwan, each of which have succeeded in controlling the outbreak to a large extent. Dr. Michael J. Ryan of the WHO noted why these countries had focused on widespread testing. He explained, “Testing results give you a much better idea, not only of the impact of the disease, but they give you an idea of the effort being made by the public health authority.” 

Community medical surveillance is a widely-instituted strategy, and one that Humboldt County officials have been working on.  Humboldt County Public Health Officer, Dr. Teresa Frankovich, pointed out during the March 30 Coronavirus virtual town hall, that tracing the path of the exposure is a tedious and lengthy process.  She noted, “Every person you identify along the way potentially branches out to other individuals, and if anyone else in that investigation is symptomatic, we start from square one with that individual to all of their activities and contacts, and again, it blossoms really quickly so it is hours and hours of investigative work.” 

In regard to the aggressive approach to the medical surveillance strategy urged by the WHO, it is unclear if Humboldt County officials intend to outsource for additional testing kits, or whether our area would even be capable of processing those additional tests with its limited resources.  At this time, it is also unclear for how long the local Health Department officials and medical professionals will be able to keep up the community spread detection efforts, due to a potential lack of resources and funding, as Dr. Frankovich noted in a media Q&A on March 31.  

At that time she stated, “We are still continuing to test. Basically the testing and the positives that we are getting right now, does help us to do two things. One, it helps us to track the outbreak, and so, you know, it gives us a real sense of how quickly we are identifying the cases and how fast that may be occurring in our community.”  She went on to say that contact investigations are tedious and costly, and that the department would likely not continue using that as a strategy for monitoring the spread of the virus through the community in the long term.

Dr. Frankovich pointed out, “…[A]s this [pandemic] grows and we have more cases, doing an extensive case investigation for each person will not be possible. We are a small health department- and bigger health departments than ours have had to move on, because of resources, as well– and what we’ll do is shift to sort of contacting people and educating them about their risk.”  She explained that at some point when the disease is widespread throughout the community, testing and isolating will no longer be considered a useful strategy, but she also acknowledged that as of now, testing and isolating positive cases is still one of the best ways to slow the spread. 

Screenshot of media Q&A March 31, Humboldt County Public Health Officer, Dr. Teresa Frankovich.

Frankovich also stated that in regard to local testing, eventually the testing criteria–like severity of symptoms, recent travel, exposure and other risk factors–will no longer be important.  When the infection rate outpaces the ability of the Public Health Department to trace it, the need to investigate the origins of infection will no longer be helpful in terms of community medical surveillance, according to Francovich.  

Dr. Maria Van Kerkhove of the World Health Organization highlighted what has proven most effective in stopping the spread by referencing recent feedback from many nations.  “We have seen in a number of countries- what works is this– what works is case finding, is contact tracing, is mobilizing your population, and communicating with your population.  So your answer to ‘can this be controlled’ is yes!  But it takes a lot of aggressive measures.” 

At the other end of California, in accordance with the medical surveillance strategy emphasized by the WHO, the city of Los Angeles has been able to source a large number of test kits from South Korea.  The county of Los Angeles is home to 10 million people, and can afford to spend millions of dollars to prepare, unlike rural Humboldt County which cannot afford that level of investment.  According to the Los Angeles Time, in an article published on March 23, L.A. City Councilman David Ryu states, “We cannot beat a pandemic we cannot see, and we cannot properly address this crisis until we better understand it. The United States has fallen behind other nations in response to this pandemic, and we can’t wait on the federal government to fix it.”  

Even with LA County’s millions to spend, testing is still limited to “Those with symptoms who are 65 and older, Those with symptoms who have underlying chronic health conditions, Those who are subject to a mandatory 14 day quarantine period due to a confirmed COVID-19 exposure (with more than 7 days of quarantine remaining).”

Locally, in Humboldt County, the testing and tracing of contacts, and the subsequent control measures continue. While hospitals are preparing for a potential surge all over the state and the nation, Humboldt County is also bracing for impact. While most experts believe that it is most effective to continue testing and tracing protocols for as long as possible, in order to flatten the curve and to suppress community spread of the virus, it remains to be seen if the testing and community medical surveillance measures will be effective locally in containing the spread, or for how much longer it will be feasible for a small public health department to continue the intensive work needed to track down, test, and isolate those who’ve been exposed.

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For more information on Contact Tracing, see this video: What Is Contact Tracing? Humboldt County Joint Information Center Answers Questions

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