How Our Increased Positive Tests Will Affect Reopenings, Casinos and COVID, and the Disease at Alder Bay–Dr. Frankovich Answers Media Questions

Humboldt County’s Public Health Officer Dr. Teresa Frankovich, and other county officials, have been answering questions since the stay-at-home orders were instituted on a two question per media outlet roughly three times a week basis. The Department of Health and Human Services office takes the questions, re-words them, sometimes chooses not ask them and then reads the remaining questions to her on camera for her response. The resulting video tape, called a Media Availability, is then provided to news outlets at the end of the day.

Here are some of the main points covered in the May 18th Media Availability session with a short recap of answers, followed by questions we would have liked to ask in response if appropriate.

30 secs in: 

Media Question:  Have you been able to trace how the Alder Bay staff member contracted Covid, and can you confirm that they brought it into the assisted living facility?

Answer by Dr. Frankovich: 

At this point, we are attributing the infection as community transmission, however in small communities as we do investigations of other cases identified, sometimes we find links between some of these links of transmission, that there was no way of knowing initially.  So, at this time that’s what it is, and that’s possible that that could still change. In terms of bringing it into the assisted living facility, there’s no way of knowing for certain, but that individual was certainly the first individual identified as having the virus.

1 mins 15 sec in: 

Media Question:  At Alder Bay, now that the first positive case was the staff member, what is being done at Alder Bay and other facilities, to try to reduce the incidence of staff members bringing the virus into facilities? 

Answer by Dr. Frankovich:

Sure, so there is a whole range of things that facilities do to try to avoid importing cases into facilities. So, in general those go to a few points. One is we can certainly work on doing some periodic screening on staff who work at these facilities, and actually that is occurring.

However, it’s important for people to remember that there is no way to screen everybody in real time. What you would love to do is to have a rapid test, where you could conduct it at the door- test immediately and then say ‘go on in and work’. Right now that technology just isn’t available to operate in that sort of setting.

The best we can do is periodically screen, try and pick up some individuals that are asymptomatic, and so certainly what we do is to offer that up, and our Optum site allows for that. And we have been encouraging facilities to utilize it in that way, but you can never rely completely on that to protect populations.

You can envision that if you are screened and you are asymptomatic, we have results for you a few days later, and in the meantime you are working, there is still that potential for exposure.

That being said, it is really important for facilities to have other protections in place. So, limiting visitors, screening staff for their temperature and symptoms, making sure that staff are washing hands frequently and are masking, and using hand sanitizer. All of those things, and many other infection control practices can help keep people safe. 

3 mins 5 sec in: 

Media Question:  What is the protocol for patients at Alder Bay, if they become infected, and how are the other residents protected?

Answer by Dr. Frankovich:

So again, I think it’s important to talk about facilities in general. You know, there are more than one kind of housing facilities for people who are vulnerable in terms of medical condition or their age. So that includes Skilled Nursing Facilities, their position is slightly different, they are structured differently, they have different levels of clinical staff on site, and their licencing is different. 

Assisted living facilities or facilities such as Alder Bay that range in size from one or two people who are being taken care of two entities that are 20, 30, 60 or 90 people on board, so they vary a little bit in terms of their practices.  

The goal of all of these are to follow some of the things that we just talked about.  Embrace the best possible infection control standards for the type of facility that you were operating, and try to make sure that you are screening employees, and trying to avoid introduction into the facility.

4 mins 15 sec in: 

Media Question: One of the state’s conditions for granting county is the freedom to loosen restrictions is having a plan in place to quickly identify and containing outbreaks and facilities housing older Californians.  Following news of a covid-related death at Alder Bay you wrote, “once the virus is carried into a facility, transmission is very difficult to control.”  So, does the county have a plan to contain outbreaks in senior housing facilities, and if so, why hasn’t it worked at Alder Bay?

Answer by Dr. Frankovich: 

So, a couple things I’d like to point out. One is that we realize that both our skilled nursing facilities populations and our assisted living populations are vulnerable populations and protecting them is really paramount in this response. We have actually, in our emergency operation center, in our operations branch, we actually have individuals working on the skilled nursing facilities end, as well as the assisted living end. And what we are doing in these instances is reaching out to all of these facilities, talking to them about plans they have in place, assessing their protective equipment, talking to them about contingency plans- if they do have a case on site, how are they going to be able to isolate that staff or that resident.  And also, again, their plans on evaluating staff, both screening them when they come to work every day and also testing staff and intervals as a screening surveillance measure. 

So, all of that is happening. That being said, COVID is new to everyone. And all of these facilities are dealing with a pathogen that they have never had to deal with before.

I am really reassured by the fact that when we are reaching out and working with these facilities, they have put thought into this. They have put planning into place. They have really tried to do what we call source control, in terms of trying to avoid introducing virus into their facility and then having measures that would help to halt it. 

That being said, it’s very challenging. It just is by the nature of this virus. When you deal with a virus that is able to be transmitted easily, before people are symptomatic, it is really problematic to get ahead of the curve in terms of preventing spread within a facility because many people may have been exposed at that point already. So, it’s a work in progress.

We can never do enough, there’s always room to do more. And that’s what we were doing with these facilities. We are helping In terms of infection control consultants, we have reached out to the state and ask them to send us assistance to boots on the ground, to health facilities as well, and they are doing that. And so, I think again, the better we can do at controlling spread of this virus within our community, the lower risk everyone who works in healthcare and other first responder capacities, the less they are exposed to in terms of becoming ill or infected, and that reduces the risk for the residents at the facilities themselves. So again, I just ask all of us to work on containment in our community, in following our orders and such so that we can keep a low level of transmission occurring.

7 mins 30 sec in: 

Media Question:  Is the county working with the state to increase testing at nursing homes and other care facilities where patients are considered high risk?

Answer by Dr. Frankovich:

We actually feel that with our Optum site as well as the testing that we are able to do internally, that we have pretty good capacity to screen people. There is no capacity to test every individual working with a vulnerable population on a daily basis, and quite frankly for individuals who have had the testing done, they would probably not choose to do that and there’s really no recommendation at this point for it.

You know, typically, the recommendation is to screen somewhere around every two weeks, some people use different criteria for that but certainly a daily basis is not going to be doable through our current system. If the testing technology changes and we have a great, fast, point of care testing, that may look very different. But right now we have to work with the capacity that we have, and the technology that we have.

8 mins 30 sec in: 

Media Question:  Governor Newsom is facing pressure from nursing home/assisted living lobbyists for wanting that industry to have immunity from civil in criminal charges related to patients that contract COVID-19.  Do you think these facilities should be held accountable for preventable injuries and death?

Answer by Dr. Frankovich: 

So, I am not a lawyer. And I have no way to comment on that and what all that entails.  I can only tell you that the facilities that we are working with are very highly motivated to protect the population and do whatever they can to keep them safe. Knowing that, as much as all of us are safe moving about in the community and trying to use all the right measures, some of us are going to become ill. And the same is true in the settings. Our goal is to minimize the number of settings that have cases, and then once they do have cases to try and limit transmission within that facility. That’s what we can do at this point.

9 mins 25 sec in: 

Media Question: With the news of Humboldt County‘s first death, we no longer meet the epidemiological stability criteria laid out by the state to advance our stage two locally. What will this mean for Humboldt County moving forward? 

Answer by Dr. Frankovich: 

So, a couple points. One is, it is true both by our case numbers per 10,000 population, and the death, we would not have met this criteria had we been submitting today. I do want to point out that the state is actually amending their guidance on this point, and is actually relaxing some of these standards. So, you know I don’t think they’ve issued a final on that yet but I think it is imminent. So, basically the question goes to how do we move forward.  And what I want to point out to people is that we laid out in the plan, the sort of factors and triggers that we would look at, that we are continuously looking at as we move forward to decide when it is safe to do so based on numbers of cases, the trend in cases, the doubling time, all kinds of factors, as well as our hospital status and our contact tracing capacity. So those are all factors that we are evaluating on an ongoing basis. I want to point out that the cases we’ve seen to date really don’t reflect any changes that we’ve made so far, in terms of amending our approach to businesses opening. You know it’s been too short of a time frame to have an impact. 

These are things that are happening I think because people are moving about more in our community in spite of our shelter in place order, and people are gathering, to some extent again not in accordance with the shelter in place order. And some people are traveling, for nonessential travel. Again, not compatible with our current order. 

And so I want to remind people that this order, our shelter in place order, remains in place, and even as we amend it to allow people to access businesses that are “nonessential” we are still asking people to limit their movement within our community- to limit their travel to essential only– if they travel, to quarantine upon return.  And to really be careful about gatherings. Right now, gatherings outside of the household unit are not permitted.

11 mins 45 sec in: 

Media Question:  Humboldt County has had 23 new cases of Covid confirmed in the past two weeks. How will the spike affect our soft opening and loosened restrictions on local businesses?

Answer by Dr. Frankovich: 

So, it’s a really important point to make. I am looking at, and our deputy officer and our team are looking at our current data. What I can tell you is right now our current hospital data looks fine. Our communicable disease teams are doing fine, we still have capacity. But again our numbers are of concern to me. We have had, as mentioned 23 cases in the last 14 days, we have seen our “row” increase, And that goes to how likely it is that the case transmits to More than one other case, if at all, and we have had some clusters of cases that are larger and still being investigated. So, we might see some increase in our numbers going into this week. And that’s possible that that will be substantial, so I am looking at this. And, we are not retracting from where we’ve been, in terms of taking applications for businesses, the types of businesses that can apply to be approved, however we may need to slow the certification of these businesses to match what is happening on the ground so that we are not necessarily opening everybody at the same time, but opening gradually over continuum based on our numbers. So we will keep people updated.

13 mins 20 sec in: 

Media Question:  What impact if any does a current spike in cases have on decisions to approve specific businesses reopening plans?  

Answer by Dr. Frankovich: 

I think we pretty much just answered that one.

13 mins 35 sec in: 

Media Question: In the Attestation you submitted to the state, you outlined the criteria that would trigger strict mitigation measures. Can you please explain what, if any criteria, have currently been met and if you believe mitigation measures are necessary at this time?

Answer by Dr. Frankovich: 

Well, again as we just discussed, we are looking at those numbers and I do have concerns about some of them. None of the individual numbers in that list are enough to necessarily change what we do. We are looking at the constellation of factors. So yes, if we are concerned looking at these numbers, then again, we may slow the pace of certifying businesses, so we slow the number of openings all at once.

14 mins 15 sec in: 

Media Question: Is there a numeric point where an increase in positive cases or deaths might spur the county to pull back on opening up sectors? Please be specific about the numeric range.

Answer by Dr. Frankovich: 

Well, I wish I could be.  As I just mentioned, we are looking at multiple factors, we are looking at not only multiple epidemiological factors but also our hospital capacity, hospitalization rates and we are also looking at our contact tracing capacity.  All of which can change, independently or together, and can change over a period of days.  And so, you know,  I’m happy to discuss it as we go forward, but there is no specific number that is going to change our game.

15 mins in: 

Media Question:  Local casino employees received a letter over the weekend informing them that they are being asked to return to work as the casino intends to open in a week, potentially before Phase 3.  Do you believe it is irresponsible and possibly dangerous?

Answer by Dr. Frankovich:

So, the answer to that question is that I am hopeful that they will reconsider. I do not think it is the right time.  I am very concerned about introducing mass gatherings, even with the best of intentions in terms of following some distancing, and trying to do cleaning, it is not safe right now. And I think it has the potential to have a negative impact on our community, and I would ask them to reconsider if that is the plan. 

Anyone who has questions or concerns can call 441-5000 to get information.