Deputy Health Officer Dr. Josh Ennis Explains the Alert Level In Humboldt, Talks COVID Hospital Capacity and Latino Essential Workers Exposure

Humboldt County officials have been answering questions since the stay-at-home orders were instituted on a two question per media outlet. The Emergency Operations Center takes the questions, and staff reads them on camera for their response. The resulting video, 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 July 23rd Media Availability session with a rough transcript of answers from Deputy Public Health Director Dr. Josh Ennis, followed by questions we would have liked to ask in response if appropriate.

Media Question:  Level 1 is listed as the “new normal”, but most indicators nationwide suggest the pandemic is far from over.  Do you anticipate Humboldt County being at that level 2 status for a considerable amount of time?  Or are local trends suggesting a potential move to level 1 in the near future?

Answer by Dr. Ennis: 

When we wrote originally, level one being characterized as the new normal, it was kind of a nod that the pandemic isn’t going anywhere anytime soon, and that we can expect things to be different for a long period of time.  So that includes all the things we’ve constantly spoken about such as hand hygiene, social distancing, masking.  The pandemic is certainly far from over and it’s nearing peak spread across the country.  So, we are certainly part of this country, we are part of the state of California, and so I don’t see us moving down any levels anytime in the near future.  If anything, I would say it’s a steady march towards escalating the amount of disease, because we’re not in a vacuum. We’re affected by the counties surrounding us.  We’re affected by other states. It’s as easy as hopping on an airplane, and so we certainly are not going to be going back to level one, I think, anytime soon as an overall alert level.

2 mins in:  

Media Question: The threat level for Humboldt County has remained at a level 2 despite a recent increase in cases, are you able to give the public a better idea of what number of cases would warrant us to move to level 3?  Level 4?

Answer by Dr. Ennis: 

Yeah, I could give an idea of that but, before we talk even about numbers of cases, I think it’s important to talk about what all is going into this decision tool.  This is allowing us to have the ability to systematically and methodically look at the same things day to day, week to week, so that we’re not missing anything. This is a very complex issue, and it’s not as easy as a static snapshot picture in time of how many cases there are, you know, in any given day or any given week.

You know, it might appear very static, but it’s it’s kind of dynamic if you picture, you know, a tub full of water- there’s a faucet with water going in, that’s the new cases, there’s also a drain with water pouring out when people recover, and you know, we can control the flow on potentially both ends- and they’re kind of different things and so the number of new cases is that water coming in. And we call that the ‘disease status’ or/and the ‘epidemiological indicators’ that we’re looking at.  You know, on that water going out, that’s the public health side.  That’s the ‘commune mitigation’, that’s ‘effectiveness of disease control’ is what we called it in this matrix. 

And so that heavily relies on that end of how much testing we have, whether that testing’s giving us a good idea of how much is actually out in the community, and so how much we’re able to contact trace and reliably make a judgment that we’re actually able to chase disease to extinction in these different lines, and so there are a lot of different moving parts. 

And we’re looking at both those, and then finally there’s also the healthcare system which is going to be a much lagging setting for evaluating how much disease there is, and so the whole idea is to be far ahead and have some kind of idea of when we can expect numbers to increase in the healthcare setting. 

And so getting back to the question about numbers of cases, it’s not as simple as drawing a line between, you know, 10 and 11.  It’s looking at the number in the context of everything else, and so in general across these four alert levels, we have kind of a sense of maybe a range of what’s acceptable based upon what’s known about hospitalization rates, based upon what’s known about ventilator rates, and so that’s kind of forming the basis of these ballpark ranges we have in mind. But it’s really one data point in the setting of 10 to 15 other things that we’re trying to look at on a daily basis.

5 mins 5 sec in:   

Media Question: Can you explain how transmission of the virus (in addition to number of cases) impacts the overall alert level?

Answer by Dr. Ennis: 

Yeah, so, transmission of the virus… I think, would fall into the effectiveness of disease control so as we’ve reported on the website you know we classify based on whether it’s travel related, contact to known case, or its community transmission meaning that we can’t readily identify exactly where the person likely had an exposure. And so community transmission is much more concerning, because it means that there are more cases for every single case that we identify through a test there’s a lot more floating out there.  And as that number increases the number of tests just floating out there, we’re going to start picking up more and more as community transmission and so we are looking in particular at how many are attributable to community transmission as part of our ability to suppress this spread of disease.

6 mins 10 sec in:   

Media Question:  The county is experiencing delays in receiving test results from certain testing methods such as the OptumServe site, does the assessment tool take those delays into account, particularly when it comes to the “Spread of COVID-19 Illness” category? 

Answer by Dr. Ennis:

Yeah, so again, the turnaround test- a turnaround time for any given test, if it’s going to be actionable, it needs to have readily access to the testing as well as ready results.  And clearly if we’re getting results after someone’s already had their illness, and they’ve already recovered, we’re not going to be able to exercise a whole lot of changing the course of the spread of disease. And so that is something that we take into account as part of the effectiveness of what we’re calling ‘disease control’ and so we look not only at how quick test results are turned around, but we’re also looking at how many we can actually get done across the entire county in any given day. As you could imagine, an outbreak in, for example the jail, would require doing a lot of tests really quickly and so this is something that we’re paying attention to as part of the alert level system. And something that we’ve discussed for months now about how to grow our testing capacity and be able to turn around the test quickly as we do it.

7 mins 45 sec in: 

Media Question:  Mendocino County and Del Norte County are experiencing large outbreaks – outbreaks large enough to nearly place them on the governor’s watch list. Given the amount of commerce and travel between Humboldt and neighboring counties, shouldn’t the alert assessment tool take into account the current state of the pandemic regionally, rather than just in our own county?

Answer by Dr. Ennis: 

Yes. This is actually a fantastic suggestion, and it is something that we have given thought to. While this alert level system is characterized as ‘what’s going on in the ground in our county’ it also acknowledges the fact that we aren’t a vacuum. We’re not an island, and so we have built in some ability to exercise a little bit of dynamic ability to move between alert levels based upon what’s happening around us.  And so this is a great example of why you can’t look at any one thing and you need to be looking at many different things, because it’s a very dynamic process and if Mendocino or Del Norte right to the north and south of us are experiencing cases, that water faucet clearly is going to be affected, and so we do pay attention to what’s happening. We also have fairly regular contact with health officers across those two counties as well as the greater northern California region, and so we’re in contact with them, and so we are aware of what’s going on in neighboring counties.   

9 mins 20 sec in:   

Media Question: Can you give us an idea of if and when you expect the ‘surge’ to hit Humboldt, and what do you anticipate the Fall will look like at local Hospitals with the coming regular flu season on top of the COVID-19 surge escalating locally? 

Answer by Dr. Ennis: 

Yeah, so harking back to the very beginning of this I presented some models, and these models were kind of more of a scenario tool- meaning that it was a simulation and it’s very different than being able to predict the future.  We made a lot of assumptions, and applied it to what we know about our county demographics to try and just demonstrate the magnitude of what we’re dealing with. So, fast forward several months and seeing where we’re at now, you know, if we wanted to quantify a lot of things we’re doing, such as mask or facial covering wearing, hand washing, social distancing- I don’t know that it could put a number of what percent mitigation that equates to as a non-pharmaceutical intervention, which is what those models were really based on. My opinion is that we can certainly expect to see a lot more cases in the Fall and Winter, and it is something we are concerned about as we know that is going to inevitably be right on top of the flu season. Now, whether we’re able to get through it successfully or not- does depend to some degree on how used to this new normal we get to, and so I don’t know that with any definite certainty, that we’re going to have a surge where it’s overwhelming like New York.  

I think we’ve had a lot more time to prepare, and so we might just see cases go up, and kind of reach a steady state at some point.  I mean, the whole idea though is that we can push it further, we can push it further out as well as further down, and we’re doing a lot of things that continue to do that.  And so our surge may actually look more like a kind of a continuous steady stream that is very difficult to manage, but actually manageable within our healthcare system.  And our healthcare system is, it is a bit of an island in Humboldt County, and so we know that we are more at risk than say, some of the more urban areas for having a surge, even if it’s small- really have a devastating effect on our ability to care for everyone who needs the care.

12 mins 30 sec in:   

Media Question:  Looking at the local demographics of people who have contracted COVID, particularly the Latino and Hispanic identifying groups, can you give an estimate of what percentage of those individuals work as essential labor (regardless of the way they contracted it), and can you be specific about what types of jobs that includes for that subset of cases?

Answer by Dr. Ennis: 

Yeah, so as far as giving a percentage, I… we are not tracking job information at this time.  We are looking to start doing that, and I know the state’s looking to start doing that, so I don’t know that I could give you a number.  I could certainly tell you that in general, Latino/Hispanic-identifying groups work in lower-wage jobs, and it is more difficult for them in general to shelter in place as a result. And so locally, what we have seen is that this particular group works more frequently in agriculture, and they also work more frequently in construction, and so they’re inevitably at more risk of exposure to the virus.

I think the point here though, is that we know that both African-Americans as well as the Latino communities suffered disproportionately from COVID-19.  They’re hospitalized at higher rates, and the pandemic has brought out long-standing health inequities that are well-accepted amongst the Public Health community. They suffer from high blood pressure, diabetes, heart disease- all with higher amounts, and this is what COVID-19 preys upon. It makes those people with comorbidities much more likely to have severe disease, and so I think we’re putting out the call, and sounding the alarm that we all need to work harder to try and alter the course here. 

It’s not about saying any one particular group is being more risky than the other. This is about trying to highlight the health inequities that exist, and and try and do something about them before it’s too late. 

 

Community members with questions or concerns are encouraged to call 441-5000 for additional information.  

Local information is also available online at humboldtgov.org or during business hours by contacting [email protected] or at the Humboldt County COVID-19 Data Dashboard: humboldtgov.org/dashboard