Dr Josh Ennis Directs Parents of Students to School Administration for Safety Concerns, Talks Effective Disease Control, and More

Humboldt County Deputy Health Officer Dr. Josh Ennis has 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 August 12 Media Availability session with a summary of answers from Dr. Josh Ennis, followed by questions we would have liked to ask in response if appropriate.

OES: Would you like to start by addressing any issues to the community?

Dr. Josh Ennis:

Yeah, in reviewing some of the questions today, I felt it was important to just maybe say a little bit about current numbers, trends.

You know at the outset we were really concerned about overwhelming our healthcare capacity. I think we’ve all seen that lately the numbers have started to trend upward, and at an increased pace, and there’s a lot of focus sometimes on the number of active cases. And what this number means is those that are actually on isolation because they’re considered infectious I think what you miss in keying on that number is that for every case that we actually identify and place on isolation there is certainly a handful of other cases out there that we have not identified. 

And, if we were to take some of the best estimates out there by leading epidemiologists, they’d estimate that there are probably ten cases for every one confirmed case that we actually have. We could make the argument, even if we wanted to say that we’re actually doing very well in testing, and we are keeping disease very low because of our community mitigation measures- we could revise that number downward as five, say.  So, somewhere on the order of five to ten times as many cases that we’re actually confirming are probably out there not getting tested for whatever reason. 

And so, as we think about how many cases are potentially floating out there in the community, we can talk a little bit about how many hospitalizations we’d expect by looking at case hospitalization rates, and that’s somewhere on the order of around ten percent. And so in the last week we’ve seen three hospitalizations and that would suggest using that ten percent number, we multiply by ten, that there’s about 300 cases, and if you put it in context of the number of active cases, it’s just north of 50 – so that’s about six times as many cases floating out there. So, I think it’s real important to not key in on this number. It’s not capturing everybody who has the illness. It’s capturing a minority, and we’re starting to see that in the hospital a little bit. 

2 mins 45 sec in:

Question by KMUD News:  Mendocino County has put a call out for volunteer contract tracers.  Is there an immediate need in Humboldt for citizen contract tracers?  Maybe more Spanish speakers?  And if so, how can community members get trained and volunteer? 

Answer by Dr. Ennis:

Yeah, so from the outset we knew that really the legs of our response were going to hinge upon a couple things. One is testing, and then the second one is the ability to do large-scale investigation and tracing, and so this is something we’ve been working on for months and we continue to build.  We do not need volunteer contact tracers at this time.

We are actively onboarding several people to assist with investigation and tracing. We have also worked hard to increase our, not only Spanish translation capabilities, but also hiring people and bringing people in who are native Spanish speakers to assist with the investigation and tracing efforts.

3 mins 50 sec in:   

Question by KMUD News:  Information on how the coronavirus spreads has slightly fluctuated since the outbreak began.  Can you share the current information, such as, does it live on surfaces or is it only airborne, can it travel in water, does it die in sunlight?

Answer by Dr. Ennis: 

Yeah, so you know there’s a lot we don’t know, but I can tell you what what we do know. I’d say the majority of transmission is via respiratory droplets. Okay and so these are bigger droplets that a mask will catch, and each droplet potentially carries you know tens, hundreds thousands of viral particles. And so if the droplets are bigger the facial covering will catch them.  And that’s the vast majority of transmission.

Can it be spread by what we call fomites or surfaces that you’ve touched?  Yeah, it’s certainly possible, but it’s a small minority. Is it spread by airborne route aerosols very tiny droplets that linger in the air for hours afterwards?  There may be some suggestion looking at specific scenarios that suggest that does occur.  I would say that if it does, it’s a minority of cases where the air flow is poor, or there’s some type of either procedure in a hospital setting that generates lots of pressure around airways, or you know for example doing an activity where there’s lots of yelling, screaming, shouting, forceful exhalation. Those may be more likely to produce aerosol, but the vast majority really seems to be respiratory droplets. 

5 mins 35 secs in:  

Question by Lost Coast Outpost:  Humboldt State University is returning from the summer break soon, and that means that at least several hundred and probably thousands of people will be moving back into the county, many or most of them from areas with higher rates of infection than our own. What steps are Public Health and the university taking to minimize risk to the student community and to the county as a whole? 

Answer by Dr. Ennis:

So, HSU has been in contact with Public Health planning over the past several months. I have been less involved in those discussions so I cannot comment on specifics of the plans but they have been in touch with one another mainly through Dr. Frankovich and they are continuing the conversation this very week.

Media Followup questions we’re unable to ask because of the format: 

Are you concerned about the influx of students into the larger community, from a Public Health view, considering the range of travel and visitors to the area? 

6 mins 30 sec in: 

Question by The Redheaded Blackbelt:  Photos were taken by a student of Fortuna High and posted on social media that showed youth apparently closer than the 3 to 6 recommended feet. The photos caused a great deal of controversy.  If parents and students are concerned, rather than posting on social media, is there a process they can follow through Public Health? And could you describe it?

Answer by Dr. Ennis:

Yeah, so, throughout the planning process this has been left up to the decision of the local needs as determined by the districts themselves. Public Health in no way can dictate or mandate, what needs to happen at each individual school.  It’s- there’s simply too many to weigh in on, and the needs are different depending upon the community themselves. 

And so if there are concerns, I would encourage parents to contact the school administration.  We’ve been very clear that if certain conditions cannot be met, that it is unsafe to reopen schools to on-site instruction, and so ultimately it’s going to be the school administration who is responsible for implementing the plans.  Now, if for whatever reason that proves to be ineffective or there are bigger concerns, anyone’s certainly welcome to call the JIC at 441-5000 and maybe walk through what the concerns specifically are and if there are alternate means for trying to make things as safe as possible. 

8 mins 20 sec in:  

Question by The Redheaded Blackbelt:  A staff member at a Fortuna Nursing facility tested positive for COVID, were patients exposed? Has there been any subsequent spread to staff?

Answer by Dr. Ennis:

So, any time there is a confirmed positive case in a nursing facility, the the state California Department of Public Health mandates that there is weekly testing until there are no new cases for 14 days. I can confirm that there are no further cases identified and we are working with the involved nursing facility to test essentially all staff members and all patients over the next couple weeks and we have yet to identify any further cases. 

Media Followup questions we’re unable to ask because of the format: 

The state also mandates that there is a plan in place for responding to an outbreak if one should occur, including isolation protocol, treatment, and mitigation methods.  Are you aware of their plans for mitigating the spread, and can you elaborate on what they are doing in response to the confirmed case? 

9 mins 17 secs in:  

Question by The Times-Standard:  How is the estimated percent of the population tested for current infection calculated? Is it based on the total number of tests done or the total number of people tested? If it’s the latter, how is it ensured people who take multiple tests aren’t double counted? 

Answer by Dr. Ennis:  

So,this is based purely on the total number of tests,there are instances in which the same individual has a repeat test for a multitude of reasons. That seems to be a minority  however it is as time goes on proving to be a larger percentage as perhaps some of the people seek re-testing because of concerns with repeat exposure and so they are double counted. Early on we did manually look and it proved to be on the order of just a few percent um that was a couple months ago.  I don’t know what percentage it is now; it’s probably, perhaps a good time to re-evaluate how we are reporting that number at this point.

10  mins 30 sec in:

Media Question by The Times-Standard:  Can you describe the issues the county is having with effective disease control?  What plans are in place to improve that metric?

Answer by Dr. Ennis: 

Yeah, so the county dashboard is arranged into three separate categories, it’s spread of disease, healthcare capacity and then the last one which this question I think is getting to, effectiveness of disease control and what we’re talking about is community mitigation measures it’s talking about the investigation and tracing making sure that we have the ability to increase as needed, making sure that people are providing information that’s needed, that we’re getting test results in a timely manner so we can intervene. And last week we moved that from level two to level three.

Now, it had no bearing on the overall alert level, but it’s telling in some other ways and this is kind of the manner in which we felt things would move. The spread of disease would move first, there’d be some period of time and then effectiveness of disease control would move next and then we’ll see the healthcare capacity move last.  And so this is anticipated. 

And so what is it, where is that coming from?  Well, I think last week we had a couple double-digit days of reporting positives.  We had nine, one day. 10, another day. 25 the next day. And we’ve built our investigation tracing team from at one point of only being three people and we’ve increased that to 41 people I believe at this point. Some of them are part-time, they’re not full-time and so you can imagine when there’s a huge bolus, huge increase of cases all of a sudden over a matter of few days that it takes a little time to sort out and distribute that load of new cases.

You know all 41 people are not working at the exact same moment in time and so the process is just, it’s slower when you get that many cases in that short of a period of time. So to improve that metric it comes down to further increasing our capacity for investigation and tracing. 

12 mins 55 sec in:   

Media Question  by North Coast News:  Fortuna high school students went back to in person classes this week. Photos surfaced of students that appeared to be sitting in close proximity, not spaced out in desks or six feet apart.  Who is responsible for making sure the schools keep with reopening instruction to ensure student safety?   Could the county require schools to close if they’re unable to ensure proper proper social distancing and COVID safety precautions are taking place?  And what happens if the school doesn’t have enough PPE like masks, hand sanitizer, etc.?  Are PPE expenses expected to come out of their own budgets to ensure student safety and compliance with the county’s order, or are there government funds available?

Answer by Dr. Ennis: 

Yeah. So, maybe I’ll just tackle that in parts. You know, for who’s responsible for making sure the schools keep with the reopening plans- I think I’ve already spoken to this, and that’s really the school administration.  If there’s really any concern, I think parents need to bring it back to the school, and try and resolve it with the school administration.  Certainly you could try and pass a message along to the school superintendent as well.  

With 70-plus schools, Public Health is not able to manage, individually, each and every  individual school. In regards to a school closure due to proper social distancing, COVID precautions, you know I think there’s a huge societal benefit to having in-person school instruction especially with younger kids. So I think we need to try hard to make this work as a community but we’ve been very clear that reopening to on-site in-person instruction should only be occurring if it can be done in a way that it follows the guidance as it exists now.

And, to keep everyone as safe as possible in regards to PPE, I believe the state has done direct outreach to the school districts, they have provided PPE to them as well and there is a route for schools to ask for PPE directly from the state.  They could certainly come to the county as well. There is a process in place for providing PPE at the county level but the schools, is my understanding, has a direct route to PPE through the state.

Media Followup questions we’re unable to ask because of the format: 

Could the county, or Public Health, close down schools- either individually, or by district- if there was a large outbreak or a super-spreader event? 

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

For the most recent state and national COVID-19 information, visit cdc.gov or cdph.ca.gov. 

Local information is available at the Humboldt County COVID-19 Data Dashboard: humboldtgov.org/dashboard, on Facebook @HumCoCOVID19, Instagram @HumCoCOVID19, Twitter @HumCoCOVID19, and Humboldt Health Alert humboldtgov.org/HumboldtHealthAlert