Community Spread Confirmed, Surge Preparedness and More in Mendocino County Virtual Press Conference

On Friday May 29, 2020, Mendocino County Public Health Officer, Mendocino County CEO Carmel Angelo, and Mendocino County Sheriff Matt Kendall held a virtual press conference providing an update on the state of COVID-19 in Mendocino County. Redheaded Blackbelt and other local media asked questions about these and other concerns.

[Note: There is a lot of information in this press conference. We’ll highlight in blue any particularly important responses but there likely will be more of interest to you.]

Opening remarks from Dr. Noemi Doohan, CEO Carmel Angelo, and Sheriff Matt Kendallw

Dr. Noemi Doohan

Public Health Director Dr. Noemi Doohan

• Mendocino County hit 30 cases yesterday. We have had a total of four hospitalizations in the last week, at least one of those hospitalized individuals returned home. We currently have three people still in the hospital but nobody requiring a ventilator, nobody critically ill. The hospital has been able to provide the needed support to keep these people healthy and recovering.
• I know that all of us are very concerned about having 30 cases. I did have posted on our tracker this morning that we have three which we believe are due to community spread. One of them is being questioned whether it was a true positive or a false positive. We have 29 cases and one of them is being questioned which will be determined with the help of the California Department of Public Health. There are two cases within our recent ones that I am calling community spread. Community spread is when we do our case investigation and contact tracing and we can’t find any connection to a known case or  an outbreak that we’re investigating and that case did not come from another County. In the two cases that we have had recently, they have had no contact with anyone outside in the county, they have had no contact with anyone that they know of that has had COVID-19.
• The two recent cases that are related to community spread. One is from the area that we’re calling North and one of them is from the region we call Ukiah Valley. (South Coast: Mendocino, Little River, Albion, Elk, Manchester, Point Arena, Anchor Bay, Gualala, South County: Philo, Boonville, Yorkville, Hopland, Ukiah Valley: Ukiah, Talmage, Calpella, Redwood Valley, Potter Valley, North County: Willits, Brooktrails, Laytonville, Covelo, Dos Rios, Leggett, Piercy, North Coast: Caspar, Fort Bragg, Cleone, Newport, Westport, Rockport) The third case that’s in question I won’t comment on that now.
• Of our first six cases, the first one seemed to be related to contact in Palm Springs, the next one was a cruise ship, one was from the southern parts of the United States, another was from New York, and another was the inmate released from Chino. Our next cases came from the Round Valley outbreak and there’s every indication that that outbreak at Round Valley was contained. We had an outbreak at the Assembly of God Church in Redwood Valley involving seven people in our county and two people from Lake County has also as far as we can do seem to be contained. There was then a worker from Sonoma County who lives in our county and that individual. We collaborated with Sonoma County and the place where they worked did surveillance testing and did not find any new cases in that workplace other than the one in Sonoma County and the one in our County. That individual did have close contacts in their own household and there have been some cases related to that individual. Members of that individuals’ household have tested positive. COVID-19 spreads in households and people in the same household will come up positive.
• Then came a new case, which is an individual that lives in the Ukiah Valley area, but has a close contact in North County, and that is leading us to be concerned about more cases in North County so there are some additional cases that have come up this week that are related to a connection between Ukiah Valley and North County. We want to message to the North County communities that the Public Health’s role is to be supportive to provide free and anonymous testing to support with isolation and quarantine housing.
• I have heard lately that there’s an idea that we’re having more cases because we’re doing more testing and I don’t believe that’s true. We have done nearly 4,000 tests and we’ve had 30 positives that’s a .8% positivity rate. We’re seeing cases coming out now where people are going for clinical care because they’re sick and they’re coming up with positive tests. This is telling me we need to encourage our population to come for surveillance testing because we are not getting positives from our surveillance testing, we’re getting them when people are coming in sick which you could consider to be there coming in later in their infection. If we could catch them earlier, we could contain whatever outbreaks might be associated with these individuals.
• Knowing that Mendocino County now has community spread, mitigation efforts come into play such as the facial coverings. All of these are mitigation efforts that have led to slowing the spread and flattening the curve. There’s now an FDA-approved drug called Remdesivir that is in crisis level shortages. We do know that those people who do receive this drug when they’re hospitalized if they can receive it early in their disease can have a significant improvement in terms of the severity of the disease and the length of time that they’re ill. We are very hopeful that as time goes on we’ll get more of this drug and that other drugs will be developed that can help with our treatment of COVID-19.
• We’ve been preparing for more cases by training our staff and volunteers for case investigation and contact tracing doing testing and we have been doing testing at 1.5 per thousand which is about a hundred and thirty-five tests a day for our ninety thousand population. We’ve also been very effective with containment in the isolation and quarantine housing that we provide for individuals that have COVID-19 and they are not able to have isolation safely where they live or they might need quarantine for family members.
• I predicted that the pandemic would hit Mendocino County by the end of May, and it is happening to us. It is going to get worse before it gets better because we are opening up.
• We’ve had the limited reopening that I promised would happen as soon as the governor allowed and that opening has been significant. Mendocino County is as open as any other county in the state and additionally we’re even more open in some areas. For example, to write orders that allow social bubbles, like the household support units is also giving us some more freedom. This week the governor announced that we could open up places of worship. Although this is going to be a high-risk activity regarding COVID-19, it’s also going to be highly beneficial for our community. I’m very concerned as your health officer about the gatherings that are going to happen and that there may be further outbreaks. As we do come together for these gatherings I do ask every single person to please be very careful and wear facial coverings and social distance, stay home when you’re sick, don’t shake hands, wash your hands frequently. There is an exception being made to the ban on gatherings for places of worship and this can be up to 100 people, or 25% of the capacity of the place of worship, whichever is less. We can also have gatherings for protest and, that is the same idea, up to a hundred people with social distancing the reason why the governor allowed these gatherings is constitutional rights. Additionally, the state did allow us to open hair salons and businesses that are there for providing services for hair. There’s one other element of that is opening up therapeutic swimming pools for the purposes of physical therapy. 
• Our PIO team closely watches social media and brings questions to me that rise up out of social media. One question was: “what is the region of each of the cases of community spread?”. Another question: “what is the protocol for declaring someone recovered?” A person who tests positive must remain in isolation for 10 days from when they had their positive test and be without a fever for 72 hours without any medicine to lower the fever.. The other question is regarding COVID-19 test accuracy and the proportion of true results: “do we trust a positive if it’s a positive test and do we trust a negative if it’s a negative test?” PCR testing has sensitivity and higher specificity, that’s the language that we use in public health to define how good a test is. The sensitivity that’s lower relates to a false negative reporting; the specificity that’s higher relates to false positives. PCR tests rarely have a false positive (one in a hundred) and more commonly have negatives, as much as 20% of the time. The false negatives are the things we worry about with the PCR testing. For COVID-19, we focus on false negatives and that’s why we want to be sure that if someone has symptoms and they test negative, we would test them again. In general if someone’s positive, we trust that positive result. It’s the negatives we question.

Around 31 minutes

Sheriff Matt Kendall

Mendocino County Sheriff Matt Kendall

• We as a county have come together and put a lot of work into things and these numbers are down reaching our original goal of flattening the curve. The next phase is going to be hard, we need to be ready for it.
• The Sheriff’s Office is continuing to put more resources into the county for patrols. I have some extra personnel that would normally be working the court system. We’ve been able to move those deputies into patrols. Most of these resources have gone to the coast over the weekend
• Crime is alive and well in Mendocino County. We’ve seen a rise in violence. I’m really concerned about child abuse cases because the number of reports are down, and it’s not because children aren’t being abused. We’ve been working with the schools trying to find some new ways through social media platforms and things like that to keep our teachers and spiritual leaders connected to the kids. 
• I just want to remind everyone in the county we’re all in this together and we need to work together to keep each other safe. Look out for your neighbors by using the social distancing and facial coverings. If you see a situation that concerns you, remove yourself from it. In the same fashion,  I would ask you to keep yourself safe from crime. Be aware of your surroundings, protect yourself and your family. If you see a business that you don’t feel comfortable shopping in, then don’t give them your business.

Around 35 minutes

CEO Carmel Angelo

CEO Carmel Angelo

• Mendocino County continues to have a call center open and the purpose of the call center is to answer questions from the public regarding COVID-19 and county services. You could also report code enforcement issues at (707)234-6052.
• We also have a warm line and this was started under Dr. Janine Miller and Behavioral Health in Health and Human Services. It is a non-crisis support line that you can call if you need someone to talk with or other services as well. That number is (707)472-2311.
• At Mendocino County’s Optum-Serve testing site, we can test 134 people a day at that site. Mendocino County Public Health staff is in the community to do testing. Our stationary site is at the Redwood Fairgrounds here in Ukiah on State Street and that is at Carl Purdy hall and they are open Tuesday through Saturday 7 a.m. to 7 p.m.. Schedule an appointment is by going to lhi.care or calling 1-888-634-1123. 

Around 38 minutes

Willits News’s Mike Adair asks: We’ve had quite a few cases here recently. Do feel like it would be appropriate to move us back sort of backwards to the beginning of Phase 2?

• Dr. Doohan says: I don’t want us to go backwards. I do ask Mendocino County that we have patience and we hold where we are for two weeks. I think we need to not have further openings beyond where we are now and we need to see what the impact is of the opening that we’ve had. We are working so hard on our case investigation and contact tracing and providing isolation and quarantine housing. We have such great collaborations with our partners, the clinics, the different agencies, I think we’re going to be okay.

Around 40 minutes

Willits News’s Mike Adair asks: Both Dr. Doohan and CEO Angelo, can either one of you fill us in on what’s happening with  regard to negotiations with the state for a public health officer after Dr. Doohan moves on to her next job?

• Dr. Doohan says: I’m still the health officer and Mendocino County must have a health officer. We are aware of two individuals that have expressed interest that are known in this local area and we’re really hoping that they’ll submit applications
• CEO Angelo says: We do have two candidates. We trust that as Dr. Doohan goes into more of a consultant role later this year that we will have a health officer to replace her. 

Around 42 minutes

Willits News’s Mike Adair follows up with:Dr. Doohan’s last day was going to be June 4th was going to be your last day. Does that still hold or has that changed? 

• Dr. Doohan says: The Board of Supervisors voted that my role would continue until December 31st with the goal to transition to new health officers so as soon as we have a new health officer.

Around 43 minutes

RHBB’s Matt LaFever asks: Now that Mendocino has confirmed community spread and we are proceeding with reopening, how would you assess Mendocino County’s ability to handle a surge in COVID-19 cases?

• Dr. Doohan says: We had modeling data early on from scientists that have been providing modeling of the pandemic response. What this modeling data showed us is that if we decrease our contacts by 25% we can do a significant amount to flatten the curve. What we did initially, based on this modeling data in Mendocino County, was a 75% reduction in social contacts. We really flattened the curve. That’s why we had so few cases in the beginning because with our activities and our behaviors we had a 75% reduction in contacts. I would estimate that what we’re doing now opens us up by 25% more. We’re at about a 50% reduction. Even based on that modeling with a 50% reduction, we can still handle the surge that we’ll have in our county.  It’ll be slower giving us time for more treatments and a vaccine. I think if we can stay where we are now longer, we can stay there. To open up even more what would look like opening up for tourism, opening up camping lodging day-trippers from the Bay Area. that would be to me. I think that would be a real stress on our system right now. I say that with a heavy heart because I know we love our businesses in our County that provide tourism but I think that that’s where I’m very very worried.

Around 46 minutes

RHBB’s Matt LaFever asks: How is testing going to shift in the time of community spread? How will our testing strategies sort of shift? Will we see an increase in availability for essential workers, people not experiencing symptoms? Will we see an increase in staffing of contact tracers? How do we kind of bolster our resources once that community spread begins?

• Dr. Doohan says: In Mendocino County, because of our very strong team and the pandemic response, we’ve done everything early before we had community spread. Because of that, our teams have gotten good at it. We call them the “swab squad.” We’ve gotten good at contract tracing because we’ve been doing it for months now. You will see more case investigation, contact tracing efforts with testing. You’ll also see more people being put in isolation and quarantine housing which the county has acquired and is free. You’ll see more surveillance testing. We were already doing the surveillance and our goal was 135 tests a day. We were doing that before we even got Optum-Serve. But now that we have Optum-Serve, the whole pathway is hardwired so we have the swabs, the sample collection kits, and we have the lab. Surveillance testing is going to become a way of life and it will become more widely available around the county. Frontline workers will get tested with some periodicity like once a month or once every two weeks depending on their job. Skilled nursing facilities will get periodic testing like that every two weeks or every month depending on if they have an outbreak. Hopefully, as the technology develops, we’ll have more of what we call point of care testing that’s better detecting the disease when people are not symptomatic. That’s the problem with this low sensitivity testing, the false negatives. Hopefully we’ll have rapid testing that then you could do a confirmatory test after.

Around 50 minutes

Mendocino Voice’s Adrian Baumann asks: What sort of enforcement will be utilized in terms of face masking protocols and businesses not following protocols? Will business licenses be revoked? 

• Dr. Doohan says: It is not my intention to have anyone arrested or cited for not wearing face masks. We need our citizens to be willing to wear it willingly. The exception would be if you are an employee in a public facing job or preparing food to wear facial covering. 
• CEO Angelo says: Code enforcement is complex and involves many law enforcement, the code enforcement unit, and health and human services. All three components of code enforcement have committed to work with the health officer to enforce the public health orders. That is the best answer I can give you.
• Sheriff Kendall says: The Sheriff’s Office will support code enforcement. If there is a determination that is made that someone is so egregious that steps have to be taken than that’s what will happen. If you see a business doing something you would like, I would suggest not giving that place your business.  

Around 54 minutes

KZYX’s Sarah Reith asks: I’m wondering about testing at congregant facilities like jails and skilled nursing facilities. Are those being tested fairly regularly?

• Dr. Doohan says: We’ve been doing this for months now. We have a weekly call with the skilled nursing facilities, assisted living facilities, care homes and the jail. We conduct facilitated public health testing where, for example, in the jail a medical team will collect samples and then the public health lab will use a courier to deliver those samples to our public health lab in Sonoma County.or the lab in Richmond. There have been cases where an arrestee has been transferred from one place to our Jail where we were concerned that maybe in that other location they might have been exposed and the jail would put that arrestee in an isolation cell and then we would do the testing and when it came back you would be able to make sure that person could go back in the general population of the jail. In the skilled nursing facility, we do regular surveillance testing with the skilled nursing facilities including their workers and that’s something we’ve done for four months. It’s very important to do this. We’ve done this with our other congregate settings like our people experiencing homelessness and we also do it for our frontline workers or county employees.

Around 56 minutes

KZYX’s Sarah Reith asks: I’m wondering what the information sharing arrangement is between law enforcement and public health. If the people who need to know what areas are unsafe had the information they need to conduct investigations safely?

• Sheriff Kendall says: The Sheriff’s Office has a data bank right now and Public Health is sharing very limited information. There’s plenty to let us know if there is an officer safety risk of a certain location. We don’t see names and we don’t receive anything that would violate the rights. However, we have enough information that I’m comfortable with my deputies being able to respond to locations without putting themselves in harm’s way.

Mendocino Voice’s Adrian Baumann: How can you tell the increase of cases is not a product of the increase in testing?

• Dr. Doohan says: We’ve conducted about 3800 tests and only two new cases have come out of it. When we’re doing surveillance testing, you would expect there would be more cases coming from that. If you had a lot of community spread, you’d start detecting a lot of cases. The new cases that we’ve had have come from people being sick and actually going to the hospital or clinic. It’s true that we’re doing more testing but those people got tested because they got sick. It worries me that these people didn’t get tested, they got sick, and they went to the hospital or a clinic. I’m worried that people aren’t coming forward enough for surveillance testing. We need to see more people coming for surveillance testing and when we start picking up cases from our surveillance testing, then I’m going to say that it’s related to doing more testing. Whereas, if people are actually ill, and go and seek medical care, we would have picked them up regardless.

Mendocino Voice’s Adrian Baumann follows up with: What would you say to those people that see hurdles in the testing process: waiting in line to get something shoved up your nose?

• Dr. Doohan says: We first want the public to know it’s free. I am working to acquire technology that doesn’t require the swab to go so deep in the nose. I think there are some people who are hesitant because of the swab. I also think there is a real concern that if someone tests positive that they wouldn’t be able to work, that they would be forced to quarantine. If you’re positive with COVID, you could be spreading it to people, so you have to stay home if you’re sick. 

The last 10 minutes of the press conference was a Spanish question and answer session between Al Punto’s Jackeline Orozco and the county provided translator George Verástegui. The questions and answers were not provided in English so a summation cannot be provided.