Dr. Josh Ennis Talks About the Super Spreader SoHum Gathering, Three Under 60-Years-Old Hospitalized, and More

Humboldt County’s Public Health Officer Dr. Teresa Frankovich has been answering questions since the stay-at-home orders were instituted on a two question per media outlet roughly two times a week basis. 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 21st Media Availability session with a summary of answers from Deputy Health Officer Dr. Josh Ennis, followed by questions we would have liked to ask in response if appropriate.

Question by North Coast News:  Dr. Frankovich mentioned that schools can utilize free testing at the Optum site as they move toward in-person learning. Where does the money come from to subsidize testing in schools?

Answer by Dr. Ennis:

So the OptumServe site is subsidized by the state so it’s California taxpayers who are paying for operations and test supplies and testing of anyone who goes through the OptumServe site, they will bill insurance to make the operations more financially sustainable but they will not place any co-payments or anything like that upon individuals seeking care there. So it’s coming from the state. To my knowledge the California Department of Education is not providing any funds geared towards specifically testing for COVID-19. I will add that we have this new testing option, the Perkins Elmer equipment coming online soon and that as well will be subsidized by the state. So at no time is anyone going to be charged for the testing through either of those two avenues. 

1 mins 30 sec in:   

Question by North Coast News:  The Health Care System Capacity alert level moved from green to yellow on Tuesday. With the influx of recent hospitalizations, do you think residents are loosening their grip on things like social distancing and facial coverings? If so, what does this mean for Humboldt County?

Answer by Dr. Ennis:

So in terms of tying the hospitalizations to people’s behavior around the non-pharmaceutical interventions, you know it’s hard to tie the two   necessarily. I think it is very easy easy for people to get lulled in complacency because they’ve been doing these things, they’ve been relatively untouched, we’ve been very fortunate in our county that numbers have remained low, so it’s very easy  to stop doing those things to become very relaxed about it.  For the current hospitalizations I’ll just note that you know, the height of our numbers was two, three, four weeks ago and this is what we expect. We expect that when we have lots of cases floating around it’s more difficult to diagnose most of those cases and then it starts spilling into people who maybe are trying to be more careful or maybe they’re not being careful and it rapidly spreads and so it’s a lot harder to chase that line of transmission to extinction and…put out that line of transmission. So I think these hospitalizations are more tied to just more disease circulation generally that we saw two, three, four weeks ago and I’d be real hard-pressed to say that it hinges upon  a loosening of things such as social distancing and facial coverings.  That being said, I think it’s a good reminder that we shouldn’t become complacent because at any one time there can be a super spreader event and if we’re continuing to do things and introduce more risk such as gathering, those things become much more important for limiting the spread of disease. 

3mins 30 sec in:  

Question by North Coast News:  Active cases in Humboldt County have dropped to the teens for the first time in months. Is there any specific factor contributing to the low number of active cases in the county? Because of this, could we see one of the alert level assessment tool categories move back into the green tier soon?

Answer by Dr. Ennis: 

Yeah I think I spoke about this a little bit in the prior question. The number of active cases is not always the best thing to judge circulation and disease by. There are many cases that go undiagnosed because people are asymptomatic or maybe they have very minimal symptoms for a very short period of time, so they never seek testing, or they may live somewhere far away, you know, in the corner of the county and testing is not accessible to them. So that measure alone is not a good one to judge how we’re generally doing. That being said, our numbers that for the active cases are lower than they have been for some time. That is certainly promising and if there were any one specific factor it’d be that our investigation and tracing team has done a good job of trying to rein in some larger clusters. We had a couple larger clusters that were ongoing and when they get that big or we have a super spreader event where you know one case turns into 20, 30, it’s much more difficult to contain those quickly and that is the concern that we tried to highlight six months ago when this all started, that the potential for exponential growth is the biggest concern and you can have a big influx of spread of disease, hospitalizations and deaths. And so you know I think this is just a testament to the fact that we’re doing better than we expected with investigations and tracing and we have been able to significantly slow the spread of disease within these larger clusters.   So there is no shortage of research ongoing about therapeutics, vaccines. The other day I think I read that across the world there were something upwards of like 200 vaccines being researched. It’s just, it’s mind-boggling to think about. 

5 mins 35 sec in:  

Question by Lost Coast Outpost:  What is the most promising therapy, prevention measure, vaccine or other pandemic-altering technology you see on the immediate horizon? 

Answer by Dr. Ennis: 

You know in answering this question I Think it’d be pure speculation about what is and is not promising because I haven’t had a chance to review any of these, like vaccines for example, in phase one, phase two, phase three trials, I don’t know the specifics of them so I Can’t speak to you know which ones are most promising, which ones are not. I can tell you that what we have today is very different from what we had six months ago. We know that there are certain people who will get more sick than others and in general that’s people with comorbidities and age and so we’ve had a chance to help protect those people. So we’ve shifted who gets sick to younger, who are much less likely to get severely ill. They’re not at 0 percent risk of becoming ill but they’re at lower risk. So we’ve shifted who gets sick and we can protect you know the vulnerable over here.

At the same time we know that many people are waiting far too long to get care and they would have really incredibly low oxygen levels, to the point where it’s very late to intervene and that in part was contributing to how sick people were getting. The whole idea is if you could intervene earlier, pick up low oxygen levels earlier, you can maybe save that person from going on to needing a ventilator. And so we know that people, if they seek care earlier, we can intervene earlier. we can affect mortality, we can affect how many people die, how many people end up on a vent. And then finally therapeutics. We have steroids, we have Remdesivir, those are, have slightly better evidence. Convalescent plasma is, has been used and is promising but the evidence is not as caught up as it is with or not as strong as it is with Remdesivir and steroids. But in any event these things shorten hospital length of stay, they decrease mortality a little bit and the end point is that our healthcare system can potentially treat, cure and discharge people faster. And so that that’s huge for having our healthcare system be able to deal with people who get sick with COVID-19. So these are not major, you know advancements, they’re not silver bullets to fix everything, but they’re little steps that help us deal better with the problem. And you know if you look at it cumulatively overthat six-month period, all those things I’ve just gone through, from who’s getting sick, when they decide to seek care, what they’re capable of getting in the hospital, really do make a cumulative difference. And so we’re much better positioned now. 

So those are things I can speak definitively to rather than speculating about, you know, the hundreds, maybe thousands of therapies and vaccines that are being researched right now. 

 

9 mins 20 sec in:   

Question by Lost Coast Outpost:  Can you give more details about the 50-person event in Southern Humboldt that has led to so many cases? Was it indoors? Were attendees masked? Were they socially distanced? Have you identified the factors that led to this becoming a super-spreading event? Maybe another way of putting it would be: Why did attending this event end up being so much more dangerous than shopping at a supermarket?

Answer by Dr. Ennis: 

So we know that most people are not going to get COVID-19 by having brief interactions.  You know walking past someone in the supermarket, if you’re both masked, you brush past each other, five seconds, that’s not a scenario in which you’re at heightened risk of of contracting COVID-19.We know that you really have to be interacting closely. So we’ve defined that as within six feet for a prolonged period of time and we’ve again defined that as 15 minutes. Now we know that there’s actually a spectrum of distance, there’s a spectrum of time, but the longer you spend with someone and the closer you are, the more increased risk you are. And so you know at a at a supermarket you’re not spending significant time with any one person, you’re not spending, you’re not inside that six-foot bubble with any one person for extended periods of time, and so it’s really transient in nature, the interaction. In contrast, an event such as this 50 person event in Southern Humboldt, people are usually gathering around a life event and so they’re spending significant time with one another in close contact. There’s often affection, there’s hugging, so those are things that are definitely within the six-foot bubble. Additionally if there’s shared food this is another area where it can cause increased risk of transmission. If the person who is ill or infected is touching the same spoon and maybe they’ve just rubbed their nose because they just sneezed, there’s potentially infectious material on each of those items. Take that one step further. 

If they prepared the food if they’re the host of the party and hand hygiene was something that they weren’t really on top of, potentially all that food could become infectious. And so bring it back home to this particular event, I don’t know about specifics, I would speculate that people aren’t masked or staying socially distanced but I don’t actually know the answer to that. One thing was apparent, people were a little reluctant to come forward about this gathering early on, and it was only after we started seeing several more cases that people pointed back to this event, and so I think one of the things I’d like to just tell people is that you know, we’re not looking to bust people on this. Public Health is all about protecting the wider community. And so by being forthcoming and talking about gatherings like this, it’s going to help us prevent spillover of disease into the community, and that’s what this is about.This is not about shaming people. You know, we really don’t think it should happen and it places a lot of risk upon the the greater community, but you know if you have a gathering that’s larger and there’s one ill individual, there’s a good chance that many others will become sick if people aren’t adhering to you know distance and masking. And so it’s very likely that it will rise to the surface at some point. And so with this event we’re starting to see people who didn’t attend the event start to become sick as well and that’s really the concern about these super spreader events. 

13 mins 20 sec in:   

Question by Redwood News:   We saw the health care system capacity alert level increase to 2 this week and yesterday, the JIC said it was due to an increase in hospitalizations. Another factor that plays into that alert level is infections among healthcare workers. Are you able to give us an update on our local healthcare workers as far as any positive tests, quarantine/isolation periods, etc. 

Answer by Dr. Ennis: 

We’re looking at several different things when we’re talking about the healthcare system and as this question kind of alludes to, the number of hospitalizations was the main driver here and so we’re looking at hospitalizations but we’re also looking at critical medical resources. So things, for instance, such as ICU beds, ventilator use, we’re also looking at the people who take care of the ill. If we have a lot of ICU staff ill, that’s going to really dramatically impact how many sick, critically ill patients we can take care of in our county. And so we’re looking at all these things. The big driver was hospitalizations. Over the past couple weeks we’ve had a couple peaks,census of four, came back down a little bit, census of five, and so this is not just something that we’re looking at day to day, but we’re also looking for a steady trend and it’s become clear to us that we are starting to see more consistent numbers of hospitalizations across the county on a regular basis. I do want to reassure people that our hospitals are not in a bad position. They certainly have more capacity to care for the ill, but we really want people to be aware that our healthcare system is in a position where as we approach respiratory season, flu season, we get other illnesses circulating, and we add those on top of what we’re seeing with COVID-19, it could place the normal operations of hospitals into a position that they were several months ago, and we do not want hospitals and clinics to stop preventive care because those are very important items for people to be able to access. We do not want to delay preventive care. So getting back to this question, for local health care workers we haven’t had any infections amongst hospital health care workers for several months. We have had one recently, and I’m not including skilled nursing facilities in that number, but there has been one recently. And that alone would not trigger movement but we are tracking that over time. 

16 mins 5 sec in:  

Question by Redwood News:   With the recent increase in hospitalizations, is Public Health concerned at all that local infections are becoming more severe? Can you also explain the trend in hospitalizations you’ve seen since the beginning of the pandemic (age, duration of hospital stay, etc.)? 

Answer by Dr. Ennis: 

I think it’d be premature to make any conclusion that we’re seeing more severe disease in our county.  The increase in hospitalizations is a pure reflection, I think, of the epidemiology. We’re seeing more cases. If you look at our 14-day case rate, if you look at our daily case  rate, and this is what we’ve been tracking all along, which is the big informer of our alert level system, it informs the blueprint exclusively at this time, we have been steadily increasing and increasing.  So right now we’re right on the cusp of, or I shouldn’t even say at the cusp, we did break across the four daily cases per 100,000 and you know that alone won’t get us into that next state’s blueprint tier of red but if it’s sustained over two weeks it will. And so the hospitalizations reflect more disease circulating in the community, it does not reflect more severe disease. We know that these hospitalizations can stack up upon one another. People who are ill and require oxygen with COVID-19, they often require care for a couple weeks, they can stay in the hospital for a long time, and so that is the big concern, if we have a rapid increase in disease, we get concerned about increases in hospitalization and those people sit in the hospital for a long time because they they need a lot of care. And you know this is just purely reflecting the epidemiology at this point. I will say one other item and that’s that you know a lot of people focus on the age of these individuals who have unfortunately passed away of COVID-19 and those who have been hospitalized. I’ll just point out that with the folks that are in the hospital right now, we we do have younger individuals who are in the hospital and we have had individuals that are even younger than what we said yesterday with three under the age of 60. So this is something that can affect younger individuals. Certainly our experience has been that those who die tend to be older, but our numbers are still so small that I would certainly expect that as more disease circulates to the community we will see younger individuals succumb to this illness and that’s an unfortunate reality. So I think what we know is that COVID-19 is going to be here for quite some time and this is really about protecting the entire community. And so when you choose to see someone else, you know, or to participate in a gathering, this is about something more than just your individual risk tolerance and your individual health. This is about someone else’s, you know, elderly grandparent or someone else’s father. We’re starting to see this, people who are actually trying to do the right thing are becoming ill because we have increasing disease circulation. So this is about something much bigger than just the individual and I would really encourage everyone to think hard about that and try and take care of one another and be nice to each other about it. 

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