Today, Dr. Josh Ennis, Humboldt County’s deputy health officer, took questions about the state of the coronavirus pandemic in Humboldt County — and more specifically about testing, infection rates, federal versus state guidelines and a few other topics.

Video of the questions to Ennis and his answers can be found above. Below, a rough machine transcript of the interview. 

###

KMUD News asks: “The health guidance for sports released yesterday forbids adult amateur sports at this time. Are there any safe ways for group sports activities to be enjoyed by adults right now”

So the guidance yesterday for youth sports is for exactly that — it’s for youth. It does allow for up to two adult coaches, but this is applicable to youth sports and the the guidance goes so far as to state that adult amateur sports are not allowed at this time.

In anticipation of this coming out for, or guidance at some point in the future potentially coming out, I would imagine that it’s going to echo the same things that we’ve been hearing — that you limit cohort size, so the fewer the better, four or five people; that you have a more stable cohort, so it’s the same four or five people; that you mask when possible; that in the absence of a high output activity where you have to breathe hard outdoors is clearly much safer than indoors; if there’s any shared equipment you should try to develop ways of not sharing equipment, and that they have to be clean and sanitized between different users.

These are all the same things that we’ve been saying frequently, so I’d expect that whenever that occurs it employ some of the same strategies.

KMUD News asks: “Can you please describe the latest trends and demographics of COVID-19 infections?”

So the demographics have continued to demonstrate that there is a disproportionate number of Hispanic and Latino people who are infected with COVID-19 and more recently, with the situation in Hoopa, Native Americans.

Now, I think it’s very important to point out that this is not necessarily due to any heightened risk-taking activity or people not collectively getting the sense that they need to be doing their part. More frequently we know that minority groups will tend to work in essential positions where they’re frequented to much more exposure, and so it’s nothing intrinsic to anything they are or are not doing. They work in jobs where they can’t be remote oftentimes and so that certainly contributes to some degree.

The Times-Standard asks: “The CDC changed its guidance this week to omit a recommendation that people should get tested if they have come into close contact with a known COVID-19 case but aren’t showing symptoms. Governor Gavin Newsom has said California will not be influenced by that change. Given the conflicting guidance will Humboldt County adjust its own testing recommendations and does it take a formal stance on the dispute? Will this impact the county’s goal to increase testing capacity?”

I think it’s worth pointing out that the CDC, in its guidance on this topic, leaves open the possibility that state and local public health officials can give recommendations otherwise, and both CDPH as well as the governor of our state have made clear that they plan to continue with the same guidance, which will be a departure from the recent change by the CDC. If you read closely the guidance it still recommends that certain subgroups can pursue testing and that those who are working with vulnerable populations such as nursing homes, those who have an elderly or vulnerable person at home, so there are other situations that they’re leaving open to pursue testing.

But you know, I think the reality is that in the face of a limited testing we have already been making some of these tough decisions about how do we prioritize who gets tested. I think what’s important to point out here is that we have always been striving for testing all the asymptomatic close contacts of confirmed cases. We have at times had to not pursue testing because of limited testing supply and so we’ve been striving to meet the bar of testing all those people who we think are high risk, who have some risk of exposure. And so we plan to continue following the guidance that the state is continuing to support, and it will not affect our push to increase testing capacity. 

The Times-Standard asks, “In general, the CDC has faced intense criticism recently from other top health officials. In the past DHHS has cited closely following CDC guidance. To what extent is Humboldt County relying on the agency’s guidance to inform its own coronavirus response?”

In general, the CDC is one of the first places we go to to look for a guidance on any particular topic and so for day-to-day operations — with isolation, with quarantine, with return to work, testing versus non-test strategies — we use it day in, day out, and in general it’s aligned with the same guidance on the same topic that’s put out by the California Department of Public Health. Nearly always they’re aligned and when they do depart we tend to align with the recommendations from the state.

You know, I think this question is trying to get out that there is a clear departure here in testing of asymptomatic close contacts and — again — where there is a difference, we tend to align with the state. 

The North Coast News asks: “Governor Newsom says soon he will announce plans for reopening business that closed nearly two months ago when cases spiked. When do you expect to see this guidance from the governor and how do you anticipate this will impact Humboldt, i.e what types of businesses he is referring to, will there be a timeline. etc.?”

I am unaware of what plans are in the works in terms of reopening businesses. Given the timeline reference here I’d speculate that he’s talking about bars, restaurants, places of worship or personal care which were closed for those counties on the County Data Monitoring List, or moved outside for those who are not on the list, but that’s speculation. I don’t know what the timeline is, I don’t know what sectors he’s talking about. 

The North Coast News asks: “This week the CDC said it’s not necessary to test asymptomatic people who have had close contact with others who are affected. Will Humboldt be influenced by that change in guidance and does the county agree with the new federal guidelines on this?”

I’ve already addressed this questionn. Maybe what I’ll add is that we have clearly seen that asymptomatic individuals who are close contacts can be infected and they can spread it to others, so we plan to continue doing exactly what we have been. 

The North Coast News asks: “The governor announced yesterday that the state signed a deal to more than double testing capacity. How specifically will this affect testing in Humboldt?”

Yeah, so this is referring to, I think, a recent contract with a company called Perkins Elmer. There are some opportunities out there to expand testing as a part of this deal and we are working actively on pursuing some of those opportunities. 

The North Coast News asks: “Under new state guidelines released Tuesday more California children with specialized needs will be allowed back in classrooms even as most schools remain shut for in-person learning. Will schools be required to provide this option to students with special needs?”

So as far as I know there is no requirement to provide this option. The guidance … I’ve only had an opportunity to glance at it, I haven’t reviewed it in depth quite yet, but I’m unaware of any requirement to do so, it more stipulates things that need to be in place in order to operate safely. And again, this will be individually up to the schools and districts to decide based upon what their resources are, what their community’s needs are and [whether] they have the guidance for reference on how to do that safely.

The Lost Coast Outpost asks: “You’ve said that the actual infection rate in Humboldt County may be five to ten times as high as our official numbers would indicate. Wouldn’t the corollary to that be that the virus is far less dangerous than we initially believed? For example it would mean that perhaps one percent of the people who have contracted the virus in the county, or even less, required hospitalization.”

This is an astute observation, and that corollary is true, but I feel that I need to talk a little bit about where those numbers come from, and then also some caveats that maybe haven’t been considered.

So the CDC itself estimates that infection rates are on the order of five to 25 times higher than what we’re actually seeing, and that number is a huge range. It’s going to depend upon how widely testing is available, how widely testing is accepted, and so and if you look at what’s happening in different states — for example, a state in the South compared to a West Coast state — those numbers can vary dramatically. In our state and in our county, there is a general acceptance of testing. It is somewhat accessible. Nonetheless, some people never pursue testing and so this range of five to ten times is on the lower end. You could even make the argument that the statewide shelter-in-place, back in March, went into effect early enough, and we had enough time to really increase testing efforts, that we may even be a little bit lower than that — on the order of three to five times.

So the point in discussing all this is that this is really an estimate. No one really knows. Nor will we know for potentially several years until we have an antibody test that captures all potentially all people, or some type of other test that captures all people who have had prior exposure.

So it is true that the actual infection, hospitalization rates and infection fatality rates will go down as you pick up more cases. That is very different from a case fatality rate. So, a case fatality rate depends upon having a confirmed case, a test that firmly proves that the person did have an infection. And so there’s a lot of misinformation and misinterpretation of that information and data out there because people are sometimes comparing case hospitalization rates with infection hospitalization rates and they’re not the same thing, they differ in our county by a factor of, as this question points out, of five to ten times.

So as that number has come down, the other thing that we have to keep in mind is that infection locally and nationwide is being driven much more by younger people. Younger people tend to have fewer or no comorbidities, and we know that those individuals are much less likely to suffer from severe disease that puts them in the hospital or that ultimately leads to death. And so when we say that the number is going down, because we’re not capturing five to ten cases out there, it’s also going down at the same time because more and more young people are being infected and the vulnerable people are having the opportunity to protect themselves, and over the last six months we’ve been able to put in a lot of infrastructure and systems to protect those vulnerable people.

If you look at the the curve of cases it’s kind of done this double hump thing across the nation. And if you look at the deaths across the nation, the first wave of deaths is way higher than the second wave of deaths even though the second wave of cases is much higher. So they totally flipped, and that to me says that we’ve had a good opportunity to really protect the vulnerable, and so that’s also going to drive down the hospitalization rates and the the fatality rates. And so it’s … you know, we’re kind of a victim of our own success to some degree in this regard. 

The Lost Coast Outpost asks, “Epidemiologist Michael Mina and several others have been urging policy makers to adopt and accelerate the production of cheap, fast, frequent, self-service COVID tests that have been developed by a few different companies. These tests, which operate something like a pregnancy test, have a high degree of specificity but are not particularly sensitive. Should policymakers be acting on Mina’s recommendation? How would the availability of such tests change the way we fight the disease here in Humboldt County?”

I think at the core of this is that as a nation as a state and on the county level we’re still falling short of what most experts think our testing capabilities need to be, and so in order to fulfill that shortcoming, you know, this is one way to potentially do that.

There are certainly some shortcomings in any test that has poor sensitivity. Sensitivity is a measure of how many people with disease you’re actually going to pick up with the test, and so you’re actually going to miss people if you have a test that has poor sensitivity. So to say that in other words, you’re potentially going to have false negatives. So this particular test — if it’s positive you can generally believe it, but if it’s negative and you have someone who has all the COVID-19 symptoms, it’s highly likely to be a false negative.

This test I think has a lot of power to distribute and make testing available, and living in a rural county like Humboldt we know that people aren’t going to seek out testing if they have to drive an hour to get it or or even further, and so making testing available within the home with something like this is one of the ways we can make testing more available. And so it could potentially contribute to reaching testing goals of what is generally felt needed to really truly understand where disease is moving around within the community and slow transmission.

But there are a lot of logistical challenges I think that would come with this, and when you throw in the mix something like false negatives it’d be very difficult to message and make sure that the test is always used appropriately and interpreted appropriately. So it would come with some very significant challenges.