Reporters had many questions today! (Apart from the Outpost, which had only one.) Dr. Teresa Frankovich, Humboldt County’s health officer, handled them all in the roughly 20-minute media availability session, as she has been doing since the start of the pandemic
Video above; rough transcript below.
The North Coast Journal asks, “We understand the OptumServe site has been extended by the state at least through November, but that its status beyond then is uncertain. If the site were to close, how would that impact overall testing capacity in Humboldt County and Public Health’s ability to set up mobile testing in outlying areas?”
Well it’s correct. Right now we understand it is going to be operational through November. It’s been really helpful because it’s allowed us some time to get our regional testing strategy set up and we expect that to be operational in November, so I think we’ll have a little bit of overlap regardless of what happens long term with Optum. I think our capacity is going to be well served between our in-house Humboldt County Public Health lab and the new regional testing partnership. Between the two we should be able to test up to 700 people per day and I think that will more than meet our needs going forward and we’ll be able to do it with the turnaround time that’s 24 to 72 hours. So I think it’ll actually serve the community really well and the ability to do a mobile testing site will be really helpful. Our goal in the long term is to have both a stable site centrally as well as mobile testing capacity, and but we’re starting with just our mobile while Optum is in place and then we will build from there.
The North Coast Journal asks, “It seems the state’s new Equity Metric hinges largely on counties’ capacity to test in the lowest quartile of zip codes under the Health Places Index which includes Hoopa and southeastern Humboldt County locally. Does the existence of this metric change testing strategies in these areas, and if so, how?”
We’ve been working since the beginning of the pandemic really to try and find ways to increase access in outlying areas throughout the county. We’ve worked really closely with Hoopa and the tribal clinic there, Dr. Eva Smith and the crew to try and make sure that people did have testing in that area. So they do have a rapid testing capacity there that is good for symptomatic individuals, not very good for asymptomatic. So on contact investigations and along the way we provided backup testing for Hoopa and confirmatory testing. So in addition when Hoopa was experiencing an outbreak, we worked with them and they were able to bring in testing to do a large portion of the community really within a week, and so that really helped in that instance as well. Southeastern Humboldt is tougher um and so we have worked to take our mobile team off site as possible to you know not only to Fortuna but to Redway into Garberville, the hospital in Garberville, Jerold Phelps does have some testing capacity and the clinic in Redway does as well, and then we coordinate with them to try and enhance testing there. Our new regional partnership I think though will allow us even more latitude and being able to get to some communities that need more access.
The Redheaded Blackbelt asks, “If an office staff member is being isolated at home due to a confirmed COVID exposure while awaiting test results, what is the recommended protocol for the office staff who are not directly exposed but are at some risk, and what measures should an employer take to promote safety in an office setting following a confirmed exposure to the office?”
Well there are a few points in there so I would say at first if there if someone has been exposed to a confirmed case they are placed in quarantine by Public Health and so they would not be in the workplace and typically those individuals are tested so that we can confirm that they actually were not positive in the workplace as well. If we determine that that individual actually is a positive case, we work with the employer in workplace to ensure that everyone is identified who may be in exposure, not everyone in the workplace necessarily would be, because one thing that people sometimes forget is that we really have to look at the infectious period for the individual, who was on site and who did they have contact with? And so you know it’s really an ongoing collaboration between Public Health and the employer and then the employer is able to communicate to the workplace as needed in addition to Public Health reaching out to individual contacts so that people are well informed.
The Redheaded Blackbelt asks, “Is it appropriate for an employer to restrict inter-office communications between co-workers regarding a potential exposure or cluster of in-office cases for fear of having a panic within the workplace? To what degree are individuals obligated to be forthcoming about their symptoms and exposure scenario taking into consideration HIPPA regulations?”
So to the first question or first portion of the question, you know again I think people need to understand that if there is a case, part of the case investigation is identifying where that individual’s been if there’s a workplace exposure then we are working with that employer to identify cases or potential exposures in that environment and there really ideally should be good communication so there really isn’t any need for people to be trying to sort of parse out rumors and figure out what is true. And there I think needs to be a good understanding among workers that if Public Health has a concern we are communicating that. Oh I’m sorry. The second part of that question, being forthcoming about symptoms and exposures, all of us are really dependent on people providing good, accurate histories and making sure that they protect their co-workers as well as family and friends by you know identifying who may be at risk so that we can take the appropriate steps.
The Redheaded Blackbelt asks, “In a contact tracing scenario involving a third-person exposure, generally how many people does a single exposure end up affecting and how often do you see an exponential growth of an outbreak stem from a single exposure?”
Well when we looked at contact tracing over time here we’ve seen a really broad range of secondary cases related to it. We’ve had everything from cases where an individual recognized quickly they had been exposed, they quarantined themselves, they were tested, positive, isolated, and there really was no exposure for instance outside the household. We have other cases, the gathering we had mentioned earlier this season where a gathering of 50 people resulted in an additional over 30 cases, and so again, we don’t track them in quite that way by how many per case and then track rates, but we’ve seen a broad range. Most cases are in the middle and so it’s not uncommon for us to have four, five, six additional cases related to a single case as well as all the individuals who are in quarantine.
The Redheaded Blackbelt asks, “Is it required for an open business to keep a register of visitors/clients/patrons at the front door for recording temperatures, PPE check, and names? Can you explain why this might be useful to a business owner as well as for contact tracers?”
So all businesses that are able to be open at this time are to have created a plan based on the state guidance documents and those plans are reviewed and approved by our Joint Information Center. Many of the components of this are suggested guidances for businesses, but not requirements. For instance they are not required to take the temperature at the door per se in all business settings. What I would tell people is that obviously if you’re operating certain types of businesses, having an ability to identify patrons who are there is extremely helpful if we know for instance that someone is in a setting where there might be an extended period of contact. Let me actually mention places of worship because that’s a really easy example to talk about is, if we have someone who’s ill when they’re attending a service and gets diagnosed with COVID or is in their infectious period when they attend and get diagnosed with COVID, if we can have an understanding of who was at that service, on that particular day, we can reach out to those individuals in a meaningful way and only the people who would be potentially considered at risk and that really informs a case investigation. If we have no idea who may have been there at that time it requires much bigger efforts in terms of contacting many more people or putting out an announcement for people to contact Public Health. So in those settings keeping a sign-in log for people is really helpful. In some business settings things like credit card receipts, things like that can be useful, but it’s very labor-intensive.
Reporter Daniel Mintz asks, “The last week has seen low numbers of daily cases except for October 14th when eight new cases were confirmed, the highest daily increase in a month. Did confirmation of all or part of those cases stem from a specific contact tracing investigation or are they unrelated to each other?”
In that particular case I believe that a number of those new positives were expected in the sense that they were related to a current case investigation. I can’t say that all of them were, but I can say that when we get a large number of cases all at a single time, often it’s because we’re directing individuals in to get tested who have been exposed or we believe have been exposed.
Reporter Daniel Mintz asks, “What are the rates of false positives and false negatives in local testing?”
I would say that in our local testing, both here in our Humboldt County Public Health lab and actually for Optum, which sends it out to Quest I believe, it’s a PCR test which actually has you know very high sensitivity and specificity, and so we don’t have significant concerns about false positives or negatives in that setting. What’s more of concern is that people, we are recognizing as we go through the pandemic, people carry varying levels of virus at different times, and so it may be possible to be really shedding virus highly at a time, get tested and be positive, but have very low levels at some point in your course and be harder to detect. This becomes an issue primarily when we are dealing with rapid tests that are not as highly sensitive or specific as our PCR tests and there it really there are increasing possibilities of false positives or false negatives with some of that testing. It’s getting better and using it as appropriate, for instance using those rapid tests in individuals who are symptomatic, where you’re more likely to get an accurate test result, improves the performance of the test. So we look at all of that over time, but as we look at testing strategies going forward and the the field of choices expands we’re looking for tests that will give us a good sensitivity and specificity or at least the best that’s available out in the community.
The Times-Standard asks, “Do new cases this week have the potential to change the state or county’s tier designation?”
Currently looking at our data I don’t anticipate a change next week in our tier status.
The Times-Standard asks, “Based on Trump’s town hall comments on masks, is it more effective to wear a mask improperly than not at all?”
Well, I would certainly argue that it’s not difficult to wear a mask properly and everyone should.
The North Coast News asks, “With the presidential election on the horizon do you think that the politicization of COVID-19 has affected Public Health’s response to the virus nationwide, either by inflating or minimizing the impacts of COVID-19? Do you think we could have had a more effective response without the politicization?”
Well the short answer is yes I think that it’s again as I’ve mentioned before it’s challenging to try and provide guidance and navigate this when it’s not simply science driving the process and I think that there has been difficulties with that from the outset with this pandemic, and I’m fairly certain that that has had an impact on how things have rolled out across the country. I think it’s challenging for citizens to make wise choices when again the science is sort of being pulled and not accepted at face value. For instance facial coverings became very political and really it should be a simple Public Health measure. Early on in the pandemic we did not understand the importance of facial coverings in helping to control spread, as we do in science we watch what’s happening and we study it and then we amend what we do based on what we find, and what we found was it’s extremely important. We’ve adjusted the guidance and without a political climate I think it would be easier for people to hear that and move forward.
The North Coast News asks, “With Humboldt County now allowing in-person weddings, do you recommend couples still only participate in virtual weddings? Or is it a safe enough bet to host in-person ceremonies with safety modifications in place? Do you see this guidance changing anytime soon and forcing couples to change their plans yet again if they choose to host in-person ceremonies now?”
Well again for weddings, weddings themselves can occur and the new state guidance you know goes into the more of the specifics about how that can happen. Obviously it is always safer not to have a gathering, we just know that to be true in COVID. If there is a gathering, making it as small as possible and intersecting as few households as possible is really important. Under the new gathering guidance a good recommendation would be no more than three households and then inviting other guests virtually would be the best option. Personally I would not want to gather, you know as much as I love attending a beautiful, big wedding, I would not want to gather my extended family, relatives and friends, many of whom may have underlying vulnerabilities or whom are older, to pull them together into a space where they might be at risk. And I would further say that even younger individuals we know can have serious illness with COVID. So bottom line is a wedding service is permitted, reception parties are not, and the smaller, the safer. If it’s outside, it’s safer and putting all the safety precautions in place that we’ve talked about add safety as well.
The North Coast News asks, “Now that case rates based by zip code are being reported are there any data points that surprise you? Are cases higher or lower in areas that you weren’t expecting?”
I would say no, not from our end, although we haven’t been looking at data by zip code per se through this pandemic because it’s just not a construct that’s been um really helpful for us, we’re obviously aware of where cases are occurring and watching that. But as we’ve said since the beginning of this, the you know it’s really important for people to understand that cases are assigned by zip code.
You might work in or live in Arcata, you might work in Eureka, or you may live in Eureka and work in Fortuna and it or you may socialize with someone or have been with someone who’s in another county or you became ill because you traveled to Utah or Arizona or Idaho or any other state or within the state of California, so seeing where the case is assigned to a resident tells you nothing about where the person was exposed to COVID. And I do worry about people having a false sense of this zip code is safe, this one is not.
It’s also important for people to recognize that these are absolute case numbers that we’re reporting and it is completely expected that a higher density area, for instance Eureka, would have more cases than a very sparsely populated, remote area. So I just think it’s important, it gives you some sense of where our cases are but I really think we need to be careful about how we use that to navigate this pandemic.
The North Coast News asks, “Being right on the cusp of moving to the yellow tier last week, do you anticipate us remaining in the yellow tier or falling back into the orange tier?”
Well as I mentioned just a bit ago I think this coming week we’ll be okay since we’re now sitting at Friday and the data is calculated on Monday by the state and released on Tuesday. I do want to mention however that through the pandemic it is very likely that we will bounce between tiers. Arriving at the yellow tier, we will strive and do our best and with everyone’s assistance we can work to stay in yellow, but an outbreak of you know significant size, we’ve seen for instance in neighboring counties, where within a very short period of time you can go from a manageable case rate to one that is much higher, and so it really is important for people to understand it is very likely that we will move between tiers and it is incredibly important we do everything we can so that we can remain where we are as long as possible and for as much of the duration of this pandemic as possible.
The Lost Coast Outpost asks, “Governor Gavin Newsom recently suggested that people eating out should wear their mask between bites. With restaurant wait staff now working long shifts indoors around people spending most of their meals unmasked, do you agree with the governor’s recommendation?”
Well I think it’s a good question in the sense that we know as we’re bringing people together into spaces that there is more risk of transmission and restaurant guidance for instance really does talk about the fact that restaurants need to have limited capacity so that they’re able to spread out tables and spread out groups from each other to decrease transmission. There’s also you know hand sanitizer other things in place, disposable menus for instance to help reduce transmission. I think that wearing a mask is important to do, I think that the more you can wear your mask, particularly in an indoor setting, the safer it is, and so I think when people are you know sitting at their table when they are not eating their food, I think masking is is really helpful to do as much as possible.