In today’s media availability, Dr. Josh Ennis, Humboldt County’s deputy health offer, took questions on the state’s new “health equity metric” and the county’s early models of disease spread.
Video above; rough, machine-generated transcript below.
Good afternoon. Would you like to start by addressing the community?
Yeah, I’d like to talk a little bit about the Health Equity Metric, which has drawn a little bit of attention by our county.
The Health Equity Metric was recently rolled out, and the whole concept here was to try to bring communities along who may be disproportionately carrying more burden of disease. And so, said in different words, you know: to make sure you don’t leave anyone behind when it comes to access for testing, access to identifying illness and access to treatment, and making sure that everyone has the same chance to prevent serious illness from COVID-19. And so the state used an existing framework, the California Healthy Places Index, and this is basically geographic locations within counties, broken down by census tracts — they’re given ratings that are based on a lot of different factors: social measures, economic, transportation, health care access, there’s a number of them. I’d encourage you to go onto their website and take a look if you’re interested in learning more.
But the most disadvantaged census tract areas within counties were, across the state, carrying disproportionate burden of disease. So to bring that home to our county, when the state looked at the lowest portion of census tracts across our county, we were actually performing pretty close to the measure of burden of disease for the entire county, and so right out the gate we’re able to benefit, so to speak, from this new measure.
And so the whole idea here is to just make sure that everyone has the same footing when it comes to testing, and that everyone has the same opportunity for success if they do fall ill with COVID-19.
The North Coast News asks, “In the past, case rates among some minority communities in Humboldt County were higher than the county as a whole. Now, it appears those numbers have stabilized to satisfy the new equity metric. When did the county start to see those numbers stabilize and what do you believe is a contributing factor for that?”
First, I want to point out that the way this Health Equity Metric is constructed, it really relies upon geographic areas or census tracts. It does not focus directly on minority communities. That being said, across the state there is a clear correlation between some of the census tracts that have some of the lowest healthy places in disease, and minority communities. So it’s kind of an indirect part of how this is constructed, but it doesn’t go directly toward minority communities as it’s built right now.
Humboldt County has definitely seen something that’s been reflected across what’s happening in the state, across the nation, and that minority communities have higher rates of COVID-19, higher rates of death as well from COVID-19. We, as I’ve already said, have performed very well from the gate, from the release of this new metric, and it’s not a matter of trying to conduct our actions in a way to meet this metric. We’ve been thinking of this all along and how do we really make testing accessible to everyone, because really if there’s an outbreak in any one community, it will spread to the entire community at some point if it’s left unchecked.
And so if we ever were in a situation where we felt disease was spreading more than we’d like, if we’re late in identifying cases, for whatever reason if people are a little hesitant to come forward and bring information that allows us to trace, test and isolate, we have made every effort to make testing available. And one of the easiest ways, if capacity allows, is to arrange for some type of mass testing. And so that has been successful, and if introduced at the right time, you can really contribute to extinguishing ongoing transmission of disease in some of these settings.
So that is one way we’ve been able to respond successfully in scenarios where there’s ongoing transmission or we’re having difficulty, for whatever reason, extinguishing the line of transmission.
The North Coast News asks, “With the county soon releasing new data about COVID-19 case breakdowns by zip code, what are the trends you are seeing in the cases in different areas? Are some zip codes seeing more cases in younger versus older people? Rich versus poorer etc.”
So we’ve been tracking age across zip codes as one kind of surveillance measure to see if there is any concerning pattern amongst young people who may be resuming in-person school. So that is one surveillance system that we’ve built into some of the statistics and measures that we’re tracking.
I can say that we haven’t seen any noticeable pattern across zip codes, but it again has reflected what we’ve seen across the nation and across our state. At this point it tends to be younger people: We know that they’re less at risk of severe disease and so they may be more tolerant of more risk and behaviors that assume more risk. And so we’ve seen that across this county, similarly, early on, as you could imagine, there was more disease in more urban areas. If we look at where we’re at now, there’s no part of the county that’s been spared at this point. The disease has rippled out into all pockets of our county.
And this is something we’ve seen on the national scale right — it started in New York in the northeast, it was big in the west, and now it’s big in the Midwest. I read in the paper the other day that Wisconsin was setting up a field hospital because they are nearing capacity for their state’s ICU beds. So, to bring it back home with what we’re seeing here, we’ve seen it start in the more urban areas. It has rippled out into the more rural areas and so it leaves no corner untouched. And those are generalizations, and when we release the data you’ll be able to see it for yourselves.
Reporter Daniel Mintz asks, “In a forum last April, you presented models of future coronavirus cases, hospitalizations and deaths based on various levels of restrictions. A model based on April’s shelter in place restrictions showed cases peaking in December, with 145 people hospitalized. Is that model still relevant or has new data changed the county’s modeling?”
I wish it was a simple “yes” or “no” answer. In some aspects, it is relevant, in other ways, it’s not. So, to go back to April, when we were initially doing some of this modeling, we were looking at what had happened in other countries and other parts of the state, and the landscape was very different. So to just remind everyone, there was very little testing available, there were health care providers being put in bad situations with PPE not being available, which meant it spread easier in those settings. There were no therapeutics. And as a result, people were coming to the hospital very late when oxygen levels were very low — they were being put on ventilators late.
So now here we are, six, seven months later and the landscape is very different. Our testing has grown probably more than 100-fold at this point in our county. Supply chains have been restored for the testing reagents and supplies. PPE has been replenished and there are caches available within facilities such as hospitals. There are caches available at the county level.
And then finally, we know a lot more about how to best treat this disease. People need to get treatment early. They need to not wait until that 7- to 10-day window when people were dramatically decompensating. And we have a few therapeutics that offer some benefit with speeding up recovery, decreasing mortality. And those allow more people to move through the acute care hospital system quicker than they could six or seven months ago. So we’re in a very different position.
So, in a lot of ways, it’s very irrelevant, it’s outdated - okay - but what’s still very relevant, and the reason we presented those two scenarios, was to illustrate the concept that if it gets away from you, it can get away from you in a really bad way. And it can accelerate really quickly, and very quickly overwhelm the healthcare system. That is still true. Our county has fared fairly well through all of this — we still have a small minority of people who have been exposed and who have had the illness. I’d estimate somewhere on the order of maybe 2%, 3% - it’s very low. Most people are still susceptible.
So, if we tomorrow start behaving like we were eight months ago, we could very much end up in that situation. We’re in a very good situation, we’ve had time to prepare. We’ve had time to maybe get used to some of the changes that are necessary to slow down the spread of disease and we’re much better prepared to deal with some of those items that come up around treatment of COVID-19, and also identifying other people who have come into contact just slow the whole process down.
So the answer is “yes and no,” but I would just caution everyone that we are in a good position and that alone is not reason to go out and start behaving differently, necessarily. This is truly a new normal, it’s different than how we could behave eight months ago.