This morning, Dr. Josh Ennis, Humboldt County’s deputy health officer, took questions from local media members on the COVID pandemic and the county’s response — as well as the health impacts of local fires. 

Video of his answers above; rough machine transcription below.

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The Senior News asks, “Has the county eased restrictions to permit family and friend visits to residents of senior nursing care facilities? If so are those published anywhere?”

So the county has never been the one who has imposed restrictions on visitation to skilled nursing facilities. This was something that was put in place by our state — California Department of Public Health. In our local order we’ve referenced that guidance.

So that being said, there has been more recent guidance released both by CMS, so a federal entity, as well as CDPH that essentially establishes kind of some ground rules for visitations to occur. I think it’s important to note that this is an incredibly vulnerable population. Early on it was somewhere in the neighborhood of 40 or 50 percent of all deaths were occurring in those amongst nursing facilities. Our nursing facilities have had time to prepare and have dealt very well with mitigating any spread of disease, so what’s important is that if there’s been any kind of easing of restrictions and visitation is now being allowed to occur, it’s not that it can’t happen without appropriate precautions.

So it it takes into account all the things that we’ve been saying all along and and basically set some ground rules for how visitation should occur and so things such as trying to minimize or discourage any kind of physical contact, keeping space, when possible do visitation outdoors, that it occurs outdoors, when possible to have a separate space, to have it occur in that separate space and so the doors haven’t flung wide open, it’s simply laying the groundwork to do it as safely as possible. 

The Redwood News asks, “Are the DIY and surgical masks we wear helping protect against COVID-19 and the bad air quality? What type of masks, if any, are the most effective against protecting against both COVID-19 and the smoke from fires?”

So if we’re talking about big stuff like ash in the air, certainly the general term of facial covering which includes, as this question poses as DIY masks, those items will help. But when we talk about, really, smoke we’re talking about smaller particulates in the air, and unfortunately respirators …

So we’ve talked a lot about N95, so N95 or greater, something that actually creates a seal on your face is what’s going to protect best against bad air quality. And there are construction-grade masks, there are health care related masks. The difference here is that they’re referred to as “respirators,” and they’re intended to really filter much more smaller particulates out of the air, and so those would offer the most protection.

I’m in no way recommending that everyone wear N95s at this time, but we know that the the smaller, tighter and more layered the mask is, the more protection it’s generally going to offer from smaller and smaller particles, whether it’s virus or particulate matter from smoke. 

The Redwood News asks, “What masks are recommended to wear during this time of fires and pandemics to protect ourselves and others? Which masks aren’t recommended to wear?”

So I think I’ve addressed this a little bit in the preceding question.

It’s hard to make a general recommendation because everyone has a different set of medical conditions or behavioral conditions that may interfere with them adhering to a tight-fitting mask. I’ll give the example of someone who has bad lung disease — they may not deal with wearing an N95 very well, and so that may cause more problems for them than simply taking it off and trying to limit exposure by staying indoors in an area that has filtered air. And so it’s hard to come up with a generalized mask recommendation for both fire and COVID-19.

We know that the local order says wear facial covering when you can’t maintain distance, when you have to go indoors. The smoke levels are monitored for parts per million and so the recommendations can range from you know being perfectly fine for everyone, to only sensitive … sensitive people such as those with asthma, those with lung disease may be having issues, to you know, downright hazardous, where it’s harmful to everyone’s health, and so it’s hard to have a blanket recommendation for every single scenario you may come across.

The North Coast News asks, “Dr. Ennis, are you concerned about outbreaks within the firefighting community?”

I spoke about this a little bit last week. Anytime you bring a lot of people together from different areas or different households — yes, there is concern about outbreaks and disease transmission. We have been working with the various fire agencies as well as agencies involved with sheltering to ensure that there are measures in place to try and limit the amount of transmission.

And so that includes screening for symptoms, it includes testing protocols to quickly identify individuals who have COVID-19 and be able to pull them out of the workforce, you know, immediately upon identification. Additionally many of these camps used to have people congregate in sleeping facilities but that has been reorganized to allow for individuals to, for example, pitch an individual tent and minimize exposure to one another in sleeping arrangements. So it is of some concern but we have certainly had an opportunity to inform the process to make sure that there is a chance to minimize ongoing transmission in that setting. 

The North Coast News asks, “What do you recommend the public do in regards to wildfire smoke and their health?”

I think I’ve spoken to that in a couple of the other questions. You know those who have lung disease are gonna be at increased risk and so you can physically move to another area, you can try to filter out the smoke, you could have air filters within buildings. You know it’s really going to depend upon the particulars because of our huge area that our county occupies, the geography involved, how it can change, as well as individual health conditions, so I think I’ve spoken to that answer already. Thank you.

The North Coast News asks, “What objective criteria does public health use to decide whether the amount of community transmission is at a safe enough level to open schools? If the answer is test positivity percentage, how do we define the locality for which that number is relevant?”

So this is really being driven by the state — California Department of Public Health. Prior to the blueprint there was a county data monitoring list and essentially if you went on that list, schools couldn’t reopen. Fast forward to the blueprint coming out now, maybe two weeks ago, and the purple tier, so the highest tier that rates disease being widespread, is equivalent to what was formerly called the county data monitoring list.

So if you’re in that purple tier, schools cannot reopen and they define that as two ways. It can either be your test positivity greater than eight percent — I’ll note that we are well below that — or it can be your daily case rate per 100,000, and so greater than seven cases per hundred thousand would land you in the purple tier and so it’s at that point that they do not allow, the state would not allow in-person instruction to begin for schools.

The locality is a non-issue. You know, we know, that people sometimes live for example in Fortuna and they come to Eureka to work, or vice versa, and so approaching this from a real local acute level, just really doesn’t make sense. It’s very clear the COVID-19 is throughout the county. Making individualized risk asset assessments really has little utility at this point and so it’s really driven by county level numbers and determined by the state. 

The North Coast News asks, “If a school is doing in-person learning, what happens when a student or teacher tests positive? Will the whole school be quarantined for two weeks and then retested?”

So, given the amount of variability between schools it’s really hard to come up with a one-size-fits-all approach and so really this is on a case-by-case basis. We look at when the infectious period was, when that individual was at school and if there was overlap, if any, so there can be a scenario where a student tests positive, but their last time in school was outside the infectious period, in which case no action is needed for those remaining in the school.

There can be scenarios where there is a lot of overlap and perhaps the structure of the in-person instruction caused more than one classroom to potentially become, be in close contact that individual, that would require quarantine of more people, and so there’s a big spectrum of a response and so it’s really on a case-by-case basis.

At this time if students do go out on quarantine … quarantine is for 14 days regardless of … or sorry, it’s for 14 days after the last day of exposure to the known positive. We are recommending that those quarantine be tested seven to 10 days after the last day of exposure prior to bringing them back. It’s not a requirement but we are strongly encouraging that to occur in instances where students have quarantined. 

The North Coast News asks, “Do you believe hybrid schedules that ask students to come to school on alternating days actually minimize risk or are they just a consequence of schools lacking space for appropriate distance?”

I think alternating days does accomplish some risk mitigation, and that’s for a couple reasons. If we’re bringing fewer people to the educational site and it turns out that one of those individuals is positive, that’s fewer people that potentially can come into contact with that individual. A second reason that it helps mitigate the risk is because we know that once someone becomes positive on, let’s say day one, we know that up to 48 hours, so two days prior, that person can actually transmit the the disease, the virus, and so as someone becomes symptomatic you know say on a day that they’re home, and if they haven’t been in the classroom for two days that’s only one exposure day to other people, and so you’re minimizing the potential for exposure to individuals.

So it does minimize risk by simply bringing fewer people together and minimizing the potential exposure. It’s a natural byproduct of that to — by virtue of having fewer people — allow for more appropriate distancing, and we know that six feet is the number we fixated on, those first three feet really give you a a lot of mitigation of transmission disease and that’s why the number is a range that’s slightly less than six feet because you get the most mileage so to speak out of the first three to four feet, but it’s a natural byproduct and it’s not a way around circumventing appropriate distance measures.