The time for coronavirus testing for the general public was in February, says Santa Cruz County epidemiologist Will Forest. The real question is how well can the county’s medical centers expand to meet expected demand. What may determine that is how well residents follow the county health officer’s order to stay home. We talk to Santa Cruz Mayor Justin Cummings and leaders from Sutter Health, Santa Cruz Community Health Centers and others about what’s next. Spoiler alert: This could be just the start of mandatory stay-at-home orders.
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KARA MEYBERG GUZMAN: I’m Kara Meyberg Guzman
STEPHEN BAXTER: And I’m Stephen Baxter.
KMG: This is Santa Cruz Local.
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SB: We’re recording this on Wednesday March 18. You’re probably listening to this at home. All of us have been ordered to stay home by the Santa Cruz County health officer, to help prevent the spread of the coronavirus.
Our previous episode was tape from a news conference on Monday. That was when our County Health Officer Gail Newel announced her order.
She said something that piqued our interest: The county is short of coronavirus test kits.
Newel said, quote, “We have been severely limited by the inability to provide testing and suspect that the number of cases is far higher.” Close quote.
We set off immediately. The first thing we wanted to know was, exactly what is our county’s testing capacity. We contacted the commercial labs that the county is working with. We asked all our contacts at the county health services agency. How many more testing kits do we need?
KMG: But it turns out maybe that’s not the question we should focus on. Maybe we should shift our focus to hospital capacity. We’re likely to have a shortage of equipment and staff. Medical providers and county leaders are trying to prepare for that.
On Wednesday, I talked to a Santa Cruz County epidemiologist.
WILL FOREST: My name is Will Forest. And I’m an epidemiologist with Santa Cruz County. I retired at the end of 2018 but they called me back for this outbreak, along with kind of everyone else useful that they can get their hands on, because it’s such an urgent situation.
I think most people are not really realizing truly that this is not what you’d look at as a temporary event. Or, and then the measures we need to have in place, that we just put in place, are not temporary measures. They’re stated as that because you have to look. You have to over time see, OK what do we need to do next. But I’m predicting that we will have to have extraordinary measures in place for the foreseeable future. People need to incorporate that in their thinking.
KMG: We talked about testing for coronavirus.
FOREST: The facts are, there just aren’t very many tests available. That is, the testing supplies are inadequate to the task. And so, testing, necessarily, is limited to very limited individuals.
That being said. Testing is not done primarily for medical purposes. It doesn’t make a lot of difference in the management or treatment of a patient to know whether or not for sure they are COVID.
You can make a diagnosis based on their symptoms and sometimes on travel history or exposure history or something like that. But usually, nowadays, not. Like three-quarters of all cases in the US, I believe, are of unknown origin, that is, they don’t have a travel history. They don’t know of anyone that they were in contact with who was a case.
Because it is present in the community, everyone is potentially infected. And so the test is not of much medical use.
Everyone should be isolating right now. Everyone should be social distancing. That’s the order in our county and Bay Area counties and will soon be pervasively across the US I think. Everyone should be doing that.
Where you have value in knowing for sure if someone is actually is a case, is for the people who aren’t isolating. Who can’t, or who have to not. So, health care workers, in particular.
Health care workers are essential employees and they need to be in contact with people. There’s no way of avoiding it. So that’s the people who should be getting tested when they’re symptomatic. So that you can know for sure, OK this is a health care worker, that even though they’re essential, we still have to take them out. We still have to isolate them.
And then there’s situations like residential facilities, long-term care facilities, prisons maybe, where if you know you have a case, and that case is in the population that can’t leave, you have to find a way for that known case, to isolate them from the people they are otherwise housed with.
I really think the focus on test kits is misguided at this point. That was something we should have been doing in February.
And that was for public health purposes at a time when if there was one case, you wanted to know about it, and identify the person and isolate them and identify all their contacts and quarantine them in order to prevent the spread.
Right now it’s going to spread. And you don’t know who’s infected but lots of people are. There are probably hundreds of infected people in the county right now. And you don’t know who they are and you can’t test everybody. It’s not even remotely possible.
People probably can transmit the infection before they are symptomatic. And so, even testing symptomatic people, they may have been wandering around infecting people previously.
My opinions about the CDC testing criteria are that they’re not keeping up with the data. And the county is acting on CDC recommendations but I think we will be moving soon to a new attitude about testing.
KMG: What can people do to help?
FOREST: Well, I saw an interesting or heard an interesting message, a tweet or something, about how in WWII, you know, to be a hero you had to die face down in the muck.
And now, to be a hero, what you need to do is to stay home and not get people sick. Not get infected and not infect other people. So following the isolation order. Taking it seriously. That’s the big thing for people to do right now.
SB: County health leaders are trying to reduce the immediate load on our medical system. It’s called flattening the curve. You may have seen it online, or in other places this week.
Picture a graph. You have a flat line. That’s the care that the medical care system can provide. Now picture a bell curve that goes above, and then below that line. That’s the number of people that are going to need care. What you want to do is get that bell curve below the line.
And the way you get there is by staying at home.
FOREST: Most of us are going to get this. But we want to delay it so that we’re not all seeking health care at the same time, but rather we’re spreading it out over a long period of time. And that’s called flattening the curve.
And that is our real goal in the admittedly extreme measures that the Bay Area counties are taking right now, that are shutting down businesses and telling people to shelter in their own homes. It’s for the purpose of delaying when we get exposed.
It’s not likely that we can prevent most people from being exposed over the next few years. But if we can drag it out, we can keep the load on our health care system at conceivably a manageable level.
KMG: I talked to some leaders from our local hospital system about how ready they are for a surge of patients. I heard from Dominican Hospital, Kaiser Permanente, Sutter Health and the Santa Cruz Community Health Centers. I’ll tell you what I heard at the end of this episode.
Will told me he didn’t know the exact number of sick people our local health system could handle. But he knows for sure: We will be short of ventilators, he said. Locally, we’ll also probably be short of respiratory therapists, he said.
State leaders are working to get more ventilators to California. I asked Will, what’s the plan to get more ventilators here, to Santa Cruz County?
FOREST: I know that It’s a high priority for them. It’s a high priority for every other jurisdiction in the nation and the world pretty soon.
And that, so there’s going to be a lot of competition for whatever resources are available. You can’t just manufacture ventilators at a high rate. And they aren’t there to buy.
We — and every other jurisdiction probably — are making every effort to procure them. And it doesn’t mean we have a good chance of procuring them.
KMG: Among the plans to increase local hospital capacity is a possible shift in where patients are treated. For example, less severe cases could go to smaller clinics, to make room at Dominican Hospital and Watsonville Community Hospital. Those two hospitals are best equipped to handle tough cases.
I asked Will about what else he’s heard, to try to increase capacity at those hospitals.
FOREST: At Watsonville Hospital, there is a large — I’m going to call it a tent, for lack of a better word — that they’ve had for quite a number of years, that is for the purpose of setting up in the event of overflow need. And I’m sure it will be set up and filled.
We have what’s called an alternate care site plan, which would involve — and it’s limited. But it’s for situations like this where you expect hospital overflow. And the idea of the alternate care site plan is to take people who would be otherwise hospitalized, but they’re not the most severe and acutely in need of hospitalization, and put them into another facility, so that hospitals can be freed up to deal with the most severe cases.
So and yes, people are talking about gymnasiums. They’re talking about facilities of all kinds. The space is part of the issue, because we have, just as we are going to have more people in need of ventilators than we’ll have ventilators, we’ll have more people in need of hospital beds than there’ll be hospital beds.
But along with that, each of those beds, just like the ventilators, needs to be staffed. And there are staffing limitations that are not much different from the space limitations. So if you set up churches, or schools or gymnasiums, whatever, as places for people to be hospitalized, you have to have the staff.
There’s something called the Medical Reserve Corps, which is an organization that, its members are people who have medical skills and training but might not be practicing, so, retirees, like that, who can be called back to help out in emergencies.
Santa Cruz County has an active and relatively large Medical Reserve Corps membership, so we might be in better shape than some counties in that regard in terms of getting people who otherwise weren’t using their medical skills to come out and use them. And they might be able to staff places like the tent at Watsonville Hospital or an alternate care site, wherever we set up beds for people to be hospitalized.
There will be some people, but there won’t very likely be enough people to staff as many beds as we will need for all the patients. So we are going to have shortages, staff.
Yes, I think arguably, space — you can create space in so many places. And some are better than others, but staffing is really probably the limiting shortage.
KMG: Governor Gavin Newsom said in a news conference Tuesday night that he doesn’t expect schools to reopen before summer. More than 6 million children across the state are not in classrooms right now.
I asked Will, is the lockdown going to be our new normal?
FOREST: Yes. I don’t see any way to avoid that. And let me explain why. It’s because the idea of this is to keep people from being exposed and infected, and to delay it as long as possible, to spread it out.
But if you’re doing this effectively then as soon as you relax the standards, then you go back into that exponential increase curve, where infections just skyrocket. So, what I cannot really envision anytime soon, is a situation where we can say, OK, we got this under control. Now we’re ready to back off from these extreme measures. I just can’t see how we can do that.
Until we have one of three things. We have an effective vaccine, that’s probably a long time. We have effective antivirals, that’s probably a long time too.
Or, as time goes by, when people get exposed to this, those who survive — which is most people — are immune for sometime thereafter. We don’t know if it’s a year or the rest of their life, or what. But you develop a portion of your population that’s immune to it.
And when that group, when the percentage of people who are exposed and therefore thereafter immune to it gets big enough, you have what’s called herd immunity. There aren’t enough people who are susceptible to infection to keep spreading it very effectively.
But that’s not gonna be anytime soon either. And the more effective we are, with our controls, the longer we put that period of time off.
KMG: In terms of what I heard from local health care system leaders today: One of the big players is Dominican Hospital. It’s the only hospital in North County with an intensive care unit.
Claire Henry, a representative from Dominican Hospital, sent me a statement. She wrote: “Dominican Hospital is prepared to respond to any sudden increases in patient load, including COVID-19 patients. Plans are in place and constantly assessed to ensure that we rapidly respond to the specific needs of this patient population.”
I was able to talk to people from Sutter Health, Kaiser Permanente and Santa Cruz Community Health Centers.
Right now, they’re testing. They’re following the CDC guidelines about who and when to test. They’re only testing people with more than mild symptoms. I heard from a Kaiser Permanente spokesman that the turnaround time is four to seven days.
When someone tests positive, then they’re quarantined.
Local health clinics are increasing capacity by doing as many health visits as they can over phone or video conference. That frees up clinics for the more acute patients. Some clinics are encouraging people to use mail-order pharmacies.
Also, some Sutter Health, Kaiser Permanente and Santa Cruz Community Health Centers now have drive-through care. Patients with flu-like symptoms can get tested and treated in their cars.
I talked with Stephen Gray. He’s the chief administrative officer for Sutter Maternity & Surgery Center of Santa Cruz. He said he’s in talks with Dominican and Watsonville Community hospitals. His center could potentially take patients with less critical needs away from those two hospitals. That way, those two hospitals could make room for more intensive care beds.
Right now, the Sutter Maternity & Surgery Center has 28 beds. Gray said more could be added.
I also talked with Dr. Casey KirkHart. He’s the Chief Medical Officer for Santa Cruz Community Health Centers. Dr. KirkHart said he could shift one of his clinics to a respiratory clinic. People with flu-like symptoms could go there for care. The other clinic would be for other patients.
We have a survey on our website asking what you, our listeners, want to know about the local response to the coronavirus. We heard from some of you, how do you care for sick people at home?
Here’s Dr. KirkHart.
DR. CASEY KIRKHART: So, we’re asking patients who aren’t feeling at home to call first. We’ll give you the best advice that we can. That might mean, come in. Because we need to see you, we need to get vitals on you. We need to test you. We need to treat you for flu or pneumonia, and we’ll do that in the clinic.
If we advise you not to come in and your symptoms are milder, then we’ll give you advice at home. You know, rest, stay away from other people, that 6-foot distance if you can. And then, really just comfort measures. Taking Tylenol if you have a fever, or if you’re not feeling well. Getting a good diet, trying to get physical activity in, if you can, around your house, or in a safe environment away from other people.
It’s kind of the routine that we would in any situation, if someone had flu or a cold.
KMG: The CDC also has guidelines for taking care of sick people in your house. We linked to those guidelines in the transcript of this episode.
KMG: On Monday the California legislature approved up to $1 billion toward coronavirus relief. There’s already plans of using some of that money for buying hospitals to increase capacity.
The state is also negotiating with about 900 hotel owners. Hotel rooms could be used instead of hospital beds for people with less critical needs. Hotel rooms may also be used as homeless shelters: for those most vulnerable and also those who have tested positive.
The state has not yet made a way for cities to apply for the new funding.
In Santa Cruz, leaders are trying to identify the biggest needs.
Here’s Santa Cruz Mayor Justin Cummings.
MAYOR JUSTIN CUMMINGS: There’s a lot of people who are concerned about their businesses going out of business. And then on the employee side, many people who just are really concerned about not having, you know, income and being able to pay their bills and their rent.
We’re still working on the costs around all of this. It’s been evolving so rapidly, that what we’ve really been trying to focus on initially, has been, you know, what are the appropriate responses to minimize the spread of the disease. And so now, we’re really, kind of, focusing on those pieces. You know, how much is this going to cost. And so, first and foremost, is, prevent the spread and not overwhelm the health care system.
KMG: Many of you wrote, asking what the city is doing to prevent the spread of the disease among the city’s homeless.
I asked Cummings. He said the city could manage more homeless camps, but they don’t have the staff. One solution might be the National Guard. Cummings is talking with state leaders to get the National Guard to help staff local homeless camps and help distribute food to those in need.
In our survey, many of you asked, “How can I help?”
Besides staying indoors, Stephen Gray had some tips. He’s the chief medical officer for Sutter Maternity & Surgery Center of Santa Cruz.
STEPHEN GRAY: From a neighborhood standpoint, if you know somebody who is a health care worker, asking them what they need. Our health care workers are working amazingly hard to keep their community safe and healthy right now.
I mean, I posted, the other, I said something the other day, in a meeting, you know, heroes don’t wear capes. They wear masks and gloves and gowns and they take care of really scared people outside in a parking lot in the rain.
Those are our heroes right now, is our health care providers. I’m just there to support them. But they’re doing the real hero work.
And so, if you know somebody who’s there, you know, ask them what they need. Do they need somebody to watch their kids for a day while they go to work and take care of people.
SB : Thanks to those of you who filled out our survey. We answered a lot of your questions on our COVID-19 resource page. That link is at santacruzlocal.org/covid-19.
You can still fill out our survey there.
We also want to hear from you. You can leave us a voicemail. It’s at:831-222-0460
We want to hear how you’re doing, your concerns, and any stories you want to share about how you’re coping.
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Thank you to our guardian level members: Chris Neklason, Patrick Reilly, Elizabeth and David Doolin, and the Kelley Family.
I’m Stephen Baxter.
KMG: And I’m Kara Meyberg Guzman.
SB: Thanks for listening to Santa Cruz Local.