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In Todays Media Availability, Dr. Josh Ennis Talks School Reopening, Testing and Tracing, and Why Active Cases Isnt a Very Important Metric – Lost Coast Outpost

https://lostcoastoutpost.com/2020/aug/12/todays-media-availability-dr-josh-ennis-talks/

Machine transcript of today’s media availability with Dr. Josh Ennis, Humboldt County’s deputy health officer, below. Video above.

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Good afternoon. We’re here with Humboldt County Deputy
Health Officer Dr. Josh Ennis for the August 12th media availability.
Thank you for being here with us.

Yes, of course.

Thank you,
and would you like to start by addressing any issues to the community?

Yeah, in reviewing some of the questions today I felt it was important to just
maybe say a little bit about current numbers, trends.
You know at the outset we were really concerned about
overwhelming our healthcare capacity. I think we’ve all seen that lately the
numbers have started to trend upward, and at an
increased pace, and there’s a lot of focus sometimes on
the number of active cases. And what this number means is those that are
actually in isolation because they’re considered infectious.

I think what you
miss in keying on that number is that for
every case that we actually identify and place on isolation
there is certainly a handful of other cases out there that we have
not identified. And if we were to take some of the best
estimates out there by leading epidemiologists, they’d estimate that
there are probably ten cases for every one confirmed case that we
actually have. We could make the argument even if we
wanted to say that we’re actually doing very
well in testing, and we are keeping disease very low because
of our community mitigation measures we could revise that number downward as
five, say. So somewhere on the order of five to ten
times as many cases that we’re actually confirming are probably out there not
getting tested for whatever reason.

And so as we think about how many
cases are potentially floating out there in the community
we can talk a little bit about how many hospitalizations we’d expect
by looking at case hospitalization rates, and
that’s somewhere on the order of around ten percent.
And so in the last week we’ve seen three hospitalizations
and that would suggest using that ten percent number
we multiply by ten that there’s about 300 cases, and if you put it
in context of the number active cases it’s just north of 50 – so that’s
about six times as many cases floating out there. So I think it’s real important
to not key in on this number. It’s not
capturing everybody who has the illness. It’s capturing a minority, and we’re
starting to see that in the hospital a little bit. 

KMUD News asks: Mendocino County has put a call out for volunteer contract tracers. Is there an immediate need in Humboldt for citizen contract tracers (maybe more Spanish speakers?) and if so, how can community members get trained and volunteer?

Yeah, so from the outset we knew that uh really the legs of our response were
going to hinge upon a couple things. One is
testing, and then the second one is the ability to do
large-scale investigation and tracing, and so this is something
we’ve been working on for months and we continue to build.
We do not need volunteer contact tracers at this time.
We are actively onboarding several people
to assist with investigation and tracing. We have also worked hard to increase our
not only Spanish translation capabilities but also
hiring people and bringing people in who are native Spanish speakers to
assist with the investigation and tracing efforts.

KMUD News asks: Information on how the coronavirus spreads has slightly fluctuated since the outbreak began. Can you share the current information? (such as does it live on surfaces or is it only airborne, can it travel in water, does it die in sunlight?)

Yeah, so you know there’s a lot we don’t know but
I can tell you what what we do know. I’d say the
majority of transmission is via respiratory
droplets. Okay and so these are bigger droplets
that a mask will catch, and each droplet potentially carries
you know tens, hundreds thousands of viral particles. And so if the droplets
are bigger the facial covering will catch them.
And that’s the vast majority of transmission. Can it be
spread by what we call fomites or surfaces that you’ve touched?
Yeah it’s certainly possible, but it’s a small minority.
Is it spread by uh airborne route aerosols very tiny droplets that linger
in the air for hours afterwards? There may be some suggestion
looking at specific scenarios that suggest that does occur.
I would say that if it does it’s a minority
of cases where the air flow is poor, or there’s some type of either
procedure in a hospital setting that generates lots of
pressure around airways, or um you know for example doing an activity
where there’s lots of yelling, screaming, shouting, forceful exhalation.
Those may be more likely to produce aerosol, but the vast majority really
seems to be respiratory droplets. 

The Lost Coast Outpost asks: Humboldt State University is returning from the summer break soon, and that means that at least several hundred and probably thousands of people will be moving back into the county, many or most of them from areas with higher rates of infection than our own. What steps are Public Health and the university taking to minimize risk to the student community and to the county as a whole?

So HSU has been in contact with Public
Health planning over the past several months. I
have been less involved in those discussions so I cannot comment
on specifics of the plans but
they have been in touch with one another mainly through Dr. Frankovich
and they are continuing the conversation this very week.

The Redheaded Blackbelt asks: Photos were taken by a student of Fortuna High and posted on social media that showed youth apparently closer than the 3 to 6 recommended feet. The photos caused a great deal of controversy. If parents and students are concerned, rather than posting on social media, is there a process they can follow through Public Health? And could you describe it?

Yeah so throughout the planning process um this has been left up to the decision
of the local needs as determined by the the districts themselves
Public Health in no way can dictate or mandate
um what needs to happen at each individual school it’s it’s
there’s simply too many to weigh in on and the needs are different depending
upon the community themselves and so if there
are concerns um I would encourage parents to
contact the school administration uh we’ve been very clear that if certain
conditions cannot be met that it is unsafe to reopen schools to
on-site instruction and so ultimately it’s going to be the
school administration who is responsible for implementing the
plans. Now if um for whatever reason that
proves to be ineffective or there are bigger concerns anyone’s
certainly welcome to call the JIC at 441-5000
and maybe walk through what the concerns specifically are and
if there are alternate means for trying to make
things as safe as possible.

The Redheaded Blackbelt asks: A staff member at a Fortuna Nursing facility tested positive for COVID, were patients exposed? Has there been any subsequent spread to staff?

So any time there is a confirmed positive case in a nursing
facility the the state California Department of
Public Health mandates that there is weekly testing until there are no new
cases for 14 days. I can confirm that there are no further
cases identified and we are working with the involved
nursing facility to test essentially all staff members
and all patients over the next couple weeks and we have
yet to identify any further cases.

The Times-Standard asks: How is the estimated percent of the population tested for current infection calculated? Is it based on the total number of tests done or the total number of people tested? If it’s the latter, how is it ensured people who take multiple tests aren’t double counted?

So uh this is based purely on the the
total number of tests, um there are instances in which
the same individual has a repeat test for a multitude of
reasons. That seems to be a minority however it
is as time goes on
proving to be a larger percentage as perhaps
some of the people seek re-testing because of concerns with
repeat exposure and so they are double counted. Early on we did
manually look and it proved to be on the order of just a few percent um
that was a couple months ago uh I don’t know
what percentage it is now um it’s probably perhaps a good time to
re-evaluate how we are reporting that number at this point.
Thank you.

The Times-Standard asks: Can you describe the issues the county is having with effective disease control? What plans are in place to improve that metric?

Yeah so the county dashboard is arranged into three separate categories
um, it’s spread of disease, healthcare capacity
and then the last one which this question I think is getting to,
effectiveness of disease control and what we’re talking about is
community mitigation measures it’s talking about the investigation and
tracing making sure that we have the
ability to increase as needed, making sure that
people are providing information that’s needed, that we’re
getting test results in a timely manner so we can intervene.
And last week we moved that from level two to level three.
Now it had no bearing on the overall alert level
but it’s telling in some other ways and this is kind of
the the manner in which we felt things would move. The
the spread of disease would move first, there’d be some
period of time and then effectiveness of disease control would move
next and then we’ll see the healthcare capacity move last.
And so this is anticipated
and so what is it, where is that coming from?
Well I think last week we had a couple double-digit days of reporting positives.
We had nine, one day 10, another day 25 the next day,
and we’ve built our investigation tracing team from at one point of only
being three people and we’ve increased that to 41 people I believe at
this point. Some of them are part-time, they’re not
full-time and so you can imagine when there’s a huge
bolus, huge increase of cases all of a sudden over a matter of few days
that it takes a little time to sort out and distribute that load of new cases.
You know all 41 people are not working at the exact same moment in time and so
the process is just it’s slower when you get that many cases
in that short of a period of time.
So to improve that metric it comes down to
further increasing our capacity for investigation
and tracing.

The North Coast News asks: Fortuna high school students went back to in person classes this week. Photos surfaced of students that appeared to be sitting in close proximity, not spaced out in desks or six feet apart.


• Who is responsible for making sure the schools keep with reopening instructions to ensure student safety?


• Could the county require schools to close if they’re unable to ensure proper social distancing and COVID safety precautions are taking place?


• What happens if the school doesn’t have enough PPE (like masks, hand sanitizer, etc.). Are PPE expenses expected to come out of their own budgets to ensure student safety and compliance with the county’s order, or are there government funds available?

Yeah so maybe i’ll just tackle that in in parts, um
you know for who’s responsible for making sure the schools uh
keep with the reopening uh plans I think I’ve already spoken to this and
that’s really the school administration if there’s really any concern I think
parents need to bring it back to the school
and try and resolve it with the school administration.
Certainly you could try and pass a message along to the
school superintendent as well. With 70-plus schools Public Health is not
able to manage individually each and every
individual school. In regards to a school closure
due to proper social distancing, COVID precautions,
you know I think there’s a huge societal benefit to
having in-person school instruction especially with
younger kids so I think we need to try hard to make this work as a community
but we’ve been very clear that reopening to on-site in-person instruction should
only be occurring if it can be done in a way that it
follows the guidance as as it exists now.
And to to keep everyone as safe as possible
in regards to PPE uh I believe the state has done direct
outreach to the the school districts, they have provided PPE to them as well
and there is a route for schools to ask for PPE directly from the state.
They could certainly come to the county as well, there is a process in place
for providing PPE at the county level but
the schools, is my understanding, has a direct route
to PPE through the state.

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