‘We Are In A Huge Surge’: Mendocino County PHO Addresses the Rise in COVID-19 Cases, Curfews, and a New Round of Closures

On Friday, November 20, 2020, Mendocino County Public Health Officer Dr. Andy Coren held a virtual press conference providing an update on the state of COVID-19 in Mendocino County. MendoFever and other local media asked questions about these and other concerns.

[Note: There is a lot of information in this press conference. We will highlight in blue any particularly important responses]

Opening Remarks from Public Health Officer Dr. Andy Coren:

• The total cases in Mendocino County as of November 19, 2020, was 1,368. to 822 of those ill or 61.5% were from the Latino community. On 11/19 alone there were 30 more cases, one was Native American. The doubling time for our community is calculated to be 6 days. 186 [people] in quarantine, 106 in isolation, and the number of individuals hospitalized as of 11/19 were 9 people, none of whom were from the Latino community. There are no individuals in the ICU. We have five Mendocino County locals hospitalized in the county. Two of the hospitalized in Mendocino County are from outside the county. Three Mendocino County residents are currently outside of the county receiving care from rehabilitation centers. The total number of deaths in our community from COVID-19 is 22. Our case rate is 8 per day. That is 47% higher than just two weeks ago. Earlier in the week, the number was 3 times higher than two weeks ago.
• We are now in the purple tier along with 41 other counties. Nearly all of California counties have gone back 1-2 tiers. The Governor applied what he called an “emergency brake.” Tiers changed back immediately and only using four days average worth of data. There is no implementation lag time. Purple tier for us means outdoor only for places of worship, restaurants, gyms, personal care (nail and hair can still be indoors). Indoor retail is cut to 25% capacity. Schools that did open during the brief time we were in the red, and the ones that have been open due to filing a waiver, may stay open. Small groups for children that need IEPs, language assistance, continue but the rest continue distance learning.
• This is because we are in a huge surge. This surge appears to just be beginning. US deaths from COVID-19 over 10 months is over 250,000 people. Over 70 years of wars in the United States, we have not lost that many people. In fact that is 2.5 times more than American lives lost back to WWII. Nationally we’re breaking records everyday. Consistently we’re exceeding 150,000 new cases/day for the last week. That is a 250% increase over three weeks. In California, we now see over 10,000 new cases per day using a seven day average. The hospitalization rate is 63% in our state, ICU utilization is up 40.5% over the last 14 days. It is this acceleration of the pandemic that has us all worried in the health fields. It is accelerating at a rate that is 2.5 times faster than the surges we saw in June and July and the numbers are much bigger now. In California, the cases are mostly driven by Los Angeles, which has a 147% increase over the last two weeks. In Madera County, a smaller county in rural Central California, they saw a 460% increase over two weeks. At this rate, Mendocino County could run out of intensive care unit beds in two weeks. We’ve gotten transfers already from counties south of us who have already run out of hospital beds. This is mostly related to the lack of health care workers who also get sick. 
• We now know that we’re seeing 12% of new cases wind up in the hospital 2-3 weeks later. We know that it is cold, wet weather that drives people indoors where germs transfer to one another easily. This germ especially likes cold weather and survives longer on cold surfaces and in a suspended state in aerosols. This is a season of holidays that are opportunities for people to gather and germs to spread. 
• On November 19, 2020, the California Secretary of Health announced a new targeted response to purple tier counties called the “Limited Temporary Stay-at-Home Order.” This means residents are staying at home from 10:00 p.m.-5:00 a.m. At those times you can go out to get food, groceries or takeout, go out to get medications or walk the dog. All the essential services are able to be open. This puts relatively small limits on most of us but it does limit spread in those key hours when gatherings are more associated with use of substances and loss of inhibitions resulting in the spread of germs. This will be from November 21-December 21 and then it will be reevaluated. More changes may be needed. 
• Regarding outbreaks, we had an outbreak in juvenile hall which has been mitigated and was relatively small. There was an outbreak in Redwood Cove Nursing Facility that has been very quickly contained with relatively few cases. This past week we had an outbreak at Noyo harbor Inn with very few cases. The business closed, cleaned thoroughly, and are working with public health who are facilitating outbreak testing. These outbreaks are quickly controlled because of the diligence and exemplary cooperation with business management. 
• Today, there was another outbreak that was reported in a board and care facility. Again, outbreak testing will be going forward. We have a great outbreak testing team. When they call, please be forthright with them and give them your information. If you have questions about businesses or a citizen, contact the Call Center at 707-472-2759.
• Outbreaks are not responsible for the vast majority of cases. There is no specific industry that we have identified. The majority continue to be community spread and close contacts. Many are home clusters. Analysis of our data over the past month shows that more than 50% of new cases were spread in the home. This has to do with failure to quarantine correctly. 
• Bekkie Emery, Director of Mendocino County Social Services: Quarantine has been defined as closer than 6 feet for up to 15 minutes in a 24 hour period. This is different than previously, specifically 15 minutes rather than 10. The 15 minutes are not required to be continuous. It could be three interactions of 5 minutes in one day. Individuals in quarantine should be separating entirely from anyone in isolation. Also, whenever possible, they should be separating entirely from other people that are in quarantine in their household. If the household doesn’t allow for the separations, we encourage residents to use our alternative care sites to help support keeping family safe. We do recognize that there are some situations where people cannot separate such as a parent and a child. In these situations, individuals in quarantine that are unable to be separate need to wear a mask and maintain a social distance of six feet whenever possible. All flat services and restrooms must be cleaned between uses and disposable dishes/utensils are encouraged. At the end of the quarantine, it is recommended individuals get a COVID-19 test. That recommendation is suggested for those that are released from quarantine, not those released from isolation. 
• Testing services have been a big concern for residents in the last month. It is improving. The new OptumServe program will continue at the fairgrounds. As of November 21, 2020, it will be open 7 days/week. We also have other contracts we’ll be getting after Thanksgiving to avail testing opportunities throughout the county. Please get tested. If you’re positive, isolate. We encourage you to call your contacts and tell them to quarantine. The instructions are on our website. Also, the Mendocino County Contact Tracing Team has been instrumental in rapidly controlling outbreaks before major spread has occurred. When they call you for a positive test result, please tell them about all of your contacts because it helps your friends and family and the entire community. This is a confidential process. None of the people contacted will be told who the original case was. No other agencies will be told about who has called them. They will help you figure out how to best protect your loved ones. If you’ve been in contact with someone closer than six feet for more than 15 minutes cumulatively over 24 hours, or if you have symptoms, do not go to OptumServe. That site is only for screening. Call your clinic, call your doctor, who can order a different test. Remember the traditional ways to protect you and your family: mask all of the time except when eating. If alone outside, take a break. But, mostly keep the mask on all the time. Distance is very important for large droplets, especially in cold weather where small aerosols can be suspended in the air outside. Wash and sanitize your hands, the surfaces you’re around, and ventilate all rooms and cars. Keep the windows open. We’re doing this to protect ourselves, our family, and our friends and also the healthcare workers in hospitals and intensive care units so they can help us when they are in need. New research shows that masks protect the person wearing them in addition to those around him or her. We do have phone numbers for people who feel down or depressed. Call the Warm Line, which is open from Monday to Saturday from 7:00 a.m.-6:00 p.m. (707) 472- 3111. For questions about health orders, contact the Call Center Monday to Friday from 8:30 am-5:00 p.m. (707)472-2759.
• We changed some health orders recently. The gatherings are now reduced to a maximum of 12 people. This should not include any more than three household units. Another change was regarding hospital reporting. Another change that occurred recently was funding for  Promotoras de salud a program designed reach out and communicate with the local Latino community. Guidance on the Mendocino County website regarding Thanksgiving is from the Center for Disease Control. I know all of us have already been through a lot: changed habits, missed milestones, celebrations, family get togethers, suffered closures, loss of jobs, bankruptcy, foreclosures. We’re tired. We’re frustrated, annoyed, angry, but a better day is coming. Vaccines are on the way. We must bear with this now a while longer. These days before us are going to be a serious challenge.
• Here is a summary of my new advisory for holidays and travel: avoid gatherings of anyone outside your household. I know I said three households and 12 people, but it is better to avoid them entirely. Use a telephone or teleconferencing to socialize. Do not travel. If you’re sick or have been in contact with a COVID patient in the last 14 days, if you are elderly or have chronic conditions like obesity, heart or lung conditions, diabetes, cancer, or other illnesses or take medicines that might affect your immunity, stay home. This is the most painful. I know it. My mother-in-law just turned 91. Her grandchildren have been asked to skip this year. They are going to stay in Santa Rosa and San Francisco and it’s heartbreaking and I’m sure it is for you. 
• Do not forget the influenza vaccine. Wear a mask all the time when indoors unless you’re alone, with members of your household group, except when eating. Maintain your six feet of distance, wash your hands for 20 seconds, and use hand sanitizer in between. Increase airflow by opening windows. If you gather, keep it to one household group. No more than three. These gatherings should be held outdoors and a maximum of two hours. Keep a sign-in list. Plan for the gatherings and traveling by minimizing contact with others a week before the gathering or travel. Consider getting tested. Avoid physical contact with those outside your household unit. Wave instead of shaking hands or hugging or kissing. If you’re eating or drinking, remove your mask at that time. Avoid shouting or singing loudly, chanting or playing wind instruments. These increase transmission and contagion. Avoid sharing phones, toys, utensils, bring wipes to disinfect objects that were shared. Do this when you return home. Finally, avoid non-essential travel outside of the County of Mendocino and upon return it is a best practice to quarantine for 7-14 days. Avoid Black Friday shopping.

Around 24 minutes

KZYX’s Sarah Reith asks: What is the status of the mobile testing unit? Are there more opportunities for the clinics to do surveillance testing through an arrangement other than the one that expired with UCSF?

• Dr. Coren: The OptumServe testing program is alive and well at the fairgrounds and will be expanded for 5 days/week to 7 days/week. We have also found they’ll have the ability to travel around the county and offer the testing at different sites. The mechanics of that haven’t been established but they are in the works. We are still in negotiations with that organization. 

Follow up question from Reith: This other OptumServe option wouldn’t be a van then? More like a pop up? What is that looking like?

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• Bekkie Emory: That will be a mobile site, not a van, and it does require a brick and mortar site but is temporary so it can move around the county so it can move around to different communities. It will complete up to 165 tests/day. We are approved to utilize that resource up to 5 days/week. It is approved to start rolling out December 2. We are working on that scheduling and making sure we have that resource working in a manner that will cover the entire county.

Around 26 minutes

KZYX’s Sarah Reith asks: Regarding the curfew, the sheriff just announced that he would not be enforcing the curfew. I’m wondering if Code Enforcement or Public Health has a policy about making sure people stay inside during those hours.

• Dr. Coren: I don’t have any plans for our enforcement personnel to go around and enforce between 10:00 p.m.-5:00 a.m. This is for the public to know and enforce themselves. We have lost many wars worth of people. This is no joke. If this was a war, we would be in our basements sheltering in place from bombs. We hope the population will understand and grasp this and police themselves. There shouldn’t be a need for enforcement. 

Follow up question from Reith: Is there going to be a messaging campaign like “Mask Up Mendocino”?

• Dr. Coren: This is part of it, you can spread it more.

Around 28 minutes

Mendocino Voice’s Adrian Baumann asks: Can you describe which department does each type of enforcement and which department has the authority for enforcement. What type of enforcement does the sheriff have? What kind of enforcement actions does Code Enforcement’s Chief Mortier have? 

• Bekkie Emery: Chief Mortier has been collaborating with the Sheriff’s Department working on masking in restaurants and businesses. There has been a lot of education they have done as well as investigations and discussions. Both departments collaborate in these efforts and as to which one specifically responds, it depends on what personnel is available. Code Enforcement works specifically in the businesses to make sure they are following guidance from the health officer. 

Mendocino Voice’s Adrian Baumann asks: Let’s say there is a restaurant or bar operating past 10:00 p.m., is that a situation where Code Enforcement comes in? Health and Human Services? Sheriffs? 

• Dr. Coren: We have a call center where we would hope citizens would report that sort of occurrence. Keep in mind, restaurants are encouraged to exclusively offer takeout. This is a difficult time for our community and the restaurants as well. I don’t want people to mistake someone going to the door of a restaurant and getting takeout with breaking the law and a restaurant serving indoors. We do have a program in our county that we’ve been using in the last month where people are evaluating local businesses compliance with health orders and food safety. These are mostly educational. The vast majority of businesses in town have been very cooperative. They have been very open to whatever changes or adjustments are necessary to comply. It was the businesses and the Chambers of Commerce who started the Mask Up Mendocino campaign and now they are beginning to organize testing onsite for their employees. 

Follow up question from Baumann: My question is a jurisdictional one. Is there something that Mortier’s department and the Sheriff’s share jointly or are they tackling different aspects of enforcement. It gets to my next question which is regarding the sheriff’s statement that says he won’t enforce the curfew. I’m wondering if that is a decision that the sheriff made in his capacity as an elected sheriff or a decision made in consultation with you, or you Dr. Coren made and directed him to follow.

• Dr. Coren: It is not a decision that was made in consultation with me. I think at this point, 99% of enforcement is education. Sheriff Kendall did not consult with us about doing it but he has been serving the community, along with other law enforcement agencies, by dealing with crime and violence. I do think the gatherings are extremely dangerous for our community and addressing them is a question of education, and in the worst cases participants would be cited. I would if a sheriff deputy would drive by a gathering and not say something. I don’t think they are going to jump out of their cars and make a bunch of arrests. That wouldn’t be good for the community. 

Follow up question from Baumann: If the sheriff is not going to enforce the curfew, will John Mortier and Code Enforcement be enforcing the curfew?

• Dr. Coren: They receive and review calls at the call center. The enforcement there has been educational. I’m going to emphasize: this is citizen enforcement. We know what protects ourselves. 

Follow up question from Baumann: Just to be clear, neither law enforcement organization will be enforcing the curfew?

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• Dr. Coren: I wouldn’t say that. The call center is available. We’ll have to see as time goes on the efficacy of citizen enforcement.

Around 37 minutes

Mendocino Action News’s Danilla Sands asks: Regarding concerns that ICUs are filling up, we have some patients here from out of county. Can you explain how these patients came to be housed in Mendocino County? 

• Dr. Coren: We have several people who have been discharged from nursing homes in another county. This is because our nursing homes did not have room for them. This doesn’t mean actual rooms, but staff as well. It’s very high intensity to take care of nursing home patients, ICU patients, and hospitalized patients. The reason for people being hospitalized in our county was due to a lack of beds and we had those beds available. We are all trying to cooperate together. When it comes our turn, those counties will reciprocate. This is the horrible future of what we want to avoid in a pandemic. These filled to capacity hospitals and ICUs shows why we have to initiate quarantine orders and curfews. 

Follow up question from Sands: Could we utilize pop-ups to house more patients if needed?

• Dr. Coren: There is a capacity for reserves but those get used up also. We’re talking about huge numbers that so far we haven’t seen in Mendocino. We see a trajectory that is going up rapidly. Again, if we think 12% of those cases are going to wind up in our hospital in the next three weeks and we see a doubling time of 6-8 days, our hospitals could be full. That’s not just for COVID-19 patients. Someone gets in an accident, someone has a heart attack- we literally won’t have the room. That’s one of the big reasons of why we’re doing what we’re doing. 

Around 40 minutes

Mendocino Action News’s Danilla Sands asks: In the beginning, Dr. Doohan had talked about the possibility of false negatives. Now, with all the tests being done, are seeing any false positives? If we are, what is the reason?

• Dr. Coren: The reality is nothing is perfect. These tests have varying sensitivity and specificity. Sensitivity describes a test that can detect small amounts of the virus. Specificity means if the test says you’re positive, then you’re positive. In both cases, you’re always going to have some false positives or false negatives. We select the type of test to use based on the sensitivity and specificity. 

Around 43 minutes 

RHBB’s Matt LaFever asks: What can you tell Mendocino County residents about the effort the county is making to shore up the necessary supplies and infrastructure to receive, store, and inoculate our population with the vaccine?

• Dr. Coren: Supplies like personal protective equipment is an ongoing effort by our Medical Health Operations Center. They are also taking care of obtaining and will be distributing a lot of the vaccinations. It’s important to recognize there will be several modalities of vaccine distribution. Two pharmacies, CVS and Walgreens, have stepped up to be able to inoculate people in our skilled nursing facilities. We also have a mass vaccination program because the logistics of distribution are difficult. We are using that mass vaccination program with characteristics of the new vaccines in mind. One of the new vaccines will require storage at 70-90 below zero Celsius. We’re looking into how to do that and collaborating with local hospitals. What about the people around the rest of the county? We’re looking at it. Other vaccines are coming online which will only need stored at a 20 below zero environment so those will prove easier to distribute. We are starting to have weekly meetings with the hospital and potentially more often and the vaccines come online faster than expected. The vaccine has not been approved so the state has developed its own task force with four work groups, one to retest the safety and efficacy of whatever vaccines come down the line. We want to make sure people have confidence in these vaccines. Many are concerned about this vaccine due to the fact they are new technologies. The California Department of Public Health is utilizing some of the most experienced minds from UCSF, UCLA, and Stanford to make sure they are safe and effective. Another work group is determining how California will distribute the vaccine. 

Around 49 minutes

RHBB’s Matt LaFever asks: What kind of stories does contact tracing tell here locally? Are we seeing patterns of transmission such as one age group to another? Are there specific locations or types of businesses more prone to transmission? Gyms? Grocery stores? Restaurants? Or is the overwhelming site of transmissions in private homes?

• Dr. Coren: Data generated from outside of Mendocino County indicates health care workers are going to be exposed to COVID-19 more than the general public. In general, we have done research locally as to where the virus is spreading, and it is not specific to a local industry but inside homes. More than 50% of contagion is coming from individual homes. Many people have the illness but are not symptomatic. It is vital residents follow the guidelines for general care. We have to teach out to successfully isolate and quarantine. There is an idea that if mom has it, that dad and the children can quarantine together. No, if one of the kids has it they can carry it to dad. I’ve heard from other Public Health Officers they cannot keep up with the demand for contact tracing and case investigation and we are doing really well. 

52 minutes

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Question from the Public: Can you explain why we should get tested for COVID-19? Is social distancing, masking, and avoiding gatherings enough to insure we don’t have the virus?

• Dr. Coren: No. The virus hangs out in the air and can get beyond the mask, into the eyes. Those are not huge effects but when you’re dealing with tens of thousands of people, this can happen. No one is perfect. Even me- I was walking into the health department the other day and got halfway to the door and realized I forgot my mask. We all make those mistakes. Some of those mistakes don’t amount to anything; some of them amount to a transmission. The testing tells us who has the virus but doesn’t know it yet. This allows us to stop residents from unknowingly transmitting the virus.

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