Local health officials call for community buy-in to stop COVID-19 spread as virus spins out of control
Schools at risk of future closures; Latino population hit hard by pandemic
‘At this point, we will not be able to slow this curve unless the community steps up.
It will continue to spread dramatically, or more likely, the state will come in and shut down everything again which we would like to avoid. That means potentially shutting down schools,
and we’ve worked with the schools really hard to reopen them
because it’s very important for kids to be in school.’
– Dr. Kristynn Sullivan,
Merced County’s supervising epidemiologist.
Since state health officials added Merced County to a list of 19 California counties hardest hit by the coronavirus on June 29, the surge in COVID-19 cases has exploded in the region.
There have been 559 new cases confirmed in a week’s time, from June 30 to July 7. As of Tuesday night, the overall number of confirmed cases in Merced County (including active cases and recoveries) was at 1,623 — up 93 cases from Monday when an increase of 122 was reported. There have also been two increases of 100 or more cases in recent days.
Merced County Health Department authorities fear that unless there is a lot more community compliance with state guidelines to turn the situation around, the county will not be able to get off the state watch list, and this will result in state health officials stepping in.
“At this point, we will not be able to slow this curve unless the community steps up,” says Dr. Kristynn Sullivan, the county’s supervising epidemiologist. “It will continue to spread dramatically, or more likely, the state will come in and shut down everything again which we would like to avoid. That means potentially shutting down schools, and we’ve worked with the schools really hard to reopen them because it’s very important for kids to be in school.
“If the state closes us down again, including schools, this will widen our achievement gap. The teachers have done a really admirable job of distance learning, but are not available in real time as they are on campus. A lot of our school partners want the teachers to be back in the classroom.
“Parents need to be available to assist the younger children with distance learning, or the children will not be as effectively taught as they would be in school.”
The following are the questions being asked of the Times most often by community members, and answers provided by Dr. Sullivan …
Where are the virus outbreaks in Merced County?
“We have an Outbreak tab on the County of Merced website under “coronavirus.” We’re getting so many outbreaks that we can’t send out a press release for all of them, so we highly encourage people to check that regularly so they can avoid places where there might be a possible exposure.
“We work with the outbreak sites so it might be possible for someone to go to an outbreak facility and still be safe. For example, we work closely with health care providers so they’re still able to provide care. We provide them with Personal Protective Equipment and we give advice on best practices for cleaning, and we conduct site visits in order to suggest best practices to avoid future outbreaks.”
What is the Positivity Rate, and what is its significance?
Dr. Sullivan said, “The positivity rate is how we track whether we are seeing an increase due to more testing, or an increase due to more disease. If there is an increase due to more testing, as our tests go up, and our cases go up, we’ve seen that our testing has increased a little bit but our positivity rate has increased a lot.
“The cases we’re seeing are much more related to the fact that we have significantly more disease in the community than we used to, and not to the fact we’re testing more.
“The State looks at our testing positivity in the last seven days. The goal is to have a rate of less than 8 percent and that indicates you are testing enough to capture the disease in the community and the spread is manageable.
“Our rate is 9.2 percent of all the tests we’ve conducted since the first incident, but the state also tracks the last seven days and that positivity rate is 13 percent.
“We would need to have pretty significant community compliance with the safety recommendations as well as individuals staying home and not gathering to have a chance of coming off this state watch list.
“Our goal is to get off the list because we don’t know if the state will implement further closures if a county is on the list for a significant period of time. They could reimpose the stay at home order which is something we want to avoid.
“By going back and forth, shutting down and then reopening and then shutting down, it is going to prolong the economic impact. The safety recommendations we’ve made are the best chance of our staying open. So there is economic motivation as well as health motivation.”
Are there statistics on virus cases by race, and what is that based on?
Dr. Sullivan said, “We have data on cases by race, and we’re behind on it so it’s a little bit older, but when we were able to track that during our case investigation, we found the Hispanic population was over-represented in our case population.
“I think they have some large family gatherings, but also I think this is highly correlated with poverty. We are not able to have people isolate away from their family if they have a large family in a shared home. So we see family clusters with large families in small houses.
“In addition, one of the reasons that we think it’s largely linked to poverty is that essential worker positions, such as grocery store or agriculture jobs, are lower wage positions but they’re essential. A lot of our Hispanics are essential workers, and they are more likely to be exposed. Sometimes those position are hourly and they might not have access to sick leave, so the workers have to make the choice between going to work when they’re ill or not being paid.”
What is the virus recovery rate in Merced County, and what does it mean?
The recovery rate in Merced County is the percentage of those who were infected by COVID-19 who have recovered.
The recovery rate in Merced County is about 40 percent but this figure is not up-to-date.
Dr. Sullivan told the Times, “Basically, the way that we clear people from active case to recovery is by determining they have been symptom free without the use of medications for 72 hours, or if they have a very mild case or are asymptomatic, it has been 10 days since their test for their onset of symptoms, whichever is soonest.
“Previously when we had a more manageable number of cases, we were making daily calls to our cases on how they were feeling, how their symptoms were, and if they were asymptomatic. Once they reported they were asymptomatic, we made three additional calls and then they were cleared.
“But over half of the cases in the county have come up in the last 14 days. In the last 14 days, we had 869 of our 1,530 cases, so we don’t have the ability to provide the same level of case management. We are no longer able to clear people in the same way, so we aren’t able to gauge if people have truly recovered any longer.
“Right now, we have a team of seven case investigators and we have three data people and we have four people like myself who are in management, and we do all the outbreak investigation, and all of the guidance and technical assistance to schools, businesses, food processing plants, skilled nursing facilities and health care providers. We are a very, very busy crew.
“The Department of Workforce Investment did get a grant to hire part-time case investigators to help us out, but as our cases explode, contact tracing becomes less useful because it’s very labor intensive and for it to be effective, the cases have to be rapidly identified and rapidly contained. When we’re getting 80 cases a day, even if we’re able to reach out and identify their contacts, we are not able to rapidly contain them.
“There are a variety of bottlenecks. Right now, people are having a hard time getting an appointment for testing. We’re also seeing the turn-around on lab results increasing. Before, it was between 24 and 48 hours that people would get their results, and now it could be seven or eight days.
“On top of that, because we’re getting slammed with cases, we have a delay in processing them sometimes, and that might be another one-day delay.
“They go into a queue to be investigated, and there might be a one-day delay there.
“All of that combined means there’s a pretty significant delay in people hearing from the Public Health Department after they’ve been symptomatic, and most of that is not within our control.”
What are the masking regulations, and how is the county not complying?
In response to the current spike of COVID-19, face coverings are now mandated by the state and county.
Dr. Sullivan told the Times, “Masks must always be worn indoors, and when obtaining health care services, and must also be worn when people are in line for an indoor facility or when waiting for or riding on public transportation or ride-sharing vehicle, and they must be worn outside if an individual cannot stay more than six feet away from others. They must be worn at the workplace or when performing work off-site.
“We hope the case numbers come down, and we know our businesses are doing the best they can to help our cases come down.
“But there is still a very large sector of our population which doesn’t believe in the truth of the virus, or they feel that wearing a mask is infringing upon their liberties, and so they are refusing to do so.
“We have heard reports of people being belligerent to businesses and causing a scene if they’re asked to wear a mask, and when people are being resistant this puts a lot of burden on the businesses.
“I think masking has become a political statement which is frustrating for us because we’re trying to advise on scientific best practices for health.
What are the other state guidelines?
“Bars have to close completely, except for curbside. Restaurants, wineries and tasting rooms, family entertainment centers (bowling, movie theaters, etc.), the zoo, museums, and cardrooms can continue to operate, but they have to limit their operations to outdoors.
“For example, an outdoor museum like Castle Air Museum can maintain outdoor operations, but they have to close their indoor operations.
“The Zoo could open under this guidance. They would just have to not allow their indoor activities.
“Businesses have the right to refuse service to patrons who refuse to wear masks or practice social distancing.
“Businesses can choose to implement stricter rules than what we have, and that is the businesses’ right.
“These closures are for an expected minimum of three weeks. If numbers continue to rise, that closure time frame could be extended by the State and additional business sectors could be closed.”