LOCAL OP-ED: It’s time to unify our efforts for public’s health, safety
‘In a sense we as a state and as a region were victims of our own initial success.
The fact that early on we avoided the brunt of what occurred in New York
through sheltering in place caused us to let our guard down.’
— Salvador Sandoval,
Merced County Health Officer
By SALVADOR SANDOVAL MD, MPH
As the Coronavirus Pandemic rages across the world, this country, the state of California, the San Joaquin Valley, and Merced County in particular, it is important to frame the problem in the proper light so that it can be dealt with effectively. If the problem were solely insufficient or absent “contact tracing” in Merced County, for example, the soaring rates seen throughout the state and in the San Joaquin Valley could not be explained.
Contact tracing is a vital and necessary component in the armamentarium for controlling the pandemic. In other parts of the world it proved most useful when utilized early in the course to prevent or at least slow down the rate of spread. However, it is highly dependent on the capacity for extensive testing with prompt access to results in order to contact all those potentially exposed to the ill person. Furthermore, it presupposes the capacity to act quickly upon the results in order to isolate infected persons so that they do not spread it to coworkers, the public, or even within their own households.
We are sorely lacking in all these measures. We struggle to reach the suggested number of tests recommended by the state because we are a “testing desert.” Fortunately, we are now receiving state assistance in Merced County. Partners have stepped forward to provide testing in community health centers and hospitals, besides the Public Health Department. Unfortunately, test result delays due to the sheer volume statewide of 5 to 10 days or more make contact tracing difficult, if not impossible.
The pandemic exacerbates existing inequities within the San Joaquin Valley and Merced County. Belying the wealth and agricultural productivity in the San Joaquin Valley are extremes of poverty which rival Appalachia and parts of the rural South. Coupled with one of the lowest physician and allied professional to population ratios in the state, diminishing public health funding, human services resources limitations, a lack of adequate housing availability, and low educational levels, is it any wonder that the valley and Merced have been impacted so severely?
After more than four months of heightened and emotionally draining mobilization, with staff pulled from various departments, the decision was made by the county in early June to return many borrowed employees to their departments and neglected duties because it seemed things were improving. Contact tracing was never abandoned, but rather the duties were combined with existing contact investigator responsibilities.
What transpired, and what we are now facing as a state, was a perfect storm.
In a sense we as a state and as a region were victims of our own initial success. The fact that early on we avoided the brunt of what occurred in New York through sheltering in place caused us to let our guard down. This, combined with mixed or contrary advice on multiple levels of government when the surge in cases was not felt initially, the relentless pressures to open up the economy that we experienced, holidays, graduations, and warm weather all contributed. Add to this the onset of the agricultural season, bringing a vulnerable and crowded work force in agriculture with little access to information and protective measures. Complicating everything was the blatant disregard of public health advice and measures from some individuals in the community.
We welcome the recent availability of funding for more contact tracing and other assistance from the state. However, we need test results available quickly when they can do the most good. In addition, the funding has to include housing for crowded living conditions to prevent spread within families, which is where we are seeing the most rapid spread.
Most of all, we need broad public information and education. As stated in Communicable Diseases, a Global Perspective by Roger Weber: “Change is always opposed, and steps that seem easy to the educated are mountains for the uneducated to climb.”
We are in this for the long term. It’s time to unify our efforts for the public’s health and safety.
So remember, wear your mask in public, socially distance, and practice good hygiene. Remember, we are all in this together.
Dr. Salvador Sandoval serves as the Health Officer for Merced County.