Santa Cruz still ‘in it for the long haul’ with COVID, county health officer says
LOOKOUT EXCLUSIVE: Gail Newel discusses how the virus is spreading, school reopening plans, testing, “COVID fatigue” and how we should handle the holidays. She even reveals her own Thanksgiving plans.
Santa Cruz County is in the midst of an unprecedented surge in COVID-19 cases, with more infections than ever: 639 active cases, dozens of new ones confirmed every day, and the county’s first death in weeks on Nov. 18.
Get ready for more. The county is expected to remain in the purple tier — the most restrictive in the state’s reopening framework — through the rest of 2020, says Dr. Gail Newel, the county’s chief health officer. And a complete return to normal is only likely months after that.
“We’re in it for the long haul,” Newel told Lookout Santa Cruz in a one-hour sitdown on Zoom. That means “we’re likely going to need to continue to wear face coverings and socially distance for at least a year.”
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There is a glimmer of hope, though: Some of the promising new COVID vaccines in development could arrive here as early as December, but it will take many months for everyone to be vaccinated. “We’re going to see things get better when we get about 40% of the population vaccinated. I think we’ll be able to do that,” Newel said.
Lookout asked Newel about how the virus is spreading, school reopening plans, testing, the “Covid fatigue” we’re all experiencing and how we should handle the holidays. She even revealed her own Thanksgiving plans.
An edited transcript of the interview is below:
On the county’s current covid status
Q: This week Santa Cruz moved into the purple, or most restrictive, tier of COVID restrictions along with most of the state. Which of the state’s metrics — case rate per 100,000 people, testing positivity rate, etc. — kicked us into the purple tier?
It was mostly our case rate. Our testing positivity rate went up a little, but not a lot. We had a 98% increase in our case rate in the last 14 days. So it doubled in 14 days. Our testing has gradually increased over time, but it’s basically stable. And at the same time, our case rate has doubled or tripled in the last week or two. That means that’s a true number. We are seeing that (there is) much more disease in our community, and it’s beginning to play out in other ways: in emergency room visits, in hospital census. And we would expect to see increasing deaths in a couple of weeks as well, that usually follows.
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Q: What has the county learned about how the virus is spreading here?
It’s still mostly within households that it’s spreading, but of course it doesn’t come into a household without one of the household members bringing it in. It’s usually a household member with a close contact outside of the household. It might be an intimate partner, someone a household member is dating outside of the household. It could be a coworker, but in most coworker cases, they don’t get the disease on the job. They get it when they’re on break or out to lunch together. Two coworkers might take their face coverings off to eat together in the breakroom, or they might get in the same car to drive-thru fast food somewhere and take their face coverings off in the car. Oftentimes it’s an extended family gathering, when multiple family households and people feel like, ‘Well, it’s my family. I’m not gonna wear a face covering. It’s my grandma, it’s my aunts and uncles. It’s my cousins.’ And they just don’t see them as potentially unsafe.
Q: Over the course of most of the pandemic, Santa Cruz County overall had much fewer cases per capita than much of the state. Why do you think that was?
I joined the other health officers in the Bay Area very early in doing a shelter-in-place order that was strict. Because Santa Cruz was lagging behind most of the other Bay Area counties in terms of disease, we really nipped it in the bud, so to speak. That was helpful, but I think the biggest factor is that in general, our community members have been willing to make the individual sacrifices needed to keep disease rates low.
Q: What’s different now that’s causing the steep increase in cases in Santa Cruz? Did people change their behavior significantly?
Some of it has been Halloween gatherings, but it’s mostly spreading within households and multifamily gatherings. We’re not a bubble in Santa Cruz; this has been happening for weeks already in the rest of the country. Then about two weeks ago, LA experienced a huge surge, then Santa Clara, and it’s finally caught up with us. There’s a lot of movement around the state. As the rest of the state developed more disease transmission it was inevitable we would be there as well.
We’re still doing relatively well compared to neighboring counties and the rest of California. And certainly compared to the rest of the country, Santa Cruz is still doing really well. Especially if you look at death rates. Ours are very low.
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Q: What do you anticipate the rest of the year to look like as we deal with this outbreak?
I would guess we’re going to stay purple for the rest of the calendar year. Our case rate is way high above the cutoff for purple now and things across the state just continue to climb: case rates, positivity rates. So I would anticipate we’ll have higher positivity rates, higher case rates, higher hospital census, more deaths, more of our most vulnerable communities, like skilled nursing and assisted living facilities getting ill, unfortunately.
Q: Has there been any point during the pandemic that Santa Cruz has been close to running out of hospital capacity or ventilator ICU bed capacity?
We haven’t been anywhere near that, we’ve barely scratched the surface of our capacity. But that’s our primary concern now.
Q: Throughout the pandemic, cases of COVID (about two-thirds) have been concentrated in South County. What has the county learned about why the pandemic is worse there?
Many of our Latinx community members and South County community members are frontline workers. They don’t have the privilege to work virtually or work mostly from home and so they are exposed to the public on an ongoing basis. Many live in multi-generational households with a bigger household size. Many South County residents also don’t have yards to have outdoor gatherings, or space to be six feet apart, or separate bedrooms or bathrooms to isolate when they do get sick.
Communities of color are less likely to trust the health care system, and less likely to have resources that allow them quarantine or stay home from work when they’re feeling ill, and less likely to have wage replacement for quarantine. We’ve noticed that when we offer quarantine housing to people who have COVID, many are afraid to leave their families, especially if there’s an issue around documentation. Some of them may have been traumatized in the past by separation at the border. And of course, South County’s right next to Monterey, which has had really high rates all the way along, especially in their North County.
Q: Is the county meeting its goals for testing?
We’re not where we want to be. We have never been where we want to be, but we’ve also never been closer to where we want to be. What we would like is that anyone who wants to get tested can get tested whenever they want, and we’re not there. We have free public testing through the state at Ramsay Park. Week after week, we’re around 130% utilization, so they’re not only filling every single appointment slot but also accepting walk-ins. But the state has granted us a second lane at Ramsay Park. So we’ll be doubling our ability to test there. We’ll go from 165 tests per day to 330, and it’s going to be seven days a week. That’s completely free and open to the public, anyone who wants to get tested. We were told that would happen by Nov. 30.
The places that we’re really seeing the gaps are in insured patients who have a commercial health plan. Some of those organizations don’t yet have adequate capacity to test everyone who wants to be tested. So they’ll draw a line at symptomatic, or, maybe essential workers if they’re asymptomatic, but they won’t just take anyone who wants to be tested, even if they’ve had a known exposure.
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Q: Looking to the next few months, as the whole country is dealing with increased cases, how likely are even more restrictive regulations in Santa Cruz than what’s outlined in the purple tier?
The additional measures I’ve heard the governor talk about, and the leadership at California Department of Public Health, are curfews. In particular around bars and restaurants where people are drinking. I don’t know what will happen, but the leadership at the California Department of Public Health has talked about statewide indoor dining bans, statewide bar closures, even for bars that are serving meals, and possibly closing gyms. In the urban areas, there have been a lot of cases linked to gyms, bars and restaurants.
Q: When do you think the first vaccines could arrive in Santa Cruz, and who would get them?
We’ve been told that it could be as early as December. The federal government would distribute to the states and then the states would distribute in various ways. The state has decided to work directly with any health care systems that have locations in three or more counties. So Kaiser, Sutter, Dignity, groups like that will have their own allocations through their central headquarters. Otherwise, the state will distribute to the local health jurisdiction to allocate and distribute, but they will determine how we allocate. They’ve set a priority scheme already, and it will start with healthcare workers and first responders who work most closely with COVID patients. The paramedics, emergency room doctors and staff, the ICU staff, and COVID ward staff.
Q: Do you think there are enough people with anti-vaccination sentiments in Santa Cruz to impact our ability to achieve herd immunity through vaccination?
Experts that I’ve heard talk about this, including Dr. Fauci, say that if we could get even 40% of our population vaccinated, we’ll have a pretty good handle on things. So I’m not too worried about that. And in Santa Cruz, even though we have a vocal group of anti-vaxxers, we actually have very good rates of vaccination in our kindergartners and seventh-graders, which is how they’re tracked.
Q: When will enough people be vaccinated that we can get back to normal life?
We’re likely going to need to continue to wear face coverings and socially distance for at least a year. It will probably be close to a year until the vaccine is available to the general public. So we’re in it for the long haul. But we’re going to see things get better when we get about 40% of the population vaccinated. I think we’ll be able to do that.
Q: This is up to the school districts, not the health department, but when in your opinion will it be safe to open schools?
When we were in the red tier for two weeks, I was hopeful that we’d be able to have more children in the classroom. We did have 14 private schools open and they can stay open even now that we’re in purple. They’ve been very successful and we’ve had almost no cases in the schools. We have a good surveillance testing program for the teachers, a contract with Stanford medical labs. They come over and provide testing here on an every two-week schedule and that’s gone very smoothly.
So I was hoping it was going to be possible for the public schools to open sometime this fall, but as case rates have risen there’s been more and more discomfort on the part of the teachers in particular but also parents and leadership. Now that we’re in the purple tier, the only way for schools to open is to apply for a waiver through the state. In conversations over this past weekend with the state, they’ve said now is probably not a good time to apply for a waiver, and I would agree about that. So, at this point, the public schools are not planning to open anytime soon. But they are providing services and they have been all along.
Q: Thinking about the holidays, what are your holiday plans? What can people think about in terms of Thanksgiving, is there any safe way for households to mix?
If you’re going to gather with more than your own household, it must be outdoors. You shouldn’t be mixing with people who have traveled from out of state unless they’ve quarantined ahead of time. Or, if you’re willing to quarantine after they’ve been here. Shorter is better. Keep your face coverings on unless you’re actually eating or drinking. And, it’s really important that people who might be sick, even just the littlest sniffles that they think might be their allergies, they need to stay home just in case. And six feet apart if you’re not in the same household, lots of hand-washing disinfecting surfaces.
Q: Right, and so what are you planning to do for Thanksgiving?
My family and my home are in Fresno, and I was really hoping to be in Fresno with my extended family and for an outdoor meal. But we have all decided that that’s not safe. So, I am hoping to take a walk in the afternoon with my 86-year-old mother who will drive to meet us along a creek bank near her residence and we’re going to go on a walk together. Otherwise, it’s just going to be my wife and I cooking a traditional turkey dinner for the two of us.
Q: Is there anything we didn’t get to?
I really want the community to know the cost of this pandemic on our children’s lives. We all hear a lot about how people are suffering from their economic restrictions. And that is a reality. I mean, people die of poverty just like they die of COVID, but we don’t hear enough of our children’s voices because they don’t have a big voice in our society. But they are the ones who were really suffering during this pandemic, really cut off from all of their opportunities for normal childhood development.
We all need to take care of ourselves: our families and our community and each other, and nurture our community resilience to get through this. I think in many ways Santa Cruz is a resilient community. We have a lot of strengths.