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COVID-19 Update

Cases Reach 100; 26 Counties on the State’s “Watch List,” Lake County Not Yet Among Them – Follow Our Performance Against State Metrics on the Coronavirus Response Hub Response to Farmworker Outbreak Showing Success; 4th of July Gatherings May Have Led to Exposure – Testing Encouraged ; Scam Alert - “Mr. Smith” Posing as the Health Department; 3 COVID-19-Positive CDCR Inmates Released to Lake County; Testing Demand Causing Delays Statewide; New Tool Released to Support Local Businesses’ “Return to Work” Decision-Making; Update on Our Tragic COVID-19-Related Death

Lake County, CA (July 9, 2020) – Since our previous update of Friday, July 3, COVID-19 infections have continued to rise in Lake County.  Yesterday (July 8), we confirmed Lake County’s 100th case.  As many will recall, we eclipsed 50 cases over the weekend of June 27 and 28.  Our total caseload more than doubled in a period of less than two weeks, and new cases have surfaced in several different communities.

As of this writing, of our 101 cases, 19 are active.  1 patient is hospitalized locally, and 1 further is hospitalized out of the area.  All of the rest of those that recently required hospital-based care are recovering well, and have been released.

There is some good news here.  Our active case count stood at 44 just one week ago, and that number has dropped by more than half, despite the increase of 16 overall cases in that period.  Even as active cases rose over the past couple of weeks, the local healthcare system was able to respond.  Our contact tracing capacity was stretched, but our team of Public Health Nurses rose to the occasion, and we are very hopeful that additional support from the State level is coming soon. 

We are always looking for patterns in the spread.  Much of it continues to be from out of county contacts with known cases or household contacts.  However, we have seen larger family gatherings where spread has escalated.

26 Counties on the State’s “Watch List,” Lake County Not Yet Among Them – Follow Our Performance Against State Metrics on the Coronavirus Response Hub
Despite all of the recent viral activity in California, our local situation has remained manageable, and we are not among the 26 Counties on the State’s “Watch List.”  Therefore, our local economy remains broadly open, at this time. 

However, the State is very closely monitoring viral activity across all California jurisdictions, and our Elevated Disease Transmission (67 or more new cases over a 14-day period or 17 cases and testing positivity rate of greater than 8%) stats have pushed State thresholds in recent weeks.  Our hospitalizations and hospital capacity have remained comfortably within allowable limits, in part because our local hospitals, due to their corporate structures and policies, are in the normal practice of transporting individuals requiring a high level of ongoing care out of the area.

As the number of cases rise, we risk being placed on the monitoring list.  Public Health measures have proven effective in slowing the transmission of the virus: preventing public gatherings and limiting large groups, requiring masks—and as things worsen, these types of interventions may become even more necessary.  Taking proper precautions now can promote public health and commerce.

In the interest of fostering common understanding with the public and our local business community, Lake County’s performance against State metrics is now published on the Lake County Coronavirus Response Hub:
https://lake-co-ca-coronavirus-response-lakecoca.hub.arcgis.com/

More information on the State’s County monitoring process can be found here:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/COVID19CountyMonitoringOverview.aspx
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/COVID19CountyDataTable.aspx
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/CountyMonitoringDataStep1.aspx

Response to Outbreak in Farmworker Community Showing Success
As reported in our July 1 COVID-19 Update, many recent cases stemmed from an outbreak in a community of farmworkers.  Approximately 35 cases have been confirmed that were workers or close contacts.  Most of the initial group is now off of isolation and no longer contagious, and cases associated with this cluster are diminishing.  We were able to very quickly identify this outbreak, and test 300 individuals at relatively high risk for exposure.  Employers, workers and their contacts did a commendable job of implementing precautions recommended by Public Health staff, and that seems to have kept the kind of exponential growth we have seen in other areas of California and around the country from occurring.

4th of July Gatherings May Have Led to Exposure – Testing Encouraged
As we often mention, large gatherings bringing people from different households together can be very risky, in terms of accelerating transmission of the virus.  Anyone who participated in this type of activity should consider getting tested.

A confirmed case has been connected to a large private 4th of July celebration held on Tribal lands, where multiple people may have been exposed.  For clarity, the event in question was not sponsored by the Tribe; this was a private gathering hosted by a private party. 

Unfortunately, an individual tested positive after the gathering.  They were not present, but several close contacts were.  We are concerned about the possibility of broad exposure, and encourage people who were at such an event to get tested.

American Indians have been disproportionately affected by COVID-19 outbreaks around the country, and we are now aware of more than one local Tribal community with at least one confirmed case.

With all new infections, we perform a case investigation and contact tracing, and reach out to people that came into close contact with a known infected person during their contagious period.

“Local 6” Tribal Members are encouraged to contact Lake County Tribal Health Consortium (LCTHC) to get testing if they have symptoms or have been in close contact with a confirmed case.  Tribal members not connected with a known case, but otherwise concerned they may have been exposed to COVID-19, may likewise contact LCTHC, for assistance with send-out testing.

Non-Consortium members, and anyone that is not currently a patient at Tribal Health, should contact their medical provider, or go to the Verily website and get screened and make an appointment:
https://www.projectbaseline.com/study/covid-19/ 

Some have expressed frustrations in the past surrounding Verily’s online registration process, and we really don’t want this to be a barrier for those who think they may have been exposed to COVID-19.  If you need assistance, please send an email request to [email protected], or call during business hours, at 707-263-8174.

Scam Alert - “Mr. Smith” Posing as the Health Department
We have been informed someone is posing as the Health Department and calling facilities regarding face coverings.  A local business owner reported receiving a phone call yesterday from a “Mr. Smith,” who claimed he worked at the local Health Department.  Mr. Smith told the owner the Health Department will fine them and close the store down if they allow even one person without a face covering into their store. 

These calls are not from Lake County Public Health Services or any of our affiliates.  Public Health may contact a business if there is a complaint about not following safety procedures like masking or social distancing.   Our goals in such a contact is education regarding the ways to follow some of the guidelines, exploring any obstacles, and encouraging compliance.  We currently do not levy fines or threaten closure of a business for these reasons.

Face coverings are one of best tools we have to slow the spread of COVID-19.  However, certain medical conditions and other circumstances preclude some individuals from wearing them.  The State’s guidance is available here:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/Guidance-for-Face-Coverings_06-18-2020.pdf (English)

https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/Guidance-for-Face-Coverings_06-18-2020_(SP).pdf (Spanish)

3 COVID-19-Positive Inmates Released to Lake County from the California Department of Corrections and Rehabilitation’s (CDCR’s) Early Release Program
Our State prison system has experienced multiple outbreaks of COVID-19, most notably in San Quentin where approximately 1/3 of inmates tested positive, and there have been some deaths.  To decompress prison populations and limit the probability of further exposure, CDCR initiated an early release program, and 3,500 inmates are being released to their home counties.  The program started July 1. 

Lake County received 3 inmates that were COVID-19-positive.  2 had completed their isolation prior to release, and the other was released into the community prior to completing the self-isolation protocol.  That individual’s isolation period has now been completed. 

These 3 cases are attributed to the county where the correctional facility that previously housed these inmates is located.  To avoid double-counting, they are not added to Lake County’s totals.

Contact with these people has been minimal due to various logistical problems.  These miscommunications carry risk to public health, and meetings are ongoing with CDCR officials to ensure more effective communication in the future.

Testing Delays Occurring Statewide, Including Lake County
Recently, our Verily sites have seen more demand for testing than can be readily facilitated.  Many people are coming in from out of county, and local residents who feel they may have been exposed are less immediately able to secure an appointment, as a result.  Testing hours have also shifted earlier in the day because of the heat, which has limited access for some.  We will continue to seek to make appropriate adjustments to our practices, but Verily’s registration process is designed to ensure broad access to testing, not to reserve appointment availability for those living nearby a site.

The significant statewide uptick in COVID-19 infections and greater number of contacts potentially exposed due to increased social movement and business activity have left us heavily reliant on commercial labs to process samples.  Sometimes, it has been taking more than 7 days to get results. 

It is important to remember, about 80,000 testing samples are being taken per day, statewide.  Some issues and delays along the way are expected.  California local Public Health agencies and the State are working hard to ensure State supply chains and processing strategies can meet the demand.

Volunteers are still needed to help with some of the daily logistics, and it is probable we will only need more local support to maintain our testing capacity in the future.  If you have clinical experience, or are willing to help out directing traffic, your assistance will be greatly appreciated.  Please contact the Medical Health Operational Area Coordinator at 707-263-8174 or [email protected].

When Someone Tests Positive that Works with the Public
People that work in high-traffic areas and are regularly exposed to numerous individuals outside of their immediate household are at greater risk of contracting COVID-19.  “Close Contact,” i.e., being within 6 feet of someone infected with COVID-19 for 20 minutes or more, carries significant risk of transmission.  If both individuals wear a mask, the risk is markedly reduced.  Precautions and transparency in the business community are essential to limiting spread and keeping potentially isolatable cases from turning into outbreaks. 

CDC guidelines regarding disinfection and return to work can be found here:
https://www.cdc.gov/coronavirus/2019-ncov/community/general-business-faq.html#Suspected-or-Confirmed-Cases-of-COVID-19-in-the-Workplace

We have also posted a “Return to Work” tool for local businesses, based on CDC guidelines, on our website.  This is intended to help individuals and business owners evaluate potential risk when COVID-19 exposure may have occurred:
http://health.co.lake.ca.us/Coronavirus/Businesses.htm

At this time, people in our communities are continually evaluating risks associated with patronizing businesses, particularly those where services involve in-person contact.  Local businesses therefore have a responsibility to be transparent with people, so they can make proper decisions. 

Infection rates and case counts have tended to be higher in neighboring counties, and cross-jurisdictional travel is discouraged, except in the most essential of circumstances.  Yet, we have heard reports that many residents have felt safer traveling outside of the county to shop.

Shopping local has never been more important, from an economic standpoint, and health precautions have never been more key to sustaining business opportunity.  Things like face coverings, and openly sharing with the public when COVID-19 infections occur may inspire greater consumer confidence. 

As a Public Health professional, my decisions to patronize businesses are informed by their commitment to precautions and disinfection practices and strongly responding to any health threats that arise; proactive and preventive practices have been proven to slow the spread.

Update on Our Tragic COVID-19-Related Death
We have received many inquiries from the public and members of the media regarding the COVID-19-related death reported on July 3. 

We would like to again extend our condolences to the family.  From a public health standpoint, our focus, as a community, should be to support the family in their loss and take precautions that stem avoidable spread of COVID-19, and preventable death events that could be related to this infection.  This disease can be deadly, as the over 140,000 deaths in the US over the last 4 months demonstrate. 

Determining causality in a death can be very difficult and time-consuming.  Usually, a reasonable determination can be made, and in the case of COVID-19, testing positive at the time of death is often considered the presumed cause of death.  An autopsy can determine more closely if another unrelated reason can be the actual cause, and the decision to perform such a procedure is made by the medical examiner.  In this case, whether that is being done is not public information.  We reported this death as COVID-related because the clinical description, in combination with the positive test, was consistent with COVID-19 being a strong informant of the death event.

We at Lake County Health Services have a responsibility to protect the privacy of this individual and their family, and it would be inappropriate to release any more information, despite the public curiosity.

Any death event is a tragedy for those close to the person and their family, and the whole community mourns in an event like this.  Please consider this when making comments online, or speculating with friends and neighbors.  There were many lives severely affected by this death, and we must maintain appropriate decency and generosity with one another, and help our community get through and heal from this terrible event.

Gary Pace, MD, MPH

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Water Faucet
Urgent Health Advisory

Effective immediately, people on private water systems whose tap water comes from their own private intake into the lake, in the Oaks Arm and Lower Arm of Clear Lake should not drink the water.

More info