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July 31 Lake County COVID-19 Update

Summary:
• 195 Total Confirmed Cases, to date
• 21 Active Confirmed Cases (“Active” means COVID-19 positive, currently being monitored by Public Health staff)
• 2 Currently Hospitalized (1 in-county)
• 173 Recovered, 1 Death
• Vigilant local monitoring has kept our numbers low and outbreaks at bay; that vigilance must be the norm for the foreseeable future
• All 6 neighboring counties are now on the State’s Watch List
• 37 total counties on the County Monitoring List (i.e., “Watch List”), 93% of California population
• Once on the Watch List, additional restrictions apply until action is taken by the State Public Health Officer, even if local numbers improve
• You can help increase our chances of maintaining Local Control, and keeping businesses open: wash your hands; wear a face covering when outside of your home; observe social distancing; cancel any gatherings with individuals outside of your immediate household, particularly any indoor activities; comply with Health Orders, which are designed to limit overall risk
• REMINDER: Face Coverings Work, Non-N95 Masks Safe for Even Many Individuals with Underlying Chronic Lung Disease

Lake County, CA (July 31, 2020) — COVID-19 activity remains manageable in Lake County at this time.  Our overall COVID-19 case count now stands at 195, up 29 from the 166 reported in our July 23 COVID-19 Update.  Active Cases, those currently being monitored by Public Health staff, have decreased to 21 from 25.  2 individuals are hospitalized, 1 in-county and 1 out-of-county, and no COVID-19 related deaths have been documented since July 3.
 
High level of vigilance has Kept Lake County’s numbers relatively low – we have to maintain it for the long haul
Statewide delays in testing results have recently affected the reliability of “Active Cases,” as a meaningful indicator of how COVID-19 is affecting Lake County communities.  Additionally, with many residents regularly leaving Lake County to work and shop, the probability of coming into contact with COVID-19 may be markedly greater, at times, than our local numbers, alone, would suggest.
 
Vigilant local monitoring by Public Health officials and staff, Sheriff Brian Martin, Captain Norm Taylor, and County Deputy Sheriffs and staff serving in our Jail, and leadership and staff at Skilled Nursing and other congregate living facilities has kept our numbers low and outbreaks at bay. 
 
That vigilance must be the norm for the foreseeable future, and will require ongoing community support to sustain.  We greatly appreciate that many have stepped up to help, of late.  Any others interested in volunteering to support Lake County’s COVID-19 response effort can write to MHOAC@lakecountyca.gov.
 
All 6 surrounding counties now on the County Monitoring List (AKA, “Watch List”)
On Saturday evening, July 25, Mendocino County announced Public Health Officer Noemi Doohan had been informed their County was added to the State’s County Monitoring List.  This came despite three weeks of proactive local safety enhancements, aimed at limiting the spread of COVID-19:
https://www.mendocinocounty.org/Home/Components/News/News/5197/3242
https://www.mendocinocounty.org/Home/Components/News/News/5153/3242 (July 1 release, describing enhanced precautions)
 
What are key differences in viral activity in Monitoring List counties? 
Both Mendocino and Sonoma Counties have recently seen outbreaks in their Skilled Nursing Facilities, and those have tragically resulted in deaths.  Outbreaks have also occurred in correctional facilities, statewide.
 
It is important to remember that outbreaks do not result from cases spontaneously arising in these congregate living facilities.
 
Staff working directly with those most vulnerable and/or at-risk may carry the infection to work.  Someone delivering essential supplies or food may inadvertently spread COVID-19, even if they don’t feel sick.
 
Because people can spread the virus without showing any symptoms, any kind of close contact has the potential to result in infection, and any single case can cause an outbreak, if the individual attends a large gathering during the time before symptoms emerge, for example, or reports to work in a high-risk or public environment. 
 
Close contact, per CDC Guidance, is defined as being within 6 feet of an infected person for at least 15 minutes, and failure to wear a mask markedly increases the risk COVID-19 will be spread:
https://www.cdc.gov/coronavirus/2019-ncov/php/contact-tracing/contact-tracing-plan/contact-tracing.html
 
You can help improve our chances of maintaining Local Control, and keeping businesses open!
Unfortunately, we cannot guarantee Lake County will maintain Local Control throughout the remainder of the pandemic.  Work in critical sectors must go on at all times, and there will continue to be significant risks until a vaccine is developed and readily available.  However, there are simple things you can do that make a significant difference:
·       Wash your hands;
·       Wear a face covering when outside of your home;
·       Observe social distancing;
·       Cancel and avoid gatherings with individuals outside of your immediate household, particularly indoor activities;
·       Comply with Health Orders, which are designed to limit overall risk.

How will local businesses and schools be affected if we end up on the County Monitoring List?
Over the course of the COVID-19 pandemic, Lake County businesses, and the people they serve and employ, have been severely affected.  Some businesses have permanently closed their doors, and nearly all face unusual challenges; our local unemployment rate is nearly 3 times what it was a year ago.  In recent weeks, our economy has remained largely open, but we are literally surrounded by others that aren’t faring as well.
 
Despite our relative success, we sit one significant outbreak, or spike in infection rate that applies pressure to our hospital capacity, away from joining the 37 counties (representing 93% of Californians) on the State’s County Monitoring List (i.e., the “Watch List”), which is “Step 2” of the California Department of Public Health’s (CDPH’s) County Data Monitoring protocol:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/CountyMonitoringDataStep2.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/COVID19CountyMonitoringOverview.aspx
 
If we cross that threshold, and our numbers don’t dramatically improve within just 3 days, the following Lake County businesses and activities will be required to close, or shift to entirely outdoor services and activities:
·       Gyms and Fitness Centers
·       Places of worship
·       Protests
·       Hair salons and barbershops
·       Personal Care Services (including nail salons, massage parlors, and tattoo parlors)
·       Schools, in most cases, cannot open in counties on the County Monitoring List

Additionally, the State will provide greater technical assistance, and determine “Key action steps,” designed to address identified drivers of increased viral activity.  If initial efforts to progress in these key areas are not effective, it is possible the State Public Health Officer will impose even further restrictions.  Progression to Step 3 has been considered in areas close to Southern California outbreaks, there are presently no counties at this step:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/CountyMonitoringDataStep3.aspx
 
As some will be aware, Imperial County (a county with a population density less than Lake County’s that borders areas with greater population density and high infection rates) has returned to Stage 1, but the Orders enacting that change were ultimately collaborative and locally imposed, though certainly responsive to pressure applied by the State:
https://abc7news.com/california-coronavirus-update-imperial-county-covid-where-is/6271101/
http://www.icphd.org/media/managed/0covid19pressreleases/Joint_Statement_Amended_Health_Officer_Order_7_1_20.pdf 
http://www.icphd.org/health-information-and-resources/healthy-facts/covid-19/roadmap-to-recovery/ 
 
Do business restrictions automatically lift when local metrics improve?  Unfortunately, no.  State permission for in-person learning at schools to resume IS tied directly to local metrics.  Business restrictions that arise from the County Monitoring List protocol are lifted at the discretion of the State Public Health Officer, per July 13 Order.
There has been much local discussion, of late, regarding whether business restrictions added as a consequence of the County Monitoring List protocol would lift when local numbers improved to the point all threshold criteria (i.e.: testing capacity; transmission rate; hospitalizations; and available hospital bed, ICU and ventilator capacity) were met.
 
The short answer, unfortunately, is “No.”
 
When additional business sector closures for counties on the County Monitoring List were initially directed by Governor Newsom, on July 1, it was broadly assumed those restrictions were tied only to local data.  Looking back, that understanding is not clearly described in CDPH’s July 1 Guidance:
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Guidance-on-Closure-of-Sectors-in-Response-to-COVID-19.aspx
 
Understanding was further complicated when “in-person learning” reopening criteria for K-12 schools in California was released, on July 17.  While resumption of in-person instruction is ultimately under the discretion of local school officials, and there are many safety-related factors to weigh, in-person instruction is allowed to resume in areas (referred to as, “local health jurisdictions,” or LHJs), “that [have] not been on the County Monitoring List within the prior 14 days.”  Language here explicitly states schools in this category “must conduct distance learning, only, until their LHJ has been off the monitoring list for at least 14 days”:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/Schools%20Reopening%20Recommendations.pdf
 
However, State Public Health Orders, issued July 13, indicate reopening of sectors closed as a result of the State’s County Monitoring List protocol will be at the discretion of the State Public Health Officer:
https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/SHO%20Order%20Dimming%20Entire%20State%207-13-2020.pdf
 
Section 3 (page 4 of 5) of that Order indicates activity restrictions apply to all counties on the California Department of Public Health’s (CDPH’s) “County Monitoring List” (i.e., the “Watch List”), as well as any “counties that subsequently appear for three consecutive days or more while this order remains effective.  Section 5 (also page 4 of 5) notes, “These closures shall remain in effect until [the State Public Health Officer determines] it is appropriate to modify the order based on public health conditions.”
 
For information on plans for Lake County schools, please consult https://www.lakecoe.org/ and District webpages.  The Four Stages of the “Lake County Schools COVID-19 Return to School Continuum Plan” are described here:
https://www.lakecoe.org/Page/2433

REMINDER: Face Coverings Work, Non-N95 Masks Safe for Even Many Individuals with Underlying Chronic Lung Disease
As stated last week, putting on a mask may save your friend’s job, or keep a vulnerable individual from experiencing severe illness or even death.  Our local economy and the well-being of many in our communities depend on all of us taking every action we can to keep each other safe.
 
There is increasing evidence face coverings have a meaningful effect on the spread of COVID-19, and are even safe to wear for many individuals with underlying chronic lung disease:
• Centers for Disease Control (CDC) Director Robert Redfield was recently quoted in the Wall Street Journal, stating the pandemic could be brought under control  in 4-8 weeks if, “we could get everybody to wear a mask” (https://www.wsj.com/articles/face-masks-really-do-matter-the-scientific-evidence-is-growing-11595083298)
• 2 Missouri stylists recently tested positive for COVID-19. Because the stylists and their clients wore masks, 0 of their 139 clients contracted the virus (https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e2.htm)
• A recent joint statement by leading respiratory medicine groups noted, “Individuals with normal lungs, and even many individuals with underlying chronic lung disease, should be able to wear a non-N95 facial covering without affecting their oxygen or carbon-dioxide levels” (https://www.prnewswire.com/news-releases/american-college-of-chest-physicians-american-lung-association-american-thoracic-society-and-copd-foundation-statement-on-importance-of-patients-with-chronic-lung-disease-wearing-facial-coverings-during-covid-19-pandemic-301095501.html)
 
Thank you for remaining vigilant and doing all you can to slow the spread of COVID-19.  Your personal choices can help keep your communities and the vulnerable safe.

Gary Pace, MD, MPH

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