An urgent and important message from Lake County’s Public Health Officer, Gary Pace, MD, MPH.
At the time of this writing there are no confirmed cases in Lake County. However, given the exponential spread of the Coronavirus in the Bay Area, I am recommending strong measures to protect the health of our community. These steps will include closing schools, preventing large group gatherings, and generally discouraging commingling of people in public.
Neighboring counties are seeing sharp rises in cases, and in response, many area schools and universities are already closing, large corporations are recommending tele-commuting to prevent the spread of the virus in workplaces, sporting events have been cancelled, and leisure activities severely limited. Governor Newsom declared a State of Emergency on March 4, 2020. He also announced significant recommendations on March 15 for people 65 and over to self-isolate, for bars and tasting rooms to close, for restaurants to minimize social gathering, and to improve services for homeless people. President Trump declared a national emergency on March 13, 2020.
This past week, I declared a Local Health Emergency, ratified by the Board of Supervisors on March 10, 2020, and Sheriff Martin declared a Local Emergency on March 13, 2020, additionally both the City of Clearlake and Lakeport declared local emergencies. The Lake County school superintendents decided to close all public schools for 4 weeks which includes spring break starting on March 16, 2020. The local health and emergency declarations will allow the ability to access staffing, supplies, and funds from State and Federal sources if needed.
Why should we take such disruptive steps?
Part of the strategy involves trying to slow the entrance and spread of the virus before it gets a firm foothold in our community. Most of the medical community is convinced that even if we haven’t proven the presence of a case yet, it is probably here or coming soon. From a prevention point of view, it is wiser to try to initiate these safety measures before people start getting sick, and healthcare facilities get overburdened.
When watching how things have unfolded in China and Italy, it becomes clear that a huge part of the problem is that there were too many patients needing help over a short period of time. The staff was overwhelmed, the beds were full and patients were turned away, and there were inadequate numbers of mechanical ventilators (particularly important for very sick people to help them breathe through the worst phase of the illness).
In our rural county, we have a dedicated, professional healthcare workforce, and our hospitals, clinics, and nursing facilities are diligently preparing for the possibility of a “surge.” In reality, though, we have a limited number of ventilators and perpetual challenges maintaining sufficient numbers of health care and medical workers. If this virus continues to escalate, the regional hospitals will be impacted in terms of beds and staffing, and our two Critical Access Hospitals will likely need to manage primarily with local resources. We also have a population that is older and with more underlying medical problems than in other parts of the state. Preventing the surges, if possible, is an important strategy.
Therefore, taking strong preventive measures is in the best interest of the health of our community. These steps we are ordering will be a hardship for many, and some of the people whose lives are most disrupted may not be the ones who will benefit. For example, the young people who are unable to attend school and have to study from home are not the ones most at risk from the virus. Closing schools minimizes the risk of students bringing the virus home to vulnerable family and community members.
Therefore, we are in support of all measures that limit group gatherings in the community. The state guidelines recommend groups no larger than 250. The Public Health Order number c20-2 prohibits groups larger than 100. It requires groups between 25-100 people to implement all of the COVID-19 mitigation measures as listed in the order. These conditions include excluding sick people, keeping 6 feet of “social distance” when with non-family, and restricting group size to less than 10 for vulnerable populations, like seniors or people with underlying medical conditions.
What would this look like in practice?
• Schools: I support the change in operation of schools for an indefinite period. Please see Public Health order number c20-1.
• Non-essential group activities: recommend cancelling until further notice, see Public Health order number c20-2.
• Senior centers (serving some of our most vulnerable community members): cancel group activities over 10 people. Keep 6 feet distance between people. Have clients and staff that are sick stay home. If possible, provide meals on a “take home” basis.
• Long-term Care Facilities: eliminate visitation, except for families of dying residents. Eliminate group activities and dining, unless in small groups with adequate social distance.
• Theatres, Movies, restaurants: limit number of patrons, keep 6 feet social distance between non-family members, increase cleaning and disinfecting of surfaces.
• Bars and tasting rooms: recommend to close immediately as per the governor.
• Workplaces: encourage tele-commuting, sick workers stay home until well and establish liberal sick leave policies, minimize group activities, cancel travel, encourage video-conferencing.
• Hospitals: discontinue visiting except for families of dying patients; continue planning for prevention of contagion and preparing for possible surges. Increase testing capabilities as soon as possible (the limitation currently is at the state level). We recommend taking significant steps to protect our healthcare workforce. This includes shifting all possible non-urgent care visits to virtual visits.
Now, these measures may seem overly harsh and difficult to manage. Certainly, we are asking people to drastically change the way they live for the coming weeks. We suspect what we are seeing in Europe is a look into what we may be seeing here in a few weeks. Just two days ago, Spain and France closed almost all businesses (except for groceries, pharmacies, healthcare, gas stations and banks) and essentially told people they needed to stay home. In watching the situation in Asia-- especially Singapore, Hong Kong, and Taiwan-- the places that took quicker and more decisive actions did better in the long run.
In Lake County, we know how to do this. Almost everyone has learned that following Sheriff Martin’s orders for a quick evacuation is a good thing. Taking the time to clear brush and make the preparations that the Fire Chiefs recommend can be life-saving. We are asking for the same kind of recognition that changing the normal routine of your family may save the lives of some of the more vulnerable.
Of course, it is possible that these steps are going to be unnecessary or counter-productive. If the virus passes by without significant impact, feel free to come and tell me that I over-reacted. However, the evidence points to the need for decisive action now. Thank you for your cooperation.
Download Public Health Orders