In the face of a COVID-19 case surge that reached record levels in August and diminished staffing, Humboldt County Public Health is triaging response efforts to focus on contact tracing in schools, skilled nursing facilities and other congregate living situations, as well as continued vaccination efforts, officials announced at a Sept. 8 press conference.
"As you are well aware, we are seeing the worst of this pandemic since the very beginning and we are in an emergency," Public Health Director Sofia Pereira said. "We are seeing a surge in our hospitals, we are seeing a surge of deaths in this community, and the impacts of this surge go beyond the walls of our local hospitals. We are triaging. We are having to triage just like our hospitals are triaging."
Health Officer Ian Hoffman said that with COVID-19 now endemic in the local community — meaning it is everywhere — traditional contact tracing efforts are no longer an effective strategy to mitigate the disease's spread. Contact investigations seek to work with people who have tested positive for the virus to track down and isolate those they may have exposed and end chains of infection. But with so much virus circulating in the local community — and many people simply refusing to participate in contact tracing efforts — officials say the strategy is no longer effective.
"We are beyond the point of trying to contain this," Hoffman said. "It's here and it's going to continue to spread throughout the community."
A Shift in Strategy
With disease so widespread, Public Health is shifting its strategy and will now simply reach out to new cases electronically with a brief questionnaire via email or text message, preserving contact tracing staff to refocus efforts on at-risk populations.
Specifically, Hoffman said contact investigations will now focus on preventing and limiting outbreaks in schools and congregate living facilities, including the jail and skilled nursing homes, following a statewide trend.
And Hoffman stressed that schools will be a priority in this new approach, calling keeping kids in classrooms "absolutely imperative."
Hoffman said school staff will remain at the forefront of day-to-day contact investigations, identifying students and staff who have tested positive for the virus, determining close contacts and notifying families. But in situations where there is an outbreak — which the U.S. Centers for Disease Control defines as three cases confirmed in a single setting or cohort over a 14-day period — Public Health staff will work with the school to both mitigate its spread and determine whether there are gaps in the school's mitigation measures or additional ones that can be implemented.
Public Health has not identified any school outbreaks in Humboldt County to date, Hoffman said, but added "there was kind of a perfect storm" with the convergence of the beginning of the school year and the emergence locally of the highly contagious Delta variant.
"As Sofia mentioned, this is triage," he said. "Our No. 1 goal is to keep those schools safe."
A Data Divide
Some parents locally have been clamoring for schools and Public Health to release more data about positive cases in local schools, and an online petition asking Hoffman to add school-level case data to the county's dashboard had gathered more than 700 signatures when the Journal went to press.
"We need to know this information so that parents/caregivers can make informed decisions about the risks of in-person learning and so school staff can make informed decisions around their health," the petition states.
Asked about the petition at the Sept. 8 press conference, Pereira said she understands parents concerns and desire for more information.
"First of all, I want to acknowledge the core of what that petition is asking, which is that they want their kids to be safe. Public Health, our schools, we want that as well," she said. "We want our kids to be able to go to school safely. I'll just say from personal experience, giving birth and having a child in a pandemic, and raising a child the first year of his life in a pandemic, I know that you would do anything to protect your child. So I understand the desire to know, 'Is it safe for my kid to go to school right now?'"
But when it came to adding the additional data to the dashboard, Pereira said it's not currently feasible. She said the county does not currently have a uniform reporting structure for all of the county's 30 school districts and more than 70 schools to report case data to Public Health, though it is working with districts to that end.
"That is quite a challenge," Pereira said. "I'm not saying that it's a never, but at this point, with the resources we have, I can't commit staff to that endeavor. ... In terms of adding something to the dashboard, we just don't have the staff capacity to take that on."
In an email to the Journal, Humboldt County Superintendent of Schools Chris Hartley said the Office of Education (HCOE) does not manage any of the data collection and reporting systems used by Public Health.
"HCOE is able to help facilitate conversations, development of procedures, training and any assistance possible for schools developing capacity to meet all the massively challenging demands placed upon them at this time," he said. "The real heroes here are our district superintendents, principals, teachers and staff who are running their programs while also managing completion of a tremendous amount of work related to contact tracing, communication with families and staff, COVID testing, and so much more."
Hoffman, who has previously said that in-person instruction has been shown to be safe as long as mitigation measures like mandatory masking, increased ventilation and physical distancing are in place, said he currently has two children in Humboldt County schools.
"I want to emphasize that I feel safe sending my kids to school in our county because I've worked closely with these educators and I know they are following the protocols, they are doing what they can to keep these kids safe."
Hoffman also urged concerned parents to communicate with their children's schools about mitigation measures and positive cases, "because that's who's keeping your kids safe right now."
What the Data Says
While Hoffman made clear in his Sept. 14 presentation to the Humboldt County Board of Supervisors that local school children have been testing positive for COVID-19, he stressed that he believes that is because more students are being tested for the virus, not that it is spreading in schools.
The county dashboard upgrades case data by age groups on Fridays, so there's a lag in reporting. But the latest available data does show an increase in new cases among the 0-9 and 10-19 age groups in recent weeks.
As of Aug. 20, before most local schools were back in session, the 0-9 and 10-19 age groups accounted for 7.7 percent and 12.7 percent of local cases, respectively. In the ensuing three weeks, Humboldt County confirmed 1,467 new COVID-19 cases. Of those, 11 percent were among residents age 0-9 and 15 percent were among those 10-19 years old. In the most recent week for which data is available — Sept. 3 through Sept. 10 — children 0-9 accounted for 11.7 percent of cases, while residents age 10 to 19 accounted for 12.4 percent.
So there does seem to have been a significant uptick in positive cases among Humboldt County's youngest residents, but whether that's simply a result of more kids getting tested amid the return to school and a surge in cases across the community or their return to classrooms is difficult to say.
In an interview with the Journal, Hartley and Assistant Superintendent Colby Smart said HCOE is focused on helping districts meet the needs of the new year, from implementing testing and contact tracing programs to keeping stocked on personal protective equipment for everyone on campus and launching long-term independent study programs for families who have opted not to send their children back to the classroom.
Smart said a survey of local districts found 57 percent have onsite testing programs up and running for staff to meet a state mandate that all teachers and staff be fully vaccinated or tested regularly, while others are still working toward that end. But Hartley said rapid antigen tests have become scarce.
"The issue is supply," he said, explaining the recent national surge in cases fueled by the highly contagious Delta variant, coupled with a host of new testing requirements across all sectors, has created a shortage of testing supplies.
Some local districts, meanwhile, are already launching programs to regularly conduct surveillance testing of students whose parents consent in an effort to proactively contain any potential strains of infection on campus.
Hartley said HCOE is also working to assemble a "health alert response team" that will include nurses and a medical clerk to help districts manage specific "COVID health needs," which he said could include everything from contact tracing and testing efforts to simply providing substitute teachers. Hartley said the pandemic has "definitely enhanced the labor shortage for all employee groups" that makes schools function, from bus drivers and para-professionals to substitute teachers, while also adding a new layer of mandates and protocols.
"It has put a massive strain on our workforce, which we consider very fragile at this point," Hartley said, saying he hopes the entire community will "show each other some grace" as schools work through the challenges of keeping students safely back in schools.
Thadeus Greenson (he/him) is the Journal's news editor. Reach him at 442-1400, extension 321, or firstname.lastname@example.org. Follow him on Twitter @thadeusgreenson.