On the afternoon of Friday, May 8, just hours after some toy stores, florists, boutiques, bookstores and other retailers throughout Humboldt County re-opened for curbside pickup and delivery for the first time in weeks, Sheriff William Honsal addressed the media with a tone of hope and optimism.
"This is a soft opening but we plan to open our retail stores [to walk in customers] very, very soon," he said, explaining that the state has laid out a set of criteria for counties to meet in order to move out of the COVID-19 induced shelter in place at a faster pace than the rest of California. "We can pretty much attest to all those things. ... we could have our businesses opening up by mid-week next week."
Restaurants could open to walk-in customers "the next week or two," he said.
The day after Honsal's remarks, the county announced it had confirmed two additional COVID-19 cases. Then came four more on May 11, as well as the announcement that at least one employee and one resident at Eureka's Alder Bay Assisted Living had tested positive. The next day, three new cases were announced, including another of Alder Bay's residents. The quick spike in cases is likely unrelated to the soft re-opening of some retail shops that had preceded it by just a few days, as health officials say it will take at least a week for such changes to show up in testing results. But it has alarmed local officials and may put the county's path to controlling its own pace of re-opening at risk.
The county has now confirmed 11 cases since April 29. That's not only a large jump from the number of cases confirmed over the prior 11 days, but it also thrusts the county perilously close to eclipsing the state's first criteria for counties to certify they are ready to exercise control over easing shelter-in-place restrictions: They can't have had more than one new confirmed COVID-19 case per 10,000 residents over the prior 14 days. Humboldt County, with a population of 135,558 has now recorded 11 new cases over that time period, or an average of 0.81 cases per 10,000 residents.
Gov. Gavin Newsom has laid out a four-stage plan to easing his statewide shelter-in-place order and re-opening California. Stage one was all about readiness, allowing only "essential" businesses to remain open as state and local governments and healthcare institutions scrambled to increase testing rates and hospital capacities to prepare for a potential surge in illnesses. Stage two began last week with re-opening of curbside retail businesses — as well as the manufacturing and warehouse services needed to support them — and will proceed gradually over time to include walk-in retail, offices, dine-in restaurants, shopping malls, childcare centers and more. Down the road, stage three will include movie theaters, churches, salons and barber shops, while the fourth stage will allow large gatherings, like concerts and live sporting events, and will constitute a full-scale re-opening of the state.
But while Newsom was insistent that the state had to move into stage two as one unit, he left leeway for some counties to ease restrictions more quickly from there, so long as their health officers and boards of supervisors both pledge they meet certain readiness criteria.
Amid what was a lull in new cases — the county confirmed just two over a 17-day period heading into May — and tons of work preparing local infrastructure for a potential surge of cases, local officials from Honsal to Health Officer Teresa Frankovich have been very optimistic Humboldt would meet the criteria to allow it to move forward at its own pace. As the Journal went to press May 12, the Humboldt County Board of Supervisors prepared to consider the following day whether to send a letter to the state supporting Frankovich's attestation that the county is ready to move forward at its own pace.
Here's a look at what the California Department of Public Health has laid out as the criteria local governments must certify they meet in order to attest that a variance from the statewide order is warranted. While the certification must be supported by the board of supervisors, it's ultimately at the discretion of the public health officer, according to CDPH.
Epidemiologic Stability of COVID-19
While this sounds complicated, it basically just means the rate of confirmed new COVID-19 must be slow enough "to be swiftly contained." Given that officials expect an increase in cases whenever restrictions are eased, the state wants to make sure they're low on the front end.
But as mentioned above, the state lays out some specific benchmarks for this provision: A county cannot have had a single COVID-19 death or more than 1 new case per 10,000 residents in the 14 days before making its certification. While Humboldt County has not recorded a COVID-19 death, the recent spike in new cases puts it perilously close to failing this readiness test and putting it into a holding pattern in which it would have to wait for infection rates to slow before proceeding.
Protection of Stage 1 Essential Workers
Before any county moves ahead into stage two, the state wants to make sure the essential workers listed in stage 1 — from grocery store clerks and healthcare workers to firefighters and maintenance crews — are protected. This means the county providing clear guidance to all these workers and their employers on how to maintain safe work spaces, as well as making sure they have necessary supplies, from disinfectants to protective gear. Frankovich indicated the organizations employing or representing these employees locally have done a good job of making sure protections are in place.
The state wants to see that counties have the testing capacity to both monitor the spread of the virus and also aggressively test to help contain a surge. To that end, the state lays out some specific benchmarks.
Counties must have a "minimum daily testing volume to test 1.5 per 1,000 residents," and provide both their testing plan and their average daily testing totals for the past week. When it comes to Humboldt County, this too is a potential stumbling block. With a population of 135,558, that would equate to Humboldt County testing an average of 203 people per day and the county's public health reports indicate the county hasn't gotten there. Over the past nine reporting days, the county has averaged 124 tests per day — a substantial increase over previous testing rates but still short of what the state wants.
In a media availability Monday, Frankovich stressed that capacity is ramping up. A mobile testing site at Redwood Acres has the capacity to test 132 people per day, with the potential to expand. Additionally, she said the local Public Health Laboratory, which can currently process about 60 samples a day, could turn out 160 daily once some ordered equipment arrives. Which all means, Frankovich said, that current capacity is very close to 203 per day and will soon increase substantially.
The state also allows counties to offer a justification for why they believe the capacity to test at those rates isn't necessary, if that's the case. But it is a bit unclear as to whether the state is looking for testing capacity or an established track record of testing volume. If it's looking for the track record, Humboldt County isn't there yet.
The state wants to see two things here: that counties have enough contact investigators to successfully catch potential new cases early — before they unwittingly spread the virus to others — and that they have the infrastructure in place to shelter and isolate those without the means to do so themselves, including homeless people.
More specifically, the state wants counties to attest that they have at least 15 contact investigators per 100,000 residents. (Humboldt County has 30, according to Frankovich, easily meeting this criteria.) And the state wants counties to have available housing units to shelter 15 percent of their homeless populations, as well as plans in place to support others who can't properly isolate. Frankovich said at a press conference last week that Humboldt County certainly has a program in place on this front, as it has already been sheltering and isolating members of the homeless population as they go through testing and quarantine, though she wasn't sure capacity was adequate at that point.
To meet this criteria, counties must show local governments and healthcare providers have plans in place to provide sufficient surge capacity for an influx of COVID-19 patients as well as enough personal protective equipment for healthcare staff. More specifically, the state is asking counties to certify they can accommodate a minimum 35 percent surge.
Humboldt County Deputy Public Health Officer Josh Ennis has indicated that Humboldt County is in good shape here, with local hospitals having planned internal surge capacities by re-arranging rooms, converting operating rooms into intensive care units and other measures. The state has also set up the 100-bed alternative care site at Redwood Acres Fairgrounds — and Mad River Community Hospital is constructing another — to accommodate a potential influx of mildly ill patients, which would free up additional space in the hospitals for the critically ill.
When it comes to PPE, Frankovich said she feels there are sufficient stockpiles, saying most local providers currently have 14 days' worth on hand, though she'd like to see that increase to 30.
The potential rub here, however, might be that the state also wants to see that counties have not just the physical capacity of hospital and alternative care space to meet a 35 percent surg, but also the workforce capacity to staff all those additional beds. It's unclear if Humboldt County is there yet.
"Our workforce is probably the most critical component of this and likely where we're to experience the most significant limitations," Ennis said recently. "There's been a lot of discussion with hospitals and other healthcare entities out in the community about what this could look like."
The focus, Ennis said, is on the various skillsets people have, realizing if the surge comes, it will necessitate an all-hands-on-deck approach. That could mean using anesthesiologists and surgeons to work in intensive care units, relying on tele-health were possible and potentially even recruiting "people out in the community comfortable enough with in-patient medicine to contribute to the workforce" at the alternate care sites. Reinforcements could come from the state, Ennis said, though he added officials would like to "see this happen locally as much as possible."
Because seniors and those with compromised immune systems are most vulnerable to becoming critically ill from COVID-19 — and because the virus can move quickly through congregate living settings — the state wants to make sure counties have protections in place for vulnerable populations, and particularly those in long-term care settings. Part of the criteria for this is making sure these facilities have the aforementioned 14 days' worth of PPE. Along with the goal of a month's supply, Frankovich recently indicated they do she'd like to see facilities "linked to commercial supply chains" so they're not counting on the county or the state for supplies. Frankovich said she also wants to make sure these facilities have plans in place — and space available — to isolate and quarantine residents as needed.
Sectors and Timelines
This just means the state wants to see how the county plans to move forward. "This should include what sectors and spaces will be opened, in what sequence, on what timeline," the state guidelines read.
Triggers for Adjusting Modifications
If the county sees a spike in cases at some point in this plan, what then? The state wants to know the county has thought out contingencies and see specific metrics as to when the county will pump the breaks and slow down its plan. Additionally, it wants to know "how the county will inform the state of emerging concerns and how it will implement early containment measures."
Overall, Frankovich has said she thinks the county is "in really good shape" and better poised than most to move forward a bit faster than other areas of the state. On May 8, she said she had a conference call with state health officials scheduled for May 11 to review the county's documentation and answer questions with the hopes of moving forward quickly with the process of certifying the county ready to move forward. On May 13, a day after the Journal went to press, she was slated to seek the board's support for her submission to the state.
But the state has also recently made very clear there are some criteria that to some extent are beyond the control of local government — the conduct of local people. Over in Shasta County, Health Officer Karen Ramstrom certified the county's readiness to move forward under state criteria May 8. But two days later, against county officials' urgings, the Cottonwood Rodeo proceeded as scheduled with 2,000 attendees — "most of whom did not practice social distancing nor wear masks," according to county officials — in violation of the governor's order. The state has since "delayed" Shasta's ability to move forward, according to a press release.
"We're all frustrated," said Ramstrom in a press release, adding that the rogue rodeo risked disease transmission and delayed the county's economic recovery.
As the Journal went to press shortly after Public Health confirmed three new cases — bringing the total to 11 over the past 14 days — it was unclear if the recent spike would change how county officials planned to proceed. Check www.northcoastjournal.com for updates.
Thadeus Greenson is the Journal's news editor and prefers he/him pronouns. Reach him at 442-1400, extension 321, or firstname.lastname@example.org. Follow him on Twitter @thadeusgreenson.