The face was fresh but the message was familiar: Humboldt County's COVID-19 case count is spiking at an increasingly rapid rate and may spiral out of control if residents don't begin wearing facial coverings fastidiously when out in public.
Hours before he would be unanimously voted in as Humboldt County's new health officer, replacing Teresa Frankovich who stepped back into a part-time, supporting role with Public Health earlier this month, Ian Hoffman addressed the board of supervisors for the first time and struck a similar note to his predecessor's increasingly dire warnings. Humboldt County, he said, had kept the virus at bay for months through compliance with health orders and aggressive testing and contact tracing efforts that quickly identified and isolated case clusters, which were long driven by travel. But the current spike, which had seen 239 cases confirmed through the first eight days of December on the heels of a record-shattering November, as the Journal went to press, Hoffman said, is entirely different.
"Winter has come," Hoffman said. "What we are seeing now is a change. ... It's no longer coming in from the outside. It's here and it's spread among our community. Very rapidly."
Humboldt County's rapid escalation of cases and a corresponding increase in the percentage of COVID-19 tests that are coming back positive comes amid national and statewide surges in virus activity and hospitalizations. Last week, Gov. Gavin Newsom announced that with state hospital capacities nearing dangerous levels, he was implementing stay-at-home orders in regions where intensive care unit capacity drops below 15 percent. At a Dec. 3 press conference, Newsom said he expected cumulative capacity in the Northern California region — which comprises Humboldt and 10 other counties — to dip below that threshold within days or a week, at most. But as the Journal went to press Dec. 8, only two regions in the state had fallen under Newsom's order and ICU capacity in the Northern California region sat at 25 percent.
Humboldt County, meanwhile, had eight COVID-19 patients hospitalized at the Journal's deadline, according to a state database, including five people the county reported were hospitalized between Dec. 4 and Dec. 7. Those came just days after the county reported last week that a total of 30 people — 29 residents and one staff member — had tested positive for the virus at the Granada Rehabilitation and Wellness skilled nursing facility in Eureka.
During the Dec. 8 Board of Supervisors meeting, First District Supervisor Rex Bohn invited St. Joseph Health CEO Roberta Luskin-Hawk to discuss local hospital capacity. She reported that the entire local healthcare system has worked hard to increase capacity. St. Joseph Hospital, she said, recently increased intensive care unit capacity from a dozen beds to 18, while Mad River Community Hospital has gone from four to six and Redwood Memorial Hospital has four. That makes 28 ICU beds currently available, which Luskin-Hawk said hospitals can keep open with existing staff. St. Joseph Hospital has plans to expand capacity further, if needed, she said, but it would require pulling nurses and staff from other shifts to work in intensive care.
She added that the county has 38 ventilators on hand between ones purchased by the hospital, by local donors, rentals and some on loan from the Providence Health System, as well as adequate supplies of COVID treatment medications. The limiting factor, should the North Coast see a sustained surge in cases and hospitalizations, she said, will be staff, noting that hospitals throughout the state and the country will be facing similar situations and she doesn't expect reinforcements to arrive from outside the area.
Currently, Luskin-Hawk said St. Joseph is able to provide COVID-19 care and "regular care" simultaneously, though that could change should hospitalizations increase.
Hoffman similarly reported that the healthcare system is not currently overrun but warned that's a delicate balance, given the way the virus can spread exponentially. He noted that while it took Humboldt County nearly 10 months to record its first 1,000 cases, it's on track to see the next 1,000 over the course of a little more than 30 days.
"If that sounds shocking, it should sound shocking," Hoffman said. "But that's just the nature of this disease."
The rate at which cases are increasing is alarming, he said, but stressed there is still time to stem the tide, saying "everything is going to be measured by what's going to happen in this next month."
"There should be no travel except for essential travel," Hoffman said. "Unfortunately, for all of us these holidays, that means staying home. Gatherings are prohibited under our current tier. You need to be aware of that and adhere to that. Gatherings, even small ones, can and do spread the disease. ... We're seeing a lot of community spread right now. We are seeing that to a degree that we have not seen before."
Finally, Hoffman said, people need to wear masks while out in public and maintain 6 feet or more of physical distance even with facial coverings.
"Why we doing all of this? Because we want to get through this winter with minimal life loss and minimal hospitalizations," he said.
Vaccines are on the way, Hoffman said, with the first doses of the Pfizer vaccine slated to arrive in the county in the coming weeks. But the health officer said he was unsure how many doses would arrive and added what does initially will will go to healthcare workers in "high-risk settings" and those living in long-term care facilities.
Toward the close of the COVID report at the Dec. 8 meeting, Fifth District Supervisor Steve Madrone asked Sheriff William Honsal about enforcement efforts should the county fall under a new stay-at-home order from the governor's office, noting that some sheriffs in other counties have publicly stated they will not enforce the new order, which the supervisor said seems like a "horrible message."
Honsal said his department will continue its "educational" approach. But the sheriff quickly added that it's "definitely a balance" and said law enforcement contacts to enforce a stay-at-home order could lead to a use-of-force situation, and potentially even a "deadly force confrontation." Plus, he said the county is seeing escalating instances of "violent acts" and crime throughout the county, and his office is going to continue prioritizing those calls. All that said, Honsal added that every deputy and officer has the discretion to issue citations.
"Every deputy and every officer uses discretion," he said. "If there's a citation needed, a deputy will cite someone. ... If there's a business that's out of compliance, they may get a citation and they'll have their day in court."
Though Madrone thanked the sheriff and his deputies for their hard work and voiced relief that the sheriff was not pledging to not enforce health orders like some of his counterparts, the supervisor seemed somewhat dissatisfied with Honsal's answer.
"In all honesty, not wearing a mask is walking around with a deadly weapon," Madrone said. "I don't mean to be dramatic, but this is not a simple case of people choosing one thing or another. People walking around unmasked and un-distanced is a threat to our society."
Honsal then voiced some frustration with the governor's office, saying it hasn't been communicating well with local sheriffs — the enforcement arm of health orders — about "how to properly manage this." The sheriff then offered an abrupt about face, saying he'd keep all tools on the table before seeming to minimize the threat of COVID-19 locally.
"I'm not going to take anything off the table because there may be a time when we need to have someone in jail over a COVID violation," Honsal said, adding that "stats show that unless you are over 70 years old in Humboldt County" the virus is "not necessarily deadly as far as percentages go."
Nationwide data, however, has conclusively indicated that while seniors and people with underlying health conditions are far more at risk of dying of the virus, healthy young people have also faced critical and even deadly outcomes, not to mention the long-term health impacts of infection. Those impacts are still being studied but preliminary research indicates they can include damage to the heart, lungs, brain and cardiovascular system.
When the conversation came back to Hoffman, he noted that Humboldt County's death numbers could change quickly with the current outbreak in Granada's skilled nursing facility.
"That could turn very quickly ... we could go from no deaths in the last couple of months to doubling our death rate, easily, in the coming weeks," Hoffman said, adding the only way to truly protect those in long-term care facilities is to limit community spread. "That's the only way for us to protect them. They were protected throughout the spring and summer and early fall."
Board Chair Estelle Fennell then chimed in, saying people should remember that even for the elderly, dying of COVID-19 alone in a hospital is not necessarily a peaceful death.
"People need to understand this isn't just fading away when you're old," she said. "This is an ugly death."
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.