A Toe in the Water

As a slow relaxing of shelter in place begins, a long road lies ahead



On May 4, Gov. Gavin Newsom delivered some desperately anticipated news: The state will begin lifting shelter-in-place restrictions May 8, in time for people to buy some flowers for Mother's Day.

"This is an optimistic day as we see a little ray of sunshine on the horizon," said Newsom. 

But he also made clear this isn't going to look the way many had hoped, and it certainly is not what protesters have been clamoring for throughout the state. Yes, you'll be able to pick up those flowers but you'll have to do it from the sidewalk in front of the florist, which will have to follow strict protocols to keep masked staff and customers physically distanced, surfaces disinfected and everyone's hands washed frequently. And if you're looking for restaurants, offices and shopping malls to reopen, that's still going to be a while, though Newsom's announcement left Humboldt County officials optimistic those things may happen sooner here than in other parts of the state.

The governor's announcement came as pressure was building throughout the state to ease restrictions, with several counties acting in complete defiance of his order and Mendocino County Sheriff Matt Kendall having split from the county health officer, saying he no longer intended to enforce her order. Locally, roughly 50 people spent part of May 1 in front of the Humboldt County Courthouse, some wearing facial coverings made mandatory by a recent health order and many others not, protesting the shelter-in-place order and urging a full reopening of the local economy. They wore American flags and held homemade signs with slogans like, "Fear is the virus," "Tyranny: spreading faster than COVID-19," "Crisis does not excuse communism," and simply, "Open now." Up in Klamath the following day, a restaurant re-opened in violation of state, county and tribal orders.

Beyond the protest, there were more tangible signs this past week that the shelter in place order is having impacts beyond slowing the virus' spread, with a case count that has hovered in the low 50s for weeks after doubling in a six-day period in early April. Humboldt County Economic Development Director Scott Adair reported that the local area saw 5,846 local unemployment claims in March alone, business owners reported to a county survey they'd lost $30.2 million in revenue and let go 2,400 employees. A planned four-hour food box distribution in Hoopa closed after just 45 minutes when supplies were depleted. In a county in which 20 percent of people lived in poverty and 40 percent of households reported food insecurity before shelter in place, food banks are reporting unprecedented demand.

Newsom said May 4 that his decision was not a response to growing unrest, coming after the state had met important benchmarks for moving to the second stage of reopening. The first stage, he explained, was making sure the entire state was prepared to move forward, meaning shelter in place had successfully stabilized hospitalization rates while officials scrambled to increase testing capacity, stockpile personal protective equipment for healthcare workers and prepare hospitals for a potential surge in patients. The second stage will see waves of businesses that were deemed non-essential under the initial shelter-in-place order, but are now considered low-risk, begin to reopen in limited capacities, starting with retail shops and moving to restaurants and office spaces. The third stage will see "higher risk" businesses begin to reopen their doors, from gyms and hair salons to movie theaters. The fourth stage — which Humboldt County Public Health Officer Teresa Frankovich has said likely won't come until there's a vaccine — will see the return of mass gatherings like concerts and sporting events in front of stadiums full of people.

It's a process that will likely take a couple years, not months, Frankovich said at the April 28 meeting of the Humboldt County Board of Supervisors.

"Two years sounds really scary to people but it's not going to be two years of looking like this," she said, adding it will be a gradual return.

And as the Journal went to press May 5, that was slated to begin May 8, with retail stores allowed to open for curbside pickup if they could follow certain guidelines that the state had yet to release. While the details remained unclear, Frankovich told the Board of Supervisors May 5 she believed they would include the basics she and Sheriff William Honsal have been urging local businesses to plan for: plans for maintaining at least 6 feet of physical distance between customers and employees at all times, monitoring employees for symptoms of illness, regularly disinfecting surfaces and providing a place for frequent hand washing.

"Those are the core principles we're asking everybody to incorporate," Frankovich said.

Honsal indicated once the state guidelines are released, the county Joint Information Center would push them out to business owners and the public so they could plan accordingly. Businesses' plans will have to be reviewed by the county, officials said.

On May 4, California Department of Public Health Director Sonia Angell explained that while these first modifications to the state's shelter-in-place order do not include re-opening offices, shopping malls or restaurants for seated dining, the next phase will allow room for regional variations that might include those changes. But it will require local governments certifying that they meet state criteria to further loosen restrictions.

Newsom said counties that have seen hospitalization and intensive care unit rates stabilize and can prove they have sufficient local capacity for testing and contact investigations, as well as the capacity to "protect the most vulnerable," can certify that they are ready to move further into phase two before the rest of the state, which could include re-opening restaurants and "hospitality more broadly" with modifications to meet state guidelines. If a county's health officer certifies its readiness and its board of supervisors agrees, the county can send its certification and re-opening plan to the California Department of Public Health for review.

While the exact criteria for making such a certification hasn't been released by the state, local officials seem optimistic Humboldt will meet many points. The county's rate of confirmed COVID-19 cases has slowed markedly, with only three of the 54 local cases having been reported since April 7. Newsom stressed the importance of contact investigations in his May 4 remarks, announcing aggressive state steps to bolster the number of investigators public health officials can use to track a confirmed new case's contacts with other people so they can be tested and quarantined, limiting spread of the virus. Only 23 counties in the state are actively conducting contact testing, he said, and Humboldt County is one of them, having used the tool aggressively since the first confirmed local case and having since trained 30 additional investigators.

Frankovich said she feels the county is well prepared when it comes to testing capacity, noting that a new mobile lab set up Redwood Acres Fairgrounds has greatly increased capacity and will soon be able to test 132 people a day, sending samples to an out-of-area laboratory for processing. Frankovich said the state wants counties to get to the benchmark goal of testing one person daily per 1,000 people in the local population with plans to get to two people per 1,000. To meet the first benchmark, Humboldt County would have to be testing about 135 people daily — which officials say can be done.

But the county has yet to reach that mark. The closest it came was 134 on May 2, and while testing has ramped up considerably in the last couple weeks, the county has averaged 65 tests per day since April 25.

On the subject of testing, Frankovich and Honsal also announced May 5 that the mobile lab is now testing people from the public without a referral from a healthcare provider. People with mild symptoms — or even no symptoms — can schedule an appointment by visiting or calling (888) 634-1123. Honsal said whether or not they have health insurance, people will not be charged for the test. People with severe symptoms, they said, should contact their healthcare providers so their sample can be tested at the Public Health Laboratory, which can process samples faster than the corporate labs.

While there has also been a lot of buzz locally about a health clinic offering serology — or antibody — testing, Frankovich warned that much about the virus is still unknown, including whether or when it can re-infect people with antibodies in their system.

"It's a really good public health tool to look at populations but it's not a really good tool for people to make decisions about their health," she said.

As to how to protect those most vulnerable to the virus, there are a couple ways to view that benchmark. Frankovich and Honsal have said the county has taken some aggressive steps to protect those living in congregant living situations — like skilled nursing facilities, senior care homes and the jail — because an outbreak could quickly spread out of control.

But the state indicated it also wants to see plans and infrastructure to protect those statistically most vulnerable to the virus — that is seniors, people with compromised immune systems or underlying illnesses — and indications are Humboldt County has a disproportionate number of these, as more of our population is 65 and older, and/or suffers from heart disease, diabetes and strokes than the rest of the state. This is also very much a part of current preparation efforts. Deputy Health Officer Josh Ennis said the county has put some systems in place to support people who have been ordered to isolate or quarantine because they've had the virus or were awaiting test results, including bringing them food and medications. The county is now looking at how these systems might be "built out" to help keep seniors at home longer term.

The state is also looking to confirm that local healthcare systems have expanded capacity to the point they wouldn't be overwhelmed by a surge of cases. Ennis said alternative care sites — one being built out at Redwood Acres Fairgrounds and another adjacent to Mad River Community Hospital — are still gathering supplies and readying for a potential surge, while the hospitals themselves are planning to maximize the number of patients they can treat and expand intensive care capacity. Overall, he said, plans are in place that would triple the number of intensive care beds in the county if needed, adding that the county currently has 46 ventilators, about 20 more than it did a month ago.

But the larger question Ennis and Public Health are scrambling to figure out is: If all those beds are needed, who is going to staff them?

"Our workforce is probably the most critical component of this and likely where we're to experience the most significant limitations," Ennis said. "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."

While hurdles remain, it does appear the county is better poised than many to move on to other controlled re-openings. But Public Health Director Michelle Stephens cautioned one limiting factor may be neighboring counties, which she said are virtual "testing deserts" with very limited testing, even comparatively.

"I wonder how that's going to play out," she said.

Frankovich later indicated a spike in cases in a neighboring county could also push Humboldt County back.

"An outbreak that's across a county border is our outbreak, too," she said.

Moving forward, Honsal and Frankovich have urged local business owners and organizations to begin preparing for re-opening in some capacity by putting health and safety plans in place to maximize physical distancing and surface disinfecting, stressing that if the county is allowed the autonomy to move forward ahead of other parts of the state, it will prioritize opening operations that can operate safely.

At the board's April 28 meeting, Fourth District Supervisor Virginia Bass asked about personal care salons and why they're lumped into the third stage of re-opening as outlined by the governor. "There are creative local business owners who could put plans in place to protect their customers and employees," she said, asking, "Do you see any wiggle room in that kind of situation?"

Frankovich reiterated that the intent is to reopen businesses based on risk factors — whether customers and employees can socially distance and wear masks, whether surfaces can be regularly disinfected and if there are hand washing stations. An issue will be making sure everyone can keep 6 feet apart from the moment they enter an establishment until the moment they leave, she said.

But if the bar is 6 feet, that's "a real hard requirement," Bass said, adding, "unless you have big sticks you use to hand people food," restaurants can't meet that requirement now for take-out services, though they're allowed to continue operations. Frankovich said she thinks the distinction there is the combination of distance and length of proximity, noting that getting your hair or nails done necessitates "prolonged, intimate contact."

Bohn then asked whether there could be separate sets of rules for those statistically most vulnerable to the virus — seniors and people with underlying illnesses or compromised immune systems — and younger, healthier people.

"There's a lot of healthy people out there that can interact a little bit more via haircuts," he noted.

Frankovich said "the answer to that" is that Public Health will be pushing for those vulnerable to isolate and avoid social contacts as much as possible until there's a vaccine or "some darn good therapeutics" that have proven very effective in treating the disease. Fennell then chimed in to note that there are some healthy people who have gotten "very, very sick" from the virus, saying everyone "wants to get back to normal but we don't want to gamble with people's lives."

Newsom and local officials have also warned repeatedly that a spike in cases could put shelter in place restrictions back in place.

During the May 5 meeting, Third District Supervisor Mike Wilson said he understands the focus on business but also urged Frankovich and Honsal to work toward the re-opening of aspects of life that don't pertain to commerce.

"It's not just all about the ability to go to a store but the ability to have human interactions," he said.

Frankovich assured there's a lot of work being done on this, saying she hears from summer camps, childcare providers and religious organizations clamoring to re-open. The issue there, she said, is "gathering sizes," saying the state and county still need time to assess when groups of people will be allowed to congregate.

With the state dipping a toe into the proverbial waters May 8, a pair of public commenters at the meeting illustrated the unease with which almost everyone is viewing this step. The first urged the county to quickly re-open everything to get people back to work. The other said no matter what re-opened, she wasn't going out.

The back and forth helps illustrate the delicate dance taking place as officials weigh statewide preparedness against local needs, preparation against urgency, protection against risk, and economic damage and all that comes with it against the spread of a deadly virus. Amid it all, there's a vocal contingent who simply don't believe the risk is what the vast majority of the world's epidemiologists, physicians and public health officials say it is.

"Sometimes people don't want to hear what's being said and so they're going to go shop for something else to try and provide an argument [against] what we're doing here. And I get that. Trust but verify, right?" Honsal said into his webcam at the supervisors' meeting. "But the fact is, we have to go with the facts. Dr. Frankovich and I are dedicated here to doing what is best for our community. And we understand these are harsh decisions at times, but these are decisions we make for our county, for our people, in the best interest of public health at this time."

Thadeus Greenson is the Journal's news editor and prefers he/him. Reach him at 442-1400, extension 321, or [email protected]. Follow him on Twitter @thadeusgreenson.

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