THE LONGEST TWO WEEKS
A look back, a year after state ordered to shut down
“Most emergencies are kind of like a sprint — this is definitely a marathon.”
— Lisa Almaguer, public information officer with Butte County Public Health
CHICO >> One week in March 2020 offered a preview of what would become a pattern during the COVID-19 pandemic: rapidly- evolving information coming from state and national sources, the impact felt on the local level and the subsequent response effort.
Thursday, March 19 was the start of it, when Gov. Gavin Newsom enacted a statewide stayat-home order, which local health officials knew was a possibility but acknowledged the reality of the order going into effect was sobering.
Just two days later, on March 21, Butte County Public Health announced the first confirmed case of the virus in the county, a Chico man over the age of 65 who had been tested in the Bay Area as part of a pre- operation procedure for an unrelated medical issue.
By March 25, the county was constructing and testing its emergency tents to ensure they could be used if needed to store supplies, or even to isolate individuals sick with the virus in the event that a surge overwhelmed hospitals.
“We didn’t know how many cases were coming, but we knew we needed to be prepared,” said Lisa Almaguer, a public information officer with Butte County Public Health.
It was around that time the weight of the pandemic began to truly hit home. Prior to that, however, the response began in January and ramped up in February when Butte County Public Health initiated its Department Operation Center as a central command center to vet and keep pace with information as it changed.
More than one year later, in between more than 11,000 cases, 171 deaths due to complications from the virus, the closure and reopening of parts of various sectors, the public response that followed, and most recently, the ongoing progress to vaccinate residents, Butte County is still in “response mode.”
“This is the longest our Department Operation Center has ever been activated,” Almaguer said. “Typically, you’re looking at maybe a few days to a few weeks on an incident. We’ve been activated in response for over a year.
“Most emergencies are kind of like a sprint — this is definitely a marathon.”
Enloe Medical Center CEO Mike Wiltermood said, “We saw the train coming,” watching the COVID-19 emergency overtaking the New York City hospital system and parts of Washington state early in the pandemic.
“We certainly did all we could to prepare,” he said. Without a vaccine, and a lot of confusion about medication, he said Enloe’s advantage came from having experience with collaborating in times of crisis, such as the Camp Fire and Oroville Dam spillway crisis.
The infodemic
In the earliest weeks of the pandemic, the “cadence” of new and evolving information from the state and national level posed a challenge for the county health department, Almaguer said, sometimes changing multiple times in a day. It made clear the need to increase staffing levels and establish a COVID-19 call center with the county, among other things.
The Department Operation Center also created a team of “sector-based liaisons,” to direct information to other departments and groups in the county — local health care facilities, schools, organizations, businesses and churches.
At Enloe, Chief Medical Officer Dr. Marcia Nelson said one positive effect was reinforcing a “sense of community and collaboration” between the hospital and the larger community. She said it also increased the awareness of the inequity of the impact COVID-19 had on multiple communities. The hospital developed new ways of tracking which groups were affected more heavily, while trying to project weekly cases and hospitalizations to prepare staff for new waves.
“We realized that sharing information was key to getting through this together,” she said. For example, the tracking tool revealed the hospital had “slightly more” Hispanic and Latino patients due to the virus, which led to the hospital changing communication to give information in Spanish as well.
In addition, research indicating high risk factors like obesity, hypertension and diabetes “helped us know how to better approach patients knowing who’s at higher risk for illness and death,” Nelson said.
Wiltermood praised Nelson
for her work improving overall communication, and said it was the hospital’s finance department which developed projection data tools updated every week for “extreme accuracy” — predicting how many patients would be in the emergency room, and using county data to provide “very thorough internal communication.”
There was also the challenge of reaching the public with accurate and uptodate information all while many were inundated with information emerging from state, national and global sources. Testing availability, for example, was very limited in the beginning with a shortage of supplies and labs qualified to do testing, as was the public’s understanding of the process, Almaguer noted.
“We would’ve liked nothing more than for everyone who wanted a test, or were even mildly symptomatic to get one,” Almaguer said, “but that wasn’t ( possible) due to just a shortage of equipment, materials and labs that were available to do the testing.”
By early May, the number of Butte County cases were in the teens and testing expanded in part thanks to a state directive to open OptumServe sites throughout California counties, including one at Chico’s Silver Dollar Fairgrounds. Butte County then became one of the first counties in the state to reopen sectors of the economy.
Battling misinformation
As outbreaks of cases and the number of deaths began to increase during the ensuing summer months, culminating in a late August, early September surge, in part attributed to the return of collegeaged individuals to the county when classes resumed at Butte College and Chico State, many sectors were forced to close or modify operations again.
A number of Butte County residents protested, and some openly f louted the restrictions and health guidelines. It reached a boiling point on Sept. 17 when a group of mostly unmasked people showed up at Butte County Public Health’s Oroville headquarters during a press conference to protest the restrictions imposed on businesses. After taking questions from reporters, a heated backandforth discussion ensued between protestors and county leaders including Butte County Public Health Director Danette York, then-Butte County Supervisor Steve Lambert and Chico Police Chief Matt Madden.
More protests have happened since, including Dec. 3, when another group gathered in front of Butte County Public Health’s clinic in Chico after Newsom announced another stay- at-home order as the county and state braced for another wave of increased transmission of the virus, later proving to be the deadliest and prompting the most hospitalizations to date.
“Everyone is entitled to their opinion and their beliefs — I’ve said that before and I stand behind it,” York said during a Dec. 3 press conference. “But what everyone needs to recognize is, this is a novel virus. This is something that has never existed before. When we started the response to this 10 months ago, there was very little information known. Public Health, government in general, scientists, everyone involved in trying to protect the public from this new virus went to extremes.”
Asked this week how the county addressed residents who have not followed health guidance
and directives during the pandemic, Almaguer said, “people rejecting health advice is not just unique to this pandemic.”
“We try to redirect misinformation as quickly as we can and try to keep messaging the correct information frequently, consistently, and with all those wonderful partnerships that we do have to help broaden the message and the voice,” Almaguer said.
Despite ident i f ied spreads of misinformation about the virus, the community was overall “very responsive” to masking and distancing to stop the spread, Wiltermood said.
He and Nelson said they worked at Enloe to share everything known about the virus, and if rumors were heard. Social media campaigns were key to this process — “We would dig in and find out what the truth was, so there was no opportunity for things to get legs,” Wiltermood said.
Orig i n a l medic a l sources were cited as much as possible.
“So that it’s not opinion, it’s the best science is teaching us. It’s changing every single day,” Nelson said.
Through trials, partnership
One of the most difficult periods for the county and at Enloe was in the summer, when many hospitals faced staff cuts and Enloe lost about $35 million.
“We made sure any opportunity we had to buy
PPE, we did,” Wiltermood said, adding “The cost escalated enormously.” Before the pandemic, N95 masks cost 95 cents, and now he said they are $ 5 each.
But the hospital kept buying equipment and did not force any layoffs — “We knew the pandemic was not behind us,” Wiltermood said.
“So when the second wave hit in October we were again more ready than most. We maintained our staffing ratios as much as possible.”
He and Nelson added that the October-December surge period with record cases and hospitalizations, as well as deaths, was “very, very difficult. … The people in the COVID19 units were extremely stressed out.”
However, sacrifices like staffers voluntarily taking more time off, and the new developed tracking tools, helped keep staffing at the levels needed to meet the crises, and protect them from getting sick as well.
“Every bit like that helped us be able to recover,” Wiltermood said.
The hospital also kept a less restrictive visitation policy, which Wiltermood said earned national recognition — “Our experience is that when a person comes in by themselves without a care partner or some kind, it causes so much anxiety, and it actually creates a less safe situation in the hospital for that patient.”
Butte County officials often say they’re wellversed in crisis and disaster preparation more so than most counties in light of recent history — the Oroville Dam Spillway crisis, the Camp Fire, a measles outbreak in 2019, and in the midst of the pandemic, another devastating wildfire season made worse by the North Complex fires.
The lessons learned during the pandemic response, though much longer than any of those other events, has been helped by county’s relationships with a number of sectors and health care systems, including the county’s three hospitals, Enloe Medical Center, Oroville Hospital and Orchard Hospital.
“We have a lot of experience under our belt and a lot of practice working together,” Almaguer said. “It’s really just the time, what we’ve been through and the relationships we’ve built over that time.”
Wiltermood called the relationship with Butte County Public Health and the region’s other hospitals “exceptional” and praised the community for stepping up as well. In the spring, multiple businesses helped secure personal protective equipment and facilitated campaigns to make cloth masks to fill the gaps.
“There’s no way to overemphasize the stress the entire community was under,” he said, particularly when the North Complex fires hit the region in September, six months into the pandemic.
“It was tough … we all had trouble with various aspects of our lives, some more than others,” Wiltermood said. “When you think about the stress we were under, it’s nothing short of miraculous that the community came through.”
Now, Wiltermood says the vaccine clinic is a major sign of progress and pride for the hospital again with help from community partners like Meriam Park and local volunteers.
Oroville Hospital, meanwhile, began receiving shipments of the vaccine on Dec. 21 and has since held a number of community vaccination clinics, namely at Oroville Sports Club, in collaboration with Butte County Public Health.
“Vaccines really are giving the kind of reaction we were hoping they would,” Wiltermood said. “Having so much of the population get vaccinated so quickly is such a game changer for Butte County.”
“We realized that sharing information was key to getting through this together.”
— Dr. Marcia Nelson, Enloe chief medical officer