Slack chats show county milestones
Conversation a completely unguarded space for colleagues, health officer says
SANTA CRUZ » When more than 100 pages of a Slack channel for the Association of Bay Area Health Officers became public through a public record request filed by a Sentinel sister paper this week, Santa Cruz County Health Officer Dr. Gail Newel re-read the conversation stretching from early February 2020 to early April 2020 in a new light.
“We thought it would be considered confidential in terms of protected patient information,” Newel said, adding that she understood the only lines censored from the document included specific case details. “It’s not that I was worried about anything I said… that was the one space we had where we could just be human.”
When the channel on Slack, an online communication platform used by many workplaces and organizations, was live, it had many uses. Health officials from wine country to the coast asked for advice, clarification and information around meetings with the California Department of Public Health and the Centers for Disease Control and Prevention. Meetings, especially, were planned at the last minute — making messaging at the click of a button that much more attractive.
“It still happens, like on a Saturday night, or Sunday night, Sunday mornings and holidays,” Newel said of the haphazard nature of scheduled meetings. “You’re always watching your email because you don’t always know.”
Though Newel and her fellow health officers included in the chat aim to be honest at all times, they needed a place to express frustration and uncertainty in the early days.
“We didn’t know anything about this virus, and we were making decisions in this context. To be able to gather even remotely at all hours of the day and night and knowing our colleagues were a safety net for us… is super important so it was really hard when that went away,” she said after adding that she understood media interest in making the information public, an effort that resulted in a lawsuit. “It really yanked the rug out from under us in many ways.”
Newel is not just the public face of the COVID-19 pandemic in Santa Cruz County but a human who had never experienced a health crisis of this magnitude before. She saw longtime health officers such as Dr. Scott Morrow of San Mateo County, a nicknamed shepherd of the health officer herd, as a real resource for both she and Dr. David Ghilarducci. Though Ghilarducci has serious EMS directing experience, he had no experience being a health officer until he was promoted after March of 2020.
Other leading health officials provided insight that built on Morrow’s.
“Alameda County Health Officer Dr. Erica Pan, the interim state health officer and now state epidemiologist, was an important role model and voice for me … Dr. Tomas Aragon from San Francisco… he’s the new state health officer. So the two top doctors in the state were a part of that Slack group,” Newel said.
Critical timeline
In the conversation, Newel’s thought process — once private, now public — is displayed.
In early February when COVID-19 positive individuals were being relocated to isolate and those exposed were moved to quarantine, Newel responded to Pan’s notice that 43 names of residents had been provided by the California Department of Public Health. “We just got one this evening,” she wrote.
Hours later they were alerted of two individuals traveling into Santa Cruz County from mainland China. Nothing could be done to make contact, however; the phone numbers provided by the CDPH were illegitimate and the addresses were temporary. Newel said Tuesday, more than a year later, that the information couldn’t be public at that time as there were only a handful of cases and the privacy of those individuals would not be protected.
Soon, Newel and her team would have the opposite problem — there were so many cases that containment was not in question.
A gala fundraiser for burn victims just before the first shelter-in-place order was extended across the region was attended by firefighters from all over the Bay Area. Ghilarducci, a former firefighter, dropped the information into the Slack channel that nearly all of the persons under investigation for COVID-19 in the county at the time had a link to Santa Clara Countybased firefighters.
“That was a big deal,” she said. “We didn’t want to get them in trouble, but I could say now that at the very beginning of this pandemic… (firefighters got) all dressed up and spouses came along… it was the beginning of spread to counties all around the Bay Area.”
Communication breakdown
Shortly after, Newel voiced exasperation of being left out of planning around the first shelter-in-place order with the “Central 7,” or the six counties that touch the San Francisco Bay plus the city of Berkeley which has its own local health jurisdiction. Though Newel came to the understanding that their county counsels had worked together before a press conference that did not represent all 13 counties of the Association of Bay Area Health Officers, she still calls it a slap in the face.
“They went out on stage without the rest of us when we had all worked closely together on that… they do deserve the credit but it was something of a slip there,” Newel said. “It happened again with other (guidance), there were times beyond that, but the Central 7 did always provide us with their legal language before it came out publicly so we adapted it to our own counties.”
That same day, March 16, Newel, Health Services Agency Director Dr. Mimi Hall and county counsel Jason Heath sat in a room together for 14 hours to go through the Central 7 order line by line and adapt it to the county. Heath missed his son’s 16th birthday party.
“The ‘Other 6’ who ring the Central 7 (have) a big ag component to our counties and our economies that isn’t there in the Central 7, so that’s something we have had to have a different approach (for),” Newel said. “They’re so urban… this is the area we often needed to approach COVID differently than our urban partners.”
Holding strong to what's right
While developments were happening, the county was learning in real-time.
“I was going through my contacts a couple of weeks ago and I saw the text I had sent to our very first quarantine patient, a physician who was exposed in the emergency department where he works over the hill,” Newel said. “We took it so seriously. We didn’t know… we had the Sheriff’s Office go out and serve him with quarantine papers.”
Newel said that she reached out to the physician then, whose wife was also quarantined because of her position in an emergency room within the county, thanking him for his graciousness and understanding.
“He sent his best back to me,” she said.
Beside those first quarantine papers, law enforcement and EMS did not have access to the names and addresses of COVID-19 patients. Just as authorities in many counties, the agencies in Santa Cruz County wanted that information with the intention of preparation in mind.
“Our stance was consistent with HIPAA laws, it was that we couldn’t do that,” Newel said. HIPAA, or the Health Insurance Portability and Accountability Act, ensures the privacy and protection of health information. The federal law sets rules for providers and health insurance companies about who can access health records, according to the U.S. Department of Health and Human Services.
This led to threats from these agencies to go to the media and strike, but the county’s health officials did not budge.
“This had already gone through courts with HIV when first responders… wanted to know all addresses and names of those with HIV for preparation’s sake,” Newel said. “That was struck down in the courts as a violation of privacy. It was an ongoing struggle, and then some counties did release them. I really stood firm and said, ‘no.’ ”
Instead, while following case law, they took addresses law enforcement and EMS responded to on any given day and compared it against the data of known positive cases in an effort to notify them of potential exposures.
“Since they’re supposed to use universal precautions, they’re supposed to treat every single person they come in contact with as a COVID case.”
‘It saved lives’
Today, Newel and her team face a somewhat smoother sea, with low daily new case counts and infrequent deaths. A lot of the stability, the foundation, was built in the beginning through the health officers and their communications.
“It’s not going too far to say that that conversation saved lives,” Newel said of the Slack channel. “We had a new administration with new appointees and leadership at the state level and a completely unhelpful national response. It really felt like we were on our own.”