San Francisco Chronicle - (Sunday)
How Bay Area county led U.S. crisis response
Santa Clara County Health Officer Dr. Sara Cody examined the raw numbers — COVID19 cases had nearly tripled over seven days — and realized the Bay Area was teetering on the brink of disaster. The region was on track to become Italy, in terms of how quickly the disease would spread, unless drastic measures were taken.
If normal life went unchanged in that moment, the numbers showed, health care facilities and staff would, within about two weeks, be overwhelmed by patients infected with the coronavirus, which causes COVID19, in need of immediate treatment. Difficult decisions that Italian health providers were facing, including who should be prioritized for care, would quickly become the reality for Bay Area doctors and nurses. Hundreds were dying each day in Italy.
One week ago, on a rainy Sunday morning, Cody convened a conference call with public health officers from neighboring Bay Area counties. Within an hour, they agreed to take the boldest and most stringent action in the nation
to confront the spread of coronavirus: requiring nearly 6.7 million people to shelter in place, with only essential activity and travel allowed.
“We know that Santa Clara County is the epicenter of this outbreak in the Bay Area and we know that COVID19 is spreading rapidly,” Cody said at a Monday news conference, which was held simultaneously with other officials in their counties, announcing the unprecedented action. “We know we need to do this and we know we need a regional approach. We all must do our part to slow the spread of COVID19.”
The Chronicle reported on how health officers made the critical decision through interviews with those who were involved. Cody was not available, but other Santa Clara officials discussed her role in the process.
Since officials made the shelterinplace order, the number of positive cases in the Bay Area counties has nearly doubled — from 273 to 539. The Bay Area accounts for nearly half of the state’s 1,286 cases of coronavirus infection. As of Saturday afternoon, Santa Clara County had the highest number of cases in the Bay Area: 263 cases and eight deaths.
“Viruses cross county lines,” said Rohan Radhakrishna, the deputy health officer at Contra Costa County Health Services. “The weekend data showed the beginnings of an exponential rise. That was the warning sign that we needed to act fast to ‘flatten the curve.’”
Under state law, public health directors have the legal authority to file a public health order.
The directive from Bay Area public health officials caused a domino effect throughout California. By Thursday, nearly 21 million people in the state were under shelterinplace orders issued by their public health departments. That evening, Gov. Gavin Newsom declared a stayathome order for the entire state until further notice.
At noon last Sunday, officials from six Bay Area counties joined a call, and began by reviewing data from the outbreak in the region. The growth in COVID19 cases didn’t reflect the whole picture. Because testing in the region, as well as in the state and the country, was severely limited, untold hundreds or thousands of cases were going undetected.
Still, the numbers showed that Santa Clara County was about two weeks behind reaching levels seen in Italy. And the other counties were just a few days or so behind Santa Clara County.
If nothing was done, officials feared for the most vulnerable populations: the elderly or people with underlying medical issues that would require intensive medical treatment. Officials were also concerned about how other treatments would be impacted — what would happen to people who need routine care due to heart conditions or if someone was in a serious car accident.
Most concerning were the number of ICU beds, respirators and other supplies that were needed to confront the crisis without any preventive action, said Jeffrey V. Smith, the Santa Clara County executive.
The need for bolder action was clear: The six counties and Berkeley decided to stand together instead of focusing on “countybycounty” measures, Radhakrishna said.
Santa Clara County officials drafted the order with input from the various health officers. By late Monday morning, just before the press conference announcing the order, the health officers in the six counties and Berkeley confirmed their intent to adopt the order.
“We needed a regional approach,” Radhakrishna said. “We couldn’t wait on the White House, we couldn’t wait on the state, we have local data from the Bay Area showing an exponential rise of community transmission, so it’s up to us to flatten that curve in our region.”
Leaders in the cities that would be affected knew a shelter in place was being planned. But many were surprised at how quickly it came. Elected officials were notified as public health directors worked with attorneys to draft the language of the order and some learned of the order in the hours leading up to the public announcement.
“I was a little surprised it came so soon, but then looking at the numbers and looking at the little bit of data that exists both nationwide and worldwide … it was clearly the right decision at the right time,” Smith said.
Since the crisis first started to spread through the country, Santa Clara County has emerged as a leader in its response. On Jan. 31, Santa Clara County had its first positive case of COVID19. Since then, the county’s public health officials have been the first in the region to take radical action to combat the virus.
Nine days later, Santa Clara County was the first to ban mass public gatherings of 1,000 or more people. Within three days, the county amended the order to prohibit gatherings of 100 or more people and to restrict gatherings of more than 35 people. Other counties, including San Francisco, quickly followed. San Francisco halted gatherings of 100 or more people a day later, on March 14.
Some elected officials said there had been conversations of a possible shelter in place, but many didn’t expect it occur for weeks. San Jose Mayor
Sam Liccardo said over the last few weeks, conversations with public health officers focused on two strategies: conducting more testing and issuing a stayathome order.
“If we were able to be much more proactive in testing ... I think we’d all recognize we wouldn’t have to make all these kinds of decisions, but clearly that horse has left the barn,” Liccardo said. Liccardo said he found out about the stayathome order Sunday afternoon and quickly moved to enforce it for the nearly 1 million residents of San Jose. He called county officials to understand how to interpret the order and how to implement it.
Adeh Skandarian, 33, works at a cannabis dispensary in San Jose. When the order was announced, he said the dispensary received 100 requests for delivery within an hour. On a normal day, the dispensary typically gets 40 requests.
“I was shocked at how sudden it was,” he said of the order.
Delaram Mehrkish, of San Jose, said the order was a welcome development after seeing how other countries, including Iran, have been suffering from the crisis.
“It’s about time,” the 24yearold said. “We were already panicking for my (76yearold) grandmother who is alone in Tehran. The way that Iran is treating this and the way that Italy is on lock down, I know this is only going to get worse, so I was really relieved to hear (about the order).”
In the hours leading up to the public announcement, officials scrambled to make sense of it.
San Francisco Supervisor Matt Haney got word Monday morning from Mayor London Breed about the order. Haney spent the rest of the day walking the Tenderloin to let corner stores and markets know they were considered an “essential service.”
“I visited 20 to 25 of them, and half of them thought they were going to have to close,” Haney said. “Time isn’t on our side here, and (the mayor) had to balance moving as quickly as possible with getting the information out.” Oakland Mayor Libby Schaaf said she received a text on Sunday night from Breed alerting her of it. “Extraordinary times” require such measures, she said.
Santa Clara County officials said Cody and other public health workers are working “around the clock” and in unity with their counterparts throughout the region.
“This is not the end of the situation, obviously,” Smith said. “The COVID crisis will be with us for quite some time. We will see a dramatic increase in severe infections and other infections over the next couple of weeks. That is because the virus is already out there.”
“The weekend data showed the beginnings of an exponential rise. That was the warning sign that we needed.”
Sarah Ravani is a San Francisco Chronicle staff writer. Email: sravani@sfchronicle.com Twitter: @SarRavani