Health officer won’t ‘squander sacrifices’
‘What we’re trying to do is gingerly chart a course forward’
Santa Clara County Health Officer Dr. Sara Cody led the Bay Area’s push in mid-March for the country’s first “shelterin-place” order to control the coronavirus pandemic. It’s kept us largely confined to our homes, successfully averted a health system meltdown, and saved lives, but at mounting cost to our livelihoods.
Now, as Cody and other Bay Area health officers have extended the order with some modifications through the end of this month, we asked her how their strategy will get us back to work, school and some sense of normalcy and why the region’s rigid approach is still necessary. Questions and answers were edited for brevity and clarity. Q Half the states are easing restrictions, as is Modoc County, and everyone talks about Sweden managing the pandemic with a much lighter touch and no full-blown disaster. Are we overreacting in the Bay Area with shelter-in-place? A The actions we’ve collectively taken across the Bay Area have prevented a number of deaths, so no I don’t think we’re overreacting. With the economic and social destruction everyone’s endured, I for one am not going to squander the sacrifices everyone’s made. If we lift too soon, there’s no reason to think we wouldn’t have exponential spread. Our whole population is susceptible and at risk. Q Has it been hard to coordinate with other Bay Area health officers? A When we put in the first shelter-in-place in midMarch, we got ourselves on the same page. That, to be honest, seems harder and harder now, because then it was very clear that’s what was needed. And the issue about how do you reopen, where do you reopen, how fast do you go, that’s in some ways far, far more complex.
QThe shelter-in-place order has been in place six weeks now. Has that changed how and where people are getting sick now? A We do not have data. Since case counts started to accelerate in March, we have not been doing those case investigations of how might you have gotten this infection, which was the whole reason we put shelter-inplace into effect. That’s the model we need to get back to. Q How do you know when we have enough testing to ease restrictions? A Health officers across the Bay Area, we made an attempt to name a number, an indicator we’d all follow. That was two tests per 1,000 residents
a day. And in our county, that translates to 4,000 a day. You can see it’s picked up a little — 800 to 1,000 a day. Maybe we’re 20%-25% of the way toward our goal. The more we test, the more cases we’ll find, and the more testing we’ll need to do with their contacts. Maybe we didn’t set our goal high enough and have to increase it. Q Are you frustrated with the inability to test for COVID-19 at a higher level? A It’s been the Achilles’ heel of this whole response since the very beginning. We just couldn’t see what we needed to see. Learning (in April) that a person who died Feb. 6 died of COVID-19 confirmed our hunch that we had community transmission and were not able to test for it. We couldn’t do the surveillance and couldn’t understand the scope and magnitude of the problem.
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What’s been the testing holdup?
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Challenges with testing have changed from just a basic “We don’t have enough of anything” to “We have enough testing reagents, but we don’t have the collection materials.” All kinds of different bottlenecks over time. Now, capacity has increased a lot, which is fantastic, and the challenge is to make sure every lab maxes out its capacity and maxes out to where the need is. Q Why were health departments so unprepared here and around the country for the scale of testing and personal protective equipment — PPE — needed in this pandemic? A Testing is much more complex, with roots in decisions made at the federal level. The PPE story is really largely about the supply chain in the United States, which
to some degree is impacted by the pandemic beginning in other parts of the world. Q How does contact tracing — tracking the interactions of infected residents — play out? A It’s going to be a combination old-fashioned shoe-leather epidemiology with assistance from technology. Our regional approach has been very helpful in this regard because we can learn from each other and innovate. Both Santa Clara County and San Francisco are using the same app for contact tracing. Q When do you expect contact tracing to get to the point that you’re confident of lifting restrictions? A We are obviously doing part of that scope of work now, finalizing plans for rapid scaling, literally hundreds of people.
We want to proceed gingerly, but we do want to be able to open things up. We cannot stay sheltered in place until a vaccine arrives. Q How long until we reach that scale of contact tracing?
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Within weeks. Q May 1 was College Decision Day for students to notify the colleges they will attend. Santa Clara County has three major colleges, and students wonder whether they’ll have class this fall. What’s your outlook?
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I think what happens in the fall largely depends on how careful we are and the decisions we make now going forward. Shelter-in-place is not without costs. However, if there were not shelter-inplace and we let the virus rip through the population, that is also harmful.
What we’re trying to do is gingerly chart a course forward. We don’t know what we’ll see in the fall. Q The current shelterin-place is through May. What’s your vision for what our lives will be like in June assuming progress continues with no unexpected developments? A My family asks me the same questions. Nobody likes this. Activities outdoors are less risky because they’re not in an enclosed, shared air space. And that’s good moving into summer, where people can spend more time outside. We watch very carefully to see what’s working in other parts of the world. We try to learn as much as we can and look at the evidence that’s developing and apply it as best we can for people in our community.