Bay Area health officials face tough COVID-19 decisions

Now comes the hard part.

Dr. Sara Cody, Santa Clara County’s health officer, knows it. So do her fellow Bay Area public health officials who are making the decisions on how and when to reopen the region for business.

Cody deserves full credit for spearheading the regional effort for the nation’s first shelter-in-place order to control the coronavirus pandemic. Her leadership averted a health system meltdown and saved thousands of lives. But she says that decision was much easier than determining what comes next.

“The issue about how do you reopen, where do you reopen, how fast do you go, that in some ways is far, far more complex,” Cody says. “And different conditions around the Bay Area influence how we might think about it. It becomes increasingly complex as we go forward.”

Prepare for a hard, likely monthslong slog.

The region’s public health officials last week decided to allow construction projects to resume. But Cody says that we have substantial work ahead to further loosen shelter-in-place restrictions and reopen additional businesses as California Gov. Gavin Newsom wants.

“With the economic and social destruction everyone’s endured, I, for one, am not going to squander the sacrifices everyone’s made,” she says. “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.”

There is no playbook for pandemics.

We’ve slowed the spread of the novel coronavirus to a manageable level in the Bay Area and California. That’s laudable. But it’s foolish to believe we’re close to stopping it.

We have no vaccine and we’re nowhere near having herd immunity that would allow a return to normal. The Bay Area’s population is roughly 7.5 million. But the region has only about 8,000 documented COVID-19 cases. Even if we have had 100 times more cases than reported, due to a lack of adequate testing, that would still equate to only about 10% of the population.

Nor do we or the nation have the testing capacity necessary to try the kind of experiments other states are nevertheless conducting, experiments that are likely to initiate a second wave of cases — and deaths. The United States already has the highest number of cases and deaths in the world.

From the beginning, public health officials have focused on testing as the most important tool for managing a pandemic. The value of testing is it allows them to make informed decisions and intelligently manage people.

In Santa Clara County, Cody’s predecessor, Dr. Martin Fenstersheib, is responsible for ramping up testing at least fourfold to a minimum of 200 tests daily per 100,000 residents, or 4,000 tests per day. That would satisfy Harvard researchers’ minimum of 152 per 100,000 residents.

In 2006, Fenstersheib produced a comprehensive 114page emergency plan to deal with a pandemic. I attended the media training session he conducted that year. The three tools he emphasized were most essential to fight a pandemic were sheltering in place, testing and an effective vaccine.

Fenstersheib’s plan was put to the test in the 2009 swine flu pandemic. The county activated the plan after a 16-yearold high school student became the county’s “patient zero,” closing schools, stockpiling medications and warning hospitals of a possible surge. But that outbreak was contained almost immediately. The difference? Testing.

“The CDC immediately sent out kits and local labs very quickly began testing,” Fenstersheib said. “The other major difference was, because it was a flu virus, we had a vaccine by the fall.”

Fenstersheib is appalled at the lack of national leadership to solve the testing debacle. “We’re doing a good job in California and in the Bay Area, but we need a unified approach. We can have the best scientists and technology in the world, but it slows our response time if we don’t have leadership at the top.”

Which brings me to the final point. I still have my notes from the 2006 media session. I reminded Fenstersheib of one sentence that I underlined and circled that day.

It was the importance of being honest with the public.

“Oh, yes,” said Fenstersheib. “The thing we learned from the 1918 pandemic is you have to be truthful. You can’t lie or sugarcoat things. People can take the facts about a situation. They can deal with the reality. What they can’t stomach is the lie. The most important thing of all is for our health officers to be upfront and tell people the truth about what we’re facing.”

Amen.