Chats between health officers show chaos
The chats provide a window into the improvisational decision-making process behind public health policies .
Just over one year ago, as the coronavirus pandemic surged through California, Bay Area health officers debated what would become one of the earliest in a series of unprecedented decisions to shut down public life for the nearly 8.5 million people in the region: Whether — and to what extent — they should shut down mass gatherings.
As the necessity of limiting contagion became clear, officers debated the numbers. Some local counties banned gatherings of over 100 people, while others went further, counseling people not to meet in groups of over 35. Dr. Scott Morrow, the health officer for San Mateo County, asked about the science behind those decisions.
“Do the numbers 100 and 35 have any basis in anything?” he asked in a Slack chat maintained by the Association of Bay Area Health Officers, a group that includes health officers from 12 local counties and the city of Berkeley.
“No basis as I can see,” Dr. Marty Fenstersheib, at the time the health officer for San Benito County, replied. “The numbers are random.”
“The point being there should not be any gatherings at this time,” Morrow noted, “but apparently orders need numbers.”
It was one of many such deliberations revealed in the Slack chats between the health officers, which the Bay Area News Group obtained through a public records request and is making public here for the first time. Though an incomplete record of the public health discussions — officials also conferred on other channels including email and phone calls — the chats comprise the most centralized record of regional health officers’ consequential consultations about COVID-19 responses as it ravaged California.
The chats, which date from January 31 to June 2, provide a window into the improvisational, harried decision-making process behind some of the most historic public health policies in our lifetime. Conversations through the early months are dominated by confusion, with the focus initially on foreign travelers, from China and then from Europe, and questions over how local health departments are expected to carry out the federal government’s quarantine orders for highrisk travelers arriving at San Francisco International Airport and at Travis Air Force Base.
The urgency of the public health response escalated through February and March, as the health officers realized that the virus was already widespread in the community and the extent of transmission unknown because of lack of testing. As crisis after crisis makes it clear just how prolonged and extensive the pandemic will be, the Slack chats show the health officers making daily decisions about how to shift the response to mitigation, rather than containment, often with little or conflicting information about the virus itself.
The chats also show the officers struggling to apply contradictory guidance from the Centers for Disease Control and Prevention, the state, their own local governments and one another.
In early February, the CDC mandated 14-day quarantines for travelers returning from parts of China, frustrating some local officials who expressed concern that such measures were premature and draconian. The officers also struggled to grasp their extraordinary legal authorities, which sparked disagreements about the relative powers of federal and local quarantine orders.
“I have spent many hours over the last 2 days on highlevel cdc calls,” Morrow said on Feb. 2. “I have repeated over and over, I have no capacity to operationalize the quarantine plan. Nothing is going to change that.”
Erica Pan, who at the time was the public health officer for Alameda County, wondered if the federal government would impose quarantine orders on potentially infected persons if local governments refused or were unable.
The earliest messages also show that, initially, the officers coordinating responses were still optimistic about their ability to prevent the virus from spreading in the U.S.
“Maybe this will be like H1N1, or a bit worse or better?” said Pan, who is now the state epidemiologist.
“One way to describe it may be somewhere between a bad flu and a really bad flu,” Contra Costa County Health Officer Chris Farnitano replied.
That optimism was dashed as health officers realized infections were emerging in California without any immediate links to foreign travelers. At the suggestion that California could soon resemble Italy — where the health care system had been overwhelmed by sick and dying COVID patients — Pan posted that “Seattle is not looking this bad yet.”
Every day, the group confronted new high-stakes challenges. By early March, the health officers were debating how to word public emergency declarations, grappling with how to increase hospital and intensive care unit capacity, and trying to determine what to do with the Grand Princess Cruise ship passengers about to disembark at the Port of Oakland. The officials’ frenzied and often impromptu decisions accelerated that month as schools across the Bay Area shuttered and President Donald Trump ordered a 30-day travel ban for parts of Europe.
By March 17, six Bay Area counties — including Santa Clara, Alameda, Contra Costa, San Francisco, San Mateo, and Marin — issued what was, at the time, the most sweeping shelterin-place order in American history.
Within days of the regional stay-at-home order, Gov. Gavin Newsom issued a statewide order.
“Urgent question,” Farnitano wrote on March 20th. “Does the governor’s shelter in place order supersede local health orders where there are discrepancies?” Thirty-seven minutes later, he informed his colleagues of the response from the executive director of the statewide Health Officers Association of California: “We are in uncharted territory here.”
In the weeks following the shelter-in-place orders, the channel’s participants debated unprecedented government restrictions that would have been, for most Americans, intolerably invasive before the pandemic: Could landscapers and pool cleaners continue to earn a living at their trades? Could construction projects worth millions in investment continue? Were medical marijuana dispensaries, golf courses and gun shops “essential”?
“Here’s a heartbreaking question for the most of us now with SIP orders,” Marin County Health Officer Matt Willis wrote on March 19. “Have you weighed in on playgrounds? Exempted?”
At another point, Pan asked if others had received inquiries about outdoor CrossFit classes: “I can’t believe the random questions we are all adjudicating!” she said.
On March 22nd, Marin County ordered the closure of all its parks — about 18,000 acres in total — amid a crush of crowds. Later that week, Willis acknowledged that shutting down access to beaches raised equity issues for many poorer residents who relied on public spaces to recreate, but that he had decided it was necessary after massive crowds suddenly congregated along Highway 1. Public park access would remain limited across much of the region for months.
The Slack messages also illumined health officers’ limitations. The health officers often complained they lacked supplies or information to formulate appropriate responses. Some also lamented the lack of unified responses by various government agencies. In addition, the thousands of chats do not include any discussion of the pandemic’s disproportionate impact on Latinos and other communities of color.
Health officers have said that those discussions took place outside the channel.
The government officials posting into the chat channel agonized over how much information to release to the public and news media. In early April, Pan wrote she was resisting Alameda County mayors who were “pressuring” her to release city-level data about infections and urged her colleagues leading other counties to hold the line against disclosure. Several counties had told Pan they had already publicized their infection data. Contra Costa’s website crashed from all the traffic. Pan seemed frustrated that other health officers shared information with the public without advising the group.
“Next time though, please do let us know in region if you are going to share more detailed data … or something others might not have in the past,” Pan said.
California county governments’ refusal to release information about outbreaks would eventually be the subject of several lawsuits, including a civil suit filed by this news organization in which a judge ruled that Alameda County officials unlawfully withheld public records.
By mid-April, Sonoma County issued the region’s first countywide mask mandate. The group debated how to guide the public about face coverings.
“Should probably include all workers that interact with customers and the public including home care workers that go into people’s homes,” Farnitano posted. By mid
April, most Bay Area counties had issued mask mandates, and by mid-June, Newsom had followed suit.
Meanwhile, the pace of infections and deaths continued to climb even as counties continued to hunt for safety equipment and science to back up their decisions. On a day when California reported more than 300 new infections, Dr. Noemi “Mimi” Doohan, the Mendocino County public health officer, posted her concerns that her rural and disproportionately elderly county would be overwhelmed by infections and deaths.
“In Mendo we are looking at commandeering a nursing home for end-of-life COVID-19, where a family member can come be with their loved ones,” said Doohan. Doohan did not know it at the time, but the county would eventually purchase the facility to quarantine COVID infected people who couldn’t isolate in their homes. “I can’t even believe I am writing this, but given we only have about 40 for a population of 90,000 and only 100 beds, I can’t avoid it.”
Bay Area News Group has preserved excerpts of these records in a digital archive with annotations for readers to explore in DocumentCloud. The transcripts are low resolution, zoom in to read them larger.
What is the ABAHO Slack group?
The Association of Bay Area Health Officials, or ABAHO, consists of local health officials from 13 jurisdictions in Northern California, including 12 counties and the city of Berkeley. Established in 1985 to better coordinate the local response to the HIV/AIDS epidemic, the close-knit collaboration is viewed as a model for regional collaboration on public health planning, including pandemic preparedness. Below are the names of the principal ABAHO health officers from January through May 2020, along with the handles they use in the Slack channels.*