COVID-19, a novel strain from the family of coronaviruses, is now in Sonoma County, but the impacts are still uncertain, and the county has declared a local health emergency to prepare for the worst.
On March 2, the Sonoma County Department of Health Services (DHS) confirmed a presumptive positive case of COVID-19 in a resident with recent international travel. A presumptive positive case is defined as likely to be positive for COVID-19. The Centers for Disease Control and Prevention (CDC) will conduct another test to confirm the diagnosis.
To respond to this most recent development, the County of Sonoma has declared a Local Public Health Emergency as well as a Local Emergency to respond to COVID-19. These proclamations will allow the county to prepare for the possibility of community spread of COVID-19. This includes a partial activation of the county’s Emergency Operations Center (EOC) to support necessary activities.
“The county is very concerned, and I’m concerned,” said north county Supervisor James Gore. “(The) reason for vigilance is that there’s a lot of unknowns with this strain, questions about mutation and community spread and how fast. (The CDC is) studying it as they respond. By us declaring a local emergency, what we are telling the community is that we are taking this seriously.”
Gore said the actions prompted by the declaration include, “Number one, do an activation of EOC to use as a hub for all departments. We know we need to do that, because we need a place where people don’t operate in silence, and number two a local emergency declaration also sets us up programmatically for state and federal aid.
“Are we declaring because I think hundreds or thousands of people are dying? No,” he said. “We’re doing it because our goal after our 2017 fires was not be ‘Sonoma respond’ but ‘Sonoma ready,’ and I anticipate we are going to have more cases come up. We are going to have to stay ahead of it, and we are going to have be able to manage it and have to adapt on our feet over the next two to three months as we figure out what the numbers and spread truly are.”
According to a statement from the DHS, “DHS is working closely with the California Department of Health (CDPH) and the CDC to monitor the cases of COVID-19 in our county. The department continues to work closely with local public health partners/healthcare providers to take action to isolate and test any high-risk individuals in consultation with the CDC to prevent the spread of disease and protect the public’s health.”
“This recent presumptive positive case of COVID-19 is a cause for concern, and the county is declaring these emergencies to activate and deploy its resources to adequately respond to an increase of cases,” said the county’s health officer Dr. Celeste Philip. “They will allow us to work in tandem with our cities and health care providers to ensure we are prepared to combat an outbreak of COVID-19 in our communities.”
According to a statement from the county of Sonoma, the county is currently awaiting test kits for COVID-19 to be used at its public health lab to be more responsive when there are suspected cases.
“So we have, I am told, 15 isolation beds in Sonoma County, the ones with low pressure that suck out all the air,” Gore said. “Now that shows you that we don’t have the capacity or technology needed unless we work well with our state and federal partners to identify other locations, because more than 15 people get the flu every year.
“The ultimate goal of the declaration is anywhere we see a hotspot in our community, to be able to contain and mitigate it and then to also send a message, not just to ourselves but the community, that we need to limit the flow of any infected people into our community,” he concluded. “That’s what’s going with the U.S. right now. When I met with (the CDC), what they are trying to do is, though they are working while dealing with what already here, they don’t want to have more outbreaks that get ahead of them.”
County residents should contact their healthcare providers if they have symptoms such as fever and cough and had close contact with someone with symptoms who returned in the last 14 days from China, Italy, Iran, Japan or South Korea.
Infections by the numbers
As of March 3 at 3 p.m., the international death toll from the coronoavirus stands at 3,165, with 92,835 people infected, most of whom are in China. The U.S. has 108 patients, and nine fatalities, with 45 infected aboard the Diamond Princess, three in Wuhan and the other 60 infected in the U.S. Seventeen of those were travel-related infections and 37 were contracted person-to-person.
Currently all the deaths in the U.S. have been in Washington state.
States with infected persons are Washington, Oregon, California, Arizona, Wisconsin, Illinois, Florida, New York, Massachusetts, Rhode Island, Georgia, New Hampshire and North Carolina.
As of March 2, there are 43 positive cases in California: 24 from repatriation from the Diamond Princess cruise ship, 10 that are travel-related, two person-to-person exposures from a family member, three due to person-to-person contact in a health care facility and four from as-of-yet unknown sources. Approximately 300 people have been tested thus far.
Passengers in need of screening are being funneled through L.A. and San Francisco airports.
Governor Gavin Newsom has asked the state legislature for $20 million in emergency funds and has activated the state operations center.
March 2 was a hotbed of activity as The Healdsburg School, a private K-8 school in Healdsburg, shut down following information that a parent at the school had come into contact with a person who had tested positive for the virus, and, separately, the presumptive positive case was declared.
The Healdsburg School reopened on March 3 following consultations with public health.
The separate March 2 patient has symptoms of the virus and is currently in stable condition in an isolation room at a local hospital. The patient, who recently returned from a cruise ship that departed from San Francisco to Mexico, has been in the county for 10 days.
DHS, CDPH, CDC and hospital officials are currently in the process of identifying individuals this patient has had contact with during the time they were in the community before being hospitalized.
The names of hospitals providing care for individuals diagnosed with COVID-19 will not be disclosed to protect the privacy of patients and prevent disruption of hospital operations.
As of March 3, this is the second case of COVID-19 in the county. In a statement on Feb. 26, the Sonoma County Department of Health Services (DHS) confirmed an individual infected with COVID-19 was being treated at a hospital in the county.
The Feb. 26 patient was transported to a Sonoma County hospital from Travis Air Force Base in Solano County, where some international travelers had been quarantined because of possible exposure to the virus. The patient tested positive for COVID-19, however according DHS they do not show any symptoms of the virus, such as fever and difficulty breathing.
This patient’s exposure likely came aboard the quarantined Diamond Princess cruise ship in Japan. They returned to the county for treatment to lessen the burden on the local health care system near Travis. Other patients from Travis are being treated in other Bay Area hospitals.
Prevention is the best medicine
Gore had just returned from a meeting in Washington D.C. with Medical Officer of the Center for Disease Control Mitch Wolfe.
According to Wolfe’s presentation, the virus is believed to spread through coughing, sneezing and close personal contact such as shaking hands. Other potential infection vectors being investigated include surfaces or objects that have the virus on them.
The symptoms include fever, cough and difficulty breathing, along with onset of severe and worsening symptoms. According to Wolfe’s presentation, there is a wide range of symptom severity, and complications may include pneumonia, respiratory failure and multisystem organ failure. The estimated incubation period is two to 14 days.
According to the DHS, the best way to avoid infection is to wash your hands often with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer with at least 60% alcohol. But Wolfe’s presentation pointed out this advice is lifted from their experience with other coronaviruses and has not been confirmed.
Avoid touching your eyes, nose and mouth with unwashed hands and avoid close contact with people who are sick. If you are sick, stay home, and be sure to cover your nose and mouth with a tissue. It is also recommended to clean and disinfect frequently touched objects and surfaces using a regular cleaning spray or wipes.
Travel to China has been restricted since Feb. 20, but for those who travel overseas it is suggested that they avoid animals (alive or dead), animal markets and products that come from animals, such as uncooked meat and avoid contact with sick people.
While a vaccine is in the works, Gore said Wolfe acknowledged it would be at least a year before it would be ready for dispersal.
Schools also received a letter from the CDPH to distribute to teachers, administrators and families. Their recommendations included encouraging students and staff to stay home when they are sick, and that those who have a fever at school should go home and stay home until they have gone at least 24 hours without a fever and without the use of fever-reducing medicine. In addition, students and staff who are ill should be isolated from others, ideally in a separate space, until they can be taken home.
Schools are encouraged to promote hand hygiene among students and staff through education, scheduled time for hand washing and making soap and water or hand sanitizer available. Teachers should also encourage proper cough etiquette and ensure that there are adequate supplies of tissues and no-touch trash cans within easy reach and perform routine surface cleaning.
Finally, it suggested that schools consider not attending large gatherings, as this is where cold, flu and other respiratory viruses often spread.
However, there is a note suggesting schools be wary of students being stigmatized and discriminated against.
N95 masks have been flying of the shelves both real and digital, though the CDC has not recommended their use to anyone but health care professionals who may be treating infected patients. Though they may have the capability of filtering out the virus, it requires a tight and precise fit that the average person is likely unable to achieve.
The surgeon general Jerome M. Adams re-iterated this in a tweet that has since gone viral. “Seriously people — STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if health care providers can't get them to care for sick patients, it puts them and our communities at risk!”
In fact, the CDC has indicated that frequent hand washing is likely to be more effective for the average person in preventing the spread of infection that widespread use of masks.
Gore drew comparisons of mask use with the fires.
“County health is putting out information that says we don’t recommend masks, and the CDC is saying same thing,” he said. “From the studies they review oftentimes masks create a false sense of security. They don’t protect fully, and (often) people wash their hands less and touch their face more. I’m not an expert, and people should do what they need to feel confident, but you need to realize that a mask in and of itself is not going to save you. The most important thing is to wash your hands.”
While Gore believes that action needs to be taken, he is not yet in fear of a major disaster.
“We in Sonoma County live in crazy times,” he said. “Since I was elected, we’ve gone from drought to flood to fire to drought to fire and now to potential pandemic. So, the key there is the true word resilience, which means to continue to operate and live within a world of threat and to continue to do what you need to do.
“Nothing so far is telling us it’s Armageddon, but everything is telling us to be smart and vigilant and prepared,” he finished.
Local information can be found at sonomacounty.ca.gov/
Daily updated information about COVID-19 in California can be found at: cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx