.How Ready Is Santa Cruz County for the COVID-19 Surge?

Santa Cruz County has seen its first death from COVID-19.

The man was in his early 70s. He had an underlying medical condition, county Health Officer Gail Newel said. The patient died in a hospital on Saturday, March 28.

“Our top priority is protecting the lives of our community members, and we’re working so hard to make sure that these solemn occasions are as rare as possible,” Newel said at a press conference on Sunday, March 29. 

The man worked in both Santa Cruz County and Santa Clara County, and his job involved working with the public. He first checked in to a local hospital on March 19 with symptoms including fever and shortness of breath. The man’s family is currently being isolated. 

The county’s first case of the new coronavirus was identified on March 6. It’s been two weeks since Newel announced a shelter-in-place order, shutting down many businesses in response to the COVID-19 epidemic and requiring that residents only leave their homes for “essential” activities, like trips to the grocery store, bank, gas station, hardware store and pharmacy.

At the time, similar orders were in place around the greater Bay Area. They’ve since expanded to all of California, and they’ve become commonplace around much of the country. Santa Cruz County’s order expires after April 7, but county spokesperson Jason Hoppin says health officials will likely extend the order. That should come as little surprise, given that President Donald Trump got blasted for suggesting the nation could be “opened up and just raring to go by Easter,” which is April 12. The president later backed away from the comment.

TESTING THE WATERS

In order to understand the size of the epidemic in Santa Cruz County, it’s important to understand how severe Santa Cruz County’s COVID-19 test shortage is.

Since the Santa Cruz County Health Services Agency (HSA) announced the first confirmed case in early March, Santa Cruz County patients have struggled to access tests when they’ve needed them. The problem is plaguing much of the country, including hotspots like neighboring Santa Clara County—an epicenter for cases of the coronavirus in California. 

No one knows how many cases Santa Cruz County really has. “We have no idea,” Newel said.

Santa Cruz County has announced 45 confirmed positive cases as of Monday morning. However, Newel referenced that some epidemiologists believe that, given testing shortages nationwide, there are likely 20 additional cases for every confirmed case. The calculation strikes Newel as plausible, and it would put Santa Cruz County’s total number of cases at well over 900.

As of midday Sunday, the county had results back for 328 conclusive test results, most of them conducted by commercial labs. Of the total tested, 12.5% came back positive for the coronavirus. Initially, commercial labs weren’t sharing results with health officials when tests came back negative. That changed when Santa Cruz County and neighboring communities began ordering commercial labs to start sharing more data.

There’s still a lag in the information.

Newel said Santa Clara Public Health Labs have been turning around results in 48 hours, but the private labs have been taking anywhere from two days to two weeks. Newel said the lack of tests is affecting the entire nation. 

“Our county is really no different than anywhere else in the country. The entire country is struggling with testing capacity. And it has to do partly with the availability of the test equipment,” Newel said. 

The shortages aren’t just with the test kits themselves. There are also shortages of nasopharyngeal swabs that nurses use to take samples from patients, Newel added. Other limiting factors, she said, include the availability of lab personnel and lab equipment needed to process the tests and provide results.

A third factor, HSA Director Mimi Hall added, is the lack of personal protective equipment, like medical masks. Workers need to wear masks in order to take samples for tests. “Every test that we do today is the use of a mask that could be used to care for a patient and keep a provider safe next week, so we have to make these decisions about where do we best utilize the use of PPE?” Hall explained.

Now that there are likely hundreds of cases in the county, testing isn’t as helpful in stopping the spread of disease. “The testing isn’t so important anymore,” Newel said. “We’re past the containment phase for the most part, and we’re really focused on what we can do to mitigate or to help lessen the impact of the disease.”

BEDDING LINES

Newel and Hall say the shelter-in-place order is working.

Santa Cruz County residents are flattening the curve and slowing the surge in new cases of COVID-19. That’s a good thing. Too many cases at once, after all, could overwhelm the county’s health care systems. As sad as Newel and Hall were to announce the county’s first death, they said that their forecasts from a few weeks ago showed the first deaths happening much earlier in the month. That in and of itself is a good sign, they said.

The number of cases is still expected to grow, and some of the new patients will end up in the hospital. In order to meet that need, the county could add up to 180 emergency beds. The county will soon launch an alternate care site at Simpkins Family Swim Center. Hall said the county is evaluating the possibility of adding an additional alternate care site. Before the county flattened its curve, Hall said health leaders had projected that the county would already be needing extra beds by now.

On top of that, the county has a temporary pop-up hospital that it keeps in Watsonville. Since purchasing the pop-up hospital two years ago, employees have staged exercises to practice deploying the facility. Hall said a task force with pulmonologists, hospitalists, medical ethicists is studying the county’s capacity issues. 

But just as the amount of tests doesn’t tell the whole story in terms of Santa Cruz’s testing capacity, one cannot fully measure Santa Cruz’s health care capacity by looking at the number of beds. In order to accommodate increased patient flows, local hospital facilities will need to make sure they have adequate staffing. Hall said the HSA is currently working on staffing for its alternate care sites, but the beds in alternate care sites won’t be suitable for patients in need of intensive care units. Many of the sickest patients will need ventilators in order to survive. Hall said the county has access to about 40 ventilators, and it has put in orders for 40 more. She said county health leaders haven’t yet been forced to make any tough decisions about who gets a ventilator and who doesn’t. 

“But we anticipate in the future that decisions like that will need to be made, so as we build our team and work with our partners to develop task forces around this issue, we’re including hospice and palliative care experts, as well as ethicists,” Hall said.

There’s also the issue of limited personal protective equipment, like masks. Hall said the county’s emergency operations center has reached out to UCSC, PG&E and Harbor Freight to see if they can help with donations. Hall said the first big donation the county got was 10,000 masks from Facebook—something she credits to Jim Frawley, Facebook’s global security manager, who is a former Santa Cruz fire chief.

For information on how to make personal protective equipment donations, visit santacruzhealth.org/ppedonate.

WORKING THROUGH

Newel said she and her colleagues at the county had mixed feelings about holding a press conference in person at the county building on Sunday. “We are doing most of our meetings remotely, and in fact, we had considered doing a remote press conference today,” Newel said.

Health officials ultimately decided an in-person conference would be a better way to honor the man who died. At the event, Newel, Hall and county Chief of Public Health Jennifer Herrera all sat spaced six feet apart. Reporters in the room did the same. Newel and Hall know full well that their own office may have to deal with the virus sooner or later, regardless.

In Marin County, Health Officer Matt Willis has tested positive for COVID-19. Newel said Willis is actually a friend of hers, and she adds that he’s recovering well.

“I’ve been on a number of remote meetings with him this last week,” Newel said. “It could happen to any of us in this room, and likely will. And we would be treated as would any other patient. We would report to our primary care physician with any symptoms as needed. If we had mild symptoms, we would isolate at home. We would follow all of the precautions that we ask our public to do, and we would return to work with all of the usual guidelines, which is three days completely symptom-free and at least seven days, since this onset of symptoms.”

Coronavirus Coverage

For continuing in-depth coverage of the new coronavirus and its effects locally, visit goodtimes.sc/category/santa-cruz-news/coronavirus.

To learn about action you can take now, whether you’re seeking assistance or want to find ways of supporting the community, visit goodtimes.sc/santa-cruz-coronavirus-resources.