The consensus among epidemiologists studying the spread of Covid-19 is that governments have three choices on moving forward, two of which are politically and ethically unacceptable.
The first is to loosen restrictions in place without adequate safeguards, which will likely result in much more suffering and death. The second is to continue lockdown indefinitely, which will cripple the world’s economy.
Santa Cruz County is now among many government entities around the world proceeding with the third option, a systematic and deliberate approach to control and reduce the virus’s transmission, endorsed by, among others, the World Health Organization.
Informally known as “test, trace and treat,” the control strategy is at the heart of a recently announced county initiative known as SAVE Lives Santa Cruz County, to be led by longtime health-care executive Margaret Lapiz. The new initiative will work to put structures in place to allow businesses to reopen in compliance with Gov. Gavin Newsom’s statewide staged plan to reopen the economy.
Working with the county Health Services Agency, with funding assistance provided by Community Foundation Santa Cruz County, SAVE Lives will be in charge of widespread testing, contact tracing, and services to help aid appropriate quarantine or self-isolation.
Such efforts come with a price tag. Community Foundation CEO Susan True says the budget for the initiative is “still a moving target because it’s still unclear what the state will be paying for and where the restraints are. But it’s definitely in the seven-figure range.”
Ideally, True says, testing will be done in stages, for medical personnel and other essential high-risk workers, people who live in residential care facilities, and then for the low-risk shelter-in-place population.
With the data collected from more widespread testing, the new initiative will then turn to “contact tracing,” the process by which health officials can map and ultimately control the spread of the virus.
Contact tracing is not new; it’s been an effective tool for epidemiologists for generations. At its core, it’s detective work, a painstaking and exacting process of following the transmission of a given contagious agent from person to person, to learn more of its distinctive qualities, and to control its spread.
In early May, Newsom announced that California would be training a force of up to 20,000 people to do Covid-19 contact tracing throughout the state, which would also standardize various methods that counties are already doing. (If those tracers are deployed to the counties on the basis of population, Santa Cruz County would be in line to get about 140 of those tracers.)
A. Marm Kilpatrick, a disease ecologist at UCSC, says contact tracing operates on the basis of probabilities and risk. “When we do contact tracing,” he says, “the major goal is not necessarily to identify every single person you could have transmitted to, but to identify people who you had the higher risk of transmitting to.”
Covid-19’s infection profile gives tracers factors to work with. Close contact and long-duration contact are big risk factors, as is sharing confined airspace, as in an airplane, a bus, or even an office. Even in those cases, though nothing is absolute, Kilpatrick says.
“You could be sitting on a bus with five other people and you may infect only one and not the other four,” he says. “It could be in which way you were facing, the difference between person to person in disease severity, in age, in pre-existing conditions, even in their susceptibility to infection.”
For contact tracing to work, comprehensive testing needs to be in place, and that testing needs to move from a passive mode—waiting for people to show up at their doctor’s office or at hospitals—to an active one—inviting people, even those with no symptoms, to be tested. Both testing and tracing have to move quickly to be effective as well.
Once testing and tracing are in place, the third piece will be to manage quarantines for high-risk populations to whom shelter-in-place restrictions pose special challenges, such as undocumented workers and the homeless.
The undocumented population is of particular concern, county Public Health Officer Dr. Gail Newel said in a press conference Thursday, May 14. Members of those communities may be less likely to seek medical care and more likely to go to work when they’re sick, especially when their jobs don’t offer benefits, she explained. Additionally, there could be language and cultural barriers. Some undocumented residents may have been traumatized by past experiences, and they could be afraid of being separated from their families during a quarantine. “It’s probably our community’s most vulnerable population,” Newel said.
Santa Cruz County is currently at the beginning of stage two of its reopening strategy, meaning that some retail stores are open for curbside pickup. Later in stage two, schools could reopen. California will likely be waiting more than a month for Newsom to announce stage three, which is slated to include hair salons, nail salons and movie theaters. Large events and concerts would be part of the following phase, stage four.
The final part of the mission of SAVE Lives Santa Cruz County will be to develop support systems and resources for local businesses to reopen safely. The new plan is putting together an economic recovery team to assist businesses in meeting the state’s guidelines on reopening.
“It’s a lot to manage,” says Susan True of the Community Foundation, which will be doing much of the work in financing these efforts.
True says the foundation’s work to fight the spread of Covid-19 in Santa Cruz County is in keeping with its founding following devastating floods in 1982.
“Our origin story is in disaster,” she says. “When the 1982 floods came, we couldn’t wait for federal and state officials to send us what we needed. So, the Community Foundation formed as a central place for neighbors to help neighbors and to respond to the pressing needs of the time. That’s what the foundation was meant to do and I feel very much that is how we’re being deployed right now. This is why we exist.”