 Good afternoon. As I understand it, this is the first of a series of weekly press conferences. So we can keep you all up to date on a regular basis with what's happening in Santa Cruz County with COVID-19. I'm Dr. Gayle Newell. I'm the Health Officer for the County of Santa Cruz and with me is Mimi Hall, Health Services Agency Director and we will be joined shortly by my Deputy Health Officer Dr. David Ghielarducci who is overseeing our alternate care sites and clinical task force coordination for clinical services response. As of this morning, we have 57 confirmed cases, including the death of the Santa Cruz County resident. One case is a pediatric case under the age of 18. 43 cases are 18 to 64 and 13 cases are over 65. Females make up 30 cases at this time and males 27. A couple of notable things have happened since our press conference on Sunday. One is that an extension and clarification of self-shelter in place orders have been released starting with the six big Bay Area counties and then we followed suit at the end of the day on the same day on March 31st and I'm happy to answer questions about those today. The Santa Cruz County order is different from the big six Bay Area counties and less restrictive in some senses. So it's important that the public understand the differences between my orders and the orders of the big six and why I chose to do it that way with consultation with my team. In addition, I think the public is clamoring to know about the recent state guidance about face coverings and what that means. So I'm happy to talk about that as well today. Anything else from you Mimi at this point? The only other thing that I would add is some of you may know that we've been working hard on expanding our care capacity across the county. So we have our alternate care site ready to go in terms of logistics. So the cots, the beds, a lot of the equipment is there. We're working on staffing up right now and we hope that so the soft opening is done, but we need people to staff it and we hope we can get that in place by next week. We're also looking at additional alternate care sites because if if what we're seeing and what we're projecting is going to happen in terms of number of cases and disease curves, it's important for us to have one, maybe even two additional alternate care sites ready to go if needed. So why don't we start with a couple questions in the room and then we'll go online. I'm Kara Myberg-Guzman from Santa Cruz Local. I want to hear about testing capacity. Do you have numbers on tests that have been administered so far? You know, this week perhaps, weekly, and is it trending up? Our testing capacity is increasing, particularly for some high-risk groups. So I'm happy to report that now Quest Labs and perhaps others are offering an expedited testing process for patients who are inpatients in the hospital, so admitted to the hospitals or health care workers. And that's a broad definition of health care workers. And Quest is pledging a 24-hour turnaround time on their results for people in those categories. And we've had good success with using that service so far. As of Monday, I heard numbers from my team of around 150 tests that had been done through the Santa Clara Public Health Lab for our residents and a number around 300 for commercial lab testing. But we only know commercial lab result numbers once we receive the results of those because we don't have any way of knowing how many tests have been ordered through the commercial labs. Another one in the room. How many people have recovered or have there been any people who have recovered yet? At this time, we haven't declared anyone recovered, partially because we don't have the testing capacity to do serial testing or everyday testing on every case. We would be overloading our public health lab partners to do that. And our commercial lab turnaround time is not quick enough to make that a feasible prospect. So we're following these cases based on clinical symptoms. And we're trying to be very careful about declaring them as recovered. We don't want them back out in public and shedding virus. Just on the testing side, what's your evaluation now of the testing availability? You talked a little bit about this on Sunday and how you said that that, you know, the tests that have been promised from federal and state sources for months hadn't quite hand out. What's your evaluation right now of what that picture looks like in general for testing with commercial labs with the Santa Clara lab? I haven't heard of any government assistance in our area for testing capacity. I do know that Dominican Hospital is hoping to be up and running for some very limited point of care testing, perhaps as early as this week and next week increasing that capacity. In addition, right here on Emeline Campus in our clinic lab, we have also ordered equipment and supplies to begin testing. And we hope we have that up and running in the next couple of weeks. And is that adequate for an effective public health response? In this county right now? Well, again, we've really moved past the containment phase. The containment phase is where we needed to identify the folks who were had the virus and then keep them out of the population. At this point, we know that the virus is spreading throughout the community. And so testing is not the key focus of our efforts at this time. It would be interesting to know from a from a data collection point of view, but it's not a focus of our efforts. So I'll come back to the room. Let's get some online questions. I want to respect the people that are stayed home to practice distancing. Please unmute your phones if you have any questions. Anybody on the call have questions? Yeah, this is Jake from Good Times. Does the county have a clear plan for its next steps in terms of COVID-19 response or is that health services agency evaluating in the code? Oh, we are so busy with our planning and preparation and putting those into place. We have a huge team just in health services agency alone in our department operations center. I think we're up to 180 or so spots in our department operations center. And each of those is two to three people deep. So we have literally hundreds of people. In addition, our county administrative officer and his staff are working around the clock on plans as well at the county level. The human services department are essential partners for us in terms of housing and hoteling. And all of us are working diligently and across all spectrums in area of the community to respond. Any other phone questions? And Jake, thank you for staying home today and physical distancing. We appreciate it. Oh, of course. Yes. Thank you for making it easy to do it. What criteria will need to be met for Santa Cruz County to either lift or soften its shelter in place order, like increased testing or better contact tracing for instance, or a better understanding of the virus? Would all that in mind even be enough? We're not going to significantly loosen any shelter in place restrictions until we see a peak in our curve of case rates and then a drop. So we need to see a significant decline in the number of cases before we consider lifting shelter in place restrictions. And Jake, this is Mimi. One of the things that I want to add, because there seems to be so much focus on testing is that it's true that our testing won't discover every single case, but hospitalized cases and ICU cases are a function of community spread. So those numbers, those folks always get tested. And that gives us an idea of whether or not we're at the peak or coming to the downside of the curve. Any other phone questions? Yeah, I pull up on that. Oh, sorry, if you have increased testing, does that let it move back? If we have increased testing and the number of activations starts to go down and what you're getting starts to go down, would that, even if this is talking like sometime over the summer, would that allow the county to keep its strategy back from engaging back towards more containment? The most important people to test are those who are hospitalized, our health care workers, and those with severe symptoms. And so increased testing community wide isn't going to help us in that respect. We make the assumption that if you're in the community of mild illness, that you're positive. It may not be, but you should treat yourself that way. And my point is that we have adequate testing for those who come into the health care facilities as inpatients or with severe illness or for our health care workers. And those give us a good indication of whether we're coming down on that downside of the curve. Thank you, Jay. Can we get another phone question? Go ahead. So first I just missed with the case breakdown beyond the one pediatric case. Could you repeat the case count for the rest of the age group? It's on our website. Sure. It's on our website. But I'll tell you again, there's one pediatric case. So under age 18, 43 who are 18 to 64 and 13 who are 65 or older, 30 females, 27 males. Let's go on the room. My other question was, I know that the county set up an online December donating, and I was curious, like, are donations coming in of supplies and how they're holding up? They are. I know that we had two days ago, this is Jason Hoppin, two days ago, I think we had 58 people fill out the form, but I have not checked in the last 48 hours. So I have seen, there were surgical masks out there today. So they are rolling in. I don't have any numbers for you at this point, but I can probably get them together. Okay. Kara. This is a question for Mimi. One second. I, could you talk about hospital capacity? What's happening in our hospitals right now? Are we seeing an influx of patients and what are we doing to rise to meet that? Sure. And I also invite Dr. David Gillard, our deputy health officer to answer as well. What I can say is Dr. Gillard, Duchy, Dr. Newell and I and some other staff have visited Watsonville Community Hospital as well as Dominican. And they're actually really quiet right now because they're doing what the rest of the health care system is doing, which is putting off elective surgeries, putting off non essential procedures, knowing that we're all preparing for surge. So the capacity is really good right now for that specific reason. It's intentional. The other thing that I'd like to say is that each of the hospitals have a plan in place to increase their bed capacity, whether it's med surge beds, regular beds, ICU beds. And so there are plans in place to do that. And those don't get triggered until that there's a need. But each each facility is aware of when they reach a certain point of capacity and when they need to expand. And then when they're full, that triggers our alternate care site opening. So Dr. Gillard, Duchy, can you also mention numbers, like numbers of beds, surge capacity? You know, excuse me, Dr. Gillard, Duchy here, I don't have the exact numbers in front of me, but I can tell you that both hospitals are working hard to probably roughly double their capacity, both in ICU and inpatient. There's some variability between the two Q care hospitals. We also have the Sutter Maternity Center, which has some capacity. And then we're also in the planning stages of opening an alternate care site, which would serve as a kind of relief valve for hospitals with lower acuity patients that could, you know, transition from hospital care to home care in there. So there's lots of plans. There's even two or three tiers behind the alternate care site of different facilities that we're looking at. Where is that alternate care site and how many ICU beds do we currently have in the county? ICU beds, I'm going to use the term ICU beds and ventilators together. And we have a surge capacity of about 50 on a normal day, non-pandemic day, that is normally about 25. So it's roughly going to double collectively. As far as the sites, the one site that is has been publicly identified right now is the Simkin Swim Center, which you might be aware of. There's another site that is still in the works. And I don't think we're ready to or are we ready to receive the contract. I haven't signed it yet. Okay. I just got it in my inbox. Well, we'll be announcing that very shortly. Is that is that surge capacity enough? And also on top of that, would it be expected to see that surge or peak here? It's a ballpark estimate. Shelly, so we don't really know. We have been doing a lot of modeling looking at data. It's severely hampered by the lack of widespread testing. And that's one of the sort of data inputs. But we could say that we think that the social distancing orders, the shelter at home orders that we've had in place now for a couple of weeks are probably having a significant effect. I think that the population here in Santa Cruz County is very responsive. They're very socially conscious and they've been largely adhering to those orders. And I believe we really flatten the curve, a term you've probably heard before in terms of slowing down that increase. But when is that increase going to happen? A rough guide is we think we're maybe two or three weeks behind Santa Clara County. That's a very rough guide. We think that the hospitals will probably start spilling over about two to three weeks after that because Santa Clara isn't quite there yet, but they're very close. The we talk about ICU beds. We talked about ventilators, the machines, the physical objects. But one of the critical things that we're worried about is the people to to staff those. People that are qualified, respiratory therapists, intensive care physicians, the nursing is huge. And so all of these machines and beds and rooms are really useless without the people that will be behind that. So we're we're anticipating that we're planning on how to expand that part of the capacity as well. But right now we don't know if there's another one more in the room and then we're going to go back to the phone. Sorry, do you want to finish here? Well, I just started with saying you don't know if there is enough. Is that fair to say right now? We just don't know if we have that search capacity. Well, may I make a comment about that? Because we've done we've done modeling and the modeling is as good as the data that you have to put into it. And because we're so small and our numbers are so small, we have large what usually you hear the word confidence interval when you project. It's called a credibility interval. We have a wide swath of a credibility interval. So I haven't had a chance to talk with you today. But this morning I talked with some of my counterparts around the state and we're talking about the fact that if we had regional modeling, it would give us a better idea of what we need. And so we do have that agreement. And I think yesterday our epidemiologist in the Bay Area, there's something called a Bajo that Gail is a member of the Association of Bay Area Health Officers. So we are working on working together because it doesn't make any sense for Napa to do their own modeling us to do our own modeling so no one to do theirs because disease spreads throughout a region. So that's coming. Part of the reason that we're reluctant to release numbers is because the data is so limited that we put into that modeling. So we're preparing for the worst. I got this question the other night on a town hall call. Do we have enough ventilators? And my answer was no, we don't have enough. So that's why it's so important for us to focus on the prevention side. Stay at home, wash your hands. Don't go out if absolutely not necessary because that's the biggest thing that the public can do to make sure that we have enough ventilators and beds for people. Well, thank you. Thanks for being here. This is this is awesome. I'm assuming of the 450 tests more or less that Gail, you mentioned earlier, that they're all PCR based tests. Curious if there's any interest in expanding that to the serological tests that are in the pipe and rapidly being approved? We anticipate that our community will respond as other communities are with increased testing capacity, including antibody testing, although we don't know what the antibody tests mean now. We don't know how to interpret them yet in terms of immunity. But eventually we will get the same testing that other communities are developing as well. OK, on the phone, are there any questions? And we'll come back to you any more. Yes, I have a question. Yes, yes, go ahead. OK, this is Adriana from Univision. Thank you for doing this. My first question. When do you expect Santa Cruz County will be experiencing the peak, the highest? So the number one on the second one. And I don't understand. I've been hearing in different versions, but I just want to know from the guy if somebody had already had the virus and had it coming, can that person get the virus again? I'm going to start with your second question first and say that the shorter answer is yes, that there have already been cases documented of people who have had this virus once and then they get the virus again. We don't have enough data on enough cases to know exactly how much immunity someone might have. We think it might be something similar to the seasonal flu, where, as you know, you can get the flu even more than once in a season and you can get the flu every season. And that's why we need to have new flu vaccines every year. So we don't know enough to answer about immunity yet. There does seem to be some immunity, but it certainly is far from perfect. And the first part of the first question was about the peak. Well, as Dr. Gehler Ducci mentioned, we expect to see an increase in cases. So a climb up that curve in about two to three weeks, because that's what Santa Clara has experienced. And then we expect to see the beginning of a rapid increase, perhaps two to three weeks after that. We don't know when we might peak if we're fortunate and we have been successful in our efforts to shelter in place, to wash our hands, to cover our coughs. Then perhaps we may have a peak as late as July. And I know that that sounds harsh, that the public doesn't want to hear that we may be doing this for months. But that would be a really good thing in terms of our hospital capacity, our ventilator capacity, and a decreased number of deaths. Any other phone questions? Can you talk about this is Steven Baxter with Sanford's local. Can you talk about guidance on face masks and face covering? Oh, I was hoping you would ask. This is a really masking is a really controversial subject and very complex. If we didn't have a scarcity of resources, then we would clearly ask everyone to mask. But we can't do that. We need to preserve masks for health care workers only. Now, the California Department of Public Health did issue guidance last night saying that face coverings may be of some use to the public, that what we've learned from other countries show that face coverings might slow the curve down by as much as three days in a curve, which sounds not significant, but it is very significant. And so there is guidance from the state that the public may opt to wear face coverings. Now, the state is clearly saying these should not be medical grade masks. They should not be masks at all unless they're not crafted for health care workers. So very, very important that we preserve our mask supplies and all of our personal protective equipment supplies for our health care workers. But if the public chooses to wear face coverings, as I see at least one of you in the room today has done, that that should definitely be allowed and even encouraged. And I was going to say, I might add that the masking really when I wear a mask, I'm protecting you from me. And I'm not protecting me from you. So it's really important to maintain the social distancing, as Dr. Newell said, hand hygiene is super important. So don't forget those sort of basics that we've talked about. The California Department of Public Health Director, Dr. Sonia Angel clearly stated that the only measures that are evidence based to reduce community transmission are physical distancing, hand washing, staying at home when you're sick, good respiratory hygiene, meaning covering your coughs and sneezes. And face coverings or masks, actually it's face covering. So there's a difference between masks is the term that we use for professional, health care professional masks. Face coverings are the term that we use for something homemade, something cloth, something that's not professional or medical grade. But the utility of those really is, as Dr. Giller-Ducci said, for now that there's some early research out that the CDC has put out that you may be asymptomatic and infectious 48 hours before you can test positive or show any symptoms. So that's the utility of the face coverings. I don't know if we've confused the issue more, but I just want to make sure that people know that the evidence base doesn't support it. However, it's not a terrible practice to do. Anything else on the phone before we go back to the room? Yeah. Yeah, this is Jay's again some good times. This is the second time that the Bay Area government announced they were sending their shelter in place or to have Santa Cruz in the same a few hours later. Is Santa Cruz included in that Bay Area planning? What's it like for Santa Cruz to communicate with those Bay Area counties? So the ABAHO group that I'm a part of, the Association of Bay Area Health Officers is 13 counties plus the city of Berkeley. And the two shelter in place orders have been developed by what they have self named themselves, the big six of ABAHO. So it's the largest six counties, and they felt that it would be easier for them, along with their county council, their attorneys to work in a smaller group to make a decision and to come to agreement because they wanted to have the exact same wording in their orders, then it would for all 13 counties to come together. And I think as a result, we have crafted an order at this time around that is a little bit different than the big six counties. And that I think is an advantage to Santa Cruz County because we aren't experiencing some of the same social pressures and crowding that the big six counties have. Johnny? I'm interested to hear about the differences, but also I wanted to ask about the accuracy of the test because I have read that there was a report from the government in Spain that the test they were using had a 30% accuracy. So I'm wondering if you have experience from the Abajo group, the big six group, where they would have a lot more cases and they would have a better idea on the accuracy? Well, as most of you know, the first test that was developed through the Food and Drug Administration by the United States government was flawed in their manufacturing. And if that had indeed been released, that would have only had a 40% accuracy. So our government, although it has delayed testing by ensuring quality, our government has been very much on top of quality of current testing standards. And so as a result, the testing that's done in our public health labs and at the state and national level at the CDC has been very good in terms of both specificity and sensitivity. So picking up as many cases as possible at the same time, not including too many false negatives or false positives. And so I think that the testing that we have in this country has been better than in many other countries, although it did result in a delay in our ability to test. Do you think that better would be 50%, 60%, 80%? Oh, the public health lab testing is closer to 90%. So we're going to do one more in the room and then one more on the phone right there. Thank you. It's kind of blown off the testing topic. I have some serious concerns with quest diagnostics ability to actually deliver on the 24 hour turnaround time. So I'm curious if that's something that's keeping you guys up at night and any sort of contingency plan to explore or expand to other private labs or you mentioned the public health lab as well. All of the commercial labs were completely overwhelmed when they opened their doors. And for example, quests open their doors with the capacity of 1300 tests in our region per day. And they have received 10 to 15,000 tests on a daily basis. So as quickly as they try to ramp up their capacity, they're receiving more and more tests. The same is true with the other commercial labs who are testing. And so we have had very slow turnaround times as long as two weeks or more from some of those commercial labs. And some of the commercial labs have even sent batches back saying we no longer have the capacity to test. I think her specific question is the expedited testing for the health care providers where there's a whole different process. So we were skeptical about that too because of this. But so far we've had results within 24 hours and as quickly as 12 in some cases. Anything else on the phone? I'm sorry, yeah, we haven't got to be in that yet. Once the, here's a question. Once the metric, if you're trying to get the public to be motivated to shelter in place through July, perhaps, what metrics should the public look for if you prior us in Santa Cruz County? So we're improving our website. We now have seven day a week posting of our number of cases and the demographics associated with those cases. And then we have a weekly website update plan that will give specifics around a breakdown of inpatient versus outpatient management, which I'm forgetting what the other breakdowns are going to be on that. I know it's going to be gender, age, oh, the means of acquisition of the disease. So we'll tell you how many of those cases were from travel versus how many from known contacts versus community acquired or unknown. And I think the metric that the public should be looking for is when you see the cases go down. And particularly hospitalized. So part of what we track are also hospitalized cases and ICU cases. So when you see the, you're going to see them go up in the next several weeks. And when you see those start to go down, that means what we're doing is working. As there are more cases, are you guys going to release area demographics to, so we kind of tell where they get, there are hotspots and that sort of thing as more cases come along? That's the plan. Yes. Can you also release numbers of test kits administered, other counties are doing it? So the hard thing for us is we're not the only ones who do the testing. And we could do those, but there would be a delay. So all of the public or the private labs, they do testing on our, they do their own testing, but they only give us the test when there are the results. So we don't know how many they're doing until it comes back to us, but that's. So the number I gave you earlier around 300, that's the number of results we've gotten back from commercial test labs. And we don't have any way of knowing how many tests have actually been sent to the commercial labs. With the, just going back to hospitalizations really quickly, I've read a lot, I'm sure you guys have seen ProPublica put out a data set. Santa Cruz County has actually been cited in multiple reports as an example of a county with a really low ratio of hospital beds to residents. And I'm just wondering if you could reflect on that challenge. First of all, do you agree with that premise, are we uniquely or disproportionately challenged in terms of hospital bed capacity? And could you just speak to that a little bit? I will say one of the reports that I saw in ProPublica said that we had six ICU beds. The NPR report, I think. Oh, was it the NPR report? Per 100,000 residents. Per 100,000. So Dr. Gillarducci just talked about the capacity that we have the capacity to expand to about 50. So what you see in a static report is based on what is planned for the community need at this point in time. So when there's no pandemic, there's no reason to have 50 plus ICU beds. And so our healthcare system has the capacity to expand and they've made plans to expand. So that's an important thing to keep in mind when looking at those numbers. But relative to other counties, as a starting point, starting with fewer beds, is that more of a challenge for us to bring additional bed capacity online? Well, what we saw was that the number that NPR posted on their national website of six beds per 100,000 people is not an accurate number. So we know that we have 25 or so ventilator ICU beds at our baseline with an ability to expand to 50. So that's far more, even if you use the 25 beds, that's far more than what they reported on the NPR site. And we're not sure where they got their data. So we know at least locally that data was not accurate. Dr. Galarducci, what does this modeling say about number of ICU beds needed? Yeah, some projections that we have now show that it's really not a matter of when we'll exceed capacity, even the surge capacity. I mean, it's not a matter of if it's a matter of when. And some projections we're seeing right now probably by the end of April or mid-May, we may exceed capacity of our ICU and ventilator. It's based on what we project to be the length of stay in the ICU and obviously the number of cases that come in. But how many, what does the modeling say? What's the actual number of ICU beds needed? Oh, the actual number needed. I don't have that number, but it's larger than 50, I can tell you that. Thank you everyone, I've got to respect your time. Can we talk about, I want to talk about shelter in place. Okay, we're going to talk about shelter in place, no point. So it's important for the public to know that I did not institute as strict an order for Santa Cruz County as the Big Six counties did, but that I will do that if the county doesn't voluntarily respond to my shelter in place. So for example, in the Big Six counties, it's a requirement that every place of business complete, implement and post a two-page form that you can find at the end of the shelter in place order, mine as well, explaining in specifics how they are following the social distance requirements. And in Santa Cruz County, I am not making that at this point an obligation or a legal requirement. It is strongly encouraged and we want our businesses and our community to fill out that form and implement the measures and post it. But at this point, we're asking them to do it voluntarily and hopefully they will do that so we don't have to make it a legal requirement. I've heard good response so far and I hope that that will continue. Another difference, very important I think for Santa Cruz County is that we have not experienced the same crowding at the beaches and in the public parks that other counties have and that it's so important to note that if we do experience crowding and people not following the social distance requirements, I will close the parks and the beaches. And at this point, I'm hoping that we continue to have good voluntary compliance so that I don't have to do that. It's very important that the public get that message. I just want to thank you again for making it voluntary. On the tracking that you're doing of the people who passed away, I read a study by the Italian government that 75% of the people who died had high blood pressure. So I'm just wondering if you're tracking other underlying conditions along with the public. We are and a very good article just came out yesterday from what's called the MMWR, the Morbidity Mortality Weekly Report. You can find it on the Centers for Disease Control website and it looks at the first US cases, the cases so far in the United States and how many of those had underlying health conditions and they cite three specific populations of people that have those underlying conditions that are put them at risk. And it's diabetes, chronic lung conditions and cardiovascular disease. So those three groups have been shown now in a good study with good numbers to put people at risk. Andrea, can you mute your phone? Thank you. Sorry. These are the challenges of remote work. Thank you for being here. Thank you all and we'll see you next week. Hopefully not before then.