Deputy Health Officer Answers Questions on the COVID Outbreak at Granada and the Coming Vaccine – Lost Coast Outpost

Today, Dr. Josh Ennis, a county deputy health officer for the county, took a number of questions from the media on the state of the pandemic — including, particularly, the outbreak at the Granada assisted living facility and the coming vaccines.

Video above, rough transcript below.

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Good afternoon and thank you for being with us. Would you like to start by addressing the
community?

Yeah, I appreciate this opportunity to do so. I

think it’s important to talk a
little bit about the situation at Granada. Yesterday we announced some numbers, and
we wanted to give you a little more context for what may be ongoing there. So
as we started testing the entire facility, as you have noticed, the numbers have
increased quite rapidly, and in analyzing the numbers and doing our investigations,
I think a fair conclusion at this point is we are somewhat late in detecting cases within
that facility. The strategy around testing is not foolproof, and that is demonstrated clearly here.

So I want you to know that we have done a lot in that first week in response.
We had our county infection preventionist involved with reviewing their policies
and procedures around this response, we’ve had CDPH have a surveyor on site
the past two weeks to go over some of those processes, and I want you to know that Granada
has been working with us hand in hand, and they’ve been doing everything really that we’ve asked for.
They have a really challenging job right now and these people are doing everything they can,
they’re knowingly stepping into a facility with a lot of COVID-19.

I want you to know that despite these numbers looking as big
as they do, they are not driving the current, cumulative totals over the same time period.
Something like 70 percent or so of all these cases are still outside of the facility,
and so it’d be really misleading for anyone to conclude that what’s happening at this facility
is driving all of our numbers here. So I’d like to remind you that these are
people we’re talking about, they have loved ones in the community, and we can really tie
our everyday actions of every single person to what’s happening in this nursing facility. So I’d
encourage you all to be kind to one another, and be respectful and try to take care of each other.

We’ll get into questions from the media.

The Redwood News asks…”Yesterday in regards to the increase in cases at Granada Rehab and Wellness,
you said ‘our community is not insulated from the facility’s outbreak, and that transmission
within our community at large can be amplified by it.’ Can you elaborate on that further?”

I touched on this just at the end of my upfront here, but taking the focus off
Granada just for a moment, I want to talk about how investigation tracing works in general.
As soon as we get a positive, we try to reach out to that individual, we tell them you’re positive,
you’re infectious, who have you come in contact with during your infectious period?
And so when there are small numbers, we can do that very quickly, we can do it effectively.
When we’re looking at the volume that we have had recently, on the order of
a couple hundred cases in about a week’s time, that process slows down.

And so
when we’re looking at very large volumes in a short period of time, the time with which we’re
able to reach out, do that investigation, do that tracing, it lengthens. And so there’s potentially
more people being exposed on account of that process generally slowing down. And so
when we talk about a facility outbreak, it’s not a contained, closed system.
There are people, by nature of caring for those people, who have to come in and out of the
facility. And so this can, really it’s a marker for disease that has come into this facility,
but when numbers get large, it can ripple back outward into the community,
and that’s the point I would like to make with saying this in our release yesterday.

The Redwood News asks…”Public Health says there are 54 positive cases in residents,
and 16 staff members at Granada. Their own website (last updated 12/9) says they only
have 5 cases in residents. With the thought in mind that Granada and Public Health are working
together through this outbreak, don’t you think the 2 very different numbers are misleading?
Can you give an explanation as to why the numbers don’t reflect each other?”

So I’ll assure that we have been working very closely from the very beginning with Granada,
as well as their regional leadership. In fact, I was on the phone at 8 p.m. a couple nights ago,
speaking with some folks at Granada. So we are in constant communication with them, as well as CDPH,
and we’ve really been moving hand in hand with this.

Any time we have numbers, for numbers of
residents, numbers of staff, we’re vetting those numbers with Granada at least daily to make sure
our numbers line up. Now when it comes to what they’re presenting on a public-facing page,
I don’t know what their process looks like for reporting of that, of their internal number,
but I assure you, their internal number on a daily basis is a match to ours.

The Redwood News asks…”We know that local health care workers are going to be the first
to receive a Covid-19 vaccine once approved and it arrives in Humboldt. Are health care
workers required to get the vaccine? Are people able to opt out?”

At this time,
there is no requirement, there is no mandate, and I think that’s all I have to say about that.

The Redwood News asks…”When vaccines eventually begin being rolled out for older individuals with
underlying conditions, are you able to talk about how those individuals will be identified locally?
Will they be notified by Public Health or their doctor that they are eligible
to receive that next phase of the vaccine?”

So I think many people in this particular
group are anxiously awaiting vaccine, I completely understand that. This fits in more with phase 1B,
and right now we’re in the very beginning here, phase 1A as it’s called by the CDC,
is really going to focus on health care workers.

To give you an idea of timeline here, health care
workers number somewhere around north of 10,000 for our county. We’re looking at allotments that
fall well short of that very early on. And so when we talk about people who might be in this next
group of phase 1B, which is what this question is asking about, that may be a month away yet. So
the planning around phase 1A has changed on an almost daily basis, but as we get closer and
closer, it has come in with more clarity.

So for phase 1B we have an idea of how we might roll this
out, there may be parallel channels here including Public Health alerts, including working through
out health care coalition and making sure there’s direct outreach from the providers themselves,
but as far as specifics go, we don’t have a specific plan because there are a lot of
specifics go, we don’t have a specific plan because there are a lot of
logistical issues surrounding receiving the vaccine and special requirements around storage
and movement and shelf life. And so, it’s been very difficult to have
real firm details as we roll out this planning, but this question is asking about phase 1B and
there would probably be several different ways we would reach out to that population.

The North Coast News asks… “How many vaccines is the county
expecting to receive in the first rollout? Also, any update on when they will roll out?”

I think that I’m unable to give an exact number at this time.
The FDA is currently reviewing the EUA submission.
In anticipation of an emergency use authorization occurring, it could be as early as
shipments shipping out next week. Again, supply will be very limited very early on,
but it could be as early as next week that they actually start shipping allotments.

The North Coast News asks… “What happens after a person receives a COVID-19
vaccine? Are they followed up with by a doctor? Do they still have to wear a mask? What percentage
of people need to be vaccinated in order for some of the safety modifications to be lifted?”

Yeah, these are all great questions and I think it goes to the fact that this could be the beginning
of the end of COVID-19. Now, is it going to happen any time soon? No, I think it’s going to
take many, many months to get people vaccinated. But the end point here, the last question here,
is asking about what percentage of people need to be vaccinated for us to go back to normal, resume
normal life.

I think that the general idea here is that we can potentially obtain herd immunity
whether that’s through natural infection, or whether through the vaccination. And so we need
to reach about 65 or 70% of people being immune to the disease all around the same time. And so,
we still don’t have an idea of how long natural immunity
lasts when it comes to actual infection. We don’t know how long immunity lasts for the vaccine.
But the idea is if we can move quickly enough and have the immunity stay, whether that’s through
infection or vaccination, we can try and hit that 65% or 70% number. And best case scenario,
lots of things have to line up, I think I’ve heard some experts say as early as June.
I think that’s optimistic.

I think that more realistic, the earliest we can probably see that
occur might be in the fall. Again, there’s a lot of unknown here. Production issues, distribution
issues. When I’m talking about this, we’re talking about developed first world nations. There will be
more difficulty doing this in developing nations, which are going to serve as
repositories for disease. So there are a lot of things that go into answering this question,
but developed nations, if everything goes as planned,
I think we might be looking at summer or fall at the absolute earliest.

The North Coast News asks… Do you expect to need the
Redwood Acres alternate care facility in the coming month?

We hope to not need Redwood Acres. We have been planning around how to use it, should we need it
at some point. I really don’t know the answer to this question and it depends to some degree
on how bad flu season is. I do know and I firmly believe that if COVID-19 spreads very quickly,
if we have more than one potentially one skilled nursing facility outbreak ongoing at the same
time, and then we have a bad flu season, it is very possible that we would need Redwood Acres.
There’s a lot in there that I can’t predict. I do know that if you project our current rate
of COVID-19 as well as hospitalizations, it could seriously tax our health care system.
But we are going to do everything we can to keep the care happening within the four walls of the
hospitals and we’ve been working with them all along to develop robust plans to do that.
But we do have a so called “pop-off valve” where we can allow very low acuity people at
the end of COVID-19 care who maybe just need another day or two to get things sorted out,
to allow that to occur at Redwood Acres.

The Redheaded Blackbelt asks… Are any residents of Granada
being transferred to local acute care hospital settings for care,
and if so how is this impacting Humboldt County‘s ICU availability percentage?

Granada patients, depending upon their already-stated end of life care decisions,
may do any one number of things. Many people if they still wish to have aggressive care,
they’re going to get transferred to the hospital. They’re going to be
offered the same standard treatments that many non-nursing facility residents would be offered.
Many patients have had the end of life discussion surrounding this pre-pandemic. So they know that
they’re constantly battling chronic medical conditions. They may have made known what their
ideas are around quality of life, as well as dependency upon health care or medical resources.
And so some of them have chosen not to have aggressive care at the end of life,
whether that’s a COVID-19 thing or not.

So, with nursing facilities in particular,
many of them are in that latter category. And so if they’ve made that known and they wish
at the end of their life to be made comfortable, we have been trying to support that occurring
wherever it is they wish for that to occur. Sometimes they may wish for
it to stay within the nursing facility, some people sometimes wish to potentially go home.
But with COVID-19 that brings in a lot of transmission and exposure concerns. Others may
wish for something in the middle that maybe the hospital is more appropriate for end of life. So,
when it comes to Granada, our current ICU capacity, it does have potential to impact our ICU
capacity significantly. At this time, it is not impacting it in a dramatic way though.

The Redheaded Blackbelt asks… Have there been any new cases of
COVID detected among the jail population in the last few weeks? If so, how many?

The short answer is no. Over the past several months, there have only been a
couple staff members, and in fact no inmates. We’ve worked very closely with the jail
to mitigate any risk of introduction of COVID-19 into the facility and they continue
to be a great partner in doing so.