May 4, 2020 Moonshine Minutes
Is the Tahoe region ready to reopen?
As case counts for the novel coronavirus continue to flatline, the Tahoe Forest Health System and the state of Nevada are joining alongside El Dorado, Nevada, and Placer counties in phasing into the gradual reopening of nonessential businesses and recreational activities.
The question to move through those phases, though, is whether or not we have adequate testing and contact tracing — or investigating people who’ve had contact with positive COVID-19 cases.
I’m Becca Loux, reporter and editor for Moonshine Ink.
Due to these gaps in data, local public health officials are operating essentially in the dark, and Dr. Aimee Sisson, Placer County health officer and public health director said, “We know that we have missed cases.”
But the reopening begins. In the past week, local counties and agencies announced expirations or pulling back of local health orders and a gradual reopening of the area. During Straight from the Source, an April 29 community conversation hosted over Zoom by Moonshine Ink, local health officials discussed with community members what it’ll take to fully reopen shuttered doors. TFHS CEO Harry Weis, Placer County’s Sisson, and Nevada County health officer Dr. Ken Cutler participated as the expert panel.
Sisson explained that though locally there might be a loosening of self-imposed shackles, the state is the ultimate decision maker.
She said: “Regardless of what action is taken at the local level, Placer County remains under the governor’s stay-at-home order, which is in effect until further notice. The governor has made it clear that any decisions to relax the stay-at-home order, at least initially, will be done on a statewide level. It will not be a local decision.”
Part 2: Hoeft
California Gov. Gavin Newsom has identified six indicators to consider before the statewide “stay-at-home” order is lifted, including the monitoring of COVID-19 cases through testing, supporting physical distancing in businesses, schools, and childcare facilities, and the handling of potential case surges.
I’m Alex Hoeft, news reported for Moonshine. On April 28, Newsom outlined a four-stage approach to reopening the entire state, with California currently trapped in phase one — residents are staying home unless they’re a member of an essential workforce.
Sisson with Placer County shared specific examples of what to expect for the next stage we’re working toward. She said: “Any initial relaxation of the stay-at-home order puts us into stage two, which is when lower-risk workplaces can reopen. That includes things like curbside retail, like manufacturing, like offices, and then some opening [of] public spaces such as parks and trails that have been closed.”
Sisson believes that the timeline for entering that phase is likely weeks away rather than months. It will be months, plural, Sisson warns, however, before we enter stage three, which will allow for high-risk workplaces to open such as hair and nail salons, movie theaters, and gyms.
“And then finally, moving to stage four will not happen until effective therapeutics [the direct treatment of a disease] are available and it won’t be until that stage — which is essentially when the stay-at-home order will end completely — that’s when large gatherings like concerts, like live audience sporting events, and large conventions will be allowed to resume. Again, that is months not weeks away.”
Nevada Gov. Steve Sisolak announced on April 29 the extension of his own stay-at-home order through May 15, with some softening on restrictions that began May 1 — specifically outdoor and recreational activities, as well as small business relief.
Though El Dorado County health officer Dr. Nancy Williams chose to allow their local stay-at-home order to expire, its order to ban nonessential travel to unincorporated El Dorado County and its emergency ordinance restricting short-term rentals and adding a fine for visitors violating it will both remain in effect.
El Dorado county’s decision was made in part due to a relatively low number of cases with four active cases currently after 40 out of 44 total known cases have recovered. There have been no deaths due to the virus in El Dorado County.
Part 3: Loux
Testing kit limitations have played a major role across the United States and locally during this pandemic. But Cutler of Nevada County said the rough edges seem to be rounding out.
“The United States, California, locally — we’ve all seen fits and starts with testing. Or there’ve been really blockades/barriers to getting wide-scale testing, whether it’s the supplies of swabs, viral transport media, the testing equipment itself, the agents for that (lab personnel), the amount of protective equipment people have … It’s always seemed like as one supply gets better, the other narrows. But those things are really coming into alignment.”
That alignment goes hand-in-hand with Newsom’s April 22 announcement that an additional 80 community testing sites would be implemented across the state, particularly in underserved areas. Kings Beach is set to receive one for North Tahoe and Truckee residents, opening the week of May 4. Both Nevada and Placer counties collaborated on local testing site locations.
At this Kings Beach site, where Sisson told us 132 people can be tested each day, those with mild symptoms now will be encouraged to be tested. Asymptomatic people at high risk, like healthcare workers, could be screened at the new facility, too. Testing will be by appointment only.
The site is a huge leap forward, as many patients treated at Tahoe Forest hospitals expressing mild COVID-19 symptoms weren’t able to be tested due to a shortage in kits. Instead, they were asked to isolate at home.
Moonshine spoke with a Truckee family who experienced firsthand the anxiety and worry of being told they have the coronavirus, but were not quite sick enough to get tested. The husband, who we’ll call Steve, said, “It’s been an unnerving seven weeks for us because we’ve been told to assume our family has COVID-19, but there is no way of knowing for sure.”
Steve said he and his family went in for an evaluation, and staff said one of their children likely had COVID-19 based on symptoms. “Unfortunately, they couldn’t offer a test because he didn’t meet the criteria due to limited supplies.”
This situation leads to a concern that the numbers of positive cases being released publicly are not necessarily reflective of the reality. Steve said: “We do, however, feel that all those people like us should be tracked or part of the equation in some way — even if it is an asterisk. Otherwise, the low number of new cases isn’t a true number and it’s only giving our community a false sense of security and people will let their guard down.”
Part 4: Hoeft
Contact tracing is another hurdle to clear before the stay-at-home order is fully phased out.
Both Cutler and Sisson pointed to a need for adequate staffing numbers to be able to handle the demand for intensive contact investigation. A fleet of contact tracers would allow people to quickly organize when a new COVID-19 case is diagnosed and rapidly uncover everyone that person has been in contact with recently.
Sisson said the goal is to “pull those people out of circulation per se so if they have already been infected but they aren’t necessarily showing symptoms, we can separate them from others so that the disease does not spread to — if you think about it as concentric circles — another circle of people that could become infected.”
Ideally, Placer needs 100 contact tracers trained with the appropriate tools to keep track of infected cases and those they’ve come in contact with, Sisson said. Currently, the county has six staffers able to perform contact tracing. Cutler said Nevada County, too, is shifting staff around, training people who might not normally participate in communicable disease control, but have public health experience, to increase its contact tracing capacity.
Adequate contact tracing is Sisson’s white whale; it’s the final countdown to reopening, the last piece of the puzzle that will give her and her colleagues enough data to ensure the peak we’ve experienced is the last while still beginning to get back to business.
Cutler said it’s vital the county ramp up “varying aggressive, intensive contact investigations” as part of what he calls “that roadmap of recovery in a thoughtful, phased approach.”
For Sisson, it’s unequivocal: “Until we have that contact tracing ability it’s not safe to relax the stay-at-home orders in Placer County.”
That’s your Moonshine Minutes today, folks. Read the full story, Tahoe on Precipice of Phased Reopening, at moonshineink.com and please check out the full video of our recent Zoom conference call, which was live streamed April 29 here on KTKE, on our YouTube channel.