BY BECCA LOUX AND ALEX HOEFT | Moonshine Ink
First Washington state peaked, and now New York is seeing a flattening in cases. But as national media offers hopeful headlines about these two states, the rest of the country has yet to reach their likely peak, including our corner of California, with Tahoe/Truckee earmarked by some as a potential “hotbed.”
Our region is an interconnected ecosystem marked by Big Blue and the spine of the Sierra Nevada, and the coronavirus, also of nature, does not discriminate its spread based on county or city lines. Yesterday, Nevada’s Washoe County announced its 10th death due to the coronavirus; and as of publication deadline, El Dorado, Placer, Nevada, and Washoe counties were reporting 547 total cases, including 15 deaths.
While some experts predicted a spike in COVID-19 positives coming for the Tahoe region, sooner and “hotter” than the overall California projections (as in, higher infected rate per capita), Tahoe Forest Health System CEO Harry Weis pointed out that recent fears over this area as a hotspot are based on the initial weeks of the pandemic.
Weis himself warned that the local impact could be “very large” in an April 1 interview with local radio station KTKE, yet he more recently believes we’re moving away from that trajectory because Tahoe/Truckee residents are doing a better-than-average job adhering to the ‘stay at home’ order.
The hospital’s CEO marked the progress of stemming the tide of the virus in Thursdays: “Last Thursday [back] to the previous Thursday we saw [about] a 71% growth rate in positive COVID lab tests. Now, since last Thursday, it’s been moving upward much more slowly, and so as we look at the days in April … we’re cooling off a little bit [compared to] California versus the U.S. average and definitely versus New York and New Jersey and even Michigan.”
That “cooling off” has involved a plateau and then drop in the infection rate in Truckee: There was a time last week during which Truckee was up to nine times more cases per capita than California’s overall average case ratio. As of Moonshine’s interview with Weis on April 7, the hospital was reporting that Truckee had fallen to six times the state average for infection rates.
To calculate these rates, Weis’ math includes only using the positive cases treated at TFHS in the Town of Truckee — 41 patients at press time, in addition to 5 patients from Incline Village for a TFHS total of 46 COVID-19-positive individuals tested there — over the town’s population. Weis explained that he uses the Truckee numbers to make sure the hospital is over-prepared; even with the drop in cases per capita ratio, the town still has a higher-than-average rate of positive cases.
It’s a model “that pushes us to plan a little bit tougher, more harshly, for a higher census,” he said, providing data that incentivizes the hospital to “[plan] for space that will hopefully be more than adequate for illness surge.”
There have been no new confirmed cases from TFHS since that interview, and Weis said he hopes to keep the decline, or at least “to show a very tiny hill and that little slope of growth in COVID cases.”
Regardless of whether we hit the spike early, on time, or not at all, “April is going to be the show-and-tell month … to show [if there was] a mountain peak and then a downhill on the other side or not.”
TFHS has maintained what’s called in the medical world an in-patient census of six COVID-19 positives (“heads in beds” at TFHS as Weis says) for a number of days now, while other areas, such as New Jersey, that had been on a similar trajectory a week ago, are now averaging 19 COVID-19 patients per hospital.
“I’m internally optimistic that we’ll have some good news to share with our community and I don’t want to jinx it,” Weis said. But he also cautioned against putting too much stock in projections or predictions of any kind, and the potential of a Tahoe spike still weighs heavily on others’ shoulders.
Will Tahoe’s ‘spike’ occur before California’s?
Dr. Aimee Sisson, public health officer and director for Placer County, told Moonshine, “We think that Tahoe has the potential to be a hotspot … and to potentially have a peak number of cases sooner than other areas. And given the limited healthcare system capacity in the Tahoe area, we have concern that it could become overwhelmed.”
Sisson explained actually predicting a peak date, however, isn’t as simple; there’s not enough data to form a solid model. At this point, she said, it’s simply a best guess that Tahoe will in fact be a hotspot for COVID-19.
Weis said his current observations and his own best guesses (for which he cautioned we need a few more weeks to see if it’s a trend) foretell another possibility: “Traveling influx of people is what really lit the fire strong [to bring the pandemic to the region], and then many of them did go back … Those that are still in the local area are really hunkering down. They’re focusing, they’re following guidelines … And that’s why I believe we’re starting to see a real down-growth.”
The Institute for Health Metrics and Evaluation offers peak projections for each state in the U.S., as well as countries across the world. Currently, California’s projected peak use of resources is April 13, with the peak number of deaths on April 15 (67 deaths). The numbers come from local and national governments, hospital systems, the American Hospital Association, the World Health Organization, and a number of other sources. Yet those projected peak resource-use dates have changed multiple times in recent days, which illustrates how variable the projection process has been.
Johns Hopkins University School of Medicine provides a global dashboard with current numbers of cases by country and, boiling it down further, the amount of deaths by city. The United States has reported over 16,000 deaths, with New York City leading the way with 5,000-plus deaths.
Fodder for the Tahoe-is-a-hotspot hypothesis comes from a few different sources, including the region’s performance as a tourist destination: people inhabiting short-term rentals and second homes have been contentious topics among locals, and both Nevada and Placer counties, reinforced by the Town of Truckee, have actually banned STRs from performing commercial operations. Placer reported a decrease in STR occupancy on April 2, so evidence at least in that county points to official STR-banning efforts being successful, and throughout the region, second-home owners are being encouraged to stay at their primary places of residence.
But that’s not all. “I do think Tahoe, being a ski area, was experiencing a fair number of international travelers coming back and potentially seeding the community with infection,” Sisson said. “I think there have been cases not just in the general community but also in healthcare workers. That is also playing a role.”
(Weis confirmed that the total number of TFHS healthcare workers known to be infected with COVID-19 is 11. He follows CDC guidelines which dictate that testing prioritize emergency room visitors and those who need in-patient care, followed by healthcare workers.)
While people often enjoy flocking to Tahoe, if infected with COVID-19, it’s not necessarily helpful to remain here. Weis brought up the point that COVID-19 is a disease that affects the respiratory system, and said patients “suffering respiratory distress [should] get to lower elevation. Being at 6,000 feet is not ideal at all.”
For Weis, the cooperation between the counties and hospitals in the region during this time has produced a “multi-county and interhealth system agreement that transferring [patients] back to the west to lower the elevation [would be best] should we get saturated.” However, he noted that they are planning beyond removal of patients to hospitals “to the west” (read: Roseville and Sacramento), and Weis said TFHS considering “a third option.”
He said those next-level capacity issue plans include “low acuity in-patient care in potentially a school setting, a gym, or something like that, but hopefully we can contain this with good community support and not have very much in expansion.”
Placer’s Sisson echoed Weis about the third option, dubbing it a “last resort” effort. “We are exploring where that facility could be physically, as well as where the staff and the supplies and the personal protective equipment would come from,” she said. “As you can imagine, it’s a rather complex endeavor to create a hospital out of nothing, but we are definitely planning for that.”
“I have absolutely no idea why Mother Nature chose my husband.”
It’s been over a week and a half since the woman who said these words to Moonshine has spoken to her spouse, who’s infected with the coronavirus and is currently the only COVID-19 patient attached to a ventilator in a Tahoe Forest Hospital ICU unit. She requested her and her husband’s names remain anonymous.
“He was three to four days, maybe five days, into a cold, and he started coughing funny,” she said. The type of cough she recognized from a CNN report. “I sat him down [and said], I gotta tell you, that cough doesn’t sound right to me, it doesn’t sound good … That is the telltale sound: it’s very dry, it’s like a seal barking kind of a sound. And that was what [he] was doing.”
Our source took her husband to the emergency room on March 29, and shortly after he was connected to a ventilator — a decision that “scared the shit out of” his wife, she said, because she thought he couldn’t stay alive without it. She quickly learned, however, the ventilator was provided not because he needed to be on it to keep breathing, but because his body was weak and could use a little help.
“His body was so fatigued, he was not able to heal himself, so [they] went through how they give oxygen, and it’s just for someone who’s in distress,” she explained. “… [My husband] is on a ventilator right now as we speak and has been to get him strong, so he doesn’t have to do the work.”
The infected man is also practicing breathing efforts between ventilator sessions, particularly through straws, and his doctors are working to get him breathing off the ventilator for two straight hours.
While the husband is at the hospital, the wife and their twin son and daughter remain at home. The couple’s son currently has a fever, so the family is starting a two-week quarantine anew. Yet the patient’s wife remains resolute, and amazed at the support she has received.
“It’s insane the amount of people I haven’t talked to in a while that have reached out,” she said. “I’m exhausted and my kids have been amazing and … my neighbors are bringing me food, which is great because I can’t go anywhere.”
Dr. Tim Lombard is battling the disease in a different way. As a specialist of internal medicine and cardiology based at the Tahoe Forest Hospital, he’s been preparing for the kind of escalation of cases we’re currently seeing for months. Lombard said that while he’s not “down in the trenches” of regular interaction with hospitalized COVID-19-infected patients, he’s personally consulted with a few local patients with the disease.
“We’re used to giving people, unfortunately, bad news, and sometimes bad news that is of an acute nature,” Lombard explained. “So the kinds of conversations we have with people are about what might occur and to get their sense of what they would want done and not done.”
Ventilator or no ventilator, CPR or no CPR — these conversations, Lombard furthered, are standard for every patient who enters the hospital, and are “apropos to patients with COVID.”
Of the potential Tahoe spike and Weis’s optimism, Lombard is a bit more cautious about what the future holds locally. He said he hopes the outlook is a good one, but he and the rest of hospital staff need to be prepared for the worst-case scenario.
“There’s a lag between when someone gets infected and when they develop symptoms, and some people don’t develop symptoms at all and may still be capable of infecting others,” he continued. “Which is one of the reasons it’s important to put into place the systems and recommendations we have, sheltering and wearing masks and so on.
“Because of that lag time, we don’t always know the effect of an intervention for a couple of weeks,” he said. “We’re hoping [a leveling off is] the case but we need more time to really know what the effect is.”
Doubling down on wants vs. needs
As far as stemming the flow of cases, the toolbox for what government officials can still mandate of people is nearing empty. At this point, those living within Placer County are directed to stay home except for essential purposes, wear masks when in public places, and to abide by the 6-foot social distancing recommendations. Sisson said the next step is doubling down on what’s already happening.
“One of the things I will hopefully clarify … in terms of renewing my stay-at-home directive, hopefully as an order this time so it’ll carry more weight, is to close some of the loopholes,” she said, noting the importance of “really remind[ing] people that the question they should be asking is, ‘Is this something I really need to be doing?’ not, ‘is this something I can do?’”
Grocery trips don’t need to happen every day or even every week with proper planning, Sisson elaborated; instead of picking up takeout, cook at home. Part of the reason COVID-19 is dangerous is people can be infected but not be showing any symptoms, and she emphasized that “every contact that they make with another person, even if that person appears and feels healthy, is a potential exposure to COVID-19 that they could bring back into their home.”
Despite the depressing potential Tahoe has of a spike in cases, Sisson said she’s also seen a counterbalance to the disease — a “spirit of volunteerism.”
“Now is the time for us to pull together and support each other even if we have to do so remotely because we can’t physically be together,” she said. “But the only way we get through this crisis is together and to recognize the enemy is the virus and not your neighbor, not the person in line in front of you who got the last package of toilet paper.”
The idea of pulling together is happening nationwide, too; high levels of private-public partnering that TFHS’s Weis called “unprecedented” to find a solution for people across the world. He said he’s been following the record-breaking work to develop a COVID-19 vaccine, as well as other antibody tests.
“One scientific group had indicated they’d developed an antibody test that could kind of stop the movement of this virus, stop it in its tracks,” he said. “We just need to let all the scientists have their time and space.”