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AD HOC COMMITTEE ON COVID-19 ECONOMIC IMPACT AND RECOVERY

  THE RECORD OF ACTION FOR

DECEMBER 17, 2020
Supervisor Candace Andersen, Chair
Supervisor Karen Mitchoff, Vice Chair
Present: Chair Candace Andersen  
  Vice Chair Karen Mitchoff  
Staff Present: Thomas Warne, M.D., Deputy County Health Officer
Julie DiMaggio Enea, Senior Deputy County Administrator
Attendees: See Attendance Record, attached.
             
1. Introductions
  Chair Andersen called the meeting to order at 1:32 p.m. and introduced the Committee, Deputy County Heath Officer Dr. Thomas Warne, and County Superintendent of Schools Lynn Mackey.  She welcomed all of the guests and explained the format of the meeting.

See attached Record of Attendance.


 
  Attachments:
  ATTENDANCE RECORD_12-17-2020
 
             
2. Public comment on any item under the jurisdiction of the Committee and not on this agenda (speakers may be limited to two minutes).
  All public comment was taken under Agenda Item 3.
             
3. RECEIVE status report on the County's COVID-19 status, including the December 10 Updated Quarantine Order, County vaccination plan, holiday planning, and school re-openings.  (Thomas Warne, M.D., Deputy County Health Officer)  
  Dr. Warne introduced himself and described his background as a primary care physician at the West County Health Center in San Pablo and TB/Communicable Disease clinician in public health.  He acknowledged the difficult circumstances presented by the unprecedented surge in the COVID 19 virus that has gripped the whole nation over the last few months.  The County’s infection and hospitalization rates are now at much higher levels than they were at even the highest points during the summer.

He reviewed the current numbers, which place the County well into the in purple tier.  The number of new cases per day per 100,000 in population is 37.9, and the test positivity rate is 8% generally and 13% in vulnerable areas.  Total cases in the County over time is 33,000.  In the past two weeks, there have been 6,000 new cases, so nearly 20% of all the County cases this year have occurred in the last two weeks.  The County has had 290 deaths so far, 30 of which occurred this month.  Hospitalizations have risen gradually with the case numbers.  Currently, 196 persons are admitted in county hospitals with coronavirus.  Two weeks ago, there were only 110.  He said we are not yet overwhelmed yet but we are concerned.  Of the ICU beds, 141 are occupied and 25 are still available.  13% availability is less than what we want to see.  There are enough ventilators.  Most affected areas are San Pablo, El Sobrante, Richmond, Byron, Pittsburg, Oakley, Bay Point, Discovery Bay, and Antioch.

He discussed the reissued stay at home order and how five counties including Contra Costa instituted it earlier than the State required based on concerning local trends.  Due to the dwindling supply of hospital beds, we are now subject to the State’s orders for at least the next three weeks and possibly longer.  He reviewed the Stay at Home Order.

He announced the arrival of vaccines, considered to be safe and effective, and said they are the light at the end of the tunnel and the ray of hope.  He said we are fortunate to have two vaccines available – Pfizer and Moderna.  He said the Pfizer vaccine received FDA approval for emergency use.  The Moderna vaccine is still undergoing FDA approval process.

He said the County has been planning in terms of logistics, supply chain and security, so as to be ready to administer the vaccines.   Shipments from Michigan began on Sunday.  We received our first doses on Tuesday morning.  He expects that the County will receive rolling shipments over the next few weeks.

9,750 doses comprising the first shipment of the vaccine have been distributed by CCHS to local hospitals.  Supply will be short initially and health care workers and nursing home residents will receive priority according to federal and State guidelines, which prioritize based on occupational risk, age and health, and situational factors such as being in a congregate care facility. The vaccines are expected to be available to the general public by early to mid-2021.  

ACIP makes recommendations about priorities and the additional phases of vaccine distribution.  A three-phase system of distribution has been established:  1A health care workers and skilled nursing facilities, 1B other essential workers, first responders, food workers, grocery stores; 1C older adults and adults with chronic medical conditions.  A pharmacy partnership (e.g. Walgreens and CVS) will deliver vaccines to long term care facilities.

Most first responders are part of Phase 1B of the rollout; some will be in phase 1A.  ACIP is still determining protocol.  Medical jail personnel are categorized with healthcare workers.  Jail inmates’ priority has not yet been determined.  

Restaurants can be open for take out and delivery, but dining is closed.  All the recommendations are science-based.  Case investigations have revealed much but are limited.  COVID is everywhere in the community and people with the virus have reported multiple contacts that could have been the source of exposure.  Dr. Warne said the County reaches 78-80% of cases through contact tracing and only about 40% of case investigations reveal their contacts, so data is limited.  The most common sources of exposure have become the nucleus of policies.  We know a lot about how the virus is transmitted, so policies focus on activities that pose the highest risk for how the virus is transmitted, which is airborne.  What may have been safe two months ago may not be safe now due to the uptick of cases in the community.

Dr. Warne recognized the economic impact of the health orders, and so he emphasized following the orders closely so that we can get our metrics out of the purple tier as soon as possible.

In reference to the recent letter from local doctors challenging current policies and claiming that the County data was inaccurate, Dr. Warne said there is a wide range of medical expertise in the medical community, and this results in differing opinions.  He doesn’t share the opinions expressed in the letter.  He said the coronavirus diagnostics test are very accurate and the current wave of infections in the hospital is not typical of the seasonal flu.  He said it is more logical to base policy decisions on our coronavirus case data than on historical seasonal flu data.  He thought it was irresponsible to spread misinformation about the accuracy of the diagnostic tests when they have demonstrated a high level of accuracy.

Chair Andersen invited public comment:
  • Mike McDermott asked if hospitals are verifying whether or not health workers have already had COVID 19 prior to immunizing them, thereby conserving precious doses of vaccine.  He noted that, in addition to the decreasing in the availability of ICU beds, that the total number of ICU beds has also dropped, from 177 on Dec 13 to 166 now.  Over the last three months, ICU beds have decreased from over 200 to the current level of 166.  He thought we should be adding ICU beds, not decreasing the inventory.
  • Garreth de Bruyn:  He also noted the drastic drop in ICU availability in the last few weeks and asked for a more granular explanation.  He asked if we are taking ICU patients from other counties and asked if that could be added to our data dashboard.

In response to the two previous comments, Dr. Warne said that it is the recommendation that the vaccine should not be withheld from people who may have already been infected with COVID 19 because the immune response varies between people.  It is believed that people who have been infected with COVID 19 may be immune for a few months, but it is not known if they will be immune beyond that, so we need to vaccinate them.  Anyone currently with the virus will need to wait 14 days until the virus has passed before being vaccinated.


Dr. Warne explained that there is a difference between licensed ICU capacity and staffed ICU capacity.  ICU beds may be flexed back and forth depending on staffing.  The County doesn’t control the staffed ICU capacity numbers used in the State reporting.  The State receives ICU capacity data directly from the hospitals throughout the county.  ICU bed utilization changes from day to day and even shift to shift.  Overall, the availability has decreased.  We need to preserve beds not only for COVID patients but also for others.


 
  • Skyler Sanders read from the CA Constitution and claimed that in order to be quarantined in the home, he would have had to have been infected.  He challenged the County’s quarantine criteria, saying they were infringing upon his rights.
  • Xia Duffy, a pet groomer, asked why her business is being categorized with high contact businesses and not included with large stores deemed essential.
  • Ross Hillesheim asked for strong leadership during this challenging time on County issues such as poverty, homelessness, high school graduation rate.  He asked County leadership to devise solutions irrespective of federal aid.  He asked for strong and compassionate leaders willing to stand for the 99.97% of County residents (presumably not infected with COVID 19).
  • Mark McClure said that he, like some other families, moved his wife and kids from Walnut Creek to Park City, Utah because of the way Contra Costa has dealt with the “Plannedemic”.  He said the doctors are smug and insulting, and that a court ruling in San Diego found no connection between the spread of the virus and restaurants, yet the County continues to apply “draconian” measures to small businesses while not applying them to large corporations, a policy he called shameful.  He suggested that the policymakers forego their salaries in solidarity with the individuals and businesses that have lost their income and livelihoods due to the shelter orders.
  • Sheila Marie asked if schools should submit their health/safety plans to the County for review even after the County achieves the red tier.  She asked why a school that opened in the red/orange tier can be deemed  safe to operate now that we are back in the purple tier.
  • Heather Chaput expressed compassion for small business owners who have been given a false choice. She suggested tying a financial incentive or high level of recognition to businesses and restaurants that demonstrate a high standard of safety during the pandemic, e.g., providing the safest environment possible.  She suggested a carrot vs. the stick of having to make a false choice of either ignoring the order or starving.
  • Derrick Boyd said we need to get schools and are restaurants back open.
  • An unidentified caller said that California HHS Secretary Mark Ghaly stated that the ban on outdoor dining was not a commentary on the relative safety of outdoor dining but to remove an incentive for Californians to leave their homes.  The caller asked for a comparison between this year’s death rate and the typical death rate for this time of year.  The caller said that some elected officials treated their constituencies with disrespect and asked how the Fourth Amendment operates in terms of the health order, which are not laws, particularly when implemented ahead of the State.
  • Another unidentified caller said her school decided not to open, she thought more due to the threatened teacher’s strike than the virus.  She said there are rumors that the teachers will refuse to return even with the vaccine.  She asked for more scrutiny of schools.
  • Douglas Lezameta, President of Hispanic Chamber of Commerce of CCC, said he was at Target, which was full of people today.  He contrasted these big retail stores with small restaurants.  He asked what plan the County has in place to help small businesses that are prohibited from operating.

Dr. Warne explained that certain activities pose greater risks.  He said the CA death rate is high but not as high as other areas in the nation.  To stem the curb, we need to reduce our levels of activity that contribute to transmission.  Restaurants are considered essential and can still be open but only for takeout and delivery. Dining inside or outside of a restaurant is not considered an essential activity because the food can be consumed elsewhere where there is less mixing of people.

Regarding big box retailers, Dr. Warne said they serve many needs that can be considered essential.

 
  • An unidentified caller said the impacts of the lockdown are more dire than the virus.  She asked who is advocating for the needs of children and cited a recent suicide of a high school student.  The caller said she sent four peer review studies to Dr. Farnitano showing that taking the vaccine will increase the chances of contracting COVID.  She complained about the salaries of the health officer and board members while they are shutting down local businesses.  She said that Governor Newsom had been served an injunction by the Court prohibiting any further unconstitutional orders.  She noted that the Governor dined at the French Laundry with 20 other people in violation of his own orders.

Dr. Warne disagrees that getting a flu shot will increase the risk of getting COVID.
 
  • Anthony asked to see the evidence of the connection between outdoor dining and spread of COVID.  He complained that the speakers at the meeting appeared to be multi-tasking during this meeting.
  • A caller identified as This Needs to End said that people are rightly upset about being shut down.  She complained that the Supervisors have the privilege of continuing to receive their taxpayer funded salaries while depriving their constituents of the right to receive their salaries.  She believes there is no authority in the constitution for government to shut down businesses for the good of the community.  She asked if board members would donate their salaries to help suffering businesses.
  • An unidentified caller said she is tailgating in a Danville restaurant parking lot, watching people create garbage and waste.  She claimed that when Governor Newsom dined at the French Laundry, he sat next to the President of CA Medical Association and his top lobbyist without masks and social distancing.  She said it is entirely hypocritical and the people will, in response, go about their business.
  • An unidentified caller said the County Supervisors should reconsider their stance.  She provided the math on COVID statistics.  She said the County is killing small business with no evidence.  She asked why the county isn’t pushing for schools to open.  She referenced the recent letter from doctors of John Muir Hospital.

Supervisor Andersen explained that CA Health & Safety Code section 101040 gives County health officer the ability to take preventative measures to protect the public during a local emergency.  We’ve been under a declared state of emergency since March.  She also said that Health & Safety Code seciton 120175 states that each state health officer shall take measures as may be necessary to prevent the spread of a communicable disease.  These are broad powers.  She said that we don’t want politicians making these decisions.  We want to rely on the knowledge and expertise of the medical community.  Survivability of COVID 19 depends greatly on the ability to receive proven treatments in a hospital setting.  We on a very serious trajectory and our board wants to make sure that people can receive the treatment they may need.  She wished we could have a normal Christmas.  She wished that all businesses could be open and thriving.  But the reality is that we are in the middle of a global pandemic.  It’s not something that somebody made up.  The decision to shelter in place in advance of the State requirement was to preserve our shrinking ICU capacity.  For as many people on the call today who said these measures were draconian, she also gets calls and emails asking the Board to take stricter measures and not open schools.  It’s a divided issue and a divided country.

Supervisor Mitchoff clarified that she is not doing other things while people are speaking.  She is working from both a desktop PC and a laptop so that she can readily see the speakers and the meeting packet.  She occasionally needs to leave her desk to assist her mother, for whom she is the primary caregiver, but she is monitoring the meeting when she does so.

She said the Court injunction mentioned by a previous speaker was a temporary injunction pending further data and our own court turned it away.  She suggested that people direct their anger at the issues and not at the people trying to address the issues.

Dr. Warne said he’s got a desk full of meeting papers and notes, two machines he is looking at, and was consulting with colleagues during the meeting regarding questions raised before and during the meeting that needed context.  He said he smiled out of frustration over not knowing all the answers but not out of disrespect for the meeting attendees.

Lynn Mackey explained that she appears to be looking down at her desk at times because she is taking meeting notes.  She said that County Health has been a valuable advisor on how to open schools.  She gets about 50/50 split of requests to either open schools or not to open schools.  Opening or not is to be decided at the discretion of each school district.  If distance learning is an issue, she recommends reaching out to the school district directly.

Right now, school districts can submit their opening plans for a future time when opening may be possible.  

Supervisor Andersen will invite Superintendent Mackey to be a presenter at the next Committee meeting.


 
  Attachments:
  CCHS Press Release_Vaccine Distribution_12-16-2020
  CCHS Press Release_Limited ICU Beds_12-16-2020
  Updated Quarantine Health Order_12-10-2020
  Openings at a Glance 12-9-2020
  County COVID-19 Vaccination Plan_12-1-2020
  Bay Area Health Officers Joint Press Release_12-4-2020
  County Stay at Home Order_12-4-2020
  Stay at Home Order ICU Scenario_12-4-2020
  Regional Stay at Home Order_12-3-2020
  Supplement to Regional Stay at Home Order_12-3-2020
  Playground Safety Guidance
  Contra Costa Responds Quickly to Climbing COVID-19 Cases __ Press Releases __ Contra Costa Health Services_11-4-2020
  State Tiers
  Public Comment_Elizabeth Gschwind_12-15-2020
  Public Comment_Laura Magu_12-15-2020
 
             
4. RECEIVE and APPROVE the Record of Action for the November 19, 2020 meeting.
  The Committee approved the Record of Action for the November 19, 2020 meeting as presented.
 
AYE: Chair Candace Andersen, Vice Chair Karen Mitchoff
Passed
  Attachments:
  ATTENDANCE RECORD_11-19-2020
  DRAFT Record of Action for the November 19, 2020 Meeting
 
             
5. The next meeting is currently scheduled for January 21, 2021.
  Chair Andersen confirmed the next meeting date for January 21, 2021 unless a special meeting sooner than that should become necessary.
             
6. Adjourn
  Chair Andersen adjourned the meeting at 3:12 p.m.

For Additional Information Contact:

Julie DiMaggio Enea, Committee Staff
Phone (925) 655-2056, Fax (925) 655-2066
julie.enea@cao.cccounty.us

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