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JUNE 25, 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
Anna Roth, Health Services Director
Julie DiMaggio Enea, Senior Deputy County Administrator
1. Introductions
  Chair Andersen convened the meeting at 1:30 p.m. and introduced the Committee and Deputy County Health Officer Thomas Warne.
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 Item 4 on the agenda.
3. RECEIVE update on most recent COVID-19 developments and on questions recently received from community members. 
  Dr. Warne introduced himself as one of several team members that support the County Health Officer.  He is a primary care physician at the West County Health Center in San Pablo and is also a County TB doctor.  He is here today representing Dr. Farnitano.

Dr. Warne then responded to a list of questions provided prior to the meeting by the offices of the Committee Chair and Vice Chair.
Regarding the Health Order, he acknowledged that it can be frustrating when one cannot get the information they need when they need it.  In most cases, the County is waiting first for State guidance.

Regarding business concerns, renting offsite venues for large meetings and conferences is not currently allowed by the State.  He encouraged holding such meetings virtually for the time being. Workspace meetings are permitted if following the industry guidance applicable to that business sector.  Small group settings within a business setting are all right but small gatherings outside of the business setting are not currently allowed and should be done by virtual means.

Swimming pool monitors are required by the State to ensure that rules are being followed.  The role can be rotated and filled by a volunteer.  The pool monitor should not be swimming in the pool but should be observing from outside the pool.  State guidance prescribes how pool equipment should be sanitized.  Pool administrators should have a compliance plan developed before opening and should address how the pool monitor will be assigned.

The Health Officer has been consulting with County Board of Education and local school districts, who are responsible for determining how schools will operate within the State guidance.  Questions regarding schools should be directed to the County Board of Education and the local school district, as the County in this regard serves only in a support role. 

Regarding the efficacy of face shields over face masks, Dr. Warne had no opinion yet and said there is currently no evidence to support this claim.  There may, however, be circumstances where face shields are more appropriate, but masks are what are required.  Certain exemptions apply to the mask requirement, in which case a face shield might be a good alternative.  If using a face shield, he recommended that a cloth attachment be added to the bottom of the shield.  He noted that face shields, like masks, can be hot and uncomfortable.  He quoted a study that said in states require face coverings, cases decreased by 51% first two weeks of June, whereas in states that did not require facial coverings, cases increased by 84% during the same period.  These are very early findings but astounding evidence of the importance of masks in preventing spread of infection.

Dr. Warne expressed concern about the recent trends of higher numbers of cases, especially in poor and Latino communities.  The County is opening new testing sites, particularly in impacted communities and is doing multilingual messaging that prevention is key.  He cautioned that all the prevention guidelines should continue to be followed, even in communities with low infection rates.

He said that the Health Department continually monitors the trends to make sure that resources get directed where most needed.  He said that economic recovery timelines are being reviewed and may change, but we are currently on target to open more business sectors on July 1 and mid-July. We are hitting our testing targets and scaling up our case tracking and tracing to position the County to open sooner.  The County is adding another 60 tracers over next two weeks plus augmentation by State resources.

Dr. Warne encouraged testing even if no symptoms. He advised people to reference the County Website a the  GetTested tab:
  Questions Frequently Asked of Committee Members
4. DISCUSS the provisions of the June 16 Health Order reducing Shelter in Place restrictions and also the timeline for future resumption of business and community activities.
  Chair Andersen invited public comment: 
  • Nancy, a craniosacral massage therapist, was concerned about opening too early for her business sector.  She felt that the close contact, small, close rooms, and close physical contact are too risky to resume on July 15, particularly West County where cases are up.  She was also concerned about continuing eligibility for Pandemic Unemployment Insurance (PUI) should be voluntarily opt not to work in the interest of public health and especially of her older, more susceptible clients.  She asked the Health Officer to consult with her industry before deciding if the July 15 opening date makes sense.
  • Kimba Joy Theurich, a massage therapist, said that giving massages violated nearly every CDC COVID-19 prevention recommendation and also said that people who are positive or recovered from COVID-19 have a high risk of blood clotting, which is the #1 contraindication for massage.
  • Barbara Csider asked why is it bad to see a spike in infections if there is no spike in hospitalizations?  She noted that deaths had increased but not hospitalizations and wondered why.  She asked if Contra Costa hospitals are accepting Southern CA patients and, if so, are those patients included in the County’s statistics.  She asked how are COVID deaths counted if there is comorbidity?
  • Linda Aldridge, a massage therapist, asked that massage therapy not be reopened yet, noting the risks that affect virus transmission:  1-2 hours with each client, small workspaces, and close physical proximity. She said that no amount of sanitizing will mitigate these risks.  She fears that therapists will lose the modest PUI insurance if their business sector becomes permissible, but they either choose not to work or their clients choose not to patronize their businesses.
  • Jared Thomsen, Pastor of a local church, asked if masks required or not for stable groups.  He requested clarification regarding church services and a clear distinction between outdoor and indoor restrictions.
  • Jonathan Katayanagi, a parks and recreation director, appreciated the new less-invasive test.  He asked for clarification on Appendix C-2 of the Health Order pertaining to stable groups.
  • Bridget O’Connor, a massage therapist, said she already takes precautions but neck massage is close to the face and impossible to do safely.  She asked how the massage therapists would survive financially if the County permits this business activity when neither the therapists nor the clients feel it is safe.  She was also uncertain and concerned about the effect of massage on people who have survived the virus.
  • Francine, who operates a nonprofit bingo program, requested advice about how the June 16 order applies to bingo.  Dr. Warne thought that bingo might be categorized with Card Rooms but would need to research this question further before he could respond definitively.
  • Ellen Mossman, a massage therapist, commented that safety protocols for her business sector are not supported by scientific data.  Most people do not feel that massage would be safe at this point.  She expressed concern about losing PUI if she chooses not to return to work in the interest of public health.
  • Toni R asked why is there a constant push for testing?  She said that testing has increased but the % of positives nor the number hospitalized hasn’t increased significantly.  She complained that it is difficult to keep face masks on small children.  She asked when will youth sports be permitted.
  • Tina Sherwin asked if staff at nursing homes should be tested every 14 days rather than monthly to match the incubation period of the virus.  She asked if nursing homes have adequate PPE.
Staff then read into the record questions that had been sent via email:
  • Can members of the same household swim in the same swimming lane or do they need to be separated by a lane? 
  • When can cosmetology schools open?  Are they considered with high education or with schools or salons?  
  • Laura Ravazza commented that HOAs usually do not have staffs.  She noted various actions to be taken to comply with the Health Order such as consent forms, pool rules, pool signage, and monitoring for social distancing. 
  • Mike McDermott noted the current County COVID statistics and wanted to know at what point are the number of hospitalizations deemed critical?  What qualifies as high risk?  What numbers will trigger reconsideration of our reopening schedule.  Publicizing these numbers would help to align expectations. 
  • Shari Downum asked for clarification about when masks are required vs. recommended in fitness clubs. 
Dr. Warne responded to the preceding comments and questions.

Regarding the need for continuing testing even when death rates and hospitalizations are relatively stable, he said that testing is key to managing the pandemic because it identifies people who have the virus but are asymptomatic so that they can shelter in place.  Testing, when combined with strong teams of workers to follow up on those cases to see who was exposed so that they can get tested and possibly quarantine, is critical in managing the infection rate.  When we do more tests but maintain a stable hospitalization rate, that indicates that we’re finding more people who have the virus but are asymptomatic, which is key to preventing further spread of infection.  He went on to say that we tend to see the number of positive tests rise followed by a rise in hospitalizations and deaths.  We are now seeing increases in both, which is of great concern. 

Health Services Director Anna Roth interjected that population resistance or immunity is not a national or local strategy or recommendation. 
Regarding HOAs and pools, he acknowledged that it can be a burden and at some expense to comply with the State guidance.  He clarified that swimmers do not have to be 75’ apart.  Rather, the rule is one person per 75 sq. ft. of pool space, which will determine the maximum number of people who can be in the pool at any one time.  The social distancing requirement in the pool remains at six feet between people from different households.  Two people in same household can exercise in the same swimming lane.

Regarding stable groups and social bubbles, he said the rules haven’t changed.  He said the rule for gatherings up to 100 for worship services is very permissive.  The County will continue to rely on State guidance and cannot get ahead of the State.  Generally, outdoor gatherings are safer than indoors.  There is some flexibility with small groups or social bubbles.  Small gatherings of people from different households is generally not allowed. Large general gatherings are not allowed outside or worship services.

Regarding the question of masks in gyms/fitness centers, Dr. Warne said that the more restrictive rules apply, so State mask and social distancing rules apply in gyms. 

Regarding massage services, Dr. Warne said the current timeline anticipates certain services excluding face to be allowed to resume beginning July 1 and then those including face beginning mid-July.  Massage services are currently allowed by the State, so the County is attempting to balance the risk with public need.  This presents hard decisions for care providers.  While acknowledging the differences in duration of client contact, Dr. Warne suggested that massage therapists look to dental and doctor’s offices, and consider ways to minimize risk such as to increase room ventilation (windows, outdoor setting), wear gowns and face shields with cloth attachment, and exercise good sanitation and hygiene.  He agreed to take the concerns about persons with blood clots to the health team, acknowledging that the condition is rare but real, and an important concern. About continuing eligibility for PUI, he suggested possibly seeking a medical exemption from personal doctor if there are personal health concerns about resuming business.

Anna Roth interjected that earlier in the week, the County Health Department provided an update to the Board of Supervisors on congregate living in nursing homes.  June 23, 2020 BOS Meeting, Item D.8.  She also directed people to the County’s COVID-19 site at: 

Regarding counting hospitalizations from other counties, Anna clarified that Contra Costa County currently has four non-county patients in our hospitals and seven Contra Costa patients in other counties’ hospitals.  She directed people to the County’s Indicator Dashboard, which shows hospitalizations.  As to triggers, she said that we don’t want more than 50% of our beds utilized for COVID. She said that ICU utilization and the 3-day average increase of cases are also critical measurements.

Dr. Warne explained that not all COVID patients die in the hospitals because some may have advance directives. 

Chair Andersen asked some follow-up questions. 

Dr. Warne answered that there is no State guidance yet on youth sports.  Youth sports involve cross contact activity and so is risky and will likely not open soon.  He noted that social bubbles could be used for non-contact youth physical activity for stable groups of 12 or less for a period of three weeks.

Dr. Warne believes that cosmetology schools will be defined under state school guidance and also state guidance for hair salons.  He will research this and follow up.

Regarding HOA/pools, it was the consensus of the Committee and Dr. Warne that legal consent forms are an HOA business policy and not addressed or required in the State or County Health Order. 

Chair Andersen ask the Health Department to update the County’s FAQs to clarify requirements for pool monitors.

Vice Chair Mitchoff encouraged people to get tested, citing that the percentage increase in positive tests and number of hospitalizations are key factors.  She said the distinction between death from COVID and death with COVid is immaterial if COVID was a factor causing death.   
Dr. Warne discussed antibody testing, saying the main test for diagnosing COVID-19 is a PCR test, which tests for genetic pieces of the virus.  Antibody test may be useful in the long run but not as much now for diagnoses.

He reminded listeners about the four preventative measures:  Face, Space, Hands, and Home, i.e., wear a facial covering, practice social distancing and hand hygiene, and stay at home if you feel sick.

Anna Roth thanked all the meeting participants saying that the input was very helpful and used to enhance the FAQs on the County website.  She cautioned that the are both good and bad information out there, and encouraged listeners to rely on the County website, which reports and contains links to credible information.  She said that the information continually changes due the nascent nature of the virus itself, and much effort is paid to maintain the relevance and integrity of the website.  She welcomes the feedback.

Chair Andersen invited participants to email questions to her office and Vice Chair Mitchoff’s Office in preparation for the July 2 meeting.
  Updates to Health Order 6-16-2020
  Media Release 6-16-2020
  Updated Road to Recovery 6-18-2020
  Contra Costa Receives State Variance for More Local Control
  CA Facial Coverings Guidance
  Public Comment_Tilde Karlson_6-18-2020
  Public Comment_Terri Nuno_6-25-2020
5. RECEIVE and APPROVE the Records of Action for the June 11 and 18, 2020 meetings.
  The Committee approved the records of action for the June 11 and 18, 2020 meetings as presented.
AYE: Chair Candace Andersen, Vice Chair Karen Mitchoff
  DRAFT Record of Action for the June 11, 2020 Meeting
  DRAFT Record of Action for the June 18, 2020 Meeting
6. The next meeting is currently scheduled for July 2, 2020.
  The Committee decided the schedule the next meeting for July 2, 2020 at 1:30 p.m.
AYE: Chair Candace Andersen, Vice Chair Karen Mitchoff
7. Adjourn
  Chair Andersen adjourned the meeting.

For Additional Information Contact:

Julie DiMaggio Enea, Committee Staff
Phone (925) 335-1077, Fax (925) 646-1353

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