• Thu. Apr 15th, 2021

Prevention & Cures

Well-Being.Medical Advances Mental Health. Longevity. Prevention & Cures.

Dr. Ennis Urges You to Get Tested and Tells You Youre Probably Not Going to Get Those Monoclonal Antibodies Quite Yet – Lost Coast Outpost

By

Nov 11, 2020

Today, Dr. Josh Ennis — Humboldt County’s deputy health officer — took questions from the local media on a variety of topics related to the pandemic, including what are preparations are for a potential new vaccine, whether or not a new therapy will be available to local residents soon, what happens if we move into a more restrictive tier in the state’s COVID framework, and much more.

He also spoke about the surge in cases — nationally, statewide, locally — and urged everyone to schedule a test.

Video above, rough transcript below.

###

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

Yeah I’d like to take a moment to talk a little bit about where we’re at right now.

So as a nation, there is a third wave, ongoing, with the pandemic.
Confirmed case positivity rates are higher than they’ve been before.
Some parts of the country are seeing unprecedented numbers.
California’s also seeing somewhat of an uptick, and here locally in Humboldt County,
we certainly are experiencing that as well.
And the vast majority of these cases appear to be travel related and in many of them,
out-of-state travel, specifically to places that have much higher rates of disease.
So what we’re looking at now is many smaller clusters or cases that are seemingly unrelated,
and so the cases are scattered throughout. This is very different from what we experienced a couple months ago, whereas related to a
couple big clusters we were chasing for some time.

So this is very different this time around, and I would like to put the call out to really
make responsible decisions and question if now is the time to be traveling out of state,
and bringing multiple, different households from different areas together.
We need to support our local businesses, we need to keep our test positivity rate down,
so I challenge you to go get a test and show that it’s negative.
The sooner we can get on top of this, the more likely it is that we stay where we’re
at, we can support our local businesses, make sure that they thrive, and that their livelihoods
are supported.

So, inherent in this is that asymptomatic spread is playing some role.
I said this a couple weeks ago when we looked at our hospitalizations, that we felt there
was more asymptomatic spread based on the hospitalization census numbers.

And so I will just reiterate, prove to yourself, prove to me that you are negative.
Drive our test positivity rate down and keep our businesses open. 

The Two Rivers Tribune asks, “Why are the County’s numbers for Hoopa different than
what Hoopa is reporting?”

The way we report this data is by ZIP code, because that is how it’s entered in the
state’s CalREDIE system.
So we look in the CalREDIE, we extract the data by ZIP code, and we report it out.

Now what you need to understand is that as investigations happen, a nurse picks up the
phone, asks ‘What’s going on, what symptoms are you having, where do you live?’
And what we experience is that the address of record can change over time.
People don’t always put the appropriate address on the paperwork that’s involved
in testing.
And so this can change on a day-to-day basis.
So the ZIP code data on our dashboard is not useful on a day-to-day comparison.

Now because of that, and that Hoopa is maintaining their own records and parallel investigations
and tracing, sometimes there can be a slight discordance in what Hoopa is reporting and
what we see in CalREDIE.
I’d reassure you, though, that if you have any concerns, that our communicable disease
team is in close contact with the team in Hoopa and we’re working, any time there
are discrepancies identified, to reconcile those differences.

The Two Rivers Tribune asks, “Why does the County lump other towns into the geographic
report? For example, Hoopa’s zip code is 95546. Weitchpec and Pecwan also use 95546, but are their own communities that are approximately
10-30 miles away from Hoopa. For the purpose of reporting data to the public, could it be misleading to lump multiple towns
into one zip code?”

So I explained a little bit about the CalREDIE data extraction by ZIP code.
The ZIP code reporting is really the easiest way to do this for what’s available.
We wish to build upon what’s already available to us rather than to recreate parallel databases
that we have to actively manage and pull data from.
So we’re building upon what already exists at CalREDIE.

I don’t think this is misleading because people should not be using this information
to judge and assess risk with towns that are only 10 to 30 miles apart.
The reality is we have seen cases everywhere.
This data speaks to their address of record, and you and I know that people drive 10, 20
miles, sometimes on a daily basis if people have work that brings them to other areas.

So it’s really not a great way to judge risk, it should not change our practices.
So I don’t think it is misleading in any way. 

The Two Rivers Tribune asks, “If there are cases on the Yurok Reservation, how will those
communities be notified?”

Any time there is a case on tribal land, we have reached out to the liaison or appointed
tribal government leader, whether that’s the incident commander or if they’ve appointed
a health officer, and we communicate and work closely with that person.
And for each individual tribe it has looked a little bit different depending upon capabilities
on the ground, as well as the governmental OES structure within the tribe.
For Yurok, they do have an appointed health official, and so we would typically reach
out to that person first and take it from there.
Thank you.

The North Coast News asks, “Recently, there has been a slight uptick in new daily cases
reported by the JIC.
Do you believe Halloween gatherings contributed to this increase?”

Certainly, we know that gatherings, when you bring more people together, there’s more
risk for transmission.
The uptick started before that.
So did Halloween gatherings spurn all the recent cases?
No, we thought it was floating out there just based on the hospitalization census data to
some degree.
But did it have the potential to amplify the cases?
It certainly did and in some of our recent investigations, we have seen gatherings on
Halloween play a role.
So it does contribute in part and if we’re going to really make any difference in slowing
down transmission, this is a big area where it can make a difference.
It’s in gatherings.
And trying to keep the cohorts stable, trying to minimize the number of people who are brought
together, and this is especially important as we go into the colder months and the holiday
season, to be really mindful of this and keep our businesses open.
Thank you.

The North Coast News asks, “One of the chief concerns about the Pfizer vaccine is the need
to keep it extremely cold.
Do any Humboldt County medical facilities have the resources to keep vaccine doses at
such a temperature, and if not, is the state providing any help to purchase such equipment?
Could more rural counties like ours be left behind when statewide vaccine rollout begins
due to equipment inequities?”

So the most likely vaccines to come out early on do require ultra-cold storage.
Our county has been planning for well over a month around a vaccine rollout in anticipation
of that coming in the near future.
So we’ve been having discussions with health care partners for quite some time.

I’d like to reassure people that we do have ultra-low temperature storage capacity in
Humboldt County.
It naturally introduces a lot of logistical challenges, because that storage, that cold-chain
management, certainly complicates things a lot.
Once you thaw it out, it’s only good for a fairly limited amount of time.
So there’s a lot of planning that has to go around this.
The state is very attuned to inequities, so they want to ensure equitable access.
So this is well on the state’s mind, and in fact, we are well positioned in Humboldt
to serve as a regional hub for a greater distributional model.

So in fact, I think we actually are better positioned where we’re at, because we’ve
shown that we can be strong in being a leader for the greater region.

The North Coast News asks, “When and if small amounts of a vaccine are provided to
Humboldt County, has public health decided which medical facilities are being prioritized?
Would priority be given to larger hospitals before smaller ones?”

So building upon that planning that we’ve been doing, the CDC has released a playbook
around this, the state has developed their own plan, and similarly, we’ve adopted some
of those guidelines for our planning efforts.

The first phase, we know there’s going to be limited vaccine, and so that’s Phase
One if you go by the CDC playbook.
And we’re planning to target health care workers who have direct exposure to patients
who are potentially infected or known to be infected.
And so naturally that’s the acute care setting.
I would hope that there would be some amount of planning at the state level around this.
And based upon the surveys they’re sending out, they are planning around this, that we
look at how many people work in that setting, and we deliver it for all of them, that we
don’t have to pick and choose.

Now if there were a prioritization that needed to happen, I don’t know that we’d frame
it as a larger vs. smaller, we’d probably look to where the most burden of disease is
at and try and make decisions based upon where the burden of disease is at.

The Lost Coast Outpost asks, “Given our rising case counts, is the county at risk
of moving back up into the state’s orange tier?
When is the earliest that could happen?”

This is certainly something that we’re paying very close attention to.
The more our case counts go up per population per 100,000 people, the more likely it is
that we have to move backwards into a more restrictive tier.
I’ve already explained that this can have a dramatic impact on some of our businesses
because they cannot have the maximum amount of capacity allowed in the yellow tier.
They may have to move some operations outdoors, instead of indoors.
So this can have a dramatic impact upon our businesses.

We have to be in a higher, more restrictive tier, for two consecutive weeks before we
actually move.
And the state has been announcing these assessments typically on Tuesdays.
So we’re awaiting the state’s announcement today with where we’re at.

Once it’s determined that we’ve been in a more restrictive tier with our numbers,
our case counts, for two consecutive weeks, the state says we have three days to enact
those more restrictive measures.
So we’re looking anxiously to see what the numbers demonstrate today.

And next week, come every Tuesday, we’re anxiously awaiting.
So, the soonest would be two weeks from the moment we are assessed to be in a higher tier
for our case counts.

The Lost Coast Outpost asks, “The FDA recently gave Eli Lilly a new emergency use authorization
for bamlanivimab, a monoclonal antibody therapy for COVID-19.
When might Humboldt County residents have access to this therapy?
Or when will we have it in sufficient supply for all patients who might benefit from it?”

First I want to clarify what emergency use authorization is.
This is a very preliminary authorization by the FDA to allow use of an investigational
drug.
It is not the same thing as FDA approval.

So that being said, it’s based on very limited, small amounts of data that look promising.
So this drug as far as I know, the analysis part way through was based on a few hundred
patients, and the data looked promising.
And it didn’t appear to cause dramatic harm so they’re allowing it’s emergency use
authorization.

Now, that being said, I believe that they had cued up on the order of a couple hundred
thousand doses.
If you think about the entire nation and what kind of disease burden there is, I think it’s
safe to say that it’s gonna be quite some time before we see this locally.
The experience with remdesivir, is that it took on the order of several weeks before
we started seeing appreciable quantities here locally.

And so, I don’t know that I’d be calling the hospital quite yet asking about this therapy.
I think it’s going to be at least several weeks before we start seeing it show up locally.

The Times-Standard asks, “What would happen in terms of changes if the county shifts tiers
in the state system?
Is it an expected move?”

I think I’ve already discussed this to some degree.
Our recent rise in case counts are of concern.
That can only go so long before we ultimately have to move back if we’re in the higher
tier – orange – or higher for two weeks in a row.
This would have a dramatic impact upon businesses.
So again, we’re trying to put the call out now.
Let’s drive our test positivity rate down.
We may see cases go up slightly, but in the longer run this is buying insurance to help
keep our businesses open longer.

The Times-Standard asks, “There seems to be an increase locally in folks not wearing
masks.
Is there any effort by the county or by local law enforcement to be more strict about enforcing
masking rules?”

This is something we’re still hearing in our Joint Information Center fairly regularly.
These complaints are now being sent on to local jurisdictions.
So for example, if the business is located within city limits, this goes on to the city
of Eureka.
At this point, nine months in, we all have to exercise some amount of responsibility
for this.
This is a social responsibility.
We are all public health, this is far bigger than just the employees that work within public
health that work within the county and we’re really asking for folks to buy into that social
responsibility.

The Times-Standard asks, “Given that vaccine hesitancy is prevalent in Humboldt County
— more than a dozen schools fail to meet the 95% threshold for vaccines among students
— what is the best-case scenario for spreading a potential COVID-19 vaccine?
What’s the worst-case?”

The answer to this question hinges upon how efficacious the vaccine is.
Pfizer has released some initial numbers, but it’s very hard to make a judgment on
those numbers when it is reported exclusively through media.
So until that data has been vetted and analyzed by the scientific community, it’s really
difficult to answer this question because the efficacy will dramatically affect how
many people will need to be vaccinated.
And over what period of time before we reach this concept of herd immunity where we can
stop transmission.

So, there’d be a lot of speculation in answering this question about best case scenario, worst
case scenario – it all hinges upon how well the vaccine actually works, so rather than
speculate, I look forward to reviewing the data from Pfizer.

Reporter Ryan Hutson asks, “On Oct. 21st, there was a notice regarding the alert system
via texts being interrupted, stating “the vendor that hosts the county’s website,
CivicPlus, is working to resolve the issue, but there is no timeline for restoration of
text message notifications.” Is this fixed, and if not, do you know when it is expected to be functioning again as
intended?”

So the CivicPlus program has been fixed, our website wasn’t impacted by it and my understanding
is that only the notifications were affected.
If you’re experiencing otherwise, we encourage you to reach out, but this issue has been
resolved to our knowledge.

Reporter Ryan Hutson asks, “The data presented in the county dashboard is proving to be useful,
except when the dashboard is translated via the Google Sheets option Google Translate,
which somewhat reformats the data as presented in English, causing many of the graphs to
overlap, making them difficult to read, while other aspects of the data are not translated
at all, leaving most of the specific data factors noted in English even after selecting
a new language.
Is there anything that the county/technical staff with the JIC can do to fix these issues?”

So this sounds to be a problem based upon Google Translate and certainly it has its
limitations.
This would be something that would probably need to be taken to Google.
I don’t know that we have any fix locally for this issue that’s pointed out.

The Redheaded Blackbelt asks, “If Humboldt County is moved to a more restrictive tier
as a result in the spike in cases lately, can you give us an idea of what restrictions
would be put into place for local businesses currently open to the public?”

Sure, so if we were to move to a more restrictive tier, and the most likely scenario is to move
from yellow to orange – generally speaking most of the sectors have to reduce maximum
capacities, they have to move some of the activities from indoors to outdoors.
And then all together close some of the indoor activities.

And the most impacted here from a move to yellow to orange would be bars, breweries,
distilleries; it’d be restaurant capacities, wineries, family entertainment centers, museums,
zoos and gyms.
And so, this would naturally have a large impact on the workers in these places, it
would have an impact on the revenue.

And so this is really important to try and work hard to prevent movement between tiers.
And I’d just like to remind everyone that this is not a local county order, this is
the state’s tier framework and it’s determined by them.
So this is something that is not negotiable.
It is a state-developed tiered framework and it is enforced by the state as well. 

 

Loading ....

Leave a Reply

Your email address will not be published. Required fields are marked *