Good afternoon, everybody.
Welcome to our special briefing on
COVID-19 for Friday,
September 4th, featuring Dr.
Sundari Mase, the Public Health
Officer for Sonoma County.
Before we get started, we have a brief
message for our Spanish
speaking viewers today.
Jose?
 
 
 
 
 
 
 
Thank you, Jose.
And so with that we'll now go to Dr.
Mase, who will go into a little bit more
on the numbers about COVID-19
and Sonoma County, Dr. Mase.
Great, thank you very much.
I'm actually just going to present
a PowerPoint for everybody at this time.
I don't know if you wanted to give the
updated numbers, Paul, while I'm
preparing the PowerPoint or
Sure.
Let me . . . so
as of the latest numbers, we have
an additional seventy five cases as of
yesterday, bringing to a total of six
thousand one hundred and forty two cases,
two thousand three hundred sixty of those
are active cases and three thousand six
hundred eighty nine recovered cases.
We had four more deaths over the last 24
hours, bringing our total death count
to ninety three for Sonoma County.
And we've had
seven hundred and seventy one additional
tests for a total of one hundred and four
thousand three hundred eighty
seven tests for the county.
OK, great, thanks very much for that.
Are you seeing my screen here, correct?
Yes, you're OK.
OK, great.
So
this presentation was put together by our
epidemiologists specifically to address
some of the questions that the community
and everybody else, the media and other
stakeholders have had about
why it is in Sonoma County
we have a higher case rate
and higher test positivity.
And how do we compare with
our neighboring counties?
So our epidemiologists (that's Lucinda
Gardner, Kate Peck and Jen Mercato) put
together (and Julia Ruben) put together a
really nice presentation that may
answer some of these questions.
So as everybody here knows, on August
28th, Governor Newsom introduced the
"Blueprint for a Safer Economy," a new four-tier structure for reducing COVID-19 with
revised criteria for loosening and
tightening restrictions on activities.
This framework replaced the former County
data monitoring criteria that we were
using for the past several months.
New criteria, just to quickly review,
consists of four tiers:
there is purple for tier one; red for tier
two; orange for tier three;
and yellow for tier four.
Purple indicates widespread
community transmission of covid.
Red indicates substantial
disease transmission.
Orange specifies moderate
covid-19 transmission in the
community and yellow minimal.
Many more businesses and sectors would be
able to reopen in yellow
and some in orange.
The red really impact schools
because schools can go to
face-to-face learning, not
just distance learning
if in the red, but in the purple we're
still restricted to where we are.
The only things that opened last week
were barbershops and hair salons and
indoor malls for twenty
five percent capacity.
And the reason for those openings was the
State determined that they were not seeing
a lot of transmission in those particular
sectors or businesses,
and they were lower risk.
Therefore, they were able to open.
Now, the two new metrics that are being
used to determine where a county falls in
terms of these tiers are new cases per
100,000 population per day,
and that's a seven-day average with a
seven-day lag period for
the State to get our data.
The other measure is testing positivity,
which we've always used, and that's also
based on a seven-day average
with a seven-day lag.
And all that means is the percentage of
tests that are positive over the
total number of tests performed.
So for Sonoma County then,
given that we have five hundred
thousand people in the population
over a seven-day average,
we would have to have
less than thirty five cases a day
over a seven-day average in order to get
out of the purple and
into the red. Right now,
and I'm going to show you that in the next
slide, our numbers are higher than that.
To be in the red, you'd have to have a
new cases per 100,000 population per day of four to seven
or again for Sonoma County, that would be
somewhere between
20 to thirty five cases per day, over a
seven day average and then one to three
point nine to be an orange and
less than one case per day
per hundred thousand.
So that would basically be less than five
cases a day over a seven-day
average to get into the yellow.
So I hope that kind of
clarifies things a bit.
Testing positivity is
what it's always been.
If you're greater than eight percent of
your total tests are positive, then you're
in the purple, five to eight percent in
the red, two to four point nine percent in
the orange and less than two
percent for the yellow.
So how does Sonoma County compare
to the region and state this week?
Well, as of last Tuesday, we were one of
thirty eight counties in
the state that are in tier one or purple.
And as you can see from this map of
California, the majority
of counties starting
in our area and down are in the purple.
There are some notable exceptions.
There's Napa that's in the
red and San Diego in the red.
And then some of the counties that are
north of us that are smaller or have lower
populations haven't been
impacted as much by covid.
And so they're actually in the
orange and or in the yellow.
And you can see it kind of
on our eastern border there.
We also have some counties in the orange
and yellow, but we are in good company in
the purple with thirty eight or the
majority of the other counties.
The measures of spread of R-effective, I
know that many people have heard me talk
about that are R-effective or are not,
that basically refers to the average
number of additional people
infected by each person with covid.
So if your R-effective is one, each
person is infecting one other person.
If your R-effective is 2 then each
person is infecting two,
so on and so forth.
If the R-effective is less than one,
then we are talking about a decreasing
spread, whereas if it's greater than one,
we're talking about an
increasing spread of covid.
We were actually the other day we were
somewhere around point eight or point
nine, which is actually
less than one, which is a good
sign suggesting decreasing spread.
However, last week we were number
five in terms of counties in terms of
the R-effective number;
in other words, the fifth highest, and now
we're closer to somewhere around
13 or 14 in terms of number,
the ranking of counties
for R-effective..
And this changes on a
daily and weekly basis.
If you look at the covid-19 cases by city,
and we're still trying to collect this
data for Cotati,
but you can see that as you'd expect,
we have the most numbers of cases in Santa Rosa, Petaluma, Sonoma, Rohnert Park,
and then some of our
more rural areas are less affected:
Healdsburg and Windsor, Sebastopol, you
can see Cloverdale had a recent spike.
And that, I think is due to some outbreaks
we've seen in farm workers and the
agricultural community and the Latinex..
So as you'd expect, it's our urban centers
that have the most cases and you can see
what the cases have
been over time as well.
If you take a look at the regional
comparison, that's to other Bay Area
counties for new cases per 100,000 per day,
the seven-day average with seven-day lag, Sonoma is an outlier.
We are at fifteen point six cases per
100,000 population per day,
whereas it looks like Alameda and Contra
Costa are around 11, San Francisco
around 10, Solano nine, Santa Clara
and San Mateo around eight point six.
Napa six point five and Marin five point
three I'm sorry, five
point nine.
And then looking at testing positivity,
we're also an outlier in the Bay Area
with ten point six percent of our cases
being positive based on our data.
The State data shows we're at six point
five or six point four percent and we're
trying to resolve that difference
in results, but in our own data,
which is quite up to date, we
are at ten point eight percent.
You can see the other Bay Area counties:
Alameda, Contra Costa are around six
percent, San Mateo at five percent, Solano
closer to four, as is Napa,
Santa Clara at three point five, San
Francisco, three point four
and Marin at three point.
So why is this? Well, it is important to keep in mind
that we in Sonoma County have a few key
differences from our Bay Area neighbors.
Sonoma County is a home to
tourism, agriculture and industry.
Essential workers in Sonoma County
largely live and work within our
borders, so we count them as our cases.
Marin and Napa have a
smaller population base.
Napa is about one hundred
and thirty five thousand.
We are at five hundred thousand.
And the essential workers,
often because they can't afford to live in
Napa and Marin, live in other counties
and commute from other places.
So those essential workers, that's the
farm workers, agricultural workers, the
vineyard workers, the
essential businesses from day one, the
food and beverage production, all those
janitorial services,
even sales and service,
Marin and Napa don't count
many of those cases
for their county data, because they don't
live in their county, it's the county of
residence that counts the cases
and Sonoma probably has a share of these
people who work in Marin and Napa.
Contra Costa, Alameda, Marin and San
Francisco do not share similar industries.
They don't have significant
agricultural and food production.
And they don't employ a lot of the Latinex
in the settings that we've already
described, which lead to more transmission with
very close, crowded conditions
and things like that.
So there are some really distinct
differences
in the drivers of infection that we're
seeing in Sonoma County versus in
our neighboring Bay Area counties.
In addition, we've had a very different
approach to testing, we have been testing
a lot and on all contacts, asymptomatic or
symptomatic from almost day one, I think
in March we implemented our very
aggressive contact tracing and
testing, isolation and quarantine
based on
our
our approach, you know,
based on the fact that I've done a lot of
work in tuberculosis, which is very
similar to an infectious disease, like
covid-19, not as transmissible.
And I put into place
complete, thorough
contact tracing early on.
So we've actually been finding
a lot of cases using these aggressive
strategies for case finding.
So we have an agile, responsive testing
team made up of many nurses
that are out there testing every single
day at work sites, at communities, at
facilities, vulnerable populations like
our skilled nursing facilities, in our
residential care facilities,
performing surveillance, testing in
the jail, in the homeless population,
going to any outbreak setting and testing
everybody and doing pop up testing, as you
know, for the Latinex every weekend we've
been doing pop up testing in Cloverdale, in
Roseland, in Santa Rosa
and setting up sites specific for Latinex
so we can find more people
who could be infected.
So the other thing we have is a really
wonderful large network of community
clinics and other major health
care providers that are testing
all persons giving access to care,
including family members and contacts.
Many of our clinics serve the Latinex.
We have very high rates of positivity,
which is a really good thing.
It means that they're testing
the right populations.
They are singling out the most
high risk populations for testing.
Santa Rosa Community Center,
the Vista Health Center, Alliance Health
Center are a few
that I know that have positivity rates in
the twenty four percent range,
meaning that one in four people that
they're testing are actually
positive for covid.
So we're really reaching the group that
needs to be tested through our
fantastic network of health centers.
We also have a fully staffed public health
laboratory, so we are not limited by
laboratory testing or turnaround times.
Even when Quest Lab
had a very slow turnaround time of seven
to 10 days, our lab was doing all of our
priority testing for our health care
workers, first responders, contacts,
outbreak situations, congregate centers
and still having a wonderful
turnaround time of 48 to 72 hours.
Now our lab is scaling up to be able to do
seven hundred and fifty to a thousand
tests a day, which is really what we
need for our capacity in our county.
And it currently the lab is
performing about 500 tests per day..
So we also have 2 OptumServe
sites rather than just one.
Early on, as soon as we got our first
OptumServe site,
we noticed that our community had booked
appointments out for a month and we turned
to the state and said, we
really need another one.
We're one of the few counties in
California that actually has 2 OptumServe
sites with four lanes total able to
do five hundred and sixty tests
per day for our community.
So I guess the real takeaway from all this
is while geographically close, our
neighboring counties have really different
drivers impacting their case rates
and have very different testing
strategies because of all the
factors that I've pointed out.
To look at a more comparable example, our
epidemiologist chose Monterey County.
Like Sonoma County, Monterey County has a
similar population size and demographics,
substantial tourism, beaches,
strong agricultural and food production
industries, and essential workers who live
and work within boundaries
within the county.
You look at the comparison of the case
statistics between us and Monterey, 
we're actually spot on.
We are at fifteen point six they're at
fifteen point five cases, new
cases per 100,000 per day.
We have a testing positive at
ten point six percent,
theirs is ten point nine percent.
And our epi curves, in other words, the
cases over time look very similar,
as you can see in these graphs.
The race and ethnicity
of our cases is similar.
They have 73 percent of their
cases occurring in Latinex.
That's where we were last month
before we started aggressively,
right after we started aggressively
testing in Latinex and we saw a shift
from Latinex to white, non Hispanic.
And because we've been testing in all the
other outbreak situations that are not
just Latinex, we're at 50 percent now.
We were at seventy three
percent a month ago.
And you can see the breakdown of the other
race ethnicity markers.
And it really is who you're testing, how
much you're testing, where you're testing
that leads to some of these disparities.
Of course, there's real disparities in why
certain race races and ethnic groups have
more covid in them,
essential workers, chronic conditions, the
inability to comply with mitigation
measures like social distancing and
physical distancing and
hygiene measures, that kind of thing.
We've talked about all this before.
So, again, Monterey County has had lots of
outbreaks in the Latinex community and
outbreaks amongst agricultural and farmworker
cases by age group were also very similar
to Monterey County, as you can see,
with a very similar distribution.
Again, because our essential workforce is
like their essential workforce:
between the ages of 18 and 54.
And they're the ones who are out there as
essential workers working in
places like agricultural farm work, food
and beverage production, et cetera.
So there's very similar trends seen in
cases by age group between
us and Monterey County.
So again, what's our
take away from all this?
Sonoma County's pattern of cases is
similar to other counties that share our
demographic industry and tourism profiles,
focus case funding efforts, extensive
field testing in vulnerable populations
such as our skilled nursing facilities and
residential care facilities at work sites
and systematic testing of all close
contacts, both symptomatic and
asymptomatic, have yielded a
higher number of positive cases.
And yes, it does show us as having
a higher test positive rate.
But it's a good thing because we're
finding the cases and finding them
quickly, getting them to isolate out of
the community, getting their contacts
to quarantine and be tested.
So it's actually a really in the long run,
this is how we're going to beat covid,
by doing all of this, of course, in
addition to other things that are around
the corner, hopefully
vaccine and more treatments.
So what can Sonoma County do now to slow
the spread of covid-19?
We can continue the focused approach to
testing, contact tracing and data driven
case finding that we've been discussing;
can reinforce the importance of wearing
facial coverings or masks, social
distancing hygiene measures,
wearing masks and ride sharing, especially
on the way to work van
pools, things like that;
and we can avoid gathering, especially as
we're coming upon a long weekend here
for Labor Day weekend.
It's going to be hot.
The air quality is poor.
I highly recommend people stay in their
households with their household members
and don't gather in large groups,
either indoors or outdoors.
We can encourage workers to stay home when ill,
make sure people don't report to work,
especially in health care settings when
they are ill, then urge employers to
provide sick leave when possible so that
people don't have to go to work
when they're ill.
We can provide outreach to the
agricultural industry, skilled nursing and
other congregate and vulnerable settings to
strengthen prevention and mitigation
measures which we're doing and which we're doing also through our Latinex core group.
I think I am going to end there.
I do believe that is the last slide.
Stop sharing and we can
take questions now.
I think we're going to
end up recording there.
Thank you very much, doctora
Mase We really appreciate that.
That overview.
