Here’s what Fresno County must do to reach California benchmarks for COVID-19 reopening
New benchmarks issued by Gov. Gavin Newsom and the state Department of Health Services set forth a path for California counties to enter the next phase of reopening their economies from a coronavirus lockdown at a faster pace than the state as a whole.
But under the criteria announced Thursday, Fresno County has considerable ground to make up before it can begin allowing a larger array of businesses to reopen while maintaining social distancing measures to prevent a resurgence of COVID-19 infections.
“The state has laid out a very detailed framework,” said Dr. Rais Vohra, Fresno County’s interim health officer. “We have a lot of work to do.”
The standards for a county to progress through Stage 2 of the state’s Pandemic Roadmap at a faster pace include being able to certify that no more than one new case of COVID-19 per 10,000 residents has surfaced in the county over the previous 14 days, and that no deaths have occurred from COVID-19 in the two weeks prior to certification.
As of Friday afternoon, however, the number of new cases identified through increased testing in Fresno County over the past two weeks is 383. That’s 3.7 per 10,000 residents – nearly four times higher than the state’s benchmark. The county also had two deaths from the coronavirus over the past two weeks. Both would appear to disqualify the county from moving forward in an accelerated manner.
The cumulative number of COVID-19 reported in Fresno County since the first case in early March was 841 on Friday, including nine deaths. Nearly 90 patients countywide, either confirmed or suspected of having the disease, were hospitalized as of Thursday, including 18 who were being treated in intensive-care units throughout the county, according to the state health department.
Testing
Fresno County also continues to lag in its capacity to test enough people to ensure that COVID-19 infections aren’t going undetected among residents who may not be sick or showing any symptoms yet can still spread the virus.
The state’s standard, based on guidance from the U.S. Centers for Disease Control, are that a county must be able to conduct at least 1.5 tests per day for every 1,000 residents. In Fresno County, with a population of just over 1 million, that means having the ability to test 1,500 people every day.
Vohra estimated that as of Friday, labs and testing sites throughout the county are conducting between 700 and 800 tests every day. That’s somewhere around half what’s needed if the county wishes to reopen businesses more quickly.
The county has been aggressive in its collaboration with the state to open testing sites. Two new “high-volume” testing sites recently opened their doors for appointments – one at Fresno City College, the other at the city of Sanger’s community center. Together, the two locations can collect nasal swabs for testing from about 260 people each day, in addition to the tests already being administered by the county health department.
“We’re slowly ticking up” the testing capability, Vohra said. “I hope that in a week or so we’ll be up over 1,000 (tests per day). Our hospitals are now finally getting the swabs and the culture kits they need to do testing at their maximum capacity.”
Contact tracing
The county must also be able to demonstrate its ability to conduct sufficient “contact tracing” – investigating patients who test positive for the virus, and track down the people with whom they’ve had contact in their workplace, stores or businesses or in the community. Those people will be tested and, if necessary, contact tracing done to follow up with their personal interactions.
The state “actually gives a number somewhere around 150 to 250 contact tracers for a county our size,” Vohra said Friday. “Currently we have 30 to 50, so we know we need to expand our number of troops … to match the number of anticipated cases that we’ll have and really to match the complexity of these cases.”
“We’re planning to have 300” tracers, Vohra added. “This does take some detective work, some deep investigation, not only to figure out who’s a ‘close contact,’ but also to ask the harder question of how to prevent this from happening again in the future.”
Fresno County Public Health Director David Pomaville said the county has about $10 million set aside from the federal coronavirus relief act passed in March to support an expanded program of contact tracing from June through the end of 2020.
Hardest standard to meet
The county has some measure of control over establishing more test sites and hiring the staff needed to conduct the necessary contact tracing.
But limiting COVID-19 cases and deaths related to the virus are beyond what county leaders can achieve through budgets, testing contracts and hiring more people.
Having no deaths over a two-week stretch “is going to be the hardest standard for us to meet,” Vohra said. “It’s going to be very difficult … the way things are going, with our case counts and (intensive-care unit) census going up.”
“Knowing that some of our skilled nursing facilities have been affected, fatalities are unfortunately to be expected with some of these patients,” he added.
Vohra added that he anticipates many counties will be vocal in expressing their concerns to Newsom and state health officials about a death standard that could be seen as unrealistic. He added, however, that the state’s standards involved any counties that want to receive a variance and reopen faster than the state as a whole.
“We do anticipate that the state will move – maybe not as fast as we would like it to – and will allow more businesses and more sectors of the economy to come online,” Vohra said. “We have to prove, if we want to move faster than the state,” that the county can achieve the standards.
“I think the state Department of Public Health understands that not all counties are the same,” he added. “I’m hoping they can rationally listen to the case that we can make whenever we as a community feel we can go forward after we’ve done our due diligence.”
As he has said in many of his frequent updates on the county’s coronavirus status, Vohra said reaching a point where the county can safely reopen the economy will depend on continued public vigilance for hand washing, personal hygiene, social distancing, wearing masks in public, and other common-sense measures to stem the spread of the virus.
“The information that we share shows that the curve hasn’t gotten totally flattened,” he said. “We need to proceed with caution. But I also understand that the way we have been operating for the last two months with only the critical infrastructure industries is not sustainable for the long term.”
The situation requires a balancing of risks. “We know the number of cases will go up when people have more gatherings and more intermixing,” Vohra said. “We pray deaths don’t go up.”
This story was originally published May 9, 2020 at 9:35 AM.
