Fresno County public health officer: In coronavirus pandemic, stay calm, stay apart

These are uncertain, stressful and disruptive times for all of us as we adjust to life with the coronavirus disease 2019 (COVID-19) pandemic, and cope with declarations of states of emergency, school closures, social event cancellations, restaurant and bar closings and most recently a shelter in place order in the city of Fresno.

As interim public health officer for Fresno County and an emergency medicine faculty member at UCSF Fresno, I want to assure the community that these steps are necessary for public health and safety. With the case count in Fresno now at 13 (as of Tuesday) and climbing, there is no time to lose in making sure that we do all we can to protect our community’s most vulnerable residents from this expanding contagion.

Fortunately, we know from the science of epidemiology and the history of medicine that community measures can keep the general populace relatively free of disease in an epidemic that is as contagious as COVID-19. Through widespread acceptance of “social distancing” strategies (including sheltering in place by staying home and abiding by a 6-foot personal separation between other people), the spread of the coronavirus can be slowed. The general concept is easy to grasp, even though the execution takes constant vigilance — break the chain of infection by minimizing all social contacts that are unnecessary. It is imperative that we use this knowledge to apply brakes to the virus now, before we see an exponential increase in cases that has engulfed Italy, France, Spain and other countries.

Make no mistake, the virus already is entrenched in California and has affected many residents of the central San Joaquin Valley. Although our testing capacity is limited, it does reflect the general pattern that has been observed in other parts of the state and nation.

First, there are cases related to travel from “hot spots” of disease, and then there is a shift to contact-related transmissions (person-to-person spread) within the county. The final and most dire stage of an outbreak is the onset of unchecked community transmission, which is extremely difficult to contain and taxes all available medical and social resources.

Our medical system faces a grave challenge in this pandemic. As of Monday, March 23, the California Department of Public Health had recorded over 2,200 cases of COVID-19, resulting in 42 deaths. Here in Fresno County, there are currently 13 COVID-19 confirmed cases, mostly related to travel and person-to-person contact with confirmed COVID-19 cases. We fully expect cases in Central Valley areas to quickly multiply in coming weeks as additional testing is done for those with symptoms of fever and respiratory illness.

Community transmission is a real possibility because of the population in Fresno County. Although 80% of people who become infected will have mild symptoms and recover at home, some scientific models show 5% of COVID-19 patients will need to be hospitalized and 2% will need intensive care. We all need to limit these numbers, which could overwhelm all of the capacity we currently have to respond appropriately.

Fresno County has 149 intensive care unit beds for a county of nearly 900,000 residents, and Valleywide there are about 300 ICU beds. In normal times, our ICU beds are full or nearly full. Our hospitals and the providers who care for patients in them will be overwhelmed unless we slow the growth rate of new cases so that a peak outbreak is avoided, or at least delayed, lessening the overall impact of the pandemic.

This novel coronavirus does not discriminate. No one has immunity to it, and people who are 65 and older have been the most vulnerable, accounting for most of the confirmed cases and fatalities worldwide. However, even children can transmit the virus to others, and younger adults have been hospitalized, according to reports from other U.S. cities. It is critical that all of us — from Gen Z to millennials to boomers — embrace and adopt extreme social distancing measures.

At our hospitals and clinics there is much concern that our providers will be running out of personal protective equipment such as masks. At a community level, the most impactful personal protective equipment we can put to use against this germ is simply the space we maintain between ourselves — and when we do, we will in turn be helping to spare our first responders and health workers from the terrifying possibility of running out of their own personal protective gear as they battle the epidemic on the front lines.

The most useful path, going forward, for all of us is to stay apart but work together in this effort to change the spread of the disease. While these are not everyday habits for many of us, they will be essential skills to curb this contagion:

▪ Observing shelter in place orders and staying home as much as possible.

▪ Abiding by the prohibitions in place for organized events: no more than 50 people in meetings; and 10 people or fewer in gatherings which involve the elderly.

▪ Washing your hands frequently with soap and warm water for 30 seconds or using hand sanitizer with 60% or more alcohol content.

▪ Avoid touching your face.

▪ Canceling children’s birthday parties and play dates for now.

▪ Keeping a 6-foot social distance rule when in public. That means avoiding crowds at all times and spacing out when enjoying the great outdoors.

▪ Separating yourself from others if you get sick with a cough or cold, especially when you have a profession in public service or health care.

▪ If you do develop symptoms of a respiratory infection, don’t panic. Most people recover with 3-4 days of rest and rehydration. Call your primary care physician for advice if simple measures are not helping.

You may need to get checked out if you are not recovering at home or have medical conditions— but telemedicine is a great option to try at first. Ask your provider about the options to communicate with him/her.

▪ Don’t show up unannounced at the ER or a clinic, but instead call ahead and make a plan for how you will be treated and roomed, to protect yourself and others in the hospital.

▪ Share what works — we will all need to communicate our successes and failures honestly and transparently.

▪ Check the Fresno County Department of Public Health COVID website and the federal Centers for Disease Control and Prevention website for information about COVID-19 and answers to questions.

In summary, I urge all of my fellow citizens to take the simple and common -sense steps that we know can interrupt the human-to-human transmission of this infection. This is not the time to panic, but it is a time to take urgent and rational action against the threat of widespread infection. Let’s all do our part, for ourselves, for our elders, our frail relatives and friends, and our brave health care heroes.

Into the midst of our disrupted lives, among the anxious statistics scrolling out of our media feeds, and despite the existential fear that this virus has aroused in so many of us, the lessons of past pandemics and the best practices of countries that have controlled their coronavirus outbreaks should be heeded here and now, like a guiding light in a fog. We must adopt and incorporate proven social distancing measures to keep ourselves, our families and our community safe and ensure the best possible outcome for the Central Valley. Stay calm, stay apart, and stay engaged against COVID-19.

This story was originally published March 24, 2020 at 3:55 PM.