Wednesday, April 29, 2020

Amador County: Health Officer COVID-19 Update


Health Officer COVID-19 Update
Dr. Rita Kerr, Amador County Health Officer
04/28/2020
Post Date: 04/28/2020 5:18 PM

Where We’ve Been
Statistics:
·  8 laboratory-confirmed cases in Amador County residents to date
Test Results: 
·  As of April 27, 2020 Amador County has received 439 test results from 379 individuals. 365 of those results were from Amador residents.
·  Sutter Amador has collected 373 tests. Of those 1.5% have tested positive for COVID-19.
Cases Hospitalized to date: 2
Deaths to date: 0
Recovered to date: 7

Amador County’s first 3 cases, which were reported in March, were related to travel to locations with COVID-19 community transmission, international and within California, prior to when the Stay-at-Home Order took effect.
The 5 Amador cases that have occurred since have been related to household contacts and individuals working in essential occupations.
As of April 27, 2020 there have been 14 cases in residents of other counties that impacted Amador County as well. The Contact Tracing Investigations from out-of-county residents include people who work in Amador but reside in other areas. These cases were related to individuals working in essential occupations.
Although Amador has had individual cases of community transmission – cases who could not identify linkage to a known case nor travel outside the county – Amador County has not experienced widespread, ongoing community transmission.
 On March 30, 2020 the Amador Health Officer issued an Order instructing all medical clinics to advise all persons who sought evaluation for respiratory illness with fever to stay home and self-isolate, whether or not they were tested for COVID-19. This has helped limit the spread of illnesses.

Where We Are:
The combination of contact tracing/isolation/quarantine, along with the Statewide and Community-wide Stay at Home Orders, has “flattened the curve” and allowed the state, region and our county an opportunity to increase readiness. The Emergency Operations Center (EOC) opened in late March to support the Public Health Department Operations Center (DOC), especially in:
·  Procuring/distributing personal protective equipment (PPE), hand sanitizer and supplies
·  Maximizing grant funding opportunities
·  Multi-agency response coordination, and
·  Planning for Amador patient surge, also known as surge planning with our health care partners, Sutter Amador Hospital and Surgery Center, plus further planning with the Sleep Train alternate care site (ACS) for regional support.
Enhanced infection control practices in congregate-living settings, including strict limitation of visitors, masking of health care staff, and pre-shift screening for symptoms of illness, has been effective so far in Amador County avoiding an outbreak of COVID-19 in long term care facilities, the Amador County Jail and Mule Creek State Prison.
 To date, our local and state health care capacity has not been overwhelmed. The timing of the ban on large gatherings in mid-March coincided with cancellation of events, such as Dandelion Days, as well as not having a large contingent of Amador County band students and families travel to Disneyland during the school spring break. This reduced importation of the virus into Amador County. The Stay-at-Home orders, which went into effect a few days later, have also helped curb the transmission of COVID-19 in our county. Everyone in this community, who has made sacrifices and adjustments to limit their activities and social mixing, shares in this success.
The EOC is currently providing guidance to county and city agencies on FEMA and the State of California reimbursement protocols.

Areas that Need Improvement:
·  Project Roomkey – non-congregate housing of homeless individuals meeting certain criteria
o    No local hotel agreements secured yet
·  Lab Testing Capacity
o    Majority of COVID-19 tests have been performed at Sutter Amador Hospital
o    WellSpace Amador has now established a dedicated COVID Care Clinic
·  Amador EOC is still working on obtaining more supplies to test more people.
o    More supplies have been requested from the State, but since our per capita test rate is a slightly better than most rural counties, Amador has been deemed lower priority by the State for fulfillment.
o    Public Health was able to obtain testing swabs and transport tubes via mutual aid from another county to have enough tests on hand in the event of an institutional outbreak, and the EOC Operations Section has organized a staffing plan with a partnership with Mountain Valley Emergency Medical Services Agency (MVEMSA) to ensure adequate personnel to perform testing.
o    The Amador Health Officer continues to advocate for increased Amador County access to State-organized testing sites. The State goal is testing within a 1-hour drive for rural residents.
§  Locations include:
§  Project Baseline by Verily testing sites in Sacramento and Stockton
§  OptumServe testing sites planned in El Dorado County for early May.
·  Amador OES, DOC and EOC have completed State-required surveys and are conducting gap analysis with the goal to meet the six key indicators that the Governor has listed as necessary to ease off of current restrictions.
o    California’s Six Key Indicators:
1.    The ability to monitor and protect our communities through testing, contact tracing, isolating and supporting those who are positive or exposed
2.    The ability to prevent infection in people who are at risk for more severe COVID-19
3.    The ability of the hospital and health systems to handle surges
4.    The ability to develop therapeutics to meet the demand
5.    The ability for businesses, schools and child care facilities to support physical distancing
6.    The ability to determine when to reinstitute certain measures, such as the Stay-at-Home orders, if necessary
·  As testing capacity increases and more cases (including asymptomatic and mildly symptomatic) are identified, Public Health DOC plans to increase workforce dedicated to Case Investigation/Contact Tracing.
o    Coordination with the Social Services department and partner agencies will continue to plan for wrap-around services needed for individuals who must stay home
o    To date, Amador County has had consistent voluntary compliance from individuals who have been instructed to self-isolate (for ill persons) or self-quarantine (for exposed persons).
§  However, as case counts are expected to increase, the Amador Health Officer will issue an enforceable community-wide order to ensure that individuals who need to stay isolated or quarantined must do so.
 This week, non-emergency but necessary health care is encouraged to resume. Elective surgeries were postponed due to concerns about PPE supplies. Subject to adequate stock of PPE, surgeries such as joint replacement and cataracts, can resume. Also, resuming are necessary in-person visits for chronic disease management and preventive care services is advised, with safety/risk mitigation measures in place. These medical services were never prohibited by the Stay-at-Home Orders, but many people delayed seeking routine care over the past month and a half. Some data has indicated that frightened people may even be hesitant to call 911 for a true medical emergency. Please be assured that the first responders and Emergency Room staff are taking all needed precautions to keep patients and themselves as safe as possible and minimize risk of COVID-19.

Where We Plan to Be:
The Amador Health Officer publically acknowledged today that the past 5 weeks of being under Stay-at-Home Orders has caused economic and emotional hardship for our entire community. As many of you are aware, the Amador Stay-at-Home Order currently in place is due to expire at the end of day April 30, 2020. If that Order lapses, Amador County would still remain under the State Order.
Any California counties that are allowing Orders to lapse will remain under the State Order. The Amador Health Officer believes there is value in re-issuing an updated version of the Amador County Order and FAQs, to be responsive to our unique community concerns at the local level. While our local Order currently cannot be less restrictive than the Governor’s Order, the Amador Health Officer is working with County Counsel and a coalition of Health Officers throughout our region to carefully evaluate how to maximize allowable activities within the current “essential” definition. The purpose of the Updated Order would be to clarify that the Stay-at-Home Order be read broadly where appropriate and within reason, thereby relaxing restrictions on social mobility and business activity in the County, within our current limitation of being under the Statewide Order.

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