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PRESS RELEASE.
Health Officer Statements from Scott Morrow, MD, MPH
San Mateo County Health Officer
Message from April 13, 2020
Please read or reread my statements below from 3/23/20, 3/16/20, 3/10/20, 3/5/20, and 2/27/20 to get a better understanding of where we find ourselves today and actions you can take to protect yourselves and your family.
We continue to be in a very challenging situation. This situation has impacted every aspect of our lives and will continue to do so for a long time. There are several bits of good news. By many accounts, there has been extraordinary adherence to the Shelter-in-Place (SIP) orders which were put into place here earlier than in other places in the country. There is no perfect adherence, by any means, but it seems to be the major reason for lowering the rate of new infections to a stable level. The adherence has been so good, in fact, the models we’re using to predict our future state don’t seem to be able to account for this fact. It appears that we have flattened the curve, at least this first curve, for now. I am hopeful we have avoided the catastrophe that New York and Italy experienced, for the time being. Everyone who is cooperating with the orders and law enforcement and others who are enforcing the orders should be commended in the highest possible way. Although it may not seem like it, you are doing your part, you are serving your community by limiting your contact with others. Thank you. And, as always, special thanks to our first responders, healthcare workers, and other essential workers who are keeping us safe and fed during this crisis.
TRADE OFFS. Without doubt, we will get through this. But we need to be very deliberate about our next steps. If we don’t take our next steps carefully, we will experience the worst of what this virus has to offer. What we’re being faced with, in our immediate future, are trade-offs of the most significant kind. We have to find a way to increase the immunity of the population (in public health terms, this is called “herd immunity”) slowly and methodically, while minimizing death, with equity in mind, while not overloading the healthcare system, and minimizing economic damage. Many of these considerations work in opposite directions. An effective vaccine or effective medical treatments would certainly make our path forward much easier, but neither of these seem to be available to us in the short or medium term. There is no playbook for the decisions we face or the balance we should attempt to maintain between these competing interests. Some very smart people have put forth some criteria that should be considered regarding how to slowly unwind the SIP orders and we are considering all of them now. Most of these decisions have very limited underlying supporting data. One thing I do know is that releasing the restrictions on movement and gatherings too soon, or in not an incremental enough way, will diminish the gains we’ve made and will unleash the very thing we are attempting to avoid. Herd immunity is typically 70-80+/-% based on the characteristics of the disease. So we have a long way to go. There are no quick fixes.
DATA. There has been some concern expressed that we’re not being transparent enough with the data. Everyone would like more data. Well, I too would like more data. There simply is not a lot of data either about the virus itself, how and why it spreads so easily, how and why it causes such devastating disease in some folks, or how it’s spreading here. For those who are deeply steeped in working with data, as I and my staff are, you know that datasets have their own personalities, their own strengths and their own weaknesses. You know that data can either lead you to an approximation of the truth, or data can mislead you and cause you to make incorrect conclusions and, therefore, take wrong actions. The data we have is, simply, very limited. This is based on the facts that many characteristics of the virus are unknown and that testing remains very constrained here. This requires us to synthesize estimates from very different sources of data that may be more qualitative in nature. For the data that is put up on our website, except for the hospital level data, which is mostly accurate, I tend to look at it skeptically, specifically the cases and the deaths, not because those aren’t accurate from what we know, but because they don’t reflect what’s actually going on very well. People generally want data to be able to make informed decisions about lowering their risk. The data we have, if it were to be presented to you on a more granular level, would be misleading, and I believe, downright deceptive. This is what I think you need to know. This virus appears to be wildly transmissible especially within households or congregate settings. Your risk from contracting the infection from any human you encounter in San Mateo County and outside your immediate household continues to be substantial unless you take all the recommended actions to protect yourself. I hesitate to give you the following numbers, because first of all they are a guess, and secondly because some will think they are too low to take action. My best guess is that approximately 2-3% of the SMC population are currently infected or have recovered from the infection. That’s around 15-25,000 people and they are all over the county and in every community. I don’t believe this number is off by a factor of 10, but it could be off by a factor of 2 to 3. Without the SIP, it could have well been over 50-75,000 by now, and that would have overwhelmed our healthcare system. So if you want to get a sense of how many infected or recovered cases are around you, just multiply your city population by 2 or 3%. My best guess on the number of people who are capable of transmitting the virus now is just under 1%, or approximately 5-7,000 people. These numbers are likely to be more accurate than the numbers we are sharing on our website. I know that sounds ridiculous, but these estimates are better than the direct counts that I can currently provide you. That’s the status of our testing data at the moment. I anticipate, and am hopeful, that our estimates will improve remarkably over time.
Scott Morrow, MD, MPH
San Mateo County Health Officer
April 13, 2020
Message from March 23, 2020
Please read or reread my statements below from 3/16/20, 3/10/20, 3/5/20, and 2/27/20 to get a better understanding of where we find ourselves today.
As I write this, I am both immensely grateful and exceedingly disappointed. We are in a grave crisis. I believe the virus is growing at an exponential rate in our county. Unless everyone does their part and follows the County’s Shelter-in-Place order and the Governor’s Safer at Home order, we will be facing an Italy-type catastrophe very soon. These orders are not recommendations, they are rules to be followed. My disappointment stems from the fact that many people just aren’t taking this seriously and going about their business as if nothing has changed. Our world has profoundly changed in an instant. It is now up to you all, the community, to decide what you want your future to be. If you decide you want to do your own thing and follow your own rules, you disrespect us all. You spit in our face, and you will contribute to the death toll that will follow. For those of you who say: “nobody tells me what to do,” now is a time to make an exception. You can go back to being ornery in the future.
Keeping humans apart from other humans is the only tool we currently have to slow this virus’ spread. This is a particularly fraught dilemma, as humans are social animals and they need each other, but we need to make every possible effort to avoid contact with each other.
For families in different households, do not mix your households at this time. As hard as this is, do not gather in any way outside of immediate households. As for outdoor exercise, people certainly need to get out, but do this in your own immediate neighborhoods. Do not drive except to provide or obtain an essential service. Do not go into other neighborhoods for recreation. This increases the risk of virus spread. Always maintain social distance. Wash your hands frequently and follow all the other recommended actions.
I’m grateful for the enormous amount of activity and the enormous amount of resources, from both the public and private sectors, going into protecting us and going into our healthcare system surge capacity. I am grateful that many people are taking this seriously and are doing everything they can to slow the spread of this virus. You are heroes for doing this.
I am deeply grateful for and everyone should thank God for our first responders and our front line medical and public health personnel. They are taking on personal risk to take care of you. They are heroes for doing this.
As for the supply shock, please lower your expectations of what you can get and when you can get it. Be grateful for anything that you can get. The capacity to deliver instant gratification is over.
As for the demand shock, look around and determine which small businesses you’d like to see still in your community when this is over. Then patronize them. Even if they are not open and you can’t get goods and services from them, you may want to consider paying them for services you might have received from them or they will be gone.
VOLUNTEER. Your community needs you now. There are many, many things that need to be done. This is the link to the survey for folks that want to volunteer: https://www.surveymonkey.com/r/WSXH6PZ
This is the email for non-profits and organizations needing volunteers: [email protected].
DONATE. There are critical shortages of supplies, especially some medical supplies. Please donate personal protective equipment (PPE). The email to donate PPE is [email protected]. There will be an SMCStrong fund set up shortly to support individuals, small businesses and non-profits in the County. Donate to this if you can, or to your charity of choice.
Now more than ever, what I need for you to do is fully follow my recommendations’ advice and orders, unite as a community, come to each other’s aid, and let kindness, compassion, and gratitude guide your actions.
Scott Morrow, MD, MPH
San Mateo County Health Officer
March 23, 2020
Message from March 16, 2020
Please read or reread my statements below from 3/10/20, 3/5/20, and 2/27/20 to get a better understanding of where we find ourselves today. Over the last few days, I’ve instituted a number of aggressive measures to try to reduce the spread of COVID-19 in our community. I have done so because time is of the essence and the types of measures implemented matter. I have implemented these measures to prevent the collapse of our healthcare system and to reduce death of our loved ones from COVID-19.
It is now time to do your part. This means I’m recommending you shelter in place at your homes, leaving them only for essential work, medical care (preferably access medical care through phone or online services), groceries and pharmacy. These are measures that have been implemented in other countries and will have an effect of slowing down this virus.
I deeply understand the hardships and frustrations these measures place on you and your families. These measures will be temporary, but they may be in place longer than you would like. What I need for you to do now is follow my recommendations, advice and orders, unite as a community, come to each other’s aid, and let kindness, compassion, and gratitude guide your actions.
Scott Morrow, MD, MPH
San Mateo County Health Officer
March 16, 2020
Message from March 10, 2020
The bulk of what I want to tell you is in my slightly modified March 5 statement below. Please re-read it slowly and carefully and consider your next actions. Over the last long weeks, I have been faced with unanswerable dilemmas and conundrums daily. I have been asked to make significant policy decisions with very little information on which to base them. I have 35 years of experience as a physician, and almost 30 years of experience in local public health, more local public health experience than almost anyone in our state. If I am filled with uncertainty, I can only imagine how the general public must be feeling. People want very specific answers to their questions, and they deserve them. But in many cases, there are not satisfactory answers to give them.
I now have evidence of widespread community transmission of COVID-19 in San Mateo County. Under these circumstances, the actions advised in my March 5th statement below become that much more critical. The only way to slow the spread of COVID-19 in the light of having community transmission is to have everything in our society grind to a halt for an extended period of time, as you have seen done in other countries. All actions have consequences. At this moment, given what I know, I believe grinding everything to a halt would cause us more harm than good. If my opinion on this changes, I will update this statement. Again, the bulk of what I want to tell you is in my March 5 statement below. Please re-read it slowly and carefully and consider your next actions. And please remember, we are all in this together. Showing each other extra measures of kindness will go a long way.
Scott Morrow, MD, MPH
San Mateo County Health Officer
March 10, 2020
Message from March 5, 2020
This is a difficult message to share, but it is important to recognize how difficult the times ahead may be and how you must now take assertive action to prepare for them. Our local situation surrounding novel coronavirus (COVID-19) is changing rapidly. COVID-19 is spreading in our community, the extent of which is unclear. It has likely been spreading for weeks, perhaps months. I have no reason to believe that how it’s spreading in other countries won’t be replicated to some degree here. We now all need to take assertive actions to inhibit the spread of this new virus. Some of those actions are described below. I advise that individuals, schools, business, and all other sectors of our community take immediate steps to change behaviors and take definitive action.
Our lives will be significantly disrupted by the measures needed to respond to a global pandemic. A pandemic is a global occurrence of an infectious disease. A pandemic is a disaster with unique characteristics. The two most important differences between a pandemic and other disasters are that the whole world is going through this disaster at the same time, and people may become fearful of other people. The current COVID-19 outbreak clearly has the potential to turn into a severe pandemic.
County Health continues to work with the federal Centers for Disease Control and Prevention (CDC) and our state and local partners to manage testing and monitoring of persons who have been exposed to COVID-19. But our focus is rapidly changing from a containment strategy (identifying cases and contacts) to one of community mitigation—taking steps to lessen the broad impact of the disease. County Health and our public and private partners are taking steps to increase our ability to respond and are planning for a sustained response to COVID-19.
How the world operates during a pandemic is different from how the world operates normally. This is not business as usual. With a pandemic comes significant disruption to supply chains (the process of how things get from where they are made to where they are used), transportation, and travel. Even if the disease is not rapidly spreading in our area, we may face difficulty obtaining the goods and services we are accustomed to, public events may be canceled, and our ability to travel might be restricted.
San Mateo County Health continues to advise that the steps to prevent the spread of flu will also guard against the spread of COVID-19: cover your cough and sneeze, wash your hands frequently, avoid shaking hands and touching your face with unwashed hands, and if you are not feeling well or are experiencing cold, flu, or other symptoms, stay home from school or work. If you are mildly ill, there is no need to contact your primary care provider as they are very busy right now. If you are significantly ill, contact your primary care provider.
Here are the most important things for you to consider to improve your personal and organizational preparedness:
What matters most is how households, neighborhoods, community groups, businesses, and other organizations prepare. What does that mean? Preparedness equals self-sufficiency. The government will help where it can, but it may have a limited ability to respond directly to you due to the scale of the disruptions.
Individual and community preparations should focus on three tasks—reducing each person’s chance of getting sick (see both individual and more general public health recommendations both above and below), helping households with basic survival needs during a pandemic, and minimizing and coping with larger disruptions in how the normal day-to-day world works.
All businesses and other organizations should now be done reviewing their continuity of operations plans for how they will operate if their employees are unable to work and how they will interact with members of the public and prepare to implement these plans soon.
All medical facilities and providers should be done reviewing their surge plans for how to handle increased numbers of patients and be prepared to implement.
Getting ready for a pandemic is largely about preparing for possible shortages. In a pandemic, supply chain disruptions are inevitable but are also unpredictable.
Since it contains vital supplies, a good start is to make sure your earthquake kit is up to date and ready to go. Of course, having supplies beyond the typical earthquake kit is a good idea. What you decide to have on hand is based on your individual and family situation and your individual preferences.
One likely shortage will be medications. You should attempt to obtain a couple of months supply for your critical medications.
If you have other critical supply needs, you should conserve them and stock up on them now.
Now is also the time to think about how you will care for loved ones at home if they or you are sick and how you would limit spread within the family.
Frequent and appropriate hand-washing is far from a perfect solution, but it’s easy, under your control, and has no significant downside.
Like washing your hands, wearing a surgical mask may help a bit, but you need to know that surgical masks don’t offer much protection when they are worn by people who are well. They are most helpful when worn by those who are already sick so that they are less likely to transmit the disease to others. Surgical masks and masks offering higher levels of respiratory protection are already in short supply and should be prioritized for use in health care settings.
You should use a barrier, such as a paper towel or tissue, to touch commonly touched surfaces, such as any door handles or elevator buttons.
Change from my previous message: I am now asking for the implementation of the activities below at this time.
All non-essential gatherings should be canceled, postponed, or done remotely. Unfortunately, at this time, I have no standard definition of “non-essential” or “gathering” to guide your decisions. Use your best judgment.
Those over the age of 60 and those with co-morbid conditions should avoid gatherings to the extent possible.
Stop shaking hands.
Increase in the amount of remote working or teleworking to the extent possible especially for those who appear at higher risk for developing the disease, those over the age of 60 and those with co-morbid conditions.
Under all circumstances, stop touching your face, eyes, nose, or mouth with your unwashed hands.
Social distancing—staying at least 6 feet away from all other people—should be attempted where possible.
I am not asking for the implementation of these activities, but these are the types of activities we may need to implement in the future:
School closures. Schools are an essential gathering. School closings present a particularly vexing social distancing dilemma but may be necessary to protect public health. Once school closings occur, they may be extensive and extended.
Rationing (a formal process of prioritizing distribution and use) of critical supplies may need to occur.
To get ourselves through the hard times that may be coming, your community may need volunteers. Think now about the skills you have and how you can help your community. Heed the call should volunteers be requested.
Other public health interventions that have been used with some effect in other countries include commandeering of both real estate or personal property, conscription, curfew, and cordons. It is unlikely that these interventions would be used here due to practical considerations.
Issues around testing for COVID-19. You may have received incorrect information from the federal and state government on March 4, 2020. San Mateo County does not currently have testing available independently of the state and CDC. The amount of testing that is available through the state and CDC is severely limited. Should testing become more widely available, testing will be prioritized based on healthcare infrastructure concerns, risk of exposure, and/or very sick hospitalized patients. Tests will not automatically be given upon request or by a physician’s order. This may change as testing capacity evolves over the next few months.
Scott Morrow, MD, MPH
San Mateo County Health Officer
March 5, 2020
Message from February 27, 2020
I share the concerns of the Centers for Disease Control and Prevention (CDC): we all need to be prepared for COVID-19 to spread within the United States. Our lives may be significantly disrupted by the measures needed to respond to a global pandemic. A pandemic is a global occurrence of an infectious disease. A pandemic is a disaster with unique characteristics. The two most important differences between a pandemic and other disasters are that the whole world is going through this disaster at the same time and people may become fearful of other people. The current COVID-19 outbreak clearly has the potential to turn into a severe pandemic. This is a difficult message to share, but it is important to recognize how difficult the times ahead may be.
County Health continues to work with the federal Centers for Disease Control and Prevention (CDC) and our state and local partners to manage testing and monitoring of persons who have been exposed to COVID-19. But our focus is changing from a containment strategy to one of community mitigation—taking steps to lessen the impact of the disease. County Health and our public and private partners are increasing our ability to respond and are planning for a sustained response to COVID-19. I advise that individuals, schools, business and all other sectors of our community take immediate steps to be prepared. Now is the time for you to prepare.
How the world operates during a pandemic is different from how the world operates normally. This is not business as usual. With a pandemic comes significant disruption to supply chains (the process of how things get from where they are made to where they are used), transportation, and travel. Even if the disease is not spreading in our area, we may face difficulty obtaining the goods and services we are accustomed to, public events may be cancelled, and our ability to travel might be restricted.
San Mateo County Health continues to advise that the steps to prevent the spread of flu will also guard against the spread of COVID-19: cover your cough and sneeze, wash your hands frequently, avoid shaking hands and touching your face with unwashed hands, and if you are not feeling well or are experiencing cold, flu, or other symptoms, contact your primary care provider and stay home from school or work.
Here are the most important things for you to consider to improve your personal and organizational preparedness:
What matters most is how households, neighborhoods, community groups, businesses, and other organizations prepare. What does that mean? Preparedness equals self-sufficiency. Government will help where it can, but it may have a limited ability to respond directly due to the scale of the disruptions.
Individual and community preparations should focus on three tasks—reducing each person’s chance of getting sick (see both individual and more general public health recommendations below), helping households with basic survival needs during a pandemic, and minimizing and coping with larger disruptions in how the normal day-to-day world works.
All businesses and other organizations should now review their continuity of operations plans for how they will operate if their employees are unable to work and how they will interact with members of the public and prepare to implement these plans soon.
All medical facilities and providers should review their surge plans for how to handle increased numbers of patients and be prepared to implement.
Getting ready for a pandemic is largely about preparing for possible shortages. In a pandemic, supply chain disruptions are inevitable, but are also unpredictable.
Since it contains vital supplies, a good start is to make sure your earthquake kit is up to date and ready to go. Of course, having supplies beyond the typical earthquake kit is a good idea. What you decide to have on hand is based on your individual and family situation.
One likely shortage will be medications. You should attempt to obtain a couple of months supply for your critical meds.
If you have other critical supply needs, you should conserve them and stock up on them now.
Now is also the time to think about how you will care for loved ones at home if they or you are sick and how you would limit spread within the family.
Frequent and appropriate hand-washing is far from a perfect solution, but it’s easy, under your control, and has no significant downside.
Like washing your hands, wearing a surgical mask may help a bit but you need to know that surgical masks don’t offer much protection when they are worn by people who are well. They are most helpful when worn by those who are already sick, so that they are less likely to transmit the disease to others. Surgical masks are already in short supply and should be prioritized for use in health care settings.
You should use a barrier, such as a paper towel or tissue, to touch commonly touched surfaces, such as bathroom door handles or elevator buttons.
I am not asking for implementation of the activities below at this time, and the implementation of these activities is not imminent, but these are the types of activities we may need to implement in the future:
Social distancing—staying at least 6 feet away from all other people and avoiding shaking hands—will be important
School closings present a particularly vexing social distancing dilemma but may be necessary to protect public health. These closings may be extensive and extended.
Event/mass gathering cancellation
Extensive increase in the amount of remote working or teleworking.
Under all circumstances, stop touching you face, eyes, nose, or mouth with your unwashed hands.
Rationing (a process of prioritizing distribution and use) of critical supplies may need to occur.
To get ourselves through the hard times that may be coming, your community may need volunteers. Think now about the skills you have and how can you help your community.
Other public health interventions that have been used with some effect in other countries include commandeering of both real estate or personal property, conscription, curfew, and cordons. It is unlikely that these interventions would be used here due to practical considerations.
Scott Morrow, MD, MPH
San Mateo County Health Officer
February 27, 2020
Author: Coastside Buzz
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