Hospitalizations rise as COVID-19 advances; Tom, Terry spar over reopening

Cases could be 5-10 times those confirmed; dread, tension mount

Daniel Mintz
Mad River Union

HUMBOLDT –  The county’s total number of confirmed COVID-19 cases has gone beyond 300 but the actual number could be 10 times that.

​And the steepening climb of cases is beginning to be reflected in hospitalizations.

​The status of COVID-19’s local prevalence was discussed by county Deputy Health Officer Josh Ennis in an Aug. 12 “media availability” video.

​He began with an assessment of the total case number, which was at 286 at the time of the video. By the end of the week, the number rose to 309.

​The case curve is noticeably rising, with 78 new cases logged in the first two weeks of August.

​“I think we’ve all seen that lately the numbers have started to trend upward and at an increased pace,” Ennis said in his video introduction.

​He added that the total case number only represents a fraction of how many cases there actually are. For every confirmed case, “There is certainly a handful of other cases out there that we have not identified,” he said.

​How big that handful is depends on how closely residents are following precautionary guidelines and the scope of testing. “So somewhere on the order of five to 10 times as many cases that we’re actually confirming are probably out there not getting tested for whatever reason,” said Ennis.

​He advised that tallies of active cases – people who are ill and in self-isolation – represent a “minority” of people who have COVID-19 and “we’re starting to see that in the hospital a little bit.”

​Ennis noted that there had been three hospitalizations that week, bringing the county’s total to 19 after a lengthy phase of minimal activity.

​Sick summer

Summer has been a season of disease acceleration and health officials and health care workers are bracing for the trend’s continuance into fall and winter. 

The re-start of the school year will contribute to it.

​Asked if the county can shut down in-person schooling if precautions aren’t followed, Ennis said school administrations are responsible for sticking to reopening plans and if parents are concerned, they can talk about it with school administrators and district superintendents.

“With 70-plus schools, Public Health is not able to manage individually each and every individual school,” he continued.

Parents can help limit the impacts by avoiding direct interactions with other households.

“I think that it is important that families keep activities to their family for the most part, their household unit, as much as possible so that the number of different places where children may be exposed to other children or adults is small,” said county Health Officer Teresa Frankovich in an Aug. 10 video.

The county has seen an increase in the percentage of children getting COVID-19, she continued, mostly from family members after the disease affects their households.

​She added that that the percentage of infected children will “certainly” increase.

​But she said the county is “not quite” at the point of being put on the state’s watch list, which would require that schooling only be done online.

​That threshold may soon be crossed. “We’re definitely seeing an increase in cases in Humboldt County,” said county Public Health Clinic and Communicable Disease Program Supervisor Hava Phillips in an Aug., 12 video. “It’s a strong upward trend and I don’t think that we expect to see that change in the near future.” 

​HSU Pushback: In a cautionary Aug. 11 email to Humboldt State University (HSU) President Tom Jackson, Jr., Frankovich advised that because of the county’s ascending case rate, “I believe we have moved to a place in which on-site instruction cannot be accomplished safely at this moment in time.”

She notes that the county logged 72 new cases in the previous two weeks, 48 of them in the prior week.

“Our 14-day case rate per 100,000 went from about 28 one month ago to 50 as of Monday,” she continued. “We are detecting more community transmission cases and 42 percent of our cases are under 30 years.”

After further correspondence and a phone conversation, Jackson emailed Frankovich on Aug. 13 to let her know he is “shocked at your sudden shift in position” following many weeks of collaborative planning.

“I am disappointed and our confidence has been shaken in your department’s ability to meet this challenge as our partner,” he continued.  

Jackson also describes Frankovich’s email as including “prejudicial statements” and he tells her that “it seems irresponsible to assume that students from outside the county are a threat, particularly in a county that remains fully open for travel and tourism.”

The emails were released by the county on Aug. 14, shortly after the posting of a media availability video with Frankovich.

Timely release of the exchanges was demanded in a submitted question by the North Coast Journal, whose editor, Thadeus Greenson, has a track record of successfully pressuring government and policing transparency.

Responding to another question about potential impacts, Frankovich acknowledged the concerns but was conciliatory, detailing HSU’s precautionary measures in housing about 750 students and resuming in-person instruction on Sept. 8.

“They are planning to move forward and we plan to basically support them in whatever way we can,” she said, adding that “we’ll be partners throughout this COVID season.”

That day, the county confirmed seven new cases of COVID-19.

Tart talk ’twixt Tom & Terry over reopening

Mad River Union

HUMBOLDT –  Two of the county’s top docs –medical and educational – had a now-public clash of wills last week over whether or not Humboldt State should install new students and reopen for classes in the current COVID-19 risk environment (see story, above). 

The disagreement was disclosed in email exchanges released by the county, and appears below.

We need to talk

From: Frankovich, Teresa 

Sent: Tuesday, August 11, 2020 12:19 PM

To: Tom R Jackson

Subject: on site education and housing

HI Tom. Thought it might make sense for us to talk today rather than me meeting again with some of your staff. Do you have availability today? Is there a time that would work for you between 1 and 3? Thanks, Terry

Teresa L. Frankovich, MD, MPH

Health Officer

529 I Street, Eureka, CA 95501

(707) 268-2181

 ‘On-site instruction cannot be accomplished safely’

From: Frankovich, Teresa 

Sent: Tuesday, August 11, 2020 6:03 PM

To: Tom R Jackson 

Subject: on site instruction and congregate housing

Hi Tom. Was hoping to speak with you but since I had not heard back, figured you have been tied up all day today. Because we are dealing with a short time frame for your students and staff, I wanted to make sure you had needed information on hand. Through our discussions over these weeks and months, we have talked about planning for a possible return in the Fall to on-site instruction at HSU. We also talked about how the landscape might change and make it impossible to open up campus. As I review our epidemiologic data and look at our testing capacity as well as case investigation teams, I believe we have moved to a place in which on-site instruction cannot be accomplished safely at this moment in time. As I’m sure you are aware, the CDPH guidance states:

“Implementation of this guidance as part of a phased reopening will depend on local conditions including epidemiologic trends (such as new COVID-19 case and hospitalization consistently stable or decreasing over at least 14 days), availability of IHE and community testing resources and adequate IHE preparedness and public health capacity to respond to case and outbreak investigations.“ At this time, we are not able to meet these pre-conditions. 

My specific concerns are as follows;

1) Epidemiology: We are reporting out a current total of 293 cases today for Humboldt County. We have now had 72 cases in the past two weeks, 48 in the past week. Our 14-day case rate per 100,000 went from about 28 one month ago to 50 as of Monday. We are detecting more community transmission cases and 42% of our cases are under 30 years. Our positives increased by 20% in the past week. In addition, we have had three hospitalizations in the past week due to COVID which is an increase in our baseline.

2) Testing: While we have successfully built our internal Public Health Lab (PHL) testing capacity and within the next week should have capacity to test as many as 300 specimens per day, our Optum site has become problematic due to long turnaround times. As you know, we have been working with community partners, including HSU, to create an alternate testing strategy and believe we will have excellent capacity in October if all goes according to plan. Until then, testing is limited primarily to our PHL and Optum, which would clearly fall short in meeting demand for a large surge occurring in context of a return of students to dorms and on-site learning at HSU. Robust testing with fast turnaround is essential to manage cases on campus that will inevitably occur and are very likely to occur quickly as we bring students from across the state to the area, many of whom are coming from places where disease circulation is vastly higher than ours. There will be positive students walking onto campus without question and congregate housing will increase transmission risk enormously. 

3) Contact investigation: We are currently managing a large number of case investigations due to the rapid increase in cases, made challenging by the large numbers of contacts associated with many of them as well as cases in high risk settings for large outbreaks. We continue to build capacity but hiring and training is time-intensive and not simply accomplished through just on-line training. While we are managing our current caseload well, we are positioned such that a large number of cases occurring in a short time frame such as return to campus, would be a potential tipping point for overwhelming the system, risking wider spread of the virus. 

As I have discussed with your team members over this past week, I envision having markedly enhanced testing and investigation capacity in October but we are not there yet. I know the safety of the students, staff and community have been at the forefront of your discussions and I am sorry that local conditions make moving forward as planned make this impractical at present.

I value our partnership and am happy to work with you all on plans should it be possible to move to a start date later this fall versus looking at next term. I completely understand the enormous impact of this for all involved, including our local community and cannot tell you how much I regret that I do not see any way in which public health can support on-site instruction and dorm living at this time. COVID-19 continues to take its toll and we all look forward to the time when an effective vaccine or treatment makes all of this manageable and allows us to return to a beautiful normal.

Best Regards, Terry

‘Your perspective is noted’

From: Tom R Jackson

Sent: Wednesday, August 12, 2020 10:55 AM

To: Frankovich, Teresa

Cc: Sherie Gordon; Wilson, Mike 

Subject: HSU

Dr. Frankovich,

Thank you for reaching out to me. It is unfortunate your perspective has shifted despite our best efforts as a major and essential enterprise to be due diligent and helpful to your office. I also regret you not waiting and speaking to me first before writing a long email to me. 

I now must respond to you in greater detail in writing, but hope we have a chance to speak first. 

Your perspective is noted. I am also providing a link to the Governor’s guidelines in case you are not familiar with them. As we proceed as we have consistently and carefully planned, we will continue to update you on additional measures we will be taking given Public Health’s limitations. The days are long but let’s try and find a small window of time to chat.

files.covid19.ca.gov/pdf/guidance-higher-education--en.pdf 

Dr. Tom Jackson, Jr., President

Humboldt State University

‘A delayed start date could serve everyone well’

 From: Frankovich, Teresa 

Sent: Wednesday, August 12, 2020 11:32 AM

To: Tom R Jackson 

Cc: Sherie Gordon; Wilson, Mike

Subject: RE: HSU

Good morning. Thanks for responding. As I referenced in my email, I had hoped to speak with you yesterday but did not hear back from you over the course of the day so sent you an email around 6 pm. Cris had also let me know you were unavailable to join our call on Monday.

I would have much preferred to chat but I knew the lead time was short and out of courtesy to you, your staff and the students impacted, I wanted to be sure you had information before your leadership team met. It seemed to me with an issue of this magnitude, I should be discussing it with you rather than the EPC. The Governor’s guidance was actually quoted in my email so yes, am definitely aware. The issues are not Public Health’s issues, they are our community’s issues and being faced by communities across the state. That is why we have been transparent in discussions all along that the COVID landscape could change and necessitate a shift to virtual learning only. It is the same discussion we have had with K-12 schools for months as well.

I would be happy to talk about options and sincerely feel that a delayed start date could serve everyone well. I look forward to speaking with you.

Terry

 ‘Inequitable and perplexing’

 From: Tom R Jackson

Sent: Thursday, August 13, 2020 1:07 PM

To: Frankovich, Teresa

Cc: Bohn, Rex; Wilson, Mike; Karen Diemer; Susan Seaman; Jones, Andrew; Ashley, Garrett P.; Flamwer, Keith

Subject: Re: on site instruction and congregate housing

Dr. Frankovich,

As you know from our phone call last night I am shocked at your sudden shift in position despite the fact that your team has been working with HSU on our plans for fall semester since June. I am disappointed and our confidence has been shaken in your department’s ability to meet this challenge as our partner.

We are moving forward with our plan to welcome a very limited number of students into our residence halls according to the Governor’s and CSU guidelines and current public health protocols. If you have any further plans to use your authority to obstruct this plan (in spite of supporting it earlier), we must be informed immediately. We anticipate such an action would produce a hardship for many students who do not have other housing arrangements. We have further concerns that many students would need to quickly find housing in the community, and in that case we would not have the same capacity to help monitor them and influence their activities. 

 It also seems perplexing that you are suggesting we should deny housing to students, who are also county residents, who will reside in Humboldt permanently when 150 hotels, 87 groceries, 34 gyms and studios, 145 barbers and hair salons, and 125 restaurants in the county are currently open and accepting guests from all over the country. Thousands of tourists have been welcomed into our County given that the travel restriction has remained lifted all summer. Restriction on travel continues to be lifted because there was an identified need county-wide for economic stimulus. We are struggling to understand the distinctions you are making between the threat/risk of the thousands of tourists coming in and out of the county, providing a very temporary economic stimulus, compared to the social and economic value of the University bringing a more stable population (adhering to public health protocols) to accomplish the same public goal. 

We are moving forward with our plans for very limited face-to-face instruction according to the Governor’s and CSU guidelines and current public health protocols. As you know, in our approved plan, the face-to-face aspects of our instructional operation begins September 8. If you anticipate using your authority to further obstruct this plan, we must be informed immediately. Such action would be inconsistent with the Governor’s guidelines, with which we are in compliance, and unusual across the CSU with the other campuses offering some form of face-to-face instruction or service to students in their counties.

 I can appreciate your concerns regarding your office’s inability to potentially meet a substantially worse outbreak. As only one of 23 communities with a CSU, and thoroughly knowing and participating in the development of our operational plan since June, it was our expectation that Public Health would have anticipated these limitations within your area well before now and adjusted service delivery in preparation for and support of the implementation of our plan. We welcome conversations with you about what else we can do to help you and your department address any resource or capacity shortcomings within your department.

As we offered earlier, HSU will substantially increase our testing ability for students. While we recognize this is a resource managed and available by Public Health, given the limitations in the County, we have acted swiftly to incorporate student testing into our campus plan for the Fall semester.

I can also appreciate your feeling that you will be better prepared by October. Unfortunately, denying on-campus housing until October isn’t a viable option for a major institution such as HSU, especially given that there is no guarantee what you described will be available in October. We are willing to work with you to become ready now. We can also advocate for additional support to your department if you want us to do so.

There are prejudicial statements in your email that are concerning. It seems irresponsible to assume that students from outside the county are a threat, particularly in a county that remains fully open for travel and tourism. While the younger adult population certainly fits the risk profile, residents remain able to leave and return to the county. Businesses all over Humboldt County are open, hairdressers are cutting, patio seating is available, gyms are open, apartment complexes are renting, hotels are open, airplanes are arriving, and retail stores are selling goods. These alone account for a substantially greater number of adults than what HSU would have on campus and in isolation. The focus on HSU students is inequitable and perplexing.

HSU has one of the best operational plans for a higher education institution in the state. While health is your primary concern, your position seems based on several projected assumptions connecting directly to HSU students. If I close housing based on these assumptions, I need to consider the impact of triple digit layoffs, hundreds of students possibly stopping their education, loss of health care insurance, collective bargaining agreements, and potentially millions of dollars lost to the region. HSU also houses some people that may have housing insecurities, low income, or are coming from abusive environments. I doubt you are suggesting we put these people on the street. We also house many persons of color. Again, I do not think you are suggesting we put these individuals out onto the street or suggest they should not progress toward a degree in this community, but your position will lead us there. Having limited campus housing actually helps the County because it allows HSU to provide concentrated support, testing, safety, and education to students that would not be as readily available in the County. Many students have already cancelled their leases and will be a part of this community whether they are in the residence halls or in private housing.

We have more than exceeded the Governor’s recommended guidance. We have also offered to you other alternatives to try and alleviate your recent fears, which you have not yet accepted. Those were examples of a university trying to assist you in your role without success. The condition of the County is not a result of newly arriving student residents. It is directly related to the soundness of partnerships like ours and Public Health’s commitment to promoting the health of all residents, including residents enrolled at HSU. 

We have kept our commitment, as an essential and critical organization in this community, to keep your department informed. Our assessment of our campus readiness is strong. While we have never tried to meet the impossibly high bar of being risk free, we have been consistent and diligent in our risk reduction. We are committed to being a partner and hope Public Health remains committed to being a partner for the better good of our entire community. 

I am copying a number of important individuals so they are aware of this email and its context. 

Dr. Tom Jackson, Jr., President

Humboldt State University

 

 







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