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'There is no playbook for the decisions we face': County health officer suspects coronavirus has infected 15,000+ county residents

There may be tens of times more people who have been infected with or recovered from the coronavirus in San Mateo County than the county has reported, said Dr. Scott Morrow, the county's top health officer, in an April 13 memo.

Morrow said he estimates that about 2% or 3% of the population has been infected with, or has recovered from, the coronavirus. That's roughly 15,000 to 25,000 people in San Mateo County, he said in the memo.

And roughly 1% of the population, he added, is likely capable of transmitting the virus. That translates to about 5,000 to 7,000 people countywide.

By contrast, only 721 people have tested positive for COVID-19 countywide, as of April 13. Twenty-one have died.

That means that there could be between 21 and 35 times more people who have been infected with or recovered from the coronavirus than the county is reporting on its data dashboard.

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That said, the residents of San Mateo County do appear to be following the shelter-in-place order, which has been very successful at stabilizing the rate of infection locally.

But that doesn't mean things can return to normal just yet, he explained.

"If we don’t take our next steps carefully, we will experience the worst of what this virus has to offer," he wrote. "What we’re being faced with, in our immediate future, are trade-offs of the most significant kind."

It also doesn't help that an effective vaccine or effective medical treatments are unlikely to become available in the short- to medium-term.

The county's task, he said, is to increase the level of immunity to the coronavirus in the community "slowly and methodically while minimizing death, with equity in mind, while not overloading the healthcare system and minimizing economic damage."

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The public health goal in the war against the novel coronavirus is to reach a "herd immunity" level, which means that roughly 70% to 80% of the population has developed immunity to the coronavirus. With only an estimated 2% or 3% of the population infected or recovered from the coronavirus and no vaccine ready, "we have a long way to go," he said. "There are no quick fixes."

But even his best estimates, he explains, are based on limited information and may be imprecise. They could be off by a factor of two or three – but probably not by a factor of 10. If that were the case, the health system would probably have already been overloaded, he said.

He said he's skeptical of some of the information the county has provided publicly because that data – confirmed cases, number of patients tested, is incomplete. The data are limited because many characteristics of the virus are unknown and testing remains very constrained in San Mateo County. The county's data panel on hospitalizations is more reliable, he added.

"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," he said.

The latest estimates, he reports, "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."

Instead, he suggested, people should focus on the facts as they do what they can to stay safe and healthy.

"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."

As for what's next, he said, "There is no playbook for the decisions we face or the balance we should attempt to maintain between these competing interests."

"One thing I do know," he added, "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."

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'There is no playbook for the decisions we face': County health officer suspects coronavirus has infected 15,000+ county residents

by / Almanac

Uploaded: Wed, Apr 15, 2020, 10:50 am

There may be tens of times more people who have been infected with or recovered from the coronavirus in San Mateo County than the county has reported, said Dr. Scott Morrow, the county's top health officer, in an April 13 memo.

Morrow said he estimates that about 2% or 3% of the population has been infected with, or has recovered from, the coronavirus. That's roughly 15,000 to 25,000 people in San Mateo County, he said in the memo.

And roughly 1% of the population, he added, is likely capable of transmitting the virus. That translates to about 5,000 to 7,000 people countywide.

By contrast, only 721 people have tested positive for COVID-19 countywide, as of April 13. Twenty-one have died.

That means that there could be between 21 and 35 times more people who have been infected with or recovered from the coronavirus than the county is reporting on its data dashboard.

That said, the residents of San Mateo County do appear to be following the shelter-in-place order, which has been very successful at stabilizing the rate of infection locally.

But that doesn't mean things can return to normal just yet, he explained.

"If we don’t take our next steps carefully, we will experience the worst of what this virus has to offer," he wrote. "What we’re being faced with, in our immediate future, are trade-offs of the most significant kind."

It also doesn't help that an effective vaccine or effective medical treatments are unlikely to become available in the short- to medium-term.

The county's task, he said, is to increase the level of immunity to the coronavirus in the community "slowly and methodically while minimizing death, with equity in mind, while not overloading the healthcare system and minimizing economic damage."

The public health goal in the war against the novel coronavirus is to reach a "herd immunity" level, which means that roughly 70% to 80% of the population has developed immunity to the coronavirus. With only an estimated 2% or 3% of the population infected or recovered from the coronavirus and no vaccine ready, "we have a long way to go," he said. "There are no quick fixes."

But even his best estimates, he explains, are based on limited information and may be imprecise. They could be off by a factor of two or three – but probably not by a factor of 10. If that were the case, the health system would probably have already been overloaded, he said.

He said he's skeptical of some of the information the county has provided publicly because that data – confirmed cases, number of patients tested, is incomplete. The data are limited because many characteristics of the virus are unknown and testing remains very constrained in San Mateo County. The county's data panel on hospitalizations is more reliable, he added.

"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," he said.

The latest estimates, he reports, "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."

Instead, he suggested, people should focus on the facts as they do what they can to stay safe and healthy.

"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."

As for what's next, he said, "There is no playbook for the decisions we face or the balance we should attempt to maintain between these competing interests."

"One thing I do know," he added, "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."

Comments

Chuck Bernstein
Menlo Park: The Willows
on Apr 15, 2020 at 1:50 pm
Chuck Bernstein, Menlo Park: The Willows
on Apr 15, 2020 at 1:50 pm

Dr. Morrow:

Your WAGs about the number of cases of COVID-19 are not helpful. In your position, you could do a limited study (say, 100 random people) to assess the number of people who have had it, but didn't know, or have it now and don't know. As I understand, Stanford expects to publish the results of a similar study, with many more participants, at the end of this week. Until then, you should have kept your speculations to yourself.

Those people who are fearful currently will become more fearful after reading your unfounded guesses. Those people who are already skeptical will find you to be a non-credible source of information. How does that help us deal rationally with what is before us?

--Chuck Bernstein
444 Oak Court, Menlo Park


Thank you, Dr Scott
Menlo Park: Fair Oaks
on Apr 15, 2020 at 2:26 pm
Thank you, Dr Scott, Menlo Park: Fair Oaks
on Apr 15, 2020 at 2:26 pm

> your unfounded guesses.

Having a bad day, Chuck? Our local medical/health pro's are doing a great job. Just look at the hard numbers about excess mortality in NYC to get a picture of how bad it could have been.


Numbers: (yes, they're early and will be adjusted; from various sources - NYC, U of A study, etc..) Per NYC:

- 18,551 people died of all causes (March 11 thru April 13)

- COVID deaths: 10,367
- non-COVID death: 8,184
- expected/non-pandemic year (5 year avg): 5155.2 deaths

3,028 people dead, above normal mortality plus known Covid19.

How many of the 3,028 excess mortality died of delays, fear of going to the doc in the middle of the crisis, longer wait times, diagnosed Covid, etc..?

Dunno.

Other studies show similar 'excess mortality' in urban settings, with a higher multiplier in rural settings.

Dr. Scott needs lots more testing. The better comments, Chuck, would be to inquire as to WHY we haven't been doing more testing.


rdegolia
Atherton: West Atherton
on Apr 16, 2020 at 1:16 pm
rdegolia, Atherton: West Atherton
on Apr 16, 2020 at 1:16 pm

I am proud that the Bay Area led the nation by implementing the first Shelter in Place. Certainly it has enabled us, where the virus probably first landed from China, etc., to avoid the horrific experience that New York is having. Dr. Morrow's guess at 2-3% having been infected is certainly more educated than my guess would be, but I'd be ALOT more comfortable with a real study of a 100 or 1,000 of our residents so that we can get the facts. I also wish that the Almanac had inquired about the testing. Dr. Morrow says that we need significantly more testing. Why isn't it happening? You can only be tested if you show symptoms or know that you've been with someone who is positive. When are we going to start testing others and is there any strategy around tracing? South Korea seems to have been highly successful with their testing and tracing. I know that Stanford has initiated tracing at their Crown clinic, but we need a broad strategy to greatly expand testing and include tracing.


Thank you, Dr Scott
Menlo Park: Fair Oaks
on Apr 16, 2020 at 1:36 pm
Thank you, Dr Scott, Menlo Park: Fair Oaks
on Apr 16, 2020 at 1:36 pm

> Why isn't it happening?

The rest of the world started using WHO testing technology back in late January. The US declined and went it's own route. We were promised 4 million tests in February.

The guy who made that promise said in March there have been plenty of tests available for everyone who wants one. So, according to him, it's someone else's fault. Here we are in mid-April.

'tis a quandary...


Peter Carpenter
Menlo Park: Park Forest
on Apr 16, 2020 at 1:47 pm
Peter Carpenter, Menlo Park: Park Forest
on Apr 16, 2020 at 1:47 pm

"WHY we haven't been doing more testing."

Simple - The Federal government refused the proven WHO test, used its own flawed CDC test and then did not start ramping up the development and approval of non-CDC tests until well into MARCH !!!


Jack Hickey
Woodside: Emerald Hills
on Apr 16, 2020 at 11:25 pm
Jack Hickey, Woodside: Emerald Hills
on Apr 16, 2020 at 11:25 pm

My son, John, who has been in a 15 bed psych ward at the Long Beach VA since last July, tested positive for the coronavirus on Monday, March 30. Twelve days later, he retested positive. Sixteen days later he was free of the virus. He had no symptoms of the virus and was not treated for it by the VA. So, how many people like John, have hosted the virus without having symptoms? And, what about those rugged individuals, who don't have time to run to the doctor, and just tough it out? These people don't get counted. One anecdotal(but true) story does not prove anything, but neither do the flawed numbers being bandied about by the media.
John was a two pack a day Marlboro man until he was admitted to the VA psych ward last July. He has emphysema, and type 2 diabetes. Go figure. The VA did not treat him for coronavirus, because he lacked the symptoms.
John was a two pack a day Marlboro man until he was admitted to the VA psych ward last July. He has emphysema, and type 2 diabetes. Go figure. The VA did not treat him for coronavirus because he lacked the symptoms.


Peter Carpenter
Menlo Park: Park Forest
on Apr 17, 2020 at 9:05 am
Peter Carpenter, Menlo Park: Park Forest
on Apr 17, 2020 at 9:05 am

Undercounting the denominator because of missing asymptomatic people does change the death rate but does not change the number of deaths.

Our objective is to minimize the number of deaths.

The true death rate from Covid 19 won't be known for years as the epidemiologists get better and better data and then continue to refine their analysis.


Tecsi
another community
on Apr 17, 2020 at 4:07 pm
Tecsi, another community
on Apr 17, 2020 at 4:07 pm

These are some of the best comments I have read on an Almanac thread. Quality thinking, respectful (mostly), good direct responses. This is a good example of how these comment threads can expand and enrich the discussion.
Thanks to all the commenters above me here.


Jack Hickey
Woodside: Emerald Hills
on Apr 17, 2020 at 8:26 pm
Jack Hickey, Woodside: Emerald Hills
on Apr 17, 2020 at 8:26 pm

I found this link from a post on Nextdoor to be worth posting here.

Web Link


Citizen
another community
on Apr 18, 2020 at 7:15 am
Citizen, another community
on Apr 18, 2020 at 7:15 am

While seeing the current flatten in the Bay Area has been encouraging, the public response to closing parks and limiting recreation to a small radius in San Mateo county had been nothing short of a disaster. San Mateo county was among the first to close all of its parks, which lead to an uptick in usage at MidPeninsula parks. Then they became burdened by the increase and closed on weekends and completely closed Windy Hill. The latest move was to ban bikes, which now forces all of the remaining traffic into the few remaining city parks that have stayed open, and I think it's clear what will happen next...

Why has our response been so uncoordinated and draconian? Contrast this to Contra Costa county and East Bay Parks that have strived to stay open to provide people of all walks of life (not just those fortunate and wealthy enough to live close to nature) an opportunity to get outside, and have explicitly and adamantly refused to impose such a limitation.

We've made a bad problem much, much worse, which is affecting people's mental health too. Keep all parks open!


Peter Carpenter
Menlo Park: Park Forest
on Apr 18, 2020 at 12:52 pm
Peter Carpenter, Menlo Park: Park Forest
on Apr 18, 2020 at 12:52 pm

"On 28 March the Guardian exposed the missing six weeks lost as a result of Trump’s dithering and downplaying of the crisis when the virus first struck. Jeremy Konyndyk, another central figure in the US battle against Ebola, told the Guardian that the Trump administration’s initial response was “one of the greatest failures of basic governance and leadership in modern times”.

Now that the US is contemplating a shift into the second phase of the crisis – tentative reopening of the economy – scientists and public health officials are agreed that three pillars need to be put into place to manage the transition safely. They are: mass testing to identify those who are infected, contact tracing to isolate other people who may have caught Covid-19 from them, and personal protective equipment (PPE) to shield frontline healthcare workers from any flare-up.

A chorus of expert voices has also begun to be heard warning that those three essential pillars remain in critically short supply throughout the US. Less than a month after the Guardian’s exploration of the missing six weeks, the chilling recognition is dawning that the country is heading for a second massive failure of governance under Trump, this time on an even bigger scale."

Web Link


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