Exclusive Q&A: Santa Clara County health chief answers San José Spotlight readers
Dr. Sara Cody (right) responds to San José Spotlight reader questions as co-founder Ramona Giwargis moderates. Screen capture by Madelyn Reese.

Santa Clara County Health Officer Dr. Sara Cody sat down Oct. 8 to answer San José Spotlight readers’ questions about the COVID-19 pandemic.

Understanding of the virus has evolved considerably since Cody last answered reader questions in April.

The advice, however, has been consistent: People should maintain physical distance from those outside their household, avoid large gatherings, wear facial coverings and isolate and quarantine if exposed.

The exclusive Q&A session was streamed online by San José Spotlight and moderated by co-founder Ramona Giwargis, who asked reader questions, which were submitted before and during the broadcast.

Nearly 50 questions were submitted for the 20-minute webinar. We’ll work on getting answers to the questions that didn’t get addressed and will post those in future stories.

On Oct. 8, Santa Clara County reported 22,154 confirmed coronavirus cases and 354 deaths, according to the county’s public health department.

The questions below have been shortened and the answers have been edited for length and clarity.

What is the plan to vaccinate everyone in Santa Clara County? What would that look like?

We don’t know yet what vaccine(s) we might have available. The two vaccines have different conditions under which they need to be kept. Once vaccine needs to be kept at minus 70 degrees Fahrenheit. Most people do not have a freezer that’s quite that cold. Another example is one vaccine needs two doses 21 days apart, the other needs two doses 28 days apart. And we know that once you start with one vaccine, you have to finish with that.

There are a lot of logistical complexities, and a lot of unknowns. It’s most likely that we would get very few doses by the end of the year, if any. And most of the vaccination would probably not start until spring or summer. The other important thing to know is we have to follow the national guidelines from the American Academy of Immunization Practices. We’re not going to have a lot of leeway in how we do this.

How close are we to allowing a percent of fans at outdoor sporting events?

An outdoor sporting event would be a very large gathering, so I think we’re a ways off from having something like that. We’re really focused on what do we need to do now, and in the next days and weeks, to protect the population, and to ensure that we get through the fall and the winter. Then we’ll sort of see where we are. The county is doing better, and we’ll be in the state’s orange tier probably as early as next week. Since we’re aligning more with the state, that’s going to mean a lot of loosening and a lot of opening.

I want to be really clear that just because something is open and available doesn’t mean it’s safe. We still have quite a bit of this virus circulating in our community. We know how easily it spreads and how quickly we can get into trouble. The wildfire analogy is quite apt. So once you have a little ember that sparks a fire, it can get out of control very quickly and can take a long time to bring back under control. So yes, we’ll be easing. There will be more activities and businesses available. But we’re still in a very vulnerable situation and we all have to be extraordinarily careful to wear our face coverings, to keep our distance from people outside the household and do as much as possible to do activities outdoors or in a well ventilated space.

How can people gather safely indoors? How would you provide good ventilation for indoor gatherings without opening windows?

First to know is we are developing some county guidance regarding ventilation so for any business or activity that’s being conducted indoors, there will be some really practical guidelines for how to improve ventilation.

Another idea is we want to assume someone in the space might be infectious and might be producing those particles of varying sizes that contain the virus. What you want to do is dilute them. You can either do that if the building has an HVAC system, so you want to make sure you have a good filter in the HVAC system, and a lot of air exchanges so you’re really refreshing the air.

If you’re in an indoor space that does not have an HVAC system, there are still things that you can do to improve the quality of the air and dilute those little infectious particles. One would be to open doors and windows and get the outside air in. You can move air with fans. If you have a ceiling fan, you want to make sure that it draws air up and you want to make sure that you place fans so you don’t blow air onto people. The general idea is you place fans so they would draw the indoor air outside and the then fresh outdoor air can go outside. So you draw the stale contaminated air outside.

The other thing to keep in mind is filtration. Even if you don’t have an HVAC system with a filter, there are portable filters. Some of them are rated so you have to look at the rating, but if you pick an appropriate rating, you can also get some benefit from filtering the air. Remember you want to dilute it by getting outside air in, and you want to filter it by trying to remove what ever infection particles. Very important: Any time you’re indoors with someone outside your family, you wear a face covering.

What are your thoughts about how access to a safe COVID-19 vaccine should be prioritized, and how do we encourage residents to get vaccinated?

That is a very important issue regarding trust in the vaccine. It’s about access to the vaccine and then if the vaccine is available, making sure that those who need it get it. The vaccine will be distributed to us initially in very small amounts and we will need to distribute it based on priorities at the national and state level. The first priority is health care workers taking care of patients with COVID-19.

Once we have ample amounts of the vaccine, our challenge is going to be getting the population vaccinated. What is going to be important is to understand how the public feels about the vaccine. What are the barriers? Why are people hesitant? It’s not just having a vaccine, it’s ensuring that people can get it and will get it.

How does the health department balance medical issues such as increasing suicide rates, drug addiction rates, depression, delayed cancer treatments, increases in unreported child abuse, domestic violence, etc. when making COVID-19 decisions?

There are so many various factors that impact our health and wellbeing. The implicit in your question is that we have seen elevation in those conditions, and actually in many cases we surprisingly haven’t. We do look at data across our county for non-COVID conditions to try to understand how the pandemic is impacting health. We look at our emergency medical service data for who is transported for things like a mental health crisis, a drug overdose or trauma, and those services actually decreased in March and April and then gradually came up and now they are back up to about where they were pre-shelter in place. Our suicide rates we follow very carefully, and they’re similar in 2020 to what we saw in 2017 through 2019.

Emergency department visits for anything related to anxiety, mood, depressive disorders and suicide attempts, those decreased after shelter-in-place, and they’re now back to pre-COVID levels but they’re not above pre-COVID levels. I know that’s surprising but that’s what our data show. In our county and many counties, we never closed any healthcare operations. It was available. We did that very, very intentionally. We didn’t want people to not access care for whatever healthcare need they had. During the earlier days in March and April we did see a decline in people accessing care. It was probably driven by fear of COVID.

The key to all of this is getting the pandemic under control and everything else really follows. Our primary focus is to protect our residents from hospitalizations and keep the general transmission levels (from COVID) as low as we possibly can.

When will our county have rapid testing available for people who need to work (i.e., 15-minute results)?

We’re looking at a lot of different antigen tests. None of them are perfect and they all have caveats. We’re actively looking for anything reliable and accurate. But none of them are accurate as PCR tests (molecular tests that detect the virus’s genetic material).

Our testing turnaround times have decreased quite a lot to 24 to 48 hours and we encourage everyone to go. All health care facilities are required to offer tests to many different groups so everyone should be able to go to their health care provider as well.

Watch the Q&A in full below.

Contact Madelyn Reese at [email protected] and follow her @MadelynGReese.

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