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