Please read or reread my previous statements below to get a better understanding of where we find ourselves today and actions you can take to protect yourselves and your family.  

I wish to apologize to all the businesses that were closed this week.  I am not supportive of these actions and, for San Mateo County, I believe they are misdirected and will cause more harm than good.  This action is a bit like looking for your lost keys under a streetlight even though you lost them miles away.  If you have read my previous statements, you know I put great import on balance.  We have to minimize spread while not destroying everything else in the process.  I watch the news and I certainly get alarmed by some of what’s going on in the country, and even in our state.  But I have to make the best decisions and recommendations based on our data which reflects the situation in our community.  Our numbers indicate we are in a relatively stable state in regards to the spread of the virus.  For those who want to drive the spread to zero, this is simply not possible.  Even with the very restrictive measures put into place in the Spring, we could only drive the Re at that time to about 0.9.  The best point estimate we currently have for Re is about 0.98.  Our Re has also been slowly dropping for at least 4 weeks.  The Re (which can be calculated in a number of ways) is a forecast subject to all the vagaries of forecasts, but the Re trend downward is an encouraging sign.  Over the last few weeks, our hospitalizations are stable and/or decreasing.  Recently, our deaths have been low.  Even with the current data meltdown at the State related to the counting of new cases, I remain of the same opinion.

We also have a good idea of what’s causing the spread and it’s not primarily from barber shops, nail salons, or the other businesses that were targeted in this most recent closure.  See my statement from 7/20/20 to gain more understanding about the main reasons for the spread here.  While it’s certainly a theoretical possibility that some transmission can occur in the businesses/operations that were just closed by the State, there is no evidence that I have, and no evidence the State has provided to me, that leads me to believe the spread is higher in these businesses than those businesses/operations that are allowed to operate.  I have made our situation very clear to the State health leadership and have given them a good understanding of the full context of our situation.

The brand new, arbitrary and constantly changing framework that the State has set up to put counties on the watch list and to determine closures (beyond the State “floor”) is fundamentally flawed in several ways.  This wouldn’t matter so much, and I wouldn’t pay that close attention to it, if there weren’t so much economic and societal damage at stake, economic and societal damage without a concomitant reduction in spread.  To me it feels like some newly created bureaucratic box is just itching to be checked.  Some of the most concerning issues include:

There are huge data quality and data consistency issues that just seem to grow over time.

Benchmarks and time frames that may work on a state level, may not work on a local level due to problems with small numbers and large variability in those numbers.  

Some of our numbers change based on actions the State takes (such as large out-of-county hospital transfers, i.e., San Quentin, or restricting testing) that are not based on what’s going on here, but are held against us anyway even though they do not reflect the reality of what’s going on here.

The underlying framework has no room to take the context of what’s actually going on in a locality into account.  A rational and logical look at the true meaning of the data (which we should do with all data) has no role in the process.

The strategy and the Order that San Mateo County set up approximately 7 weeks ago, which focus on risk reduction/behavioral aspects seems to be working.  That Order does rely on the State to set an appropriate floor as to which businesses can operate and how they can operate and I support the current State “floor” of restrictions.

Where are the case-control studies (something most localities are not capable of performing, but the State is) that would actually tell us what’s happening in our state and allow us to design and implement appropriate interventions?

Because of the above, I feel the State has made the wrong “diagnosis” and therefore is prescribing the wrong “treatment” for San Mateo County.

Probably the biggest problem I see is in the application of public health law.  While it is true the State Health Officer and the Local Health Officer have partially overlapping statutory authorities, it is generally understood, and there is very long precedence, that the State Health Officer doesn’t take action against the Local Health Officer unless there is an ask to do so, the Local Health Officer can’t take action because of extenuating circumstances, or the Local Health Officer is negligent.  I didn’t ask for these actions to be taken, I’m certainly capable of taking these actions if warranted, and I do not believe I’m being negligent. 

I applaud the many great, broad and appropriate actions taken by the Governor over these last few months.  He has shown great leadership and nothing said above can or should take away from that. Unfortunately, in this instance, and in my opinion, the Governor isn’t being given good advice.

To get out of this situation depends on all of us. Our collective best course of action: No gatherings outside of immediate households, use facial coverings extensively, and social distancing.

Scott Morrow, MD, MPH, MBA
San Mateo County Health Officer