July 20, 2020 Health Officer Statement
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.
Why is the virus spreading here at it’s current higher level now? I don’t know exactly, but it appears to me that there are 3 major factors. In order to understand what’s going on completely with transmission risks, we would need to do case-control studies. We don’t have the resources to do case-control studies given the enormous burden on all the staff at the health department at this time, but we can take some educated guesses based on patterns that we are seeing here.
- The virus appears remarkably, even surprisingly,
transmissible. At pretty much every point over the
last 6+ months, I’ve been surprised, and impressed, at how
capable this virus is at moving itself between
people. It spreads in households like wildfire and it
spreads in other indoor environments too. It seems to
be everywhere we look. I know this is hard, we’re all
exhausted and frustrated by having to take precautions, but the
implication of this fact is that you can’t let your guard down,
or be careless, even once, especially if you are at high
risk.
- Fundamental structural failures of the US economy are being
laid bare by the pandemic. These structural issues seem to be a
major cause of the transmission we’re now seeing, at least in San
Mateo County. Many elements of the US economy can be
viewed as illogical, even immoral in my opinion, in that so many
people are forced to live lives of economic desperation, live pay
check to pay check, are not paid a living wage, live with no
workplace safety nets, like healthcare, like paid sick leave, or
other wage protection programs. While these structural
issues are illogical in good times, they are downright
inexplicable in times of a pandemic. These structural
problems are at such a massive scale, they can not be
ignored. A majority of people we are seeing infected
now are front line workers (people who allow the rest of us to
eat, and have electricity, and have our garbage picked up, etc),
live in crowded multigenerational conditions, live with lack of
trust in, and in fact have downright fear of,
government. Remember to stem the spread of this very
transmissible virus, people who are infected need to be separated
from others (isolation and quarantine), not go out in public, and
not go to work while they are infectious. Try getting
compliance with isolation and quarantine when the infected person
is the breadwinner for the family and the family will be out on
the street if they don’t go to work. And when they go
to work they will, perhaps, interact at that job with
you. There is not enough enforcement capacity in the
world to stop this from happening. The implication of
this is that the current business focused restrictions will do
little to stem the spread of the virus when the spread is
exacerbated by these conditions. This requires rapid
policy and systems changes at every level of both public and
private sectors, from the feds on down, and from the largest
corporations to the smallest business. We need to see
much more work in this area, and we need to have less reliance on
business sector closures and restrictions, beyond getting
businesses to do the basic transmission control
measures. Failure to fix some of these issues will
prolong our collective pain.
- Complacency is the other majority factor enabling spread. This is either born of belief systems (this is all a hoax, this isn’t that bad for me, let’s go to a party and get infected), or born of just not paying attention. Many, many of our infections are related to fairly small gatherings of family and friends. Birthday parties, picnics, eating at restaurants with mixed households, etc, without the basic precautions being taken. Most of these gatherings are innocent, no doubt, not intending to spread the virus, but they do spread it, and with far reaching implications. Please note, your seemingly innocuous get togethers are driving the spread and are a major reason why you can’t go to a restaurant, why you can’t go to the gym, why you can’t go get your hair cut, why kids can’t go to school. Until, or unless more people get this fact, we will continue to be stuck in the situation we are in. 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