This is a difficult message to share, but it is important to recognize how difficult the times ahead may be and how you must now take assertive action to prepare for them. Our local situation surrounding novel coronavirus (COVID-19) is changing rapidly. COVID-19 is spreading in our community, the extent of which is unclear. It has likely been spreading for weeks, perhaps months. I have no reason to believe that how it’s spreading in other countries won’t be replicated to some degree here. We now all need to take assertive actions to inhibit the spread of this new virus. Some of those actions are described below. I advise that individuals, schools, business, and all other sectors of our community take immediate steps to change behaviors and take definitive action.

Our lives will be significantly disrupted by the measures needed to respond to a global pandemic. A pandemic is a global occurrence of an infectious disease. A pandemic is a disaster with unique characteristics. The two most important differences between a pandemic and other disasters are that the whole world is going through this disaster at the same time, and people may become fearful of other people. The current COVID-19 outbreak clearly has the potential to turn into a severe pandemic.

County Health continues to work with the federal Centers for Disease Control and Prevention (CDC) and our state and local partners to manage testing and monitoring of persons who have been exposed to COVID-19. But our focus is rapidly changing from a containment strategy (identifying cases and contacts) to one of community mitigation—taking steps to lessen the broad impact of the disease. County Health and our public and private partners are taking steps to increase our ability to respond and are planning for a sustained response to COVID-19.

How the world operates during a pandemic is different from how the world operates normally. This is not business as usual. With a pandemic comes significant disruption to supply chains (the process of how things get from where they are made to where they are used), transportation, and travel. Even if the disease is not rapidly spreading in our area, we may face difficulty obtaining the goods and services we are accustomed to, public events may be canceled, and our ability to travel might be restricted.

San Mateo County Health continues to advise that the steps to prevent the spread of flu will also guard against the spread of COVID-19: cover your cough and sneeze, wash your hands frequently, avoid shaking hands and touching your face with unwashed hands, and if you are not feeling well or are experiencing cold, flu, or other symptoms, stay home from school or work. If you are mildly ill, there is no need to contact your primary care provider as they are very busy right now. If you are significantly ill, contact your primary care provider.

Here are the most important things for you to consider to improve your personal and organizational preparedness:

What matters most is how households, neighborhoods, community groups, businesses, and other organizations prepare. What does that mean? Preparedness equals self-sufficiency. The government will help where it can, but it may have a limited ability to respond directly to you due to the scale of the disruptions.

Individual and community preparations should focus on three tasks—reducing each person’s chance of getting sick (see both individual and more general public health recommendations both above and below), helping households with basic survival needs during a pandemic, and minimizing and coping with larger disruptions in how the normal day-to-day world works.

All businesses and other organizations should now be done reviewing their continuity of operations plans for how they will operate if their employees are unable to work and how they will interact with members of the public and prepare to implement these plans soon.

All medical facilities and providers should be done reviewing their surge plans for how to handle increased numbers of patients and be prepared to implement.

Getting ready for a pandemic is largely about preparing for possible shortages. In a pandemic, supply chain disruptions are inevitable but are also unpredictable.

Since it contains vital supplies, a good start is to make sure your earthquake kit is up to date and ready to go. Of course, having supplies beyond the typical earthquake kit is a good idea. What you decide to have on hand is based on your individual and family situation and your individual preferences.

One likely shortage will be medications. You should attempt to obtain a couple of months supply for your critical medications.

If you have other critical supply needs, you should conserve them and stock up on them now.

Now is also the time to think about how you will care for loved ones at home if they or you are sick and how you would limit spread within the family.

Frequent and appropriate hand-washing is far from a perfect solution, but it’s easy, under your control, and has no significant downside.

Like washing your hands, wearing a surgical mask may help a bit, but you need to know that surgical masks don’t offer much protection when they are worn by people who are well. They are most helpful when worn by those who are already sick so that they are less likely to transmit the disease to others. Surgical masks and masks offering higher levels of respiratory protection are already in short supply and should be prioritized for use in health care settings.

You should use a barrier, such as a paper towel or tissue, to touch commonly touched surfaces, such as any door handles or elevator buttons.

Change from my previous message: I am now asking for the implementation of the activities below at this time.

All non-essential gatherings should be canceled, postponed, or done remotely. Unfortunately, at this time, I have no standard definition of “non-essential” or “gathering” to guide your decisions. Use your best judgment.

Those over the age of 60 and those with co-morbid conditions should avoid gatherings to the extent possible.

Stop shaking hands.

Increase in the amount of remote working or teleworking to the extent possible especially for those who appear at higher risk for developing the disease, those over the age of 60 and those with co-morbid conditions.

Under all circumstances, stop touching your face, eyes, nose, or mouth with your unwashed hands.

Social distancing—staying at least 6 feet away from all other people—should be attempted where possible.

I am not asking for the implementation of these activities, but these are the types of activities we may need to implement in the future:

School closures. Schools are an essential gathering. School closings present a particularly vexing social distancing dilemma but may be necessary to protect public health. Once school closings occur, they may be extensive and extended.

Rationing (a formal process of prioritizing distribution and use) of critical supplies may need to occur.

To get ourselves through the hard times that may be coming, your community may need volunteers. Think now about the skills you have and how you can help your community. Heed the call should volunteers be requested.

Other public health interventions that have been used with some effect in other countries include commandeering of both real estate or personal property, conscription, curfew, and cordons. It is unlikely that these interventions would be used here due to practical considerations.

Issues around testing for COVID-19. You may have received incorrect information from the federal and state government on March 4, 2020. San Mateo County does not currently have testing available independently of the state and CDC. The amount of testing that is available through the state and CDC is severely limited. Should testing become more widely available, testing will be prioritized based on healthcare infrastructure concerns, risk of exposure, and/or very sick hospitalized patients. Tests will not automatically be given upon request or by a physician’s order. This may change as testing capacity evolves over the next few months.

Scott Morrow, MD, MPH
San Mateo County Health Officer
March 5, 2020