Category Archives: #novaccinenocure

CDC COVID-19 Aerosols for Hours.

By Michael G, Stogner

Here we are Nine months into a PANDEMIC. Remember You are responsible for protecting yourself and loved ones. The U.S. Centers for Disease Control and Prevention acknowledged Monday that the coronavirus can spread through microscopic respiratory particles known as aerosols that float in the air for minutes or even hours before being inhaled.

WEAR A MASK, STAY SAFE.

Todays LATIMES Article:

CDC warns of aerosol spread

Tiny particles that linger in the air can help transmit virus, especially in crowded indoor spaces.

WEARING masks and social distancing indoors are keys to stopping the virus from being transmitted. (Allen J. Schaben Los Angeles Times) 

By Richard Read

SEATTLE — The U.S. Centers for Disease Control and Prevention acknowledged Monday that the coronavirus can spread through microscopic respiratory particles known as aerosols that float in the air for minutes or even hours before being inhaled.

On its website, the CDC said that even people who followed social distancing guidelines have been infected through this type of transmission — and added a warning against frequenting crowded, poorly ventilated indoor spaces.

The acknowledgment comes after months of campaigning by independent experts and brings the agency into line with research on the role of aerosols in “super-spreading events” such as a choir practice in Washington state that infected dozens of people and killed two.

But some researchers said the agency did not go far enough, because it maintains that the virus is still far more likely to spread through larger respiratory droplets that quickly fall on people in close vicinity.

Donald K. Milton, a University of Maryland environmental health professor and expert on aerosols, said Monday that the CDC was “slowly moving along in the right direction, but is not where I would quite like to see it.”

He said that mathematical models show that aerosols carrying the virus are more apt to spread the disease than larger droplets spewed as projectiles, even when an infected person is less than six feet away.

“At close range, you’re still going to see aerosol transmission dominant most of the time,” he said. “Spitballs are much less frequent.”

He said that means that masks — which the CDC has long recommended be worn when near others — are useful both indoors and outdoors for preventing the spread of the virus.

“Outdoor dining is associated with increased risk of getting COVID-19 because people are sitting there for a long time without a mask in one spot,” he said.

Moving around when outdoors lowers the risk of inhaling aerosols and becoming infected, he said.

When the coronavirus began spreading in the United States early this year, the CDC advised people to stay at least six feet away from other people and wash their hands frequently in case they happened to touch contaminated surfaces.

Later the agency said that contaminated surfaces played only a minor role in spreading the virus.

Researchers began following up on reports of super-spreading incidents in which aerosols appeared to be the main culprit.

The scientists urged the CDC and the World Health Organization to acknowledge airborne transmission, but health officials were skeptical.

In July, after 239 researchers from 32 countries signed an open letter urging the WHO to accept the possibility that aerosols played a major role in spreading the virus, the international agency revised its guidelines to recommend that people avoid poorly ventilated, crowded spaces.

Still, the WHO maintains that aerosol transmission has not been definitively demonstrated.

On Sept. 18, the CDC revised its guidance without notice to say that the virus spread through aerosols, but withdrew the new advisory three days later , saying it was a draft of proposed changes posted by mistake.

CDC officials did not respond to requests for an interview Monday.

A letter written by Milton and five other researchers and published Monday by Science magazine cited “overwhelming evidence” that inhalation was “a major transmission route” for the coronavirus and cited an urgent need to define terms consistently across scientific fields.

Respiratory droplets, defined as larger than 100 microns, can be sprayed like tiny cannonballs and typically fall to the ground in seconds within six feet, the letter said.

But the letter said that aerosols — defined as particles smaller than 100 microns, less than the diameter of the average human hair — “can remain suspended in air for many seconds to hours, like smoke.”

Milton said that tobacco smoke is an apt analogy to understand how tiny respiratory particles waft through the air.

“If somebody goes out for a smoke and they come in and you smell it on their breath, you’re inhaling their exhaled breath,” he said.

Milton said while the virus is most apt to spread through the air indoors, where aerosol can accumulate, it’s possible that airborne transmission occurred at the Sept. 26 White House Supreme Court nomination ceremony for Judge Amy Coney Barrett.

The event included a large gathering in the Rose Garden and a smaller, indoor reception. Photographs show that in both locations few people wore masks and that social distancing guidelines were not widely followed.

The CDC has the technical resources to conduct an investigation that could determine who infected whom, Milton said.

“It would be very interesting to know which way the wind was blowing in the Rose Garden,” he said. “They were really close to each other, they were hugging each other, they were shaking hands. They were throwing all precautions to the wind, and the wind got them anyway.”

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Half Moon Bay Beaches OPEN Labor Day Weekend.

By Michael G. Stogner

Half Moon Bay City Council voted 5-0 last night to keep the Beaches in Half Moon Bay Open while Monterey County, Santa Cruz County and the City of Pacifica have decided to Close Beaches and Parking Lots.

There is a Worldwide PANDEMIC, No Cure, No Treatment, No Vaccine but that has never been a concern for San Mateo County Leadership. They have consistently been dedicated to Staying off of the States Watchlist, or Getting Off of the States Watchlist. That might be why they have made so many changes to the Data Base, None of it matches.

Back to the Beaches of Half Moon Bay you can’t blame the elected officials in this case, so many moving parts and they don’t get paid for this. The City Manager, Assistant Manager, Sheriff, Chief of Police they do, the Chief who by the way said he would make some calls to see if he could get some extra staff to enforce the closure of Beaches if they voted to close. Think about that, He didn’t say Of Course I will get the extra staff I need to enforce your decision. This is San Mateo County, now known as Silicon Valley and the Police Chief says its going to be tough to enforce it. All five council members were OK with his response.

Even from a simple Math point of view, This is a very bad idea. Half Moon Bay and the SMC Coast experience Gridlock on normal weekends, watch what happens now. This is an invitation to the world the Party is in Half Moon Bay this Labor Day Weekend.

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Citizen Advocate Brent Turner Petition to remove Dr. Scott Morrow.

By Michael G. Stogner

Brent Turner

If any San Mateo County Residents have asked/wondered how did the San Mateo County Coast Beaches Close on July 3-6 2020. The simple answer is Brent Turner and two Mayors and about 100 phones calls, e-mails etc. His concern has remained consistent every single day Protect the Residents of San Mateo County.

Now Mr. Turner has started a Petition for the same reason, He is unable to find any elected official to take charge to protect the Residents of San Mateo County.

Petition to remove Dr. Scott Morrow & HMB City Manager

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California COVID-19 Data Glitch Fixed.

By Michael G. Stogner

San Mateo County Dashboard should be fully functional by Sunday night.

A technical glitch that has plagued the data system the state relies on to make decisions about reopening businesses and schools has been fixed but it could take up to 48 hours to get the numbers updated, California’s top health official said Friday.

California Health and Human Services Secretary Dr. Mark Ghaly said that up to 300,000 records might have been backlogged — but not all of them are coronavirus cases and some may be duplicates. California reported 8,436 new confirmed cases Friday and surpassed 10,000 deaths from the coronavirus.

“We apologize. You deserve better, the governor demands better of us and we are committed to doing better,” Ghaly said.

County health officials say they’ve been flying blind, unable to conduct robust contact tracing or monitor health factors without timely information, especially at a time when parents are on edge about school plans.

Update: August 8, 2020 San Mateo County Website does not inform the residents that the Glitch has been corrected.

Health Officer Updates

 

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The Horse Park at Woodside, August 7-9

By Michael G. Stogner

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The Horse Park at Woodside

I have asked San Mateo County Sheriff Carlos G. Bolanos his Public Information Officer Rosemary Blankswade and San Mateo County Manager Mike Callagy to comment on this subject. So far none of them have made a comment to me yet. If they do I will publish it.

As most of San Mateo County is starting to realize the County has remained off of the State Watchlist for several weeks when there was no benefit in doing so even if the Data on the County Website were true. SMC has always had SFO in County and San Jose International just to the south in Santa Clara County, Both had several non-stop flights to and from Wuhan per day. To this day we do not know how COVID-19 is transmitted, There is NO CURE, NO TREATMENT, NO VACCINE. San Mateo County Website claims it has a Testing goal of 1,800 per day, in the entire month of July they reached that goal only 2 days for the entire month.

They are expecting between 300-350 people to attend this three day event.

Now is not the time to hold this event. There is a Pandemic.

 

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Upcoming August Events at The Horse Park

     and COVID-19 Preventative Measures

The Horse Park will be hosting two major horse shows in August, which are put on by two of the West Coast’s top show producers, The Summer Event at Woodside Horse Trials (August 7-9) and Silicon Valley Equestrian Hunter/Jumper Festival (August 19-23 & 26-30). These shows are authorized under the State guidance.  Every aspect of the shows will meet the strict requirements for competition outlined in the California Department of Food and Agriculture’s “Equestrian Event Resources.” These outdoor, controlled-access shows will adhere to the robust Covid-19 biosecurity protocols and compliance measures established by the national federations for the sport, specifically the United States Equestrian Federation.

The Horse Park prioritizes the safety of our members, exhibitors and surrounding community. The following are some of the things that will be strictly enforced in regard to Covid-19 preventative measures:

 

  • Every person entering the property will be screened and have their temperature taken every day. No one with Covid-19 symptoms or who has known direct exposure to Covid-19 will be allowed on property.
  • Following successful daily screening, participants will receive a daily wrist band.
  • Social distancing will be required and strictly enforced.
  • Masks are mandatory at all times except when riding a horse or consuming food or beverage.
  • No spectators are allowed.
  • No social events or gatherings are allowed.
  • Additional handwashing stations and sanitizer dispensers will be widely spread around the facility for everyone’s use.
  • Signage is posted throughout the Horse Park regarding basic rules and Covid-19 safety measures. Additional signs will be installed for even greater visibility.
  • All show attendees will sign a statement in advance agreeing to Covid-19 rules for competition and acknowledging that they will be asked to leave if they do not comply. The signed statement will also include contact information and consent for future contact tracing should that be required.
  • There will be biosecurity compliance officers walking around the property for the duration of the competition to ensure strict adherence to the rules.
  • The Horse Park will ensure ongoing cleaning of all common surfaces and areas.

 

We are pleased to support our valued equestrian constituents and host these exciting events. We will insist on participants’ compliance with the rules to ensure a safe and enjoyable competition for everyone. We continue to be impressed by the wonderful Horse Park community, and we thank you in advance for your support.

Steve Roon

Executive Director

 

 

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San Mateo County COVID-19 Data is Flawed.

By Michael G. Stogner

San Mateo County was the only County in the entire Bay Area to remain off of the State of California’s Watchlist. Why was that a goal for the Supervisors and County Manager instead of Protecting the Residents of SMC.

San Mateo County News.com has reported for weeks that the data did not add up. We also contacted County Manager Mike Callagy to explain the additional 15 ICU Beds and Staff that were reported on a single day only to disappear the next day.

His response was:

Michael,
I don’t know specifically, but I do know many hospitals now are able to easily convert rooms to ICU… it is not like the ICU wards they use to have.  Most rooms now are set up to convert to ICU.
Mike

Its fair to say that a Shut Down is in order until the real data is available.

Why would anybody believe San Mateo County with SFO and San Jose International Airport to the South not be a natural HotSpot.

 

SAN MATEO COUNTY HEALTH DATA

A significant unresolved problem with the State of California’s reporting system for communicable diseases (California Reportable Disease Information Exchange [CalREDIE]), has resulted in significant underreporting of COVID-19 testing results to San Mateo County Health and local health departments state-wide. Local health departments are receiving incomplete information regarding laboratory test results, which affects our ability to identify new cases of COVID-19, to accurately report the testing positivity rate in our community, and to identify the number of persons tested for the last few weeks. Without timely reports of all new lab results, it is impossible for the California Department of Public Health (CDPH) and local health officials to identify the extent to which COVID-19 is circulating in the community. It also hinders our ability to conduct effective contact tracing and case investigations to slow the spread of COVID-19.

The extent of this issue is currently unknown, and the expected resolution date is also unknown.  San Mateo County Health is in conversations with CDPH, working to rapidly resolve this issue and creating new paths for laboratory results to be reported to our County. In the meantime, we are continuing to report the testing data we do receive and will make clear to the public which data reported on our website are affected by this issue. Data currently affected are in the County Data Dashboard, the Lab Testing Data Dashboard, the Cases by City map, and the Long Term Care Facility Data Dashboard. CDPH has confirmed that although received data are incomplete, the data are valid for those results we are receiving. We expect the testing positivity rate, the daily and cumulative case counts, and other data points on the County’s COVID-19 data dashboards to change as more complete test results are reported to San Mateo County Health.

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San Mateo County Data Dashboard.

By Michael G. Stogner

How does San Mateo County Government tell you that on July 30, 2020 there were 64 New Cases. Where does that data come from? It should come from LAB TESTING DATA. When you look at LTD you’ll see there is NO DATA for July 30, 2020.

 

Screen Shot 2020-07-31 at 8.57.35 AM

64 New Cases July 30, 2020

Screen Shot 2020-07-31 at 9.07.21 AM

Last date of Data is July 29, 2020

Screen Shot 2020-07-31 at 9.07.59 AM

Last date of Data is July 29, 2020

 

7 Day Average Positivity Rate from July 22-28, 2020 is 8.614%

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Supervisor David Canepa is the problem.

By Michael G. Stogner

david_canepa

SMC Supervisor David Canepa

We have plenty of hospital beds and are ready for a surge. I don’t want to take a step back, but we must all be prepared. This will require an extraordinary effort at every level of government to ensure these businesses do not fail,” said Supervisor David Canepa. You can see he has shifted to protect businesses instead of Residents.

Supervisor Canepa knows his statement is Misleading and False ICU Beds are the issue not Surge Beds.

San Mateo County has 67 ICU Beds & Staff and was supposed to have 13 ICU Beds and Staff available to meet the 20% Availability Rate 67 ICU Beds & Staff x 20% = 13.4. You will see on the chart below July 23-24 the gray bar is blank the available beds & staff were 5 and 3. Does that sound like “We have plenty of hospital beds.”

Screen Shot 2020-07-29 at 4.04.32 PM

 

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Shut it down, Start over, Do it Now.

DOWNLOAD THE LETTER** This is an open letter to America’s decision makers, on behalf of health professionals across the country. We’ll update the list regularly with signatures. If you’re a health professional and want to add your name, you can do so here

Dear decision makers,

Hit the reset button.

Of all the nations in the world, we’ve had the most deaths from COVID-19. At the same time, we’re in the midst of “reopening our economy,” exposing more and more people to coronavirus and watching numbers of cases — and deaths — skyrocket.

In March, people went home and stayed there for weeks, to keep themselves and their neighbors safe. You didn’t use the time to set us up to defeat the virus. And then you started to reopen anyway, and too quickly.

Right now we are on a path to lose more than 200,000 American lives by November 1st. Yet, in many states people can drink in bars, get a haircut, eat inside a restaurant, get a tattoo, get a massage, and do myriad other normal, pleasant, but non-essential activities.

Get our priorities straight.

More than 117,000 Americans had died of COVID-19 by mid-June. If our response had been as effective as Germany’s, estimates show that we would have had only 36,000 COVID-19 deaths in that period in the United States. If our response had been as effective as South Korea, Australia, or Singapore’s, fewer than 2,000 Americans would have died. We could have prevented 99% of those COVID-19 deaths. But we didn’t.

The best thing for the nation is not to reopen as quickly as possible, it’s to save as many lives as possible. And reopening before suppressing the virus isn’t going to help the economy. Economists have gone on record saying that the only way to “restore the economy is to address the pandemic itself,” pointing out that until we find a way to boost testing and develop and distribute a vaccine, open or not, people will not be in the mood to participate.

Listen to the experts.

Public health professionals have made clear that even after we’ve contained the virus by staying at home, in order to reopen American cities and towns safely, we will need:

— Enough daily testing capacity to test everyone with flu-like symptoms plus anyone they have been in close contact with over the last 2 weeks (at least 10 additional tests per symptomatic person). We currently have only 35% of the testing capacity we need to meet that threshold. The more people get sick, the more testing is required.

— A workforce of contact tracers large enough to trace all current cases. That’s 210,000 more contact tracers than we had in April, but the number keeps going up as infections rise. Most states are far short of the number of contact tracers they need.

In addition, we need more personal protective equipment (PPE) to keep essential workers like health professionals, emergency responders, and grocery store clerks safe.

Shut it down now, and start over.

Non-essential businesses should be closed. Restaurant service should be limited to take-out. People should stay home, going out only to get food and medicine or to exercise and get fresh air. Masks should be mandatory in all situations, indoors and outdoors, where we interact with others.

We need that protocol in place until case numbers recede to a level at which we have the capacity to effectively test and trace. Then, and only then, we can try a little more opening, one small step at a time.

You should bar non-essential interstate travel. When people travel freely between states, the good numbers in one state can go bad quickly.

If you don’t take these actions, the consequences will be measured in widespread suffering and death.

We need you to lead.

Tell the American people the truth about the virus, even when it’s hard. Take bold action to save lives — even when it means shutting down again.

Unleash the resources needed to contain the virus: massively ramping up testing, building the necessary infrastructure for effective contact tracing, and providing a safety net for those who need it.

Many of the actions of our government thus far have fallen short of what the moment demands. Mr. Trump, federal administration, honorable governors: we remind you that history has its eyes on you.

Sincerely,Matthew Wellington
Public Health Campaigns Director, U.S. PIRG

Ezekiel J. Emanuel, M.D., Ph.D.
Vice Provost of Global Initiatives
Chair, Department of Medical Ethics and Health Policy
Levy University Professor
Co-Director, Healthcare Transformation Institute
Perelman School of Medicine and The Wharton School
University of Pennsylvania

Krutika Kuppalli, MD
Infectious Diseases Physician and Emerging Leader in Biosecurity Fellow at Johns Hopkins Center for Health Security

William Hanage, PhD
Harvard T. H. Chan School of Public Health

Saskia Popescu, PhD, MPH, MA, CIC
University of Arizona

David Sherman, PhD
University of Washington

Richard H. Ebright, Ph.D.
Rutgers University

Angela Rasmussen, PhD
Columbia Mailman School of Public Health

Seth Trueger, MD, MPH
Northwestern University

Megan Ranney, MD, MPH
Brown University & GetUsPPE

Sanjat Kanjilal MD, MPH
Harvard Medical School, Brigham & Women’s Hospital

Joan Casey, PhD
Columbia University Mailman School of Public Health

Karen Thickman, PhD
University of Washington, Department of Microbiology

Valerie Bengal, MD, FAAFP former UCSF Associate Clinical Professor
UC Santa Cruz and Capacitar International

Reshma Ramachandran, MD, MPP
National Clinician Scholars Program, Yale School of Medicine

Howard Forman, MD, MBA
Yale University

Ryan Marino, MD
Case Western Reserve University

Eric Goralnick, MD, MS
Brigham and Women’s Hospital/Harvard Medical School

Wade Berrettini, MD, PhD
University of Pennsylvania Perelman School of Medicine

Janet Perlman, MD, MPH
UCSF

David Rosen, MD, PhD
Washington University School of Medicine

Drew Schwartz, MD, PhD
Washington University School of Medicine

Krysia Lindan, MD, MS
University of California, San Francisco

Yaneer Bar-Yam, PhD
New England Complex Systems Institute

Margaret Handley, PhD, MPH
University of California San Francisco, Department of Epidemiology and Medicine

Thomas Lietman, MD
UCSF

Travis Porco, PhD, MPH
University of California, San Francisco

Veronica Miller, PhD
UC Berkeley School of Public Health

Kenneth Rosenberg, MD, MPH
PHSU-PSU School of Public Health

Jason Newland, MD
Washington University

Elizabeth Jacobs, PhD
Department of Epidemiology and Biostatistics, University of Arizona

Fern P. Nelson, M.D.
Veterans Administration Hospital

James Gaudino, MD, MS, MPH, FACPM
OHSU-PSU School of Public Health & Gaudino Consulting

Bruce Agins, MD, MPH
UCSF

Bonnica Zuckerman, MPH
UVM

Paul Song, MD
PNHP

Katherine Villers, MUA
Community Catalyst

Bethany Letiecq, PhD
George Mason University

Vineet Arora, MD, MAPP
University of Chicago and IMPACT4HC

Pete DeBalli, MD
UCF School of Medicine

Carrie Beckman, PharmD
UC Health

Krys Johnson, PhD, MPH
Temple University

Aalim Weljie, Ph.D. University of Pennsylvania

Michael Kelly, PhD, MSW
Loyola University Chicago School of Social Work

Kevin Foskett, PhD
University of Pennsylvania

John Hansen-Flaschen, MD
University of Pennsylvania

Garret FitzGerald, MD
University of Pennsylvania

Amy Humrichouser, MD
University of Michigan

Aurora Horstkamp, MD
Washington State University

Timothy Ellender, MD
Indiana University

Christine Brewer, MSW, MSN, RN
Villanova University

Pamela Norton, PhD
Drexel University College of Medicine

Diane McKay, Psy.D.
LECOM

Kay Mattson, MSW, MPH
Independent international Public Health Consultant

Dominique Ruggieri, PhD
School of Medicine and Center for Public Health Initiatives, University of Pennsylvania

Eve Bloomgarden, MD
Northwestern University and IMPACT4HC

Nicole Theodoropoulos, MD
UMass Memorial Medical Center

Catherine Marsh, B.A.
EndCoronavirus.org

Patricia Harper, MA
San Bernardino Balley College

Jamie Burke
Colorado State University

Jessica Garfield-Blake, MEd
Knox Trail Middle School Teacher

Jerry Soucy, RN, CHPN
Death Nurse, LLC

Jonathan Moreno, PhD
University of Pennsylvania

Lana Fishkin, MD
Thomas Jefferson University

Jack Colford, MD, MPH, PhD
UC Berkeley

Rohini Haar, MD, MPH
UC Berkeley School of Public Health

Maimuna Majumder, PhD, MPH
Boston Children’s Hospital & Harvard Medical School

Sangeeta Ahluwalia, PhD
RAND Corporation/UCLA

Laura Whiteley, MD
Brown University

Patience Afulani, PhD
UCSF

Vernon Chinchilli, PhD
Penn State College of Medicine

Pamina Gorbach, DrPH
Fielding School of Public Health, UCLA

Judith Hahn, PhD
University of California, San Francisco

Benjamin Lerman, MD
Alta Bates Summit Medical Center

William Davidson, M.D.
PNHP

E John Wherry, PhD
University of Pennsylvania

Mary Sullivan, RN, DNP
University of Massachusetts Medical School

Mark Cullen, MD
Stanford University

Nathan Wong, PhD
University of California, Irvine

Resa M. Jones, PhD, MPH
Temple University

Brandie Taylor, PhD
Temple University

Ondine von Ehrenstein, PhD, MPH
Fielding School of Public Health, UCLA

James Fletcher, MD, FACEP
Brody School of Medicine at East Carolina University

Meenakshi Bewtra, MD, MPH, PhD
University of Pennsylvania

David Albright, MD
UPMC

Michael Gough, MD
Catholic Health System of Buffalo and University at Buffalo Jacobs School of Medicine

Dianne Friedman, Ph.D.
Retired university professor

Karen Walter
University of Washington

Robin Taylor Wilson, PhD
Department of Epidemiology and Biostatistics, College of Public Health, Temple University

Janice Nash, RN, MSN, DNP
Carlow University College of Health and Wellness

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San Mateo County Manager Mike Callagy ” Pretty Good Position.”

By Michael G. Stogner

Update: July 24, 2020 San Mateo County has had 3 COVID-19 Deaths and as of this morning the County is reporting only 5 ICU Beds and Staff available. That number has been 13 up until July 21, 2020. 20% Availability of 67 = 13 on the bar graph below you will see on the far right the GRAY color is supposed to show how many ICU Beds and Staff are available, for the first time it is BLANK.

Screen Shot 2020-07-24 at 7.42.11 AM

In a SMDJ article this morning titled “Keeping closures at bay in San Mateo County.”

Mr. Callagy says: “Dr. Morrow does believe that we’re in a pretty good position here that doesn’t warrant the type of measure of closing more businesses down.” 

I don’t know where Mr. Callagy got his information about Dr. Scott Morrow’s Belief’s but I do know This is exactly what Dr. Scott Morrow said. Nowhere in this statement does he mention “PRETTY GOOD POSITION.”  He said “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.” “No gatherings outside of immediate households, use facial coverings extensively, and social distancing.”

It’s a shame the SMDJ which has 84,000 readers just promoted the PGP statement. This is a PANDEMIC.

Health Officer Statements

Message from July 20, 2020

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.

  1. 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.
  2. 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.
  3. 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

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