'We’re still very early in this pandemic,' health officer says as county reaches 100 cases.

On April 14, four weeks to the day that Monterey County Health Officer Edward Moreno announced his shelter-in-place order to stop the spread of Covid-19, he told the Board of Supervisors it’s working. The rate of people becoming infected has greatly decreased and the hospitals have yet to be overwhelmed. That was the good news.

The challenging news: The order will mostly likely be eased up—not entirely lifted—for an unknown amount of time. Meaning some in the county could go back to work at some point as long as strict social distancing rules are observed.

"I think we’re going to be implementing social distancing or some version of social distancing for a while," Moreno said. "We’re still very early in this pandemic."  

Hours later, the Health Department updated its test result numbers showing that the county hit the century mark in confirmed cases—100 positive results up from 87 the day before. The new cases included: two more between the ages of 0-23 for 11 cases; four more in ages 24-34 for 33; one new case in ages 55-64 for eight; two additional cases in age 65+, for a total in that age group of 16. The updated numbers show twenty people currently hospitalized. Eighteen have recovered. The death toll remains at three people.

There were no set dates given for when an easing of the order could happen. Moreno acknowledged that shelter-in-place has both social and economic impacts and at the rate the pandemic is progressing it’s not feasible to keep a strict order in place indefinitely. He said there are discussions at the state and local level about de-escalating orders while striking a balance between protecting vulnerable populations and keeping the economy going.

"We are starting to have discussions about how we might release some of the restrictions in California," he said. "We are looking at criteria that could be modified to provide less restrictions on certain populations for a balance of social and economic benefits. Our goals are still to protect the vulnerable population, and to protect the healthcare system from a surge."

Simultaneous to the board meeting and through a recess due to audio issues, Gov. Gavin Newsom held a press conference where he outlined a cautious approach to easing some restrictions. He gave examples of what life could be like with eased restrictions, including waiters wearing masks and gloves to serve restaurant patrons. He also suggested those patrons could have their temperatures taken before being seated. Students might attend schools in shifts this fall.

“Normal it will not be,” Newsom was quoted as saying.

Moreno shared with the supervisors the computer modeling the Health Department is using to predict a surge in Covid-19 patients requiring ventilators, hospital beds and other needs. With no social distancing the model predicted 1,960 people would have needed a ventilator by April 4, at the rate cases were increasing before the order took effect after March 17. Moreno reported there are currently 158 ventilators in Monterey County as reported by local hospitals to the state.

The chart also showed the need with compliance to the order at various percentages of compliance with social distancing rules: 815 people needing a ventilator by mid-April with 50-percent compliance; 500 by May 4 with 60-percent compliance; 210 by late May/early June with 70-percent compliance. That last curve, while the flattest, is also the longest. It shows the county’s outbreak potentially over by early August.

That long curve buys the county time to acquire more ventilators, personal protective equipment, or PPE, critical care beds and other supplies before a surge of patients hits, Moreno said. From other modeling charts Moreno shared more critical care beds are going to be needed. Even at 70-percent compliance hospitals could need 235 of those beds in the next month-and-a-half. Only 33 were reported to the state by hospitals in the county.

Currently hospitals are reporting 678 licensed beds total in the county, while the potential at the top of the surge could be over 950, again, that’s at 70-percent compliance to the current shelter-in-place order.

Another sobering chart showed that had there been no social distancing in place, more than half the county’s residents may have been infected by now: 231,000 residents in a population of 435,000. The projection drops to 113,000 with 50-percent compliance; 75,600 with 60-percent compliance; 33,000 with 70-percent compliance.

The planning for more capacity to care for patients has been ongoing since January, Moreno said, and will continue. The board also heard during the meeting plans for additional care facilities for people who don’t need increased hospital care, or for some, like homeless individuals, who need a place to recuperate, be quarantined or remain isolated.

The ability to test people remains a challenge for the county, which lacks the federally approved testing supplies to test more than are currently being tested. Covid-19 tests continue to be prioritized to people hospitalized with suspected symptoms, healthcare workers and first responders. Moreno noted that it would help if investigators could test all people who came into contact with a person who is confirmed to have the virus, but testing supplies remain a constraint.