Gov. Gavin Newsom took the first step in rolling back some restrictions on his stay-at-home order on Wednesday by announcing that hospitals could now start doing some elective surgeries. He cautioned, though, that the small step is just that: one piece in a series that will unfold only as health authorities feel they have made progress on controlling the spread of the COVID-19 disease.
Elective surgeries such as heart-valve replacements, angioplasty, removing tumors and performing colonoscopies, which were deferred as the state's health care delivery systems prepared for a surge of COVID-19 patients, may proceed. The restrictions are being eased based on progress the state has made toward preparing hospitals to handle COVID-19 patients, he said.
As painful as continuing the shutdown is socially, economically and emotionally, state leaders warned they will not push the boundaries before the number of COVID-19 patients shrinks. The state will also need adequate safeguards in place: higher levels of testing, tracking of patients, and personal protective equipment such as masks. All currently remain in short supply, Newsom said.
"Normalcy needs to be guided on slowing the spread. We've tried to make that clear. There is no light switch, no date. … We are not prepared to reopen large sectors of the community," he said.
Testing is the most important factor in getting the state to reopen, he said. The state can't consider lifting its stay-at-home order until it has completed much more testing and contact tracing. The latter follows up with whoever has been in contact with a COVID-19 patient and those people are tested, he said.
The importance of widespread testing — and the consequences of not doing it — were also illustrated on Wednesday by Dr. Sara Cody, chief health officer for Santa Clara County. She stated that three COVID-19 deaths occurred weeks before staff announced what they believed at the time to be the first coronavirus-related death on March 9.
In a follow-up phone call with the Weekly, she said wider testing has been needed since the beginning of the outbreak. The U.S. Centers for Disease Control and Prevention had set narrow parameters in January when the criteria were narrowly focused on testing travelers from Wuhan City and Hubei Province in China. County health leaders were worried the testing wasn't enough.
"We thought we were missing cases. How can we determine community transmission if the testing is narrow?" she asked.
And now they know they couldn't, she said.
On Tuesday, the county learned that two people who died Feb. 6 and 17 at their homes, a 57-year-old woman and a 69-year-old man, respectively, and a 70-year-old man on March 6 died from the disease. The first case was weeks prior to the nation's first deaths in Washington State, which were announced Feb. 29. None of the patients had a significant travel history, which Cody said "presume(s) community transmission (of the virus)."
For weeks, public health leaders had no idea how many people were actually spreading the disease. The cases were only discovered because the County Coroner suspected they could have been caused by COVID-19 after tests failed to detect other viruses during autopsies. She had preserved tissue samples from the victims and sent them to the CDC for testing, she said.
The deaths are the tip of the iceberg of unknown coronavirus cases in the community, Cody said.
Newsom said during his noon press conference that the state has asked Santa Clara County administrators to investigate deaths back through December.
After weeks of lagging testing, the state received some good news. It will now receive hundreds of thousands of swabs, which will allow testing for the coronavirus on a much larger scale, a prerequisite to any normalizing of the economy and society, he said.
Newsom said he spoke with President Donald Trump at around 11 a.m. Wednesday. Trump said the state will receive 100,000 swabs this week, 250,000 by next week and a "substantial increase" by the third week. Each swab represents another person who can be tested, Newsom added. With an abundance of swabs, the state could test up to 400,000 to 500,000 people weekly.
The state has tested 465,325 people to date and 16,000 patients per day, but Newsom said the goal is to reach 25,000 per day by the end of April and 60,000 per day over the next months. Ultimately, the state hopes to test 80,000 people each day using the polymerase chain reaction (PCR) test, which detects the presence of the virus in nasal and throat sputum.
The testing has been mired in shortages of components for taking and preserving the samples, the latest being the swabs. At each step, public health staff have had to resolve missing or deficient quantities of reagent, viral transport media for fixing the samples in test tubes and other supplies, he said. While those bottlenecks continue, in some areas it is improving, he said. A dearth of swabs has been the latest hiccup, however.
The governor could not say if the troublesome supply chain would be permanently fixed. The state can only conduct more tests if the availability of the supplies doesn't slip backward.
With a projected 2,000 to 3,000 people a day expected to be positive for the coronavirus and each of those having an average of 10 contacts, health workers would need to have 30,000 tests per day, Dr. Mark Ghaly, the state's secretary of health and human services, said.
Newsom said public health leaders are therefore looking at building "an army of tracers," as many as 10,000 people, who will help with tracing and tracking people who have had the disease and the people with whom they have been in contact. The state also is working with Google and Apple to develop smartphone apps for symptom tracking to aid in contact-tracing efforts.
Public health administrators will develop protocols for how to isolate and quarantine those who are still actively infectious.
In addition to the swab tests, the state has the capacity to perform 1.5 million serological, or blood, tests, which identify antibodies for the virus. These tests help health officers to understand the prevalence of the disease across California and where they might focus efforts to corral the disease. It's still not clear whether the antibodies neutralize the disease and give a person immunity or if patients could become reinfected and pass on the disease to others, Ghaly said.
He reiterated Newsom's call for a phased-in approach to reopening the state based on data and the availability of protective gear.
"It's not a switch; it's a dimmer," he said. "We need significant amounts (of protective equipment and testing) before we can move forward on any plans."
The state also is focusing on creating "hubs" for testing, such as in skilled-nursing facilities and communities of color. The state is advancing an egalitarian response to the virus by opening 86 testing sites in rural areas and communities of color — so-called "testing deserts," Newsom said.
Cody, said that testing has been "like a crazy quilt," with a shifting pattern of multiple factors contributing to the problem. On the local level, besides the dearth of kits, she's been bombarded by everyone offering the next test and the next new test.
The county also is dependent on state and federal resources, with many moving parts.
"The challenge as of today is that some labs have excess capacity (to do testing) and there are places where there's an unmet need," she said, echoing a goal Newsom also outlined in his briefing.
"We have to figure out how to match those two things up," she said.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.