VC Health Officer Facing Biggest Challenge of Career With COVID-19, Speaks With Citizens Journal

By George Miller

Ventura, 5-6-20- I talked with Dr. Robert Levin, Ventura County Health Officer, Public Health, of the County Health Care Agency, who quickly agreed with my statement that dealing with the COVID-19 pandemic situation is likely the biggest challenge of his career. He has the difficult job, among others, of managing Ventura County’s role in combating the virus, which is highly infectious, with a long (up to 14 day) incubation period and can sometimes be very damaging or fatal, especially in older people and those with pre-existing conditions which weaken them. Fortunately, one of Dr. Levin’s specialties is infectious diseases. In a county of 850,000 people and 2208 square miles, adjacent to the enormous population of Los Angeles County, he has his work cut out for him.

His actions are constrained by medical science, many unknowns about this new threat, politics, multiple overlapping jurisdictions/rules, lack of supplies, equipment, trained manpower, therapies, no vaccine, plus fear and sometimes even pushback among the public.  Public, government and business education, understanding, action and cooperation is vital to contain and defeat, or at least contain/check the pandemic. He is thankful that cooperation has been excellent in nearly all quarters.

County CEO Michael Powers said that they are working together with the state, environmental health, code compliance and city governments to make all this happen. There are nearly daily meetings/calls to plan and coordinate activities.

The county has a useful information site for this crisis: https://www.vcemergency.com/

Death toll reduced?- Dr. Levin stated that initial forecasts of up to 1.5- 2 million deaths nationally now look much less likely and that county deaths will likely be proportionally lower. He attributed that to aggressive actions taken by governments, health care professionals, business and the public. Some say that the seriousness of the threat was overestimated, but there is little doubt that measures taken have reduced the toll.

Trends- Levin said there is still a slight uptrend in cases/deaths for the US (heavily influenced by NY/NJ) and CA, but it is stable/declining in Ventura County. VC is one of the best in the state and the state is doing relatively better than the US. For perspective, 19 had died in the county last time I checked. Levin said that there are 15-20 flu deaths/year in VC. Two years ago, it was 49 – and 150,000 in the U.S. He estimates that there are about 70 infected for every case identified. This would mean that the true death rate is much lower than reported, since it based only upon identified cases.  But it also means that the infection rate is far higher than reported and those numbers will likely rise as more are tested.

Funding- Fortunately, lack of funds is not a problem, according to County CEO Mike Powers, who told me this week that there are $50 million in reserves which he can quickly draw upon for supplies, manpower or anything that is needed. State and federal money may also be forthcoming. The Board of Supervisors has been monitoring the situation very closely, working with Levin’s organization and the state.

Jurisdictional Authority- The states have been the controlling authority in issuing orders to deal with the pandemic. The county and cities are responsible for implementing guidelines/orders and may issue some even more stringent than the orders, or implement them in different ways within their parameters. For example, this is why we see stores with aisles closed in some jurisdictions and not others and the same with beach closures and rules and more, which sometimes seem confusing, illogical, arbitrary and unnecessary. The federal government has issued guidelines and provided some resources, including, data management, some equipment and supplies. The federal government, following  the US Constitution, has tried to mostly stick to controlling things which fall within its enumerated powers, which include things like interstate commerce, interstate communication, international travel and commerce and providing some common resources, such as FEMA and CDC. The hospital ships deployed to NY and LA are examples, although it turns out they weren’t needed.

Reopening- Right off in our conversation, Dr. Levin stressed the priority of getting the economy reopened as fast and safely as humanly possible. He remarked that it is also a political necessity for the President. Come to think of it, that should also be a necessity for everyone else in the political universe, or we have a problem. Michael Powers and Supervisor Kelly Long told me that they have enormous pressure from business and the public to do so and share that priority. Supervisor Bob Huber’s public statements underline that as well. We did not hear back from any other Supervisors we asked about this. The economic and social impact of the lockdown has been enormous, even catastrophic. At the very least, 20 million people have already been thrown out of work and that is just those who are eligible for unemployment. Supply chains are being disrupted and life sustaining income has been cut off, only partially and inconsistently substituted by various “bailouts,” stimuli and loans, which are creating enormous financial problems. So getting back to work is just as important as fighting COVID-19.

CA 4 Phase Plan- The County has already met state qualifications for completing Phase 1 of the state’s 4 phase plan for ending the pandemic emergency and is poised to begin Phase 2 on Friday, Levin stated.  This would then permit conditionally opening up a host of businesses, including some retail, supply chain, manufacturing organizations, restaurant curbside service and more. Per Mr. Powers, implementation guidelines hadn’t yet been received last time we talked early this week. Even though the reopenings would be made possible, complying with the guidelines might involve some time delay and expense, we concluded.

To get this far, the County had to successfully implement and oversee the social distancing regimen, business and organization closures and/or procedural/equipment/layout modifications and put in place public and staff education, case monitoring, making sure treatment is available, contact tracing and more. City governments have a role in this, too. Testing had to be expanded, up now to 1500/week, with a short term goal to expand that to 4000/week, Levin described at the Board of Supervisors meeting on May 5. Our understanding is that this is a public and private effort, with commercial labs/hospitals involved, too.

They are just beginning antibody testing of recovered people and will set up a plasma bank to collect material from such people who have developed usable antibodies (not all do, so testing will determine), which could be used to help immunize more people, Levin explained.

Levin estimates that about 4% of the population has already been infected, based upon samplings done in nearby counties. So, far more might be infected than cases identified. The vast majority, he said, will be asymptomatic. He did not hazard a guess as to what portion of the population would ultimately be infected, but said it takes at least 60% of the population to develop effective “herd immunity,” which includes those who have developed immunity via infection/recovery and those who have been vaccinated. No vaccine is now available and none is expected to be available for actual use for at least a year and that is only if one in late stages of development goes into trials in the very near future and is successful, if at all. This may make full Phase 4 reopening problematic, since Governor Newsom recently stated that a vaccine is needed to get there. However, previous materials state that “therapies” are required to do so, which is interpreted as treatments, rather than vaccines. According to an article in last Sunday’s LA Times, 207 existing medications are in some stage of testing/trials to be approved for various COVID-19 treatment approaches.

Dr. Levin answered some more questions we had that hadn’t been covered before or not in as much detail when we had asked them of Mr. Powers …..

Can infected people be reinfected? 

Almost definitely no.

What is the incubation period?

2-14 days max.

When would symptoms show up?

from 2-4 days after infection, up to 14 days, with 6 days being the most probable.

How long are people infectious and when are they most so?

They are most infectious for 2 days before symptoms show to 2-5 days after they occur. Infected people have been shown to shed some virus for as long as 8 days after symptom onset.

Are recovered people immune? 

Yes, to varying degrees.

Can recovered persons’ blood serum be used?

If immunity levels are high enough, which can be determined via testing. The serum must be extracted by separating out the red and white blood cells. The County is just about to start such a program and will build a serum “plasma bank” of donations to be used.

Containment- So, public health officials are concentrating on finding and/or treating infected people, which at this time mostly consists of those showing symptoms, or their identified contacts who test positive. County staff attempt to trace the contacts of people determined to be infected, then quarantine them and contacts who can be identified. Such people are asked to stay at home. At-risk infected people may also be offered hospital rooms or hotel rooms if the home situation isn’t suitable for quarantining. Homeless people have priority for such accommodations. Levin stressed that this is voluntary and told me he clarified that at the Wednesday 1 pm press conference. However the wording of CA AB262 has concerned some people.

Added 10 am 5-7-20: Dr Levin told me that about 600 people were isolated to date in the county and that virtually none were removed against their will. He said that we “moved homeless people from the river bottom who were mostly grateful for a hotel room and three meals a day.” He made a very clear, unambiguous clarification that isolation/quarantine are voluntary, at the Wednesday May 6 1 PM press conference : https://www.vcemergency.com/newsroom at about 7:50 on the video.

Certain high risk people such as health care providers, first responders and nursing home residents may be tested, too. Between the lockdown and those, it is more possible to contain the spread of the virus. However, what isn’t covered are all the undetected, infected people who can spread the virus, which Levin and Powers both agree is a problem which can’t be further contained or eliminated without a vaccine and/or more “herd immunity”, or even more severe lockdowns. Isolating people past their infectious period should substantially reduce cases, if they truly purge the live virus out of their systems and are no longer infected/infectious. But not everyone was locked down. Many were still working in “essential” activities, or didn’t strictly adhere to sanitizing, social distancing or lockdown policies.

At this point, VC has “flattened the curve” per the goal, which was only supposed to contain the spread somewhat until vaccines, therapies and immunity are achieved. There is some fear of a major COVID-19 resurgence if lockdown policies are relaxed, but adequate preventive measures aren’t in place. Many people will likely continue safety procedures and high risk people especially may stay more isolated than before, Many will become more “germophopic” and less likely to go into crowded venues and other places they are likely to be exposed, such as mass transit, theaters, gyms, unless those change to become safer. This will help reduce exposure to other diseases, not just COVID-19.

Dr. Levin’s final parting words to the public- I asked him what message he would like Citizens Journal to convey to the public from him. He said: “please follow the guidelines, follow the orders, quarantine if needed, don’t cheat, use social distancing in stores and in public. Wash your hands frequently.”

On masks, he was a bit more ambivalent. They are not required in the county, but some establishments require them and more recommend them. He said he prefers that N95 and surgical masks be reserved for health care professionals/first responders and used only once by them. He see supply of them starting to improve. He warns against washing masks too much, as fibers break down after 3-4 washings. He never even mentioned gloves.

He says the virus contagion is worst when spread to mucous membranes, nose and eyes. It can be picked up via sneezes, coughing nearby, or touching contaminated places-  to hands, glasses, infected people, even dirty masks. When I asked him if it could be brought in via the gastrointestinal system, he seemed less certain. We didn’t discuss it, but pets could touch and  transfer contamination as well. Keeping things you touch clean/sanitary is helpful.

He also said that the bigger the dose of virus received, the harder for the body to fight off.

Related …..

the May 5 Ventura County Board of Supervisors meeting– read, watch video: Receive a Report Regarding the Novel Coronavirus and Associated Disease known as COVID 19.  It focused on the status of the battle against the COVID-19 pandemic, what was done and will be done to protect public health and reopen business and society.

The discussion covered:

Public health steps, such as public education, mitigation steps such as social distancing, sanitizing, case identification and disposition, quarantining, diagnoses/testing, quarantining, assistance  to those impacted- healthwise and economically,

Business regulation and reopening, including: reopening criteria, planning

County officials believe that they have successfully completed Phase I of the Four phase state plan for dealing with the COVID-19 pandemic and have qualified to go into phase II, although they must first obtain approval for their plan and progress.

Ventura County Officials Answer Questions About COVID-19 Employment Impact

By George Miller We asked Ms. Jennie Pittman of the Ventura County Office of Human Services about the impact of COVID-19 lockdown layoffs in the county and received this thoughtful response from Ms. Marleen Canniff, MPA, Communications Manager, Human Services Agency, Office of Strategy Management: Hello Mr. Miller, In response to your inquiry, this email […]

May 4, 2020

But there is some serious pushback to the orders.. Saw this posting on Facebook today, regarding Dr. Levin instructions:

https://www.facebook.com/watch/live/?v=2862198483900176&ref=watch_permalink

Here’s what I sent to the BOS…

George Miller is Publisher/Co-Founder of CitizensJournal.us and a “retired” operations management consultant residing in Oxnard.

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