(From Press Release – Yolo County) – Yolo County would like to take the opportunity to address an article regarding the experience of the first confirmed COVID-19 case with our local public health system. By providing some additional context we hope to offer more clarity on our public health role during this pandemic.
Prior to addressing these concerns, we want to first express our appreciation for this individual sharing her story to help educate and inform the public about this illness. We sympathize with what must have been a very difficult and frightening situation as this individual navigated through what turned out to be the first confirmed case in Yolo County. We are thankful that this individual has recovered and hope that she continues to feel better.
Since this individual was the County’s very first case, much has changed since she was diagnosed and the County has taken away many lessons learned from those early days when the federal, state, and local entities were trying hard to ramp up response efforts to address the growing COVID-19 pandemic. To provide additional clarity, the County would like to provide some information regarding a few key concerns in the article.
- Concern regarding information in the initial press release.
An initial press release from the County announcing the first COVID-19 case described the patient as an “older woman with underlying health conditions” based on initial information received from health care providers. While a correction to this information was requested it unfortunately did not occur in the rush of containment efforts and COVID-19 related events that followed. The press release has now been updated.
- Concern over the thoroughness of contact investigations following the COVID-19 diagnosis.
Following the diagnosis of the first confirmed case, the County worked closely with the California Department of Public Health (CDPH) to review contacts and ensure appropriate follow-up. As a result, immediate notifications were made to the entities potentially affected which included the patient’s workplace, the county of a relative; the Center for Disease Control (CDC) to report flights travelled on; and various healthcare facilities that the patient visited. In the process of contact tracing and in consultation with the CDPH regarding potential local exposures, including a nail salon, no other 
contacts met the CDPH’s exposure criteria for evaluation and follow-up.
- Concern over being released from isolation prior to receiving a negative COVID-19 test.
Guidelines from the CDC and the CDPH allow patients to be released from isolation once they are symptom free for 72 hours without first having a negative COVID-19 test. Due to continued shortages on testing, tests continue to be prioritized to confirm high-risk cases and exposures and not to confirm recovery status. Additionally, due to those shortages, household contacts are currently not prioritized for testing; particularly if they are asymptomatic.
We know that many people with COVID-19 are suffering and dying from this terrible infection. Additionally, the isolation and quarantine required to fight the disease are incredibly challenging for individuals and their families. As a county we can always do better and are looking at this account as an opportunity for checking and improving our own response efforts going forward. In this consistently evolving pandemic, agencies such as Yolo County Public Health along with the local healthcare system are continually changing to better coordinate and to ensure that the various needs of patients are met.
For detailed information and guidance about COVID-19, visit the Yolo County webpage at: www.yolocounty.org/coronavirus. Residents can also call Yolo 2-1-1 for resource information. For additional updates follow Yolo County on Facebook at: https://www.facebook.com/YoloCounty/ or Twitter at: https://twitter.com/YoloCountyCA.
Here’s the article by Marilyn Stebbins, PharmD, a UC San Francisco School of Pharmacy faculty member. She lives in Davis
The article is in today’s Davis Enterprise.
I am aware of people who likely were ill but lack a particular symptom, so were not tested at all, or not tested until well into their illness. I know that Kaiser has, or had, a policy to not test unless the patient was so ill that they were being admitted to the hospital. Meanwhile, the patients seemed to be on their own in dealing with their care, their level of isolation, etc., despite repeated calls to health care providers and trips to urgent care clinics and emergency rooms.
The woman in the article was asked repeatedly whether she traveled to China, etc. or had been in contact with someone diagnosed with COVID-19. She answered no every time, but never thought to point out that she worked at a hospital where COVID-19 patients were receiving care. She was not tested based on her verbal responses to these questions, despite have some of the symptoms of COVID-19 and other tests were coming up negative.
Then I read about testing of celebrities and politicians, etc. who have no symptoms at all and only may have experienced exposure, no matter how fleeting ….. It all seems like a real mess. I really hope that the antibody test is developed soon and medical testing of ill patients is better managed. Until then, it is all really frightening.
Sharla, you mentioned that Stebbins
Does she mention that in the article, i.e. that she – a medical professional – was never asked or didn’t provide this information?
Here is what she wrote in the Pharmacy article :
So she answered the usual question re travel, contact with someone ill, etc as “No” but didn’t consider working at a hospital might be significant.
Again, you seem to be saying that she didn’t offer information about where she worked, or that they didn’t ask where she worked — or if they did that they didn’t ask about nor confirm the situation in that facility… right? How does her first person account or the Enterprise article support that? That she said she had “…no direct exposures…” is only a piece of this.
It doesn’t appear that this was enough of a significant factor in her care, per her own description. That’s all I have to go on, really. She answered the questions as she understood them and early on the questions were designed to exclude people from the need for COVID-19 testing.
Sharla, the article linked by Todd above is written by Marilyn Stebbins herself and published on the UC San Francisco website. It is not the same article as appeared in the Davis Enterprise this morning. She states pretty clearly that her job is working in a “telephone clinic” with no direct contact with patients or their care takers. One would think that the county would ask her occupation and location of work as well as age and medical history. I’m very unimpressed with the lack of seriousness with which her case was handled by Yolo County public health.
What is, perhaps, even more concerning is their failure to correct her own history. If the public had heard that the first case in the county was for a healthy, athletic person of 58 who was admitted to a hospital, it would have helped change behavior a little quicker. It is too easy for most people to want to believe that if it’s an “elderly patient with underlying health problems”, then I’m okay because I don’t fit that description.
I read both – the UC SF article last night and the Enterprise article this morning. She starts her timeline at the beginning of her vacation, but her exposure must have been in the weeks leading up to the onset of her illness.
This particular case as described in her letter posed a few special challenges to those deciding how to use their very limited testing resources. She was not manifesting a fever which was one of the primary testing criteria. In addition, she had an additional symptom that was initially not felt to be associated with COVID-19, diarrhea, which according to her account preceded the use of antibiotics. We subsequently have case studies showing that diarrhea may be an associated symptom about 12% of the time, but that was not known at the time. Thus her symptoms did not fit the then known criteria for COVID-19. This sequence of events was unfortunate but understandable given the unusual presentation and lack of supporting criteria such as travel or known exposure.