Commentary: Covid-19  Kudos, Complexities, and Challenges

By Tia Will

Last week I attended both the Board of Supervisors Meeting and the Health Council. What follows are my notes of appreciation, summaries of the current ambiguities in the provision of community health care, a brief summary of the confounding factors facing our public health community, and future challenges in dealing with the pandemic. Due to the rapidly changes circumstances, some of this information may already be slightly dated. I will amend those of which I am aware and apologize for those I leave uncorrected.

Kudos:

1. All involved in the development, implementation and ongoing management of Healthy Davis Together, the collaboration of health care and public health experts of UCD and Davis proponents who have worked together to provide extensive testing and messaging on campus and in the community. This program has been essential for both testing and tracing, but also for the detection of mutant strains in the county. This program has been so successful it has drawn national attention as a model program.
2. Our county Board of Supervisors. Although I am less familiar with the actions of Supervisors Villegas and Sandy, both Supervisors Saylor and Provenza have been active in developing processes to enact safety recommendations within the community. I want to make a special commendation of the newest member of the BOS, Angel Barajas who has been a champion of health equity for his constituents, especially those in our rural areas who have less access to testing and care and are more difficult. to reach to inform about available services. He and his staff have taken a “boots on the ground” approach to community outreach in some areas going door to door to inform those who are not connected to the internet and thus lacking in ready access to updates.
3. Aimee Sisson: Dr. Sisson has arguably the most challenging job coupled with the most thankless task during this challenging time. New to our county she is using medical science to inform our specific actions. Her task is complicated by the national and state directives to focus narrowly on the saving of lives directly as opposed to a broader approach of saving lives through containment of community spread. To her credit, when challenged as to a potential conflict between immunization by age, vs immunization by broader risk using other demographic risk factors, she was willing to make a reassessment and to walk all in attendance through the data.
4. Our County Health Department Staff: Temporarily without a medical lead, the staff of our Health Department led by Brian Vaughn did a commendable job of data collection, planning and implementation as well as community outreach and we owe them all a debt of gratitude for their long hours spent trying to assure our safety.
5. Our volunteers, largely members of the Health Council, their community affiliates and independent community groups as well as students who have volunteered first for testing and tracing at numerous community venues and are now manning the immunization venues.

Complexities

1. In his newsletter, Don Saylor noted the improving statistics which can also be found on the County Covid-19 dashboard. While these numbers are encouraging, the same could have been said when we were on the downslope of the first and second surge. In each instance we added to the scale of the viral resurgence by letting down our guard and believing we could “open up” safely. I hope we will not repeat this error, which has cost us many lives.
2. The emergence of new mutations in our community. Yolo County has isolated the B117 strain originally identified in England which is believed to be as much as 50% more infective and up to 30% more lethal. This strain is probably present in our surrounding counties as well however, at the time of the BOS meeting, none of our adjacent counties were testing for it. This combined with the identification of the South African strain in some Bay Area counties which may have greater vaccine resistance add to the complexities of depending heavily on a vaccination strategy and stresses the need to continue with the behavioral approaches of distancing, masking, and disinfecting.
3. Determining an optimal approach to vaccination distribution. First, the good news. As of today, the number of allocated doses of vaccine will be provided 3 weeks in advance, thus allowing states, counties and multi state health care distributors to plan more effectively. This will hopefully lead to more immunizations and less vaccine wastage.
4. The unknown impact of the transition from the electronic interfaces for the county distribution points to make an appointment to the state wide system called My Turn to schedule an immunization appointment.

Challenges

1. Opening of schools. There is a growing consensus that safe opening of schools, especially grades K-6 is achievable. However, this is dependent upon the implementation of a number of modifications including improved ventilation, smaller class sizes, strict protocols for masking and distancing, plus or minus immunization of teachers and other adult workers.
2. Achieving health equity especially for those who cannot reasonably limit their work interactions. This will be especially challenging as the county enters the season in which our area sees the return of seasonal laborers whose work, living and travel situations frequently bring them into close proximity to others.
3. Providing immunizations to all who will accept them while reassuring those in communities with traditional reluctance to accept vaccination of the wisdom of this action to protect themselves, their families and their community overall.
4. Leveraging the advantages provided by vaccination without surrendering to the temptation to abandon the critical behavioral approaches of distancing, masking, and sanitizing that have led to a relatively low number of cases, hospitalizations, and deaths that Davis has experienced as compared with surrounding communities.

Tia Will is a retired OBGYN and a member of the Vanguard Board

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