The state of Mono County’s coronavirus response
Mono County seems to be crushing the curve. Where have we been and where are we going — what now? Part one.
Mono County seems to be crushing the curve. Where have we been and where are we going — what now? Part one: data and demographics, local testing at Mammoth Hospital and the Elon Musk BiPAP machines.
By Monica Prelle
It’s been more than a month now since Mammoth Mountain closed and local tourism officials started asking visitors to stay away to slow the spread of the coronavirus. Mono County residents are mostly staying home and practicing physical distancing while public health officials continue to work relentlessly to protect the community from COVID-19 worst-case-scenarios.
Recent updates are hesitantly optimistic with no new hospitalized patients, increased testing capacity, and a hospital that is ready for surge capacity. Now many residents are asking: how are we doing and when will this end?
“By no stretch of the imagination are we out of the woods, despite the fact that we put forward framework to begin to consider the prospects of reopening certain sectors of our economy,” Governor Gavin Newsom said on Wednesday. “I want folks to know we need to maintain our vigilance and we need to maintain the path that we are on, a path that is producing results.”
Mammoth Hospital CEO Tom Parker echoed the governor’s sentiment.
“We are doing a great job at distancing — it’s working, but we have to keep it up,” he said. “That’s not going to be our message forever. We are working on the next phase of guidance on how to manage post surge and get our economy back on its feet in a safe way.”
Where have we been? And where are we now? Projections, Numbers and Demographics
Last month Mammoth Hospital issued staggering projections using global modeling. Without distancing measures, the hospital estimated 132 coronavirus patients by April 18 and 512 patients by the end of the month. Thankfully, residents took stay-at-home orders seriously and worst-case projections have not happened.
As of Friday, there are 23 positive cases of COVID-19 in Mono County. Tragically, there has been one death. All of the surviving critical patients who were transferred to other have been discharged from the hospital and expected to recover. There are no coronavirus patients currently hospitalized.
With hundreds of new cases being reported statewide, the coronavirus does not seem to be going away anytime soon, even though University of Washington modeling suggests that California may have reached its peak and the peak deaths are just a few days away.
Currently there are nearly 1,000 deaths in California and Los Angeles recorded its highest single death toll, 55 people, on Wednesday. There are more than 28,000 positive cases statewide.
“Any peak, when it comes, will probably not be significantly higher than today on ICU hospitalizations and overall hospitalizations because we have done all the right things on physical distancing and staying at home,” California Secretary of Health and Human Services Dr. Mark Ghaly said on Friday.
In Mono County, until recently, all of the positive cases of the coronavirus were in the population hub of Mammoth Lakes, but two of the most recent results are from other parts of the county. Mono County Public Health will not disclose the specific locations of patients for privacy.
According to Parker, at least one local health care worker has tested positive.
Nearly 80% of positive cases are between 18 and 49 years old, 16 percent are 50 to 64, and five percent are over 65. More than 60% of cases are male and less than 40% are female.
Latinos account for the highest percentage of COVID-19 cases ethnically in the state with 38% of positives and 30% of deaths, according to the California Department of Public Health, which is relatively in-line with population. Latinos make up for 39% of all Californians. Caucasians account for the second highest ethnic group with 31% of positive cases, 38% of deaths and 37% of the population.
Both Mammoth Hospital and Mono County Public Health declined to release racial demographics locally. Even with relatively low overall numbers, and age and gender demographics readily available, Counsel Stacey Simon says the county does not have racial data.
Updates on projections, testing, oxygen, and equipment
Mammoth Hospital’s new local testing lab is now open. The quick turnaround test will provide results within 45 minutes, however, even with the lab open here, those tests are also in short supply, CEO Tom Parker said, and won’t expand testing. The state has also expanded testing capacity and past results started coming back in 24 to 36 hours.
Dr. Ghaly said on Wednesday that the state has a goal to get to 25,000 tests per day statewide by the end of the month, and expanding capacity to 95,000 tests per day into May and June.
“We received a shipment of swabs here that we did distribute throughout the state and targeting some of those clinics, some of those healthcare delivery system centers that don’t traditionally have the supplies first,” Dr. Ghaly said.
With an increase of testing capacity in Mono County, residents can expect to see a surge in numbers, which is reflective mostly of an expansion of capacity, not necessarily a higher rate of infection.
The hospital is also researching antibody testing, but cautions that the science is relatively new and not entirely reliable, yet. According to Mammoth Hospital Chief Medical Officer Dr. Craig Burrows, Mono County has a relatively low number of infections, which means a higher likelihood of false positives on antibody testing. It will be a valuable piece of information when testing gets better, he said, but right now it could be counter-productive.
“It’s the Wild Wild West in terms of testing products out there,” Public Health Officer Dr. Tom Boo said. “When we have more confidence in the products, we will invest in one.”
According to Unified Command Chief Frank Frievalt, the state system previously showed that Mono County had 14 ventilators, which is incorrect, and he requested an update. He expressed mild frustration that ventilators were being sent out of state while Mono County’s requests were still not filled. That seems to be changing, even if slowly, and so far, the demand for ventilators locally and statewide has not exceeded capacity.
In March, the state had just over 7,000 ventilators, but since then, that inventory has exceeded 12,000 and as of last week only 30% of ventilators were being used in California hospitals. Governor Newsom sent hundreds of ventilators on loan to Illinois, Maryland, Nevada, New York, New Jersey, and Washington DC, to assist surge capacities in regions with a higher need.
“Some people have expressed concern about California’s willingness to extend a hand,” Gov. Newsom said. “We thought it was the right thing to do, but it was also the responsible thing to do, as American citizens, from a moral and ethical imperative to save lives.”
Last week Mammoth Hospital received one new ventilator from the state supply, bringing the total to five ventilators in Mono County with five more requested. The hospital also received 10 BiPAP devices from Elon Musk, according to CEO Parker. These devices are not primary ventilators for acute respiratory syndrome, however, but they offer breathing support and can be used to help prevent patients from going on to ventilators or can assist with post-ventilator breathing if necessary.
Still, Mammoth Hospital prefers to transfer critical patients to lower elevations where there is a higher level of oxygen.
“This is not a good place to get sick with a respiratory illness,” Mammoth Hospital Chief Medical Officer Dr. Craig Burrows said. “It has very little to do with our capability or knowledge to care for people, and a lot to do with the reality that the air is just thinner here.”
Because of statewide distancing efforts and the governor’s stay-at-home order, hospitals have not exceeded capacity and it is possible to transfer patients, but Mammoth Hospital is continues to prepare nevertheless.
The hospital has reassigned staff to assist in the coronavirus response. Pulmonologists are still responsible for emergency intubation if a patient is in acute respiratory failure and needs to be on a ventilator, but physicians with other medical specialties are now trained and can assist with operating ventilators.
A number of residents continue to sew masks and other personal protective equipment for the community’s personal protective equipment and face mask drive. Parker said because the hosptial stopped elective procedures early and implemented a strict rotation system, he is confident that health care workers have the equipment they need.
Earlier this week Dr. Boo ordered all essential workers to wear face coverings and says that an order for all residents to wear face coverings in public may come soon. Initially, he was unsure of supply and wanted to makes sure essential workers were covered first, but it is definitely recommended.
Gov. Newsom announced a new direct contract to procure 200 million masks, monthly, and is confident that this new partnership will be sufficient. The equipment also includes shields, gowns and other protective equipment for front line health care workers and the like.
Mammoth Hospital also completed its restructuring of the hospital and has COVID-positive and negative zones and there are strict guidelines for staff moving in-between and the nurse triage line is up and running to assist patients with questions without entering the hospital.
After weeks of preparation, CEO Parker seems confident that the hospital is fully prepared.
“We took some early measures, we were very concerned about modeling and didn’t know how people would respond,” Parker said. “We are feeling good, we are ready for a worst-case scenario, but nothing would make me happier than if we don’t need any of that flex capacity.”
Parker hopes everyone in the community will keep up the good work and stay with it. And now, also start planning for a return to some aspects of normalcy and economic recovery.
When will Stay-at-Home Orders End? The Next Phase in Mono County
“That is the ten-thousand-dollar question,” Public Health Officer Dr. Tom Boo said. “We don’t want to just open the doors and go back to business as normal. We have to be careful and try to balance the potential harms to community health with the needs of business owners and people who need to get back to work.”
“It’s a tough one… we are thinking about it and discussing a lot.”
Part Two will be published next week.
Monica Prelle is a Mammoth Lakes-based freelance writer. Follow her local COVID-19 reporting on Facebook, or other banter on Twitter.