Shelter order extended and tightened as virus spreads

David Briggs
While business is slow or halted entirely, some businesses are using the time to make improvements. On Monday, workers repaired the roof of Osteria Stellina in Point Reyes Station on Monday. The next day, a stricter order limited construction to essential work.  
04/01/2020

The coronavirus is spreading exponentially, and an estimated 2 percent of West Marin has been infected with it, according to Dr. Lisa Santora, the county’s deputy public health officer. A more restrictive shelter order and improved testing capabilities should help slow transmission.

At least five Marin residents have died from the disease in the last week, and intensive care units are seeing an uptick in patients needing treatment for untested respiratory illness. 

The rise in cases prompted Bay Area counties on Tuesday to update their shelter order, which now extends until May 3. The Marin County Sheriff’s Office announced it will be ramping up its enforcement of the order, which mandates social distancing and limits businesses to their essential component only, among other restrictions. 

Now, the public “must comply” with social distancing requirements. Essential businesses have to post and implement social distancing protocol and maximize the number of employees who work from home. 

Sports that have shared equipment can only be played by members of the same household. Landscapers cannot provide cosmetic services or general upkeep, and construction is restricted to projects that fulfill an immediate need or provide affordable housing.

“Failure to comply with any of the provisions of this order constitutes an imminent threat and menace to public health, constitutes a public nuisance, and is punishable by fine, imprisonment, or both,” the order states.

The sheriff’s office has been receiving dozens of calls every day about people gathering in groups and non-essential businesses operating as usual. Deputies are proactively contacting non-essential businesses to gain voluntary compliance and have not yet issued citations. 

The office will ramp up its enforcement of the order and try to curb the number of people driving to parks. Staffing increases are not planned, but the office may move resources around and provide extra coverage in West Marin if necessary, said Sgt. Brenton Schneider, a public information officer.

“While the prior shelter order has been effective in reducing the rate of transmission of the Covid-19 disease, it is not enough,” the order’s summary states. “More and stricter social distancing is needed to slow the rate of spread, prevent deaths, and stop the health care system from becoming overwhelmed.”

Each receiving hospital—Kaiser San Rafael, MarinHealth Medical Center, Novato Community Hospital and Kentfield Hospital—is working with the county to prepare for the anticipated surge. A task force is working to operationalize the county’s pandemic flu and surge plans. Later this week, Marin will begin tracking and publishing data about the availability of ventilators, masks and hospital beds.

Getting equipment and personnel to local hospitals will be a challenge, Dr. Santora said, partly because Santa Clara and San Francisco Counties are expected to see surges before Marin. The State of California is taking the lead in allocating scarce resources, and Governor Gavin Newsom has called on all medical professionals, including recent retirees and soon-to-be graduates, to register for the new California Health Corps. California needs to add 50,000 beds to prepare for more patients, the governor said. Hospitals will provide 30,000 of those beds, and the state will acquire the rest from outside the hospital system. Hotels, fairgrounds, convention centers and other facilities could be used to house patients.

“This is an all-hands-on-deck situation as we prepare for what’s ahead,” Gov. Newsom said.

The nationwide lack of testing for the coronavirus is reflected in Marin. In March, 107 people tested positive, but that’s a drastic undercount of the true number of cases. Marin realistically has thousands of cases, based on data extrapolated from other parts of the world.

“We know we’re significantly undertesting,” Dr. Santora said. 

That is expected to change as tests become more available. A shortage of the reagent needed to detect the virus’s genetic material was limiting the production of tests, but Kaiser’s regional office in Northern California has secured the reagent and is now distributing more kits.

Hospitals are opening up their own drive-through testing sites, and positive results can now be returned from the lab in Richmond within 24 hours. The United States Food and Drug Administration this week approved a test that can detect the coronavirus in minutes.

Doctors are now allowed to refer patients with mild symptoms. Previously, the criteria were moderate illness and known exposure to the virus, and even then, a test was not guaranteed. 

The lack of testing frustrated hospitalized patients who thought they had the disease but couldn’t get tested. Still, whether a patient has Covid-19 or not, the treatment is the same, Dr. Santora said. She acknowledged that patients may already have died from Covid-19 without being tested.

Locally, Steven Siegel, the C.E.O. of the Coastal Health Alliance, is waiting for the introduction of rapid and mass testing. The alliance has tested a few patients, but no tests have come back positive. At the clinic in Point Reyes Station, a tent was set up last week in the parking lot to triage patients with respiratory illness.

“Until we can test on a larger scale, it’s hard to really know what is going on with the community,” Mr. Siegel said. 

Testing helps health officials understand the disease’s activity, and it helps people who test positive because they know to self-quarantine. After each positive test, health workers interview patients about their exposure since the day they had symptoms. This outreach has been effective in educating people on how to behave, Dr. Santora said.

The time it takes for the number of cases to double has slowed: When the virus first arrived in California, cases doubled in about two days. The current doubling time is about six days. Still, cases will continue to climb as long as people are out and about.

“Unfortunately, we haven’t optimized shelter-in-place. We still see people congregating,” Dr. Santora said. “We have partially slowed the spread, but everyday we’re seeing more positive patients.”

Since seven Bay Area counties first issued a shelter order on March 15, the number of cases has increased from 258 to 2,092, and the number of confirmed deaths rose from three to 51.