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US, California and New York starting to plan for re-opening

This update is provided to you by the Montecito Association because these are extenuating circumstances in a pandemic crisis. We share this information daily with our membership by email. We hope you find this useful, and encourage you to support this work for our community by becoming a member. You can become a member here.


Today, across all press conferences, everyone sounded a theme of thinking about how to move to reopening, and what that's going to look like. You can read it in more detail below. Several of you have asked me what we can do in our county about this same subject. In a perfect world, we'd love to see everyone get tested here, and those with antibodies identified and told to go back to work now. However, that's likely to take some time to roll out on a mass scale. So in the meantime, given what we saw today in the world, the country, and in California and New York, it would be good for our county to be thinking this way as well, and making similar plans. How will health officials know it's safe enough to re-open? What can re-open, and when? What new norms will have to be in play to ensure safety and reduce / eliminate virus spread? Those are the important questions. I reported to you last week that Supervisor Adam let me know he and Supervisor Williams were teaming up in this direction. Perhaps the most useful thing you can do right now is openly advocate for that planning, and for conversations within our county, within our business communities, to start happening. You can email the Board of Supervisors directly: Das Williams: DWilliams@countyofsb.org Gregg Hart, Chair: ghart@countyofsb.org Joan Hartmann: jhartmann@countyofsb.org Peter Adam: peter.adam@countyofsb.org Steve Lavagnino: steve.lavagnino@countyofsb.org You can also send in letters to the editor at our local media, advocating for leadership and planning for re-opening. 1. Montecito Journal: letters@montecitojournal.net 2. Noozhawk: (200 word limit, tell them your name, and include a short description of yourself so readers can judge your qualifications.) news@noozhawk.com 3. NewsPress: voices@newspress.com 4. Independent: 50-250 words for letters, up to 800 words for Voices: In your advocacy, you may want to use some of the language that's being used by top leaders worldwide, and from the conversation with Brian Goebel today at Noozhawk. We don't have to reinvent the wheel in every single jurisdiction worldwide to navigate through this. We can find proven paths through, but we must plan for that now. OK, Updates for today: Update by Santa Barbara Public Health Department April 13, 2020 Santa Barbara County Public Health Department (PHD) reports an additional 17 confirmed cases of COVID-19 in the county today, April 13. The total number of confirmed cases is 284.

Seven cases [of the new 17 cases] are people incarcerated at the Federal Prison in Lompoc, CA.

One hundred twenty-four people are recovering at home, 40 are recovering in a hospital, 15 of whom are in an Intensive Care Unit (ICU), 109 have fully recovered, and nine are pending an update. Two deaths have been reported.

Visit Santa Barbara County’s coronavirus web page for full updates.

Cottage Health Numbers - April 13, 2020

· Cottage Health is caring for a total of 185 patients across all campuses.

· 143 are acute care patients; 230 acute care beds remain available. 11 patients are on ventilators. 51 ventilators still available. 16 are in isolation, 10 in critical care, with COVID19 symptoms, 13 confirmed COVID positive.

· In surge planning, capacity is identified for adding 270 acute care beds.

· Of the 143 patients, 16 are in isolation with COVID-19 symptoms; 13 are confirmed COVID-19 positive.

· 1,723 cumulative test samples: -140 positive - 1,539 negative - 44 are pending. In most of these tests, patients did not require hospital admission.

Cottage offering free online visits for individuals who may have COVID-19 symptoms. Source: Cottage Health For the health of our community and patients, Cottage CareNow will begin offering free online visits for individuals who may have COVID-19 symptoms. Individuals with COVID-19 symptoms (fever, cough or shortness of breath) or upper respiratory symptoms (sore throat, runny nose, nasal congestion), can visit Cottagehealth.org/carenow for a free initial online diagnosis. This free online visit is for upper respiratory or COVID-19 related conditions. If clinically appropriate, Cottage CareNow providers will refer patients to the appropriate site for an in-person evaluation. If any individual is having severe breathing difficulties or a life-threatening emergency, they should call 9-1-1 or visit the nearest emergency department immediately. Cottage CareNow is an online service from Cottage Health that began in December 2019. This platform connects patients with Cottage providers who can offer online diagnosis and treatment for common medical conditions. Cottage CareNow helps patients with conditions like colds, flu, skin rash and more. Users can access Cottage CareNow 24/7/365 from their smartphone, tablet or computer by visiting cottagehealth.org/carenow. No insurance plan is required to access the service. The fee for non-COVID-19 related common conditions is just $29 for an online interview or $39 for a video face-to-face visit, payable by credit, debit or health savings card. Anyone in California who is over 18 can create an account, and dependents can be included. Visits for children under 18 must be completed by a parent. The service is easy to use. After entering symptoms and health information, patients choose to have a Cottage Health provider review their results and respond with a treatment plan within an hour or request an immediate face-to-face video visit. CareNow is staffed by Cottage Health nurse practitioners and Cottage Health credentialed providers. When appropriate, prescriptions are submitted directly to the patient’s preferred pharmacy. If virtual care is not appropriate, the patient is not charged for the Virtual Visit and will be referred for an in-person evaluation. Cottage CareNow assists in connecting patients with a primary care physician if they do not currently have one. Brian Goebel call with Noozhawk: These are my notes from the call between two Montecito residents: Bill MacFadyen of Noozhawk, and Brian Goebel. California – hospitalizations coming down. More discharges than admissions April 10th. Facilities have likely peaked, though will know for sure over next few days. Very confident that we’ve more than 'met the moment'. Santa Barbara County: Hospitalizations have been steady, no exponential growth. There’s a new normal we need to transition to. We need to devise a set of public health measures that are less disruptive than stay-at-home orders, but are sustainable, and don’t return us to a rate of spread at the start of the pandemic. Could be living like this for quite a while. Arrival of therapeutic medicines that improve outcomes will have a big impact on our communities. Testing in Santa Clara and Los Angeles designed to look for COVID19 antibodies. That will help us find out how many were exposed, and if that’s a large percentage, than this means we’re on our way to getting herd immunity. It’s also going to mean our fatality and hospitalization rates are actually lower since those cases never got into our system because they didn’t require hospital care. When will widespread testing be available in Santa Barbara? Are there unofficial records being kept of those who wanted to be tested, but didn’t meet conditions? These are the questions the media can and should be asking our elected officials. The future of testing is uncertain. Whether we see widespread or very carefully developed random sample testing, probably the latter, to determine infection and antibody rates to provide to policy makers. How have elected and public health officials risen to the challenge, in your opinion? Not sure why our government is not willing to acknowledge success of stay at home order? Larger media starting to fan this question: What’s the plan???? SB County not tracking people who’ve been denied tests, as there’s probably no way to do that. No plans to test widespread, only for those severely ill, healthcare workers, and first responders. What about a second wave of infections? Need to design public health measure correctly, and monitor them to keep cases and hospitalizations to acceptable level over time going forward. We will likely design better measures than we had in early March, prior to the stay-at-home order. California: Governor Newsom’s Briefing: California, Oregon and Washington to work on regional plan to lift coronavirus restrictions New York region of 6 states also planning a re-opening strategy. California will be releasing a framework at noon tomorrow that will include physical distancing and other guidance for moving forward into easing restrictions. Questions to answer: How we move from containment to mitigation to surge to supression to herd immunity to vaccine. Hospitalized: 3,015 ICUs: 1,178 +2.9% (modest increase) 22,348 total positive cases. 687 have died. Curve is being bent because of YOU. United States: New York death toll passed 10,000. Monday marked one month since the president declared a national emergency. There were fewer than 2,000 confirmed cases nationwide then. 583,411 confirmed positive cases. 23,642 fatalities. White House Press Briefing: Condolences to all who just suffered and lost their lives in the tornados in the South. Hospitalizations are slowing in hotspots. Clear evidence that aggressive strategy to combat the virus is working. We are coming in far less than our projected 100,000-200,000 deaths in this country. 28,000,000 doses of hydroxychloroquine deployed from national stockpile. Scientists pursuing use of convalescent plasma therapy, made from blood of recovered patients, to help someone who is sick. Friday, Americans began receiving checks from the relief bill. By mid-April you will be able to check on your payment online. If you’re a social security recipient, you don’t need to do anything. It will be processed automatically for you. Very close to completing a plan to open the country ahead of schedule. Working on guidelines to give governors to re-open their states. The US has developed a committee to guide the re-opening. $23 billion in loans processed in SBA by 4,600 banks. This is proving far more popular than anticipated. May need to get Congress to put more money into it. What does opening the economy look like? The plan to do that will be rolled out over the next few days. Over 100 business people are advising the President on it, with guidance from the health leaders to do it safely. Expect it to vary state-by-state, given where they are in the situation. Is it possible to re-open the economy by May 1st? They did not want to commit to that. Phase IV Economic Stimulus coming: focus on infrastructure, help to specific industries. Dr. Birx She presented this graph that I grabbed a screenshot of:


New York / New Jersey metro area is the center of the pandemic in the world right now. They're the top blue line that you see. All the other lines are all the other cities, which gives you a sense of how massive the pandemic effect is in New York. Here are the other cities WITHOUT New York in the graph:

Smaller epidemics in metros like Detroit, Boston, Chicago also being tracked closely. Detroit is flattening, but Chicago and Boston are passing them. Our mortality is less when you combine European countries into a country comparable size to the US. That’s because of our incredible people, in the healthcare delivery system. *********************************************************************************************** As governments begin to move into the planning phase of opening back up, the Wall St Journal has looked at how it could work, based on other country’s experience, with some examples. World Health Organization Briefing - Geneva Again, notice the focus on how to move to easing restrictions and go into re-opening: Some countries are starting to look at lifting restrictions after many weeks of strict lockdowns. In opening back up, there are 6 key criteria to consider:

  1. Transmission is controlled.

  2. Adequate health facilities are in place to detect, test, and treat every case and trace every contact.

  3. Outbreak risks are minimized in specialized facilities, like health care organizations and nursing homes.

  4. Preventive measures are in place in schools, workplaces and other places where it’s essential for people to have to go.

  5. Importation risks can be managed.

  6. Communities fully engaged, educated and empowered to adjust to the new norm.

Aim is to reach steady-state of no or low transmission going forward. World: French President Macron said their lockdown will continue until May 11, when they expect to reopen schools. This same date, France will be able to test every citizen for COVID19. Deaths in Italy passed 20,000. Spain saw another fall in its death toll, bringing the total to nearly 18,000. They’re loosening their lockdown. People in manufacturing, construction and some services are being allowed to return to work, but must stick to strict safety guidelines. Masks are being handed out at subway stations for returning workers. The rest of the population must still remain at home. Lockdown in the UK expected to last into May. 11,000 deaths recorded so far. ************************************************************************************************** That's it for now, and it was a long day watching all these briefings, but it was very uplifting to see that across the country and world, we're starting to emerge from this crisis, and mentally shifting into how we plan for re-opening. The weather is expected to be very nice this week, perfect for afternoon walks. Upper Manning Park was completely deserted when I visited it at 1 PM Saturday, and it's gorgeous right now.


Have a great evening! Kind regards, Sharon Byrne, Executive Director 805-636-0475 http://www.montecitoassociation.org

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