At a time when good news has become a rare commodity, the County Board of Supervisors got a painful dose of it on Tuesday morning. It was the most informative presentation to date of where the county stands in its fight against COVID-19.
Physical isolation really does make a big difference, said county health officials. Should Santa Barbarans continue to shelter in place at their current rate — estimated to be about 50 percent — it appears there are enough intensive care unit (ICU) beds throughout the county to handle the anticipated surge of cases. As of the Independent’s deadline, there have been 218 confirmed infections. For those experiencing acute respiratory distress at the time of the surge, however, there will not be enough ventilators.
If county residents would pick up the pace of physical isolation by just 5 percent, County Public Health Director Van Do-Reynoso stated, the county’s 50 available ventilators would be sufficient to handle the patient load. But if residents backslide in their sequestering efforts by as much as 10 percent, county hospitals could collectively find themselves about 500 beds short for the number of critically ill patients seeking help.
That was the good news.
The bad news is that the same studies projected that the current restrictions on county residents could remain in place well into the fall, possibly as late as November. Social distancing, staying at home, and not gathering in groups is the key to lowering the curve, reducing the number of deaths when the surge hits, and slowing the spread of the virus. The longer it takes before the surge gathers steam, the better prepared the medical facilities will be. More people will be treated, fewer hospital workers will get infected, and fewer people will die.
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According to the worst-case scenario, however, the surge could peak as soon as late June. That will not be good. In the best case, it will not hit until the last day of August. The question confronting elected officials, public health experts, and all 450,000 county residents is whether everyone can hold on that long.
Sheltering at Home for the Homeless
Less explored by the supervisors were the difficulties county officials have encountered in securing hotel and motel rooms for chronically homeless people who are vulnerable to the disease. These temporary rooms would also allow for quarantining those without housing who may already be infected but are not requiring hospitalization. The county has thus far secured only 15 motel rooms, though some nonprofits have independently secured an additional eight motel rooms, paying the room rates out of their own limited operating funds or with help from private philanthropists.
Ventura County, by contrast, has secured 270 units in four motels targeting the same population. Ventura is using state emergency funding to pay for motel security and oversight, while providing mental health and public health services.
Supervisors were told that no operator been found to take on the challenge of running a shelter for southern Santa Barbara County, but in Santa Maria, Good Samaritan had taken over managing the shelter setup, but closed, three weeks ago in the high school. That shelter, which houses a maximum of 71, had proved to be more than a handful for the county employees — few of whom had any direct experience working in homeless shelters. Good Samaritan, by contrast, has an experienced staff. It reportedly has engaged with state COVID-19 emergency planners to secure 10 trailers for temporary housing.
Santa Barbara’s second COVID-19 fatality was a 66-year-old homeless man, Leland Goodsell, better known on the street as “Hobo.” Goodsell died at Cottage Hospital this past weekend after spending seven days in intensive care. A fixture in Santa Barbara homeless circles for 14 years, Goodsell was a gregarious man, a gifted mechanic, and a heavy drinker. He’d reportedly been sick for seven weeks but resisted entreaties to seek medical attention because he worried about what would happen to his dog, Dreamer. At that time, Goodsell and Dreamer were living in a van. As his sickness progressed, Goodsell was reportedly overwhelmed by uncontrollable vomiting and diarrhea, prompting a friend to call an ambulance, which delivered him to Cottage. By that time, however, he’d come into contact with countless people, some of whom laundered his blankets, cleaned his clothes, and looked after his dog.
Masking the Problem
Not mentioned at all during the supervisors’ deliberations was the fact that 70 percent of the million N95 masks delivered to the county’s Public Health Department 10 days ago were defective. The straps attaching the mask were old and had lost adhesive function. Efforts are now underway to determine whether they can be fixed. State emergency officials — who provided the masks in the first place — have reportedly stated they’d send another 100,000 masks.
Staying the Course
Based on cell-phone tracking data maintained by Google, somewhere between 40 and 60 percent of Santa Barbara County residents have complied with physical-distancing requirements. According to one modeling projection, Do-Reynoso said, county hospitals will become most slammed in the third week of August, when 274 hospital beds, 176 ICU beds, and 130 ventilators will be needed. Currently, the county has roughly 700 licensed hospital beds. Of those, 131 are slated for intensive care. Assuming that 40 percent will be occupied by patients with illnesses other than COVID-19, that means there would be 376 beds left over, more than enough to accommodate the projected surge. The number of ICU beds, however, will fall short of surge-related demand by 85. And the ICU will need 80 more ventilators than now available. Currently, hospitals are seeking 100 new ventilators and 500 disposable ones. Ventilators are needed to keep patients breathing after they can no longer do so.
If, however, county residents can double down on isolation methods and increase their social distancing to 55 percent, the maximum demand for hospital beds — projected to peak at the end of August — would drop to just 42. The demand for ICU rooms would drop to 27 and for ventilators to only 20. But conversely, if county residents weary of the sacrifice and social isolation rates fall by just 5 percent — to 45 percent — the numbers become ominous and the existing health-care infrastructure overwhelmed. Another model, a simpler one, suggests that there would be 57 deaths by August 4.
The Winning Number: 55 Percent
How exactly to increase social distancing by 55 percent was not specified, although County Health Officer Dr. Henning Ansorg quietly suggested leveling $1,000 fines on businesses that violate the county’s social distancing protocols. Health and law enforcement officials prefer education to enforcement. The City of Lompoc has asked the public to report violators. Supervisor Joan Hartmann expressed hope that requiring the public to wear face coverings — as opposed to medical-grade masks — might help tilt the scales.
Supervisor Peter Adam expressed alarm at the economic violence inflicted by so prolonged a shutdown. Could residents last through the fall without resisting? “If we get to August and have to start arresting people,” he said, “that’s not America.” Supervisor Das Williams, who had brought one of his young daughters with him on the dais, had similar misgivings. “It is a fact that economic collapse and poverty also kills people,” he stated. “I don’t mean in terms of having people lose a little bit of their income. I mean it in terms of ruining their lives.” Even so, Williams said, it was “premature” to be discussing November.
Do-Reynoso stressed that the numbers surrounding COVID-19 have changed dramatically since she first reported to the supervisors a month ago. “I can’t believe it’s been a month, but it’s been a month now.”
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