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“In my professional opinion, it doesn’t make sense to me either.”
Spoken by Dr. Van Do-Reynoso at the Board of Supervisors meeting Tuesday, her words solidified the loss of confidence that many county residents have expressed toward Governor Gavin Newsom in recent days. Santa Barbara County’s public health director was referring to the milestones the governor released last week that preclude the county from reopening more businesses.
When applied to Santa Barbara County’s population, the governor’s new epidemiologic criteria would require the county to have zero COVID-19 deaths and no more than 45 positive cases in a 14-day period. Do-Reynoso called the criteria “insurmountable” hurdles to jump.
“I sent a letter to the state saying that what makes more sense is returning to the two original metrics, one being safeguarding our health-care system,” Do-Reynoso said. “We have data that shows we can safeguard our health-care system. The other is safeguarding our vulnerable populations … we have stood up homeless shelters; we have alternative-care sites; we have done all of that. I am encouraging the state to change its metrics.”
The Board of Supervisors unanimously voted to send a letter, too. The letter asks the governor to measure the county by the state’s original metrics instead: a less than 10 percent positivity rate in tests and a less than 2 percent mortality rate. It also hits a touchier nerve — the Lompoc federal prison.
The prison accounts for nearly 70 percent of the county’s positive cases. The board’s letter points out that the county has an 11 percent positivity rate excluding the prison population, while the positivity rate inside the prison was reported at 67 percent since it began mass testing, greatly skewing the county’s overall positive case rates.
“Santa Barbara County has no authority over this population, and while we have worked diligently in offering our assistance, we have no authority to impose disease mitigation strategies,” the letter to Newsom reads.
The letter asks the state to exclude the prisoners who have tested positive from the county’s count, but notes that any staff who work at the prison would be included in the community count.
But There’s Good News
Aside from falling hopelessly short of Newsom’s epidemiological requirements, the county is excelling in nearly all other areas the governor mandated in exchange for more local control over “low-risk” business reopenings.
The county’s testing capacity is not quite to the state’s standards, but Do-Reynoso said it has improved significantly because of the three community-based testing sites opened up last week. Over 1,600 specimens have been collected in the week that the sites have been operating, though only 191 results have come in so far due to an unintended lag she said she believes will be fixed.
The governor’s criteria also calls for hospitals county-wide to be able to accommodate a minimum surge of 35 percent, which Santa Barbara County has far exceeded. Skilled nursing facilities throughout the county also have at least 14 days’ worth of personal protective equipment stored away that’s separate from the state’s supply chain — yet another box checked toward meeting Newsom’s standards.
It also requires the county to have at least 15 contact tracers per 100,000 residents to locate and quarantine any person who was in contact with an individual who tested positive for the virus. Santa Barbara Public Health wasn’t meeting that, so Do-Reynoso put out a “cry for help” to other county departments for additional employees to train as contact tracers. She was given 96 county employees. She also said 240 community members have filled out applications.
“These are happy moments in terms of building the work capacity to box this disease in and move through [the reopening stages],” Do-Reynoso said.
Santa Barbara Will Rise Again
As more guidance from the state continues to come in waves, the county’s team of business stakeholders has worked to develop a Santa Barbara–specific reopening plan that’s in line with the governor’s criteria. That plan has a name now — RISE (Reopening in a Safe Environment).
The group, which initially had a six- to eight-week timeline for creating the plan, crammed its work into just three weeks after the governor allowed for reopening efforts earlier than expected. Now the group has shifted its focus again with the governor’s new criteria announced last week.
“Now we are going to present this as more of a supplement to the state’s resilience roadmap,” said Nancy Anderson, assistant CEO of the county, “though we are including the information the state put out last week, so it’s complementary to it.”
She said the state issued multiple industry guidelines, which are included in the RISE document. She said it will also include industries more specific to Santa Barbara that the state did not include in its guide, including the farmworker and immigrant communities in the agriculture industry.
“I think this work is critical given how many people have lost their jobs and under threat of losing their businesses,” 1st District Supervisor Das Williams said about RISE. “And I think part of people’s mental health and economic health shares the same underlying need, which is for a light at the end of the tunnel, for hope.
“This plan, whether we need to use it next week or the week after that, will provide people with a roadmap and give them hope to keep on trying,” Williams continued.
The 300 or so stakeholders from sectors like education, faith institutions, lodging, agriculture, building and development, beverage and restaurant industries, and others will conclude their roundtable discussions this week. The plan, which Anderson described as a “living document,” will be posted online after it is presented to the Board of Supervisors next week. Community members will be able to submit their input on RISE electronically.
The Unintended Side Effects
The very order enacted to protect the public from a health crisis is the same order that has begun to spark another — mental illness.
As each day passes that the shelter-in-place order remains, many are beginning to struggle to pay their bills, take care of their families, and maintain hope that their lives will go back to “normal.” Alice Gleghorn, director of the county’s Department of Behavioral Wellness, presented data to the board that reflects the unintended side effects.
The county has seen an increase in the number of deaths by suicide in the month of April. It has also seen an increase in information requests for mental health and substance abuse, as well as an increase in referrals for mental-health screenings from the Child Welfare System, and the Santa Barbara County Psychiatric Health Facility has received a high volume of referrals from the criminal justice system since the stay-at-home order went into effect.
Gleghorn also said there has been “a dramatic drop in requests for substance-abuse treatment.” She said calls to the 24-hour access line have decreased overall, though the lack of requests for treatment does not mean residents aren’t abusing substances. In fact, alcohol sales state-wide have skyrocketed since March.
Anecdotally, much of the increased substance-abuse and mental-health problems stem from not only the uncertainty around the pandemic’s endless unknowns but also the extreme economic stress experienced by those who lost their jobs from the business closures. Along with the mental-health issues born from poverty, there are also other physical health issues, too.
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“I am worried that we are undervaluing the health effects on the families of millions of people now out of work. Just in our county, thousands of people are descending into deeper poverty,” Williams said. “And many of those workers descending into poverty have children who will face decreased lifespans and health effects from that. I just really hope that in our discussions, more so with state public health officials, that we do not undervalue the statistical deaths and decreased lifespans we are creating.”
But help is still available. Gleghorn said that her department is offering its usual services, but some are modified to meet health orders.
She said nearly half of her department is working from home, mostly by providing services through the phone or Telehealth, a platform psychiatrists use to communicate with patients via video. About a third of the department’s workforce is still seeing clients in person, though. She said Telehealth is mostly successful, but the most difficult clients to reach remotely are those with co-occurring and complex disorders.
The psychiatric health facility, crisis stabilization unit, crisis services, co-response teams, and the sobering center are all open for inpatient treatment; outpatient services are available remotely.
What’s Legal Anymore?
The only constant in the COVID-19 pandemic is change. Weekly, daily, or sometimes hourly, everything that was understood about the virus becomes null and void.
The laws around the order have changed, too. Take face coverings and masks, for example. Early on in the pandemic, wearing a mask wasn’t recommended for the public. Now, some cities in the county have enacted laws that require the public to wear one in order to buy groceries or get takeout food.
Sheriff Bill Brown and District Attorney Joyce Dudley set the record straight on where law enforcement stands in the pandemic.
“The law is very clear,” Brown said. “Once the governor and public health officer evoked special powers, the Sheriff’s Office and other local law enforcement agencies became responsible for enforcing those orders. It’s not a question of whether or not we agree with some of those orders; it is our duty to enforce them.”
Brown said that neither his department nor surrounding law enforcement agencies in the county are using force to ensure compliance.
“We are committed to being long on education, engagement, persuasion, and encouragement — and short on actual enforcement tactics,” he said.
In nearly every instance of noncompliance with the law, said the sheriff, his department has been able to talk to the individual and get them to voluntarily comply without any trouble.
With low-risk businesses opening for curbside pickup, it can be confusing to know what permits residents to leave their homes. Newsom’s shelter-in-place order is still the law, but slightly more relaxed.
Individuals who are not deemed essential workers should still minimize leaving their homes. Exercising on the beach or taking a walk around the neighborhood is perfectly legal, as long as people who don’t live in the same household stay six feet apart from each other. Gathering in large groups is not permitted and may warrant a talk from law enforcement.
When going inside a business, whether it be an essential business or one of the newly opened low-risk businesses, staying six feet apart is also mandated by law, not just by the businesses themselves. The cities of Santa Barbara and Goleta also passed ordinances that require customers to wear face coverings, though neither the county nor the state issued such requirements.
Overall, Brown said Santa Barbara County has exceeded his expectations in following the governor’s order. Other crimes, however, are becoming a larger issue. Dudley spoke to the crimes that happen inside homes, such as domestic violence, child abuse, and animal abuse.
“Households are under a tremendous amount of stress right now,” Dudley said. “They’re worried about money; they’re worried about employment; they’re worried about the life that they had before COVID-19. Children are home from school, and parents are worried about them not getting the right education. So the stress level rises.
“When the stress level rises, they start engaging in abusing alcohol and drugs. And when there’s stress plus alcohol and drugs, we see a rise in in-home violence.”
Dudley emphasized that anyone who suspects ongoing abuse should call 9-1-1, even if they only have a sense that it is happening. There is also a victim advocate line for victims who cannot dial 9-1-1, which is (805) 568-2400.
If you or someone you know is thinking about hurting themselves, call 9-1-1 or the 24/7 National Suicide Prevention Lifeline at 1 (800) 273-8255. For more information on suicide prevention, including warning signs and risk factors, visit suicidepreventionlifeline.org. A list of regional resources can be found at countyofsb.org/admhs.