Sansum Medical Clinic CEO Dr. Kurt Ransohoff expressed serious concern that other countries, such as South Korea, are doing so much better than the United States — and Santa Barbara County, too — at keeping the rates of COVID-19 infection and mortality under control. While Santa Barbara County’s mortality rate is much lower than the nation as a whole — 7.1 per 100,000 for Santa Barbara as opposed to 45 per 100,000 for the United States — Ransohoff stated, it’s still 15 times worse than South Korea’s.
“It’s not like they have penicillin and we don’t,” Ransohoff said in a recent interview. “They have the same lack of vaccine that we do.”
The solution? “You do need a consistent message from the leadership,” Ransohoff said. “In countries that do better, there’s a sense of ‘This is what we need to do’ without the equivocation we see here.” In more countries that have successfully flattened the COVID curve, he noted, public health had not become so politicized. “It’s crazy. There’s so much data here. It’s not political. It’s just fact. We could do better.”
And the data shows, Ransohoff said, that countries doing well have been more diligent in their adherence to social distancing, enhanced hygiene, and mask wearing. Residents there “just received and followed public health advice more faithfully than the United States did.”
Last week, Ransohoff issued a letter to all Sansum patients in which he discussed much of this. In an interview with the Santa Barbara Independent afterward, he expanded on his thoughts.
At the dawning of the COVID crisis, Ransohoff said it appeared Santa Barbara County was successfully keeping a lid on its rate of COVID-19 infections. “We were at one percent for many weeks,” he said. “We were doing good. We were not like those other places doping it bad.” But after the Memorial Day weekend, he said, that all changed fast. “We went from one percent to over 10 percent.”
Based on anecdotal reports from Sansum’s frontline medical practitioners, it wasn’t much of a mystery why. Different doctors found themselves treating patients — who trickled in over the course of a few days — that all had attended the same graduation parties. The number of younger people testing positive skyrocketed. But older patients, Ransohoff said, took care to lay low. “These were not people saying, ‘Hey, let’s have a party.’”
Ransohoff took issue with the argument — popularized by President Donald Trump, among others — that the higher number of COVID cases is strictly a manifestation of increased testing. Certainly, he said, the number of tests has exploded. In March, he said, there would be maybe 21 tests — countywide — in one day. Now the number is typically in the thousands. But while the percentage of positive tests fluctuates dramatically from day to day, the overall trend has been one of significant increase. The last time county public health officials reported a weekly average rate that fell below the state’s thresholds for concern was July 13. On that date, the weekly rolling average was 7.5 percent. The state’s action level is 8 percent.
Since then, the county hit its all-time high — 12.1 percent — on July 18. But in the last five days, the weekly averages have vacillated between a low of 8.4 percent and a high of 9.7 percent. The most recent report — for July 26 — was 9.4 percent. This general trend has given Ransohoff guarded cause for some optimism.
Ransohoff stressed the value of masks in limiting the spread of the virus, citing the case of the two infected barbers in Missouri who wore face coverings to protect their customers. Not one of the 131 customers who’d been tracked and traced, Ransohoff noted, tested positive. On the flip side, he cited the case of the one singer in a Seattle choir who managed to infect 50. “I know that’s anecdotal,” he said, “but sometimes anecdotes help.”
Ransohoff suggested that the long duration of the pandemic has discouraged compliance with some of the precautionary measures needed to diminish the rate of spread. “If this seems eternal — like it’s going to be this way forever — it becomes burdensome,” he said.
To that, he expressed more guarded optimism about the possible release of an effective — however imperfect — vaccine. “We’ve been dealing with this thing for only six or seven months now, and we know so much more about it than at the beginning,” he said. By contrast, as a young doctor dealing with the HIV/AIDS epidemic 30 years ago, he said it took the medical profession “two to three years” to wrap their heads around what was happening.
Sansum has taken a financial beating because of the pandemic, closing down or greatly reducing all non-essential services for a while. Hundreds of employees were furloughed in the process, and Sansum lost millions of dollars on nonessential procedures not performed. Ransohoff estimated that 90 percent of all furloughed workers are back on the job, but he noted that maybe 25 percent of the Sansum’s medical visits now take place via telehealth.
The requirements of social distancing on the job, he said, have posed serious challenges. “It’s much harder to operate the business in these times,” he said.
Flu season, he said, is looming not far on the horizon. Typically, he said, it would have been a simple matter to organize “Flu Fairs” for seniors, dispatching 25-30 medical practitioners to give flu shots to 600-1,000 patients in a single afternoon. That will prove logistically impossible given the restrictions now required by social distancing. Typically, he said, the public starts tuning into the advent of a new flu season sometime around Halloween. Given the logistical demands — coupled with the potentially dire results — Halloween will be too late.
This Tuesday, the Santa Barbara City Council will be deliberating whether to initiate enforcement actions where people are not wearing their masks in public. Currently, face coverings are required for people when outside if they cannot achieve the separations of six feet or more, as required by county and state public health edicts.
Ransohoff conceded that the messaging by public health professionals regarding the medical value of face masks has been inconsistent, but said the reasons were anything but political. In the early stages of the outbreak, he noted, it was not yet understood that the disease could, in fact, be transmitted by people who showed no symptoms. In addition, he said, there was a severe shortage of face masks in the United States, and for obvious reasons, frontline medical workers had first dibs.
The question of greater enforcement remains a very charged subject — perhaps more for political reasons than from a public-health perspective. It remains unclear what government agencies will find themselves charged with the new and unpleasant task of confronting those pushing the limits of ever-shifting public-health directives or flouting them completely. Equally contentious is what good effect such actions will have.
While Ransohoff has taken no position on the matter before the City Council, he did say, “I think there’s a role for enforcement to make sure people do what they’re supposed to do.” But in the same breath, he suggested face-mask enforcement would not be appropriate for two people outside who were 15-20 feet from each other. “It’s complicated,” he said.
At the Santa Barbara Independent, our staff is working around the clock to cover every aspect of this crisis — sorting truth from rumor. Our reporters and editors are asking the tough questions of our public health officials and spreading the word about how we can all help one another. The community needs us — now more than ever — and we need you in order to keep doing the important work we do. Support the Independent by making a direct contribution or with a subscription to Indy+.