This past Tuesday, the fond farewells showered upon Van Do-Reynoso — who stepped down last week after five very long years as Santa Barbara County’s public health director just as the county’s COVID risk level moved to “high” — by the county supervisors was infused with a sense of urgency and intimacy common to people who have spent too much time hunkered down in the same foxhole.
That’s because, in this case, they have.
For the past two and a half years, Do-Reynoso held the unenviable task of guiding Santa Barbara County through the COVID pandemic, the most profound, prolonged, deadly public health crisis to seize Santa Barbara County — not to mention the state, the nation, and the world — since the great flu epidemic of 1919. Before COVID, Do-Reynoso found herself occupying the Public Health hot seat during the debris flow of January 9, 2018, when 23 people perished. Before that, it was the raging inferno of 2017’s Thomas Fire, which reigned briefly as the biggest and worst fire in state history.
By necessity and inevitability, all public health chiefs will eventually experience a baptism of fire; by contrast, Do-Reynoso — who moved from the Central Valley with her husband and three daughters to take the job — faced a nonstop firing squad of flamethrowers blowing hot and heavy almost from the start.
What wasn’t said was almost as striking as what was. None of the county supervisors mentioned — or even alluded to — the spike in cases now taking place throughout Santa Barbara County because of the new and highly contagious Omicron subvariant of COVID, BA.5. Hospitalizations are going up. At the time of the hearing, the county’s COVID-related death count hovered just under 700. In the days since, it has now reached 702. None of the supervisors asked Do-Reynoso if she had any parting thoughts as to what the county should do next. If the County of Los Angeles was about to impose an indoor mask mandate, they could have asked but didn’t, why shouldn’t Santa Barbara?
Conspicuously, none of the many anti-vaxxers and anti-maskers who have long dogged county board meetings with questions, accusations, and some angry denunciations bothered to show up for the occasion.
Instead, Do-Reynoso — in person subdued and reserved, but very definite — was thanked for her commitment, determination, leadership, resilience, ability to create partnerships, hard work, and, above all else, even-keeled calmness in the face of unimaginable confusion and fear at a time when the stakes could not have been higher. Those in attendance heard how Do-Reynoso worked an endless succession of 14-hour days; later, they’d hear that no, those were really 18-hour days. But throughout it all, it turned out, Do-Reynoso — who’d been sent from Vietnam to Orange County at age 9 to find a better life — still found the time to bake chocolate-chip cookies for coworkers. And vegan ones at that.
Many of the supervisors and members of the county’s executive staff had already said their goodbyes to Do-Reynoso, who’d announced her plans to step down a month ago. But even so, some of the supervisors appeared to grow verklempt while bidding their final farewells; so, too, did some of Do-Reynoso’s colleagues.
Keeping things characteristically light, however, was Supervisor Steve Lavagnino, who exclaimed at Do-Reynoso’s ability to maintain her composure in the face of constant criticism. “Why is Van so chill?” Lavagnino recounted wondering many times. “I know my mouth would have got me in trouble,” he added. “I’d probably be yelling back at people.”
In fact, many public health directors throughout the California and the rest of the nation resigned in the face of public rage and anger sparked by COVID and the health and safety mandates it engendered. Many public health administrators came to fear for the safety of their families and themselves. Throughout the pandemic, Do-Reynoso found herself moved to take certain safety precautions as well.
The challenge for anyone in Do-Reynoso’s position was that the science kept evolving, knowledge kept shifting, and the state and federal rules kept changing. How did all this translate for Santa Barbara? It was not always clear. How to balance between the carrot and the stick to achieve maximum safety? How to make do without adequate supplies? Then how to get the supplies distributed once available? How to communicate a clear message to the public in the face of mixed messages being received? How to reach underserved communities for whom English was not their first language and government officials not necessarily trusted?
“We were making the best decisions with the information we had at that moment in time,” Lavagnino stated. “It was an ever-changing world. Nobody’s been through this before.”
What Lavagnino remembered most about Do-Reynoso throughout it all was, he said, “the grace.” Do-Reynoso, he said, was “the right person at the right time.”
Supervisor Das Williams expressed similar sentiments. “Van led us,” he said. “To me, she translated her faith into a calmness; she was a rock in the storm. She responded with grace to people’s anger and rhetoric.”
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Others praised Do-Reynoso’s commitment to racial equity, especially when it came to making health care accessible to populations like immigrant farmworkers. She embraced the notion that racism constitutes a public health issue; it was not something foisted upon her. And she was praised for her willingness to take on seemingly no-win issues like the operation of county animal shelters and the humane treatment of animals.
When Do-Reynoso took the podium to speak, she wore a zip-up jacket bearing her department insignia and a black mask over her nose and mouth. She was the only person doing so. In her remarks, she thanked her three daughters for backing her up; she credited her faith and family for getting her through the long hours; she thanked her executive team, who, she said, “always went the extra 100 miles.” And she thanked each of the supervisors by name and cited specific reasons for each one. She expressed thanks to her family sending her to the United States, where she could get an education, earn a PhD, and serve 20 years at various public health agencies. Before moving to Santa Barbara, she worked in Tulare and Madera counties. Her experience in Santa Barbara, she said, had been “the apex” of her professional career.
Do-Reynoso will be heading off to CenCal to take an executive post where she can focus her administrative skills — honed after running a department with a $109 million budget and 529 full-time employees — on matters related to health equity. She will be replaced in the short term by Daniel Nielson, who for the past nine years ran the county’s Department of Social Services. Finding a permanent replacement is estimated to take six months.
Even if Do-Reynoso has moved on, the issues of COVID still confront the county. Wrestling with the big, hairy issues this poses will be Dr. Henning Ansorg — as it’s been throughout the entire pandemic — the county’s public health officer. In a recent interview, Ansorg confirmed that that the hospital bed count and the COVID case count have both risen enough to place Santa Barbara in what the Centers for Disease Control and Prevention has designated as being in the red zone, or at a “high” community level of COVID risk.
What that means now is not the same as what it meant earlier in the pandemic.
“Most people in the United States and California have some form of immunity,” Ansorg said. “That makes the virus work really hard for its money, so to speak.”
In response to such “evolutionary pressures,” Ansorg said, the disease has mutated yet again, and the latest variant is even more contagious. The protein spike of the BA.5 variant has demonstrated an ability to get past the body’s defenses and not activate the production of antibodies. It’s now possible to get reinfected after having just gotten sick or vaccinated, Ansorg said.
Even so, he noted, it’s still advantageous for county residents to get vaccinated and get all their booster shots. “Your length of infection will be five times shorter,” Ansorg stated.
Many of the symptoms of the new variant, Ansorg said, are typical to other forms of COVID — loss of taste and smell. In addition, the BA.5 makes those infected extremely tired and can cause intense fevers, with temperatures up to 103 and 104 degrees. The intensity of these fevers, Ansorg said, set this variant apart.
Ansorg said medications like Paxlovid are now available that will treat such symptoms and stop the virus from replicating in a patient’s body. It won’t, however, knock the virus out. Pharmacists are now authorized to prescribe Paxlovid directly to eligible patients with certain limitations.
Ansorg explained that under the CDC guidelines, Santa Barbara needs to meet two criteria to fall within the “high” community level. Based on county size, Santa Barbara would need to experience more than 29 new cases a day. “Right now, we are at 33.2 a day,” Ansorg said on Friday. And that number, he cautioned, is dramatically underreported. Most tests are now home tests, and the findings are neither reported or recorded.
The other criterion involves the number of new hospital beds needed to handle those infected. “Right now, we’re at 10.2 new cases,” he said. “We need to be below 10 to say out of red,” he said. “Two to three weeks ago, we had maybe 30 people in hospital beds. Now we’re averaging around 50. Today, we had 49. Of those, six are in the ICU.”
Los Angeles, Ansorg said, will declare a mask mandate if it stays in the red zone continuously for two weeks. “L.A. is a very different county,” Ansorg said. “It’s a much bigger county with far more people, and it’s far more diverse. An incredible number of people are infected, and people there routinely travel much greater distances than we do,” he said. Hospitals in Los Angeles are more impacted than those in Santa Barbara. “Although we’ve seen an increase in number of hospitalizations, our percentage of hospital beds still remains pretty good. Based on all of this, I’m not in favor of an indoor mask mandate for Santa Barbara.”
Mandates aside, Ansorg noted the CDC guidelines strongly advises people to wear masks when in indoor spaces — like grocery stores — and crowded outdoor space. An example of the latter would be concerts at the Santa Barbara Bowl. The effectiveness of masks, he said, is “self-evident.” He doesn’t socialize all that much and makes a point to wear a mask when shopping indoors. Two and a half years into the pandemic, Ansorg has never tested positive or gotten sick from COVID. “Knock on wood,” he said.
CORRECTION: This article was updated on July 28 to clarify that pharmacists are now authorized to prescribe Paxlovid but with certain limitations.