Coronavirus exposure no longer means automatic isolation in Sacramento, Yolo, Placer
Public health leaders in Placer, Sacramento and Yolo counties say their departments will no longer recommend isolation or quarantine for people exposed to someone with COVID-19, as they now will focus on reducing the risk to populations at the greatest risk of dying from the respiratory illness.
In an interview Monday, Dr. Peter Beilenson, head of Sacramento County’s Department of Health Services, said public health officials quarantined the sick and those who came into close contact with them as a way to slow spread of the disease, but as the number of cases increase statewide, public health has to acknowledge that those measures aren’t enough.
“Once you get a certain number of cases, it’s hard to continue to contact-trace back the way you tried originally,” Beilenson said, “so we move to mitigation, which is basically trying to mitigate the risk to those who are most at risk: the elderly and those with chronic underlying conditions.”
Because the new coronavirus poses the greatest threat to these individuals, he said, they and their families must take precautions to avoid exposure. If AARP is having a gathering, for example, the health department might recommend that people in their 70s or 80s not attend. If children are showing symptoms of COVID-19 — fever, coughing, shortness of breath — their parents should avoid taking them to visit grandparents either in their homes or at an assisted living facility, he said.
When Beilenson made his announcement Monday, he expected other California counties to follow suit. On Tuesday, Placer and Yolo counties issued news releases saying that they also were shifting strategies.
In a joint statement, Placer and Yolo officials said: “With community spread, public health departments must now shift their efforts to community mitigation measures that will slow the spread of COVID-19 in the community, protect those who are most vulnerable to severe illness, and allow the health care system to prepare resources to take care of severely ill patients. Like a handful of other counties in California, Placer and Yolo counties will now enter this new phase.”
While Sacramento County is emphasizing keeping the elderly and other vulnerable people away from public gatherings, the Placer and Yolo health departments urged event planners follow guidelines from the California Department of Health on when to modify, postpone or cancel events.
Shift makes sense, expert says
Epidemiologist Catherine Troisi of the University of Texas Health Science Center at Houston said this change in strategy may be risky from a public perception standpoint because of the level of fear about this new illness. However, she said, this shift makes a lot of sense to her as an infectious disease researcher.
“I’ve been saying for a week that we cannot contain the virus. It’s time to move to mitigation,” Troisi said. “I don’t want to say we’ve lost the battle because that implies we could have won it, and this is an infectious virus, and due to a lot of circumstances, the odds of us being able to contain that were very small. China bought us some time. Unfortunately in the United States, we didn’t take advantage of that time. We had problems with the testing kits.”
COVID-19 is spreading fairly significantly around the United States, Beilenson said. While public health officials had confirmed roughly 700 cases of COVID-19 across the country as of Monday evening, Cedars-Sinai researchers estimated that more than 9,000 people in the United States already had been infected with the new coronavirus by March 1.
“This suggests that the opportunity window to contain the epidemic of COVID-19 in its early stage is closing,” the researchers stated in their paper, which is posted online on a forum where physicians and researchers share information.
The Cedars-Sinai investigators said they used “very conservative” methods to make their estimates, so they likely underestimated the number of cases. Their study modeled only COVID-19 coronavirus cases that could have been “imported” directly to the U.S. from Wuhan, China, before Jan. 23, when the Chinese government locked down the city. They assumed the lockdown stopped all outbound traffic from the city, which was the epicenter of the new coronavirus outbreak.
Beilenson said scientists have had the opportunity to study COVID-19 and have found that 80-plus percent of those infected are not symptomatic or have only mild symptoms. In addition, he said, it appears that people who have the disease gain an immunity to it. Medical researchers differ on how long that immunity will last. Some say a season, while others say it could be effective for next season.
That immunity, however, could buy time for researchers to develop a vaccine, a process that experts say will take at least a year.
When to seek emergency care
Until then, Beilenson said, there is no need for the general public, health care workers or first responders to isolate themselves after an exposure. They should stay home only if they develop symptoms, he said, and call 911 for assistance only if they are extremely sick or believe their lives are in imminent danger.
Dr. Theresa Cheng, a senior resident who works at several hospitals in California, said that, as an emergency room physician, she is seeing people on both ends of the spectrum coming in seeking advice on COVID-19 and other respiratory illnesses. There definitely has been an upswing in asymptomatic people in ERs asking to be tested for the coronavirus, she said, and there are also people who have underlying health conditions who should have sought care earlier.
“If you’re feeling fine, if you’re otherwise well, then the best thing you can do is put on a mask to prevent the transmission of those little droplets to other people, those around you,” she said. “It’s those people who have those comorbidities who are at higher risk. They should come in, or if they’re experiencing severe symptoms, they should definitely come in.”
If people have symptoms that get better and then grow worse, Beilenson said, they should call ahead for care with their health care provider or an urgent care center. People who have mild symptoms can treat themselves at home with over-the-counter medications.
If you are in a high-risk group, Beilenson said, consider avoiding crowded social gatherings where you cannot put at least two arms’ length worse of space between you and others. And although the CDC recommends face masks only for those who have COVID-19 and their caregivers, Beilenson said that some physicians may recommend that immuno-compromised patients wear them when out shopping for groceries or running other errands.
“If you can, go to the store and do two or three weeks’ worth of shopping at one time,” he said. “That makes a lot of sense. And try to go in off-peak hours.”
Public health officials recommend that companies give employees the option to telecommute from home or teleconference with other workers because people may still be able to work with mild cases of the illness. If schools have a COVID-19 exposure, Beilenson urged them to collaborate closely with their local health department and County Office of Education to determine appropriate steps to take.
This story was originally published March 9, 2020 at 8:43 PM with the headline "Coronavirus exposure no longer means automatic isolation in Sacramento, Yolo, Placer."
