Self-isolation hits California during coronavirus spread. Here’s expert advice on how to plan
Faced with a series of conflicting rules and advice, some California residents on Monday said they were confused and angered by what they consider inexplicable decisions by state and local leaders.
In an attempt to quell the spread of the coronavirus to older, more high-risk individuals, Gov. Gavin Newsom on Sunday advised anyone age 65 and older to self-isolate at home, and for restaurants to serve only at half-capacity.
But that guidance was immediately contradicted in Los Angeles by the mayor, who ordered all restaurants closed, and by mid-day Monday, Bay Area health officials in several counties were asking that all residents, regardless of age, “shelter in place.”
The governor has yet to offer details about what self-isolation means, and his administration so far on Monday has not responded to Sacramento Bee requests for details on what degree of isolation older people should practice.
Sacramento County officials said as of noon Monday that they are studying the Bay Area order, but have not decided whether they should impose tougher restrictions locally.
In the Bay Area, banks, gas stations, pharmacies, some transit, stores, laundromats and city and county services such police and fire are still up and running. But people are asked not to have dinner parties or go out for non-essential shopping or get a haircut.
The conflicting messages left retirees like Jeff Shulmister, 73, who hikes five days a week, demanding an explanation.
“I call BS,” he said. “What happens to that 70-year old marathon runner who was out of lettuce, tomatoes and avocados yesterday, planning a trip to the grocery today and waking up to this news?”
Richard Kircher, a local hospital emergency room nurse, is among those who went to work anyway, pending his employer telling him not to.
“I am older than 65 and am a registered ER nurse and currently working three shifts a week,” he said in an email. “Which very quickly may become more. I would love to just kick back and isolate myself. I work with (emergency department) doctors that are over 65, and are some of the most dedicated and healthy people I see.”
The risks are profound
The messages about what you should do may be conflicting, but global public health experts are in wide agreement that the United States is at a critical tipping point when it comes to preventing hundreds of thousands — if not millions — of people from dying from COVID-19. Humans have no natural immunity and there is no vaccine.
So far, testing for the disease has been limited, but there are already signs that the disease is spreading widely through California communities.
Health officials say the coronavirus has an incubation period of anywhere from two days to 14 days before symptoms emerge, meaning seemingly healthy people who are now infected are likely spreading it as they move from place to place.
Healthy, younger people are much less likely to fall seriously ill and some may not even show symptoms if they contract the new coronavirus. But the elderly and sick are at particular risk and have alarmingly high fatality rates. In China, about one in every six people over the age of 80 died after contracting the disease. Nearly one in four of the patients died at the Kirkland, Washington, nursing home that was the center for the outbreak in the Pacific Northwest.
Those factors are why public health experts say the time to act is now to avoid a situation in the coming weeks similar to what Italy experienced as massive amounts of people with severe symptoms swamped hospitals.
Sacramento health chief advice
Sacramento County health chief Dr. Peter Beilenson told The Bee that his guidelines, as of now, are that people 65 and older who are healthy should be able to go for walks and can have friends over to their homes, as long as everyone is healthy.
That would include a group of healthy 65-and-over people getting together, for instance, at someone’s house, or for family to visit each other. “Otherwise, you have no life,” he said.
In each case, only healthy people should be visiting, and people should follow federal guidelines for distancing and washing hands.
He said that while seniors are out and about, they can talk with others, but keep their distance.
Beilenson’s office noted on Monday that the two people who have died so far in Sacramento County from contracting the virus where older than age 70 and had chronic health problems.
Dr. John Swartzberg, at UC Berkeley School of Public Health, said that one thing is very probable: However government restrictions shake out in the next few days, they will be in place for weeks or longer.
“We don’t know how long this struggle will continue,” he said. “We need to plan for many months.”
No restaurants for seniors?
It appears from the governor’s Sunday statements that Newsom expects older residents to stay out of restaurants.
Newsom said he has not ordered or suggested that restaurants close down yet, partially because he expects higher-risk age groups to no longer go to restaurants in the coming weeks.
Some Sacramento older residents reacted to the governor’s guidelines by getting out early in the morning to the store, before stores got crowded. Still, stores like the Raley’s on Freeport Boulevard in South Land Park were packed mid-day, and many of the shoppers were older individuals.
Kirk Vyverberg, 70, was loading groceries into back of his car at Raleys on Freeport in the morning. “I wanted to get in and out before a lot of people,” he said. “I’m assuming they cleaned the store last night.”
He was a little disappointed they were out of toilet paper and paper towels.
City, county health officials uncertain
The city of Sacramento has suspended programs at the Ethel MacLeod Hart Senior Center through April 12.
County health officials in California report Monday they wait on guidance from the state as to what exactly “self-isolation” means, and how they should direct residents to alter their behavior.
“That was a huge bombshell yesterday,” said Yolo County spokeswoman Jenny Tan. “How to translate what Governor Newsom said is still up in the air.”
In anticipation of more strict home-isolation guidelines, Tan said local public health officials are now in the process of identifying local partners like the Yolo Food Bank and Meals on Wheels that can help with the lift of getting medicine and food to residents who might have health or mobility issues.
Placer County spokeswoman Katie Combs Prichard said officials there are looking for advice from the state.
“We’ve been refreshing the state website,” Combs Prichard said. “We’ll be updating local guidance but we haven’t seen written communication yet, but I’ll refresh and see if I missed something.”
In general, Placer County will continue to harp on the same message as in previous weeks — “stay home as much as possible, unless absolutely essential” if you’re over 65 or have existing health conditions, Combs Prichard said.
“If others can support you with grocery shopping and step in,” take advantage of that, she said.
In Sacramento County, officials say some workers 65 and over have begun working at home. County officials say they expect to have a policy established by end of the day Monday.
Play it safe
Absent any hard and fast rules, healthcare experts say older people and those with chronic health issues should play it as safe as possible.
Dr. Joshua Sharfstein, a vice dean at Johns Hopkins Bloomberg School of Public Health: “Really start to change your routine so you’re reducing your exposure to a lot of people. Telework if you can. Anything you can do without major hardship, you should be trying to do. It’s now everyone’s job to do those things, and what individuals do is going to matter a lot.”
Your parents and grandparents
Health officials are divided on how to interact with elderly relatives. The general principle is to use common sense, and limit visits.
“It’s painful advice,” said Dr. John Swartzberg, a professor emeritus at UC Berkeley.
He called the Bay Area’s announcement on Monday a good healthcare step.
He and his wife are in their 70s. They made the decision to only visit with their grandchildren outside, and to keep their distance. “We’re not touching each other when we see each other. We’re not giving the people we love the most in our world hugs. And that’s because I know and they know that’s an easy way to transmit the virus.”
Helping older neighbors
People should check in on older neighbors and help them out, said Dr. Jonathan Fielding of the UCLA Fielding School of Public Health.
“There will be people who are elderly who can’t get out to get any food or any prescriptions and it will be nice if healthy people in that community were concerned about them and helping them, and if it’s urgent getting them to a doctor’s appointment or whatever it is.
“I’d like to see that happen, but we don’t have much history of that at least not broadly in the United States.”
How feds define ‘self-isolation’
The term can be used to describe varying degrees of restrictions, according to national health officials.
The U.S. Centers for Disease Control and Prevention urges people to self-isolate if they are experiencing symptoms like a fever or cough, even if they haven’t been diagnosed or tested for the new coronavirus.
Guidance from New Zealand’s Ministry of Health describes self-isolation as a “precautionary measure,” and means staying at home with limited contact with others. It’s OK for delivery drivers or friends to drop off food or supplies, but self-isolating individuals shouldn’t share dishes, towels or pillows with others at home.
The Canadian government states that a person who does not have symptoms but has had possible exposure to the virus — because of travel abroad or through a close contact diagnosed with COVID-19 — should self-isolate.
That means staying at home and monitoring for symptoms for 14 days, and avoiding contact with others to prevent the spread of the disease.
This story was originally published March 16, 2020 at 2:21 PM with the headline "Self-isolation hits California during coronavirus spread. Here’s expert advice on how to plan."