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County hits public health ‘trigger’ as state mandates masks

Wilma J. Wooten, Public Health Officer County of San Diego
County Public Health Officer Wilma J. Wooten speaks at a press conference in April.
(Nelvin C. Cepeda / The San Diego Union-Tribune)

Officials to pause any further reopenings after Friday and double down on enforcement

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For the first time since it began lifting stay-at-home restrictions earlier this month, San Diego County has hit one of three COVID-19 triggers that require public health officials to re-examine their previous decisions to reopen a range of businesses and activities after months of forced inactivity under COVID-19 shut-down orders.

At an impromptu press conference held Thursday afternoon, county officials announced that eight community outbreaks had occurred in the seven-day period from Thursday, June 11, through Wednesday, June 17.

Community outbreaks, clusters of cases that occur outside congregate living facilities such as nursing homes, are one of three immediate red flags that require Dr. Wilma Wooten, the county’s public health officer, to consider modifying her existing public health order.

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Seven such epidemiological events in seven consecutive days is the threshold set weeks ago for immediate public action and is among 13 different triggers collectively designed to serve as a kind of canary in the coal mine that the SARS-COV-2 virus is starting to spread more rapidly in the community.

Timeline of community outbreaks that hit the trigger

County Supervisor Nathan Fletcher said that in light of tripping the trigger, the county will take three actions: Pause further implementation of state guidance allowing additional types of businesses or activities to reopen beyond those planning to open Friday (nail salons, spas, tattoo parlors), step up targeted enforcement of specific entities not complying with the public health order and continue to remind the public of the seriousness of following the orders to protect public health.

The news surfaced just one day after the county said that the total number of community outbreaks in the past seven days stood at six.

It turned out, though, that even as officials were delivering that total during a regularly-scheduled news conference Wednesday, the county epidemiology department was actively investigating three more.

Though one turned out not to meet the official definition of an outbreak — three or more confirmed cases from different households contracted in the same location — the additional two were enough to officially meet the threshold.

Had those two outbreaks occurred on Thursday, instead of Wednesday, the trigger threshold would not have been met as three outbreaks that occurred on June 11 would have fallen out of the seven-consecutive-day window.

In addition to the three outbreaks on June 11 and two Wednesday, three on June 16 brought the total to eight.

But that’s far from the grand total.

Throughout the entire months-long pandemic, the public health department had recorded a total of 39 community outbreaks as of Wednesday. While some, like a group ski trip out of state, have a tinge of the exotic, most, like a grouping of infections at an unnamed manufacturing plant, are right there in the mainline of daily life.

Each takes the work of county contact tracers and public health investigators working diligently to interview each person who tests positive, building a list of close contacts and branching out to ask all affected to self quarantine for two weeks. Wooten said Thursday that it can take the county three or more days to identify an outbreak.

A total of 417 cases and 6 deaths were attributed to the 39 community outbreaks, according to the county’s data. Of the 39 outbreaks, 16 were active as of Wednesday, while the others had been closed after two weeks without any new positive tests.

The information offers a glimpse at how the novel coronavirus has been spreading, but it does not include data for individual cases or outbreaks at the case level.

“The only identifiable commonality among most non-outbreak positives is that they have not stayed at home,” county spokesman Michael Workman said. “We may not know where a person contracts COVID-19. At this point, with wide community spread, it can be anywhere.”

Here is the list of the number of outbreaks associated with each category of activity, according to the county.

  • Nine outbreaks at “various health/medical service offices”
  • Five outbreaks at “manufacturing and repair facilities”
  • One outbreak at a “resort hotel”
  • Five outbreaks at “food processing facilities”
  • Two outbreaks at restaurants
  • One outbreak at a “landscape company”
  • One outbreak at an apartment building
  • Three outbreaks at “private residences,” which include a barbecue and a party
  • One outbreak at a business park
  • One outbreak at a grocery store
  • One outbreak from a ski trip
  • One outbreak at an out-of-county bachelor party

Of the eight outbreaks reported in the last seven days, the biggest had four or five cases, Wooten said. She said no deaths had been associated with any of the eight outbreaks.

The two outbreaks confirmed Wednesday and announced Thursday were at a campground and a “social club,” according to county officials.

Fletcher said the social club should not have been open.

Officials said they were asking the public to voluntarily comply with the public health orders. If officials find egregious violations of the order at businesses, they could be shut down or cited by law enforcement agencies.

The county refused to release the names of businesses associated with outbreaks. They said outbreaks at businesses had involved only employees, and identifying the businesses would create the risk of a chilling effect on businesses reporting and cooperating with contact-tracing efforts.

Fletcher acknowledged that gatherings in people’s homes that involve people from different households would present a challenge for law enforcement agencies. Such gatherings are illegal under the county’s public health order.

Wooten said such private gatherings in homes, where people are less inclined to wear masks, would likely be banned under the public health order until herd immunity could be achieved, and that was unlikely to happen this year.

The failure to wear masks prompted Gov. Gavin Newsom on Thursday to order all Californians—with limited exceptions including children under 2 and people with certain physical or mental health problems — to wear face coverings in public in almost all settings.

The order came amid concerns that people failing to voluntarily wear them was contributing to the recent surge in cases in California.

Newsom did not say how the order would be enforced or if people who violated it would be cited.

Newsom’s order comes a week after Orange County lifted a requirement for residents to wear masks and other counties are reportedly debating whether to mandate face coverings.

San Diego County’s public health order has required face coverings when in public and within six feet.

County officials said Thursday they were depending on the public to voluntarily comply with the face covering requirement because a growing body of published research indicates that while coverings do not provide total protection from COVID-19, they are effective at reducing virus transmissions from the wearer to others.

Facial coverings have become a divisive political issue, with many people vehemently opposed to wearing masks, which they consider an infringement on personal freedom.

County officials argued Thursday that masks increased personal freedom because they slowed virus transmission, enabling looser public health restrictions on where people can go and what they can do.

Asked if she, like public health officers in other places, has received threats related to the county’s face covering requirements, Wooten declined to comment.

“Yeah, we’re not going to go into any details about that,” Wooten said. “Our focus is to do the right thing and help to protect the public’s health.”

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