Before the pandemic, county health officers mainly worked behind-the-scenes. Now, they are center stage. In a one-on-one conversation, KAZU’s Erika Mahoney interviewed Dr. Gail Newel, the Health Officer for Santa Cruz County. They discuss a variety of topics, from new evidence on the effectiveness of masks to how the pandemic has affected her daily life.
Erika Mahoney (EM): I was first just curious about when you became health officer and how someone comes into that role.
Dr. Gail Newel (GN): I have been health officer for the county of Santa Cruz for just over a year now. Although it seems much longer at this point. Before that, I was health officer in San Benito County. And before that, I was working in public health in Fresno County. But during all of this time, I've been a practicing obstetrician gynecologist. So I did that for 30 years, delivering over 10,000 babies in my career. But I've always had an interest in public health and have dabbled in it along the way. And so when I retired from clinical practice in 2012, I started getting involved part time in public health and then was hooked.
EM: And now, 2020, pandemic. And for the first time, I think a lot of community members now know the name of their public health officer. How has this affected your day to day life?
GN: It is unbelievably difficult… this whole pandemic for health officers. I'm sure that many of your listeners know that health officers have been experiencing a tremendous amount of harassment and abuse, become the targets for peoples’ fear and anger about the impacts this virus has had on their lives. So, in some respects, I've had far more notoriety than I was ever ready for. And certainly much of it is unwelcome.
EM: When this is all over and you look back, what's something to be proud of?
GN: I'm really proud that I joined the other Bay Area health officers in early March to put down a strong shelter in place. We were the first health officers in the nation to do so. And as a result, we've been able to contain the virus in our communities in a way that hasn't been true anywhere else in the country. And I'm proud that I was part of the group that did that. And I'm grateful for my colleagues who have decades of experience in public health who mentored me through that.
EM: Now, California's seeing this spike, and I'd say up until about a month ago, Santa Cruz County was doing fairly well in terms of containing the spread. And then recently, cases spiked. What do you think happened?
GN: We started to see a little uptick in cases after Mother's Day, and we were able to do case investigations and we found four distinct family clusters, all in the Watsonville area. And we were able to contain those clusters and shut them down. But as we've had more and more, we are unable to do that kind of containment. So now we move into mitigation strategy to try to look at a population level and how to work with the public to help lessen the impact of the disease. But what we're seeing is still the same mode of transmission that generally people are getting the disease from gatherings of friends and family outside of their household unit. So, close contact, generally not wearing face coverings, spending a lot of time together within six feet. Often indoors. Those are all the big risk factors for disease spread.
EM: The 18 to 34-year-old age group comes to mind when you're talking about these things. They do have most of the cases now. So from your perspective, you know, why do you think that's happening?
GN: The 18 to 34-year age group is definitely the fastest growing age group, not only in the county of Santa Cruz, but throughout the state of California and across the nation. It's understandable that this age group is tired of being at home, tired of being with their parents if they're living there, like my kids are, and ready to get out and spend time with their friends. And of course, this is multi-household gathering and that puts people at risk. This age group also tends to be our frontline workers. So stocking the grocery shelves, being out and about with the public in their day to day work.
EM: Recently, Santa Cruz County was placed on the state’s COVID-19 watchlist because of the case rate. So they, the state, wants that number to be 100 people per 100,000 people. And I think as of Wednesday, it’s 123. How do you see that number coming down?
Dr. Gail Newel (GN): It's going to be individual behaviors that make a difference in that case rate. I think that the new economic restrictions that we're under now, that we've exceeded that case rate, will remind people of the importance of limiting their gatherings with others, of wearing their face coverings, of staying six feet apart… the importance of all of those. Until we're all doing those more consistently, we're going to be under these economic restrictions and our schools aren't going to be able to open either. So it's really those behaviors that impact our ability to return to some sense of normalcy.
Erika Mahoney (EM): That's something you've said before, that it's individual behaviors that are perpetuating the spread of the coronavirus. So what do you think needs to change?
GN: I think that when the governor reopened the economy in May, that it happened too quickly, one opening after another without really seeing the impact of each opening. And I think it sent a message to the people of California that it was party time, that things were going to go back to normal. It didn't help that it was the beginning of summer, it was the time of year when we celebrate graduations, Mother's Day, Father's Day, Memorial Day and then Fourth of July and all of those events and the sense of returning to normal. And the sun's out and it's summertime. It really made people feel like they could go back to how things used to be. And we're not there yet.
EM: Originally you had closed the beaches and there were these restrictions in place where you couldn't come to the beach. I think it was around 4th of July that those restrictions were lifted. From your point of view, do you think that led to any increase in cases?
GN: I want to make sure that our listeners understand that beaches themselves are not dangerous for COVID-19. We know more about this virus now and we know that being outdoors, especially if you're active outdoors, it's almost impossible for disease transmission to occur in that setting. It's very low risk. So the reason the beaches were closed was never about preventing disease at the beach. It was about discouraging travelers from coming into our community. And I think in that regard, the beach partial closure from 11:00 in the morning to 5:00 every day was effective. But it just didn't make sense anymore after the governor started promoting tourism throughout California and allowing nonessential travel and booking of our hotels and short term vacation rentals by tourists. So it's something that we could consider again locally. But it may not be that effective in light of the governor's promotion of tourism.
EM: What worries you the most at this point?
GN: The things that I lose sleep over at night... I worry about our most vulnerable populations. As we've seen in other communities across our nation, the populations who are most at risk are the people who are in the skilled nursing facilities or nursing homes and places like our jails. And so, in those kind of congregate living settings, as we call them, there's not a lot of choice for those folks about who they're exposed to or how and when an outbreak happens. It can spread very quickly, as we've seen at San Quentin Prison. That's where I'm most worried and where we're focusing most of our effort in public health.
EM: That kind of all ties back to housing, being in close quarters. We've also seen nationwide the pandemic disproportionately affect communities of color. And I know in Santa Cruz County, slightly over 50 percent of the cases are among Hispanics and Latinos. How is the county working to address that?
GN: Yes. So this is a trend we saw very early, beginning after Mother's Day. And since then, the vast majority of our COVID-19 cases have been in South County. So we've been working with a group out of Pajaro Valley, the PVPSA and associates to message culturally or appropriately and bilingually, plus some Mixteco, to message to our populations there, who are especially vulnerable. And it's not because Latinx people are more genetically predisposed to get this virus or anything like that. It has to do with what we call the social determinants of health. So housing. Many of these families live in crowded housing where it's difficult to isolate or quarantine if they’re impacted family members. Many of them work on the frontlines of essential work, like our agriculture workers... our skilled nursing facility health care workers come from this area usually. So they've got riskier work to do.
EM: In the beginning of the pandemic, the messaging around masks was that they protected others. And now that's changing, right?
GN: Right. So there's increasing evidence that when you wear a mask or a face covering of any kind, that you are not only protecting those around you, but maybe yourself as well. And some recent evidence I've heard from UC San Francisco supports the theory that perhaps by wearing a face covering, you're getting less of an inoculum, so fewer strands of the virus that enter into your mouth and nose via droplets, and that results in, we think, a more mild case of COVID-19 and less likely to end up needing to be hospitalized and less likely to die.
EM: Looking back, what have you learned since the pandemic first began in Santa Cruz County?
GN: Well, we know a lot more about the virus than we did back in January when we first started working on this. So, you know, some people have felt like that was a wasted six months of sheltering in place and restricting ourselves and our economy. But, it was actually a very important time for us to prepare and learn more about this virus. And we have learned a lot more about the virus. We have more effective treatments in the hospital. We have a better understanding of how the virus spreads and doesn't spread. And face coverings, as we talked about, are a great example of that.
EM: Is there any end in sight for this pandemic?
GN: Well, I know that we're all hanging our hopes on a vaccine. You know, I wouldn't hold my breath for that to happen in early 2021. I think we're looking beyond that… late 2021 or 2022 to the point where we have any significant herd immunity in our population, either by vaccination or by illness. We're in it for the long haul here. So everybody should buckle up and get ready for a bumpy ride ahead.
Excerpts of this story aired as a two-part series on 90.3 KAZU.