Sonoma County, California declare emergencies in wake of state’s first coronavirus death

Amid fears about a widening presence of novel coronavirus in Sonoma County, the Board of Supervisors finalized a local public health emergency Wednesday as health officials step up efforts to locate 78 local residents who may have been exposed to the disease during a San Francisco-based cruise to Mexico.

Those Sonoma County residents were among 2,600 passengers on the Grand Princess ship that returned to San Francisco Feb. 21 after a 10-day cruise. Twenty-five shared a shuttle trip from San Francisco back to Sonoma County Airport.

The move comes as the county ratchets up emergency preparations to control the spread of a virus that still is not entirely understood.

The county currently has two confirmed cases of the virus, known as COVID-19. Both patients are hospitalized in isolation, though county officials have declined to say where.

But “we now believe that there a number of other people in our community that have been exposed, and so we're trying to identify who those folks are,” Sonoma County Health Officer Celeste Philip told supervisors during an emergency meeting Wednesday.

Partial activation of the county emergency operations center already has begun, and the county is establishing a 211 hotline intended to help residents find answers to pressing questions, Emergency Management Director Christopher Godley told supervisors.

But the county already is at a disadvantage in its efforts to gain control of the virus, in that it is still awaiting the delivery of test kits from the national Centers for Disease Control and Prevention, and so is limited in the capacity and speed with which it can attempt to detect the virus, Philip said.

She said she hoped the county receives some test kits later this week, which would reduce lag time between a patient's expression of symptoms and confirmation of the virus. But for the moment, specimens from patients showing signs of infection have to be sent to a state lab in Richmond or a CDC lab in Atlanta for testing, she said.

That makes it critical for residents to focus on practices “that we know prevent spread of disease,” such as social distancing, hand washing and telecommuting, Philip said.

She and Godley said local medical and emergency officials had been monitoring the growth of coronavirus since long before the first cases began appearing in the United States, largely through the transfer of patients from a Diamond Princess cruise that had been quarantined in Japan until late February, when American passengers were returned to March Air Reserve Base in Riverside County and Travis Air Force Base in Solano County.

One of the patients from Travis Air Force Base who tested positive for the virus but never developed symptoms was transferred Feb. 24 to a hospital in Sonoma County, where the person remains asymptomatic, according to Rohish Lal, public information analyst with the Sonoma County Department of Health Services.

A second patient believed to have contracted the virus on a Grand Princess cruise ship voyage from San Francisco to Mexico Feb. 11-21 fell ill later and also is hospitalized in Sonoma County, health officials said. That person is in stable condition, Lal said Wednesday.

They are among at least 53 confirmed cases in California, where the first confirmed fatality included another Grand Princess passenger from Placer County, who died at Kaiser Permanente Hospital in Roseville on Wednesday, officials said.

County officials have steadfastly refused to identify the hospital or hospitals where the two local patients are being kept, citing provisions of the 1996 Health Insurance Portability and Accountability Act that protect patient confidentiality.

During an interview Wednesday, Health Services Director Barbie Robinson said the limited number of negative pressure rooms necessary to isolate an infectious patient at the few major hospitals in the county would make it “reasonable to conclude that those individuals could be identified” if the institution were known, in direct violation of federal law that the county is obligated to uphold.

Robinson also said that in weighing the threat of violating patient privacy against the public's interest in knowing where those patients are during what is already a period of widespread uncertainty, there is actually more risk to the public than benefit, including the possibility that patients in need of care might avoid the involved hospital; that hospital operations might be disrupted by phone calls and inquiries; and that there might be unwanted media presence.

“Folks are wanting information, and we want to be able to respond to them in the appropriate manner, with the appropriate information,” Robinson said. “....But we really want to protect the health and safety of the patient, as well.”

County supervisors supported her decision. Two of them, James Gore and David Rabbitt, said they heard from a CDC official during a visit to Washington, D.C., earlier in the week that patient information and whereabouts needed to be kept private.

Supervisors' unanimous approval of both a local emergency and a local health emergency expands on local proclamations made earlier this week and came at the same time Gov. Gavin Newsom made his own declaration for the state of California.

Godley said the state emergency may allow counties to apply for reimbursement of up to 75% of local response costs.

Also Wednesday, the U.S. House passed an $8.3 billion emergency package to fight the spread of the coronavirus and support treatment research. The Senate is expected to take up the measure Thursday.

The CDC also has liberalized testing criteria, allowing doctors to decide if their patients warrant investigation for possible COVID-19 infection. The new CDC guidelines published Wednesday recommend physicians first rule out influenza and other respiratory illnesses, as well as determine if a patient has had close contact with a laboratory-confirmed case while contagious or if he or she traveled to affected geographic areas like China, Iran, Italy, Japan or South Korea.

The expanded testing parameters further highlight a nationwide shortage of test kits, however.

“We don't have the full resources that we need yet,” Philip said.

Earlier this week, county officials confirmed that Philip had resigned and that her post would be filled on an interim basis until a replacement could be found through a national recruitment process.

Philip, whose last day as the county health officer is March 16, said Wednesday she is taking an assistant director position at the CDC in Atlanta on March 30. Philip said she accepted the position earlier this year.

“It's a really great opportunity. I prefer not to spend a lot of time talking about that because I'm dedicated to spending every minute I can possible while I'm here to work on coronavirus,” she said.

Asked whether she was concerned about the message her departure might send to the public during a health emergency, Philip said the local public health campaign does not rely on the efforts of one individual but is “about our team effort.”

“That's why we have these emergency declarations to be able to pull in resources,” she said. “We have an entire department of emergency management that is standing this up with us. So I am confident in our team approach, that we'll be ready, depending on what happens.”

Philip's post would be filled by Dr. Robert Benjamin, who county officials described as a “nationally and internationally recognized” public health and preventative medicine physician. Officials said Benjamin has leadership experience in policy development, program implementation and administration at the local, state and national level.

Benjamin is currently a tuberculosis program consultant and tuberculosis clinician for the county's Public Health Department. He has served as acting deputy health officer for Marin County and both interim public health officer and director of communicable disease control for Alameda County.

You can reach Staff Writer Mary Callahan at 707-521-5249 or mary.callahan@pressdemocrat.com. On Twitter @MaryCallahanB.

EDITOR'S NOTE: The text and headline of this story has been revised from a previous version that reported an incorrect number of Sonoma County residents potentially exposed to the coronavirus on a San Francisco-to-Mexico cruise aboard the Grand Princess that returned Feb. 21.