Miller Report for the Week of August 24th, 2020
By William Miller, MD – Chief of Staff at Adventist Health – Mendocino Coast Hospital
Overall, I believe the COVID situation here on the Coast has stabilized with only a gradual increase in newly identified cases. In other words, we are not seeing an appreciable surge at this time. As a result, Tabatha Miller and I have agreed that we will alternate our reports each week; I will submit this week and next week will be her turn. If there is a significant turn of events then we can always submit together.
Sherwood Oaks. The outbreak at Sherwood Oaks is definitely coming under control. There has been only one new case identified in the past two weeks. This is much improved from the 2-3 new cases we were seeing every few days at the beginning. Per our mitigation strategy, this resident has been moved to the hospital and remains without symptoms. As of today, the total number of residents affected since the outbreak began on July 3rd is 25 with 16 making full recoveries. Additionally, there were 8 healthcare workers, all of whom have recovered, and no new cases in the staff in over 30 days. Plus, there was one known family member of a staff member who also became infected. So, a total of 34 cases in all attributed to the outbreak. There were 8 deaths, one in a resident who had made a recovery and then died as a result of a preexisting heart condition that might have been made worse by his recent COVID infection.
Adventist Health – Mendocino Coast Hospital. As mentioned last week, we learned a lot from our experiences taking care of the residents from the Sherwood Oaks outbreak. We are using that information to further refine our processes so that we will be even better prepared in case there are any more surges in cases. Because of the stability of the situation, we have opened our facility to visitors again. We allow one visitor at a time per patient between 11:00 AM and 7:00 PM. If a patient is at the end of life, then we will accommodate more visitors. Unfortunately, we cannot allow visitors into our COVID unit except at end of life. I wish to thank the Fort Bragg Rotary Club for the donation of two iPads to be used to help family and friends visit virtually with loved ones who might be hospitalized with COVID.
Mendocino County. As a whole, the County is experiencing a steeper rise in new cases than we are on the Coast. I believe that this is largely due to the spread out nature of the majority of the 20,000 or so folks who live here which is having a natural dampening effect on transmission (40% live in Ft. Bragg with the remaining 60% spread out along a 40 mile stretch of coast). Having said that, testing is more readily available in the Ukiah Valley than here, which undoubtably skews things. From the County’s website, there are now some 650 cases to date with only 70 cases or 11% coming from the Coast. Further, half of the Coast cases are attributed to the Sherwood Oaks outbreak. Thus, cases in the general coastal community only represent 6% of the total cases in the County despite the Coast representing 22% of the County population. This should not give us a false sense of security, but it also should help keep things in perspective and further supports that we currently have a stable situation of gradually increasing cases and not a surge.
On the Importance of Masking. Recently, I saw a pickup truck in Ft. Bragg with a sign on the side stating that masks are as effective at containing the virus as underwear is at containing a fart. I must admit, I got a pretty good laugh at that, even though it is completely incorrect. Obviously, flatus is mostly made of methane gas, which is a very small chemical molecule. Viruses are spread through droplets when an infected person coughs or sneezes. I don’t think you need more than a passing interest in science to understand that a droplet is massively larger than a methane molecule. Several studies are now showing that a double layer, cloth mask made from material with a high thread count is extremely effective and may even be equivalent to an N95 mask if the right material is used. I will do a future Miller Report with more specific details on the subject.
Two weeks ago, I discussed the benefit of masking as an effective strategy for controlling spread of COVID. In that article, I stated “Masks must be worn in all settings outside the home in which you might encounter others. While it is fine to go without a mask while biking along a public trail, it isn’t okay when strolling down the sidewalks in town.” I received feedback on this statement that it is not consistent with the CDC guidelines that state masks should be worn in enclosed areas and where 6 feet of distancing cannot be maintained. Thus, being outside should be okay as long as we have good separation. Also, that the CDC considers an exposure to require a minimum of 10 minutes of such close contact without a mask. I agree with that clarification and appreciate the feedback. You are not going to catch this disease by walking past someone casually on the sidewalk, unless perhaps if that person sneezes directly at or on you. The point I was trying to make is that masks are quite effective and the sight of everyone wearing masks should not instill undue fear, but instead some sense of assurance. As I mentioned above, I will dedicate a future Miller Report to the science behind masking and the research facts that support it as an effective strategy.