04.22.20 Press Briefing Transcript

The County of Santa Clara
April 22, 2020
Press Briefing with the County of Santa Clara
10:45am PT

Evenlyn Ho: Good afternoon or good morning, my name is Evelyn Ho I am the Lead Public Information Officer for the County of Santa Clara Emergency Operations Center.

Before Dr. Cody joins us this morning, I would like to read a statement provided by our Medical Examiner Coroner who was not able to be here in person this morning.

The Medical Examiner Coroner has identified three individuals who died with COVID-19 in the county before the first COVID-19 death initially known and
reported on March 9th, 2020. The medical examiner has a protocol in place in which individuals who died, who exhibited flu-like symptoms prior to death, undergo studies for viral illnesses prior to the end of February COVID-19 tests were not available for these earlier cases. These individuals tested negative for other viruses but because there was continued suspicion by the Medical Examiner that these deaths were caused by COVID-19, the medical examiner sent autopsy tissue to the CDC for definitive testing.

Yesterday, the Medical Examiner Coroner received the confirmatory test results from the U.S. Center for Disease Control and Prevention for tissue samples from two individuals who died on February 6, 2020 and February 17, 2020. The CDC confirmed SARS-CoV-2 or the virus that causes COVID-19 in these tissue samples. Routine post-mortem viral testing and autopsies are critical modalities used by our
Medical Examiners in identifying COVID-19 but most importantly understanding its pathogenesis in the human body.

The Medical Examiner Coroner has worked closely with Public Health on a procedure in which post mortem samples are routinely tested for COVID-19 on current and potential future cases.  And now I'd like to invite Dr. Cody up to provide her remarks about these cases as well.

Dr. Sara Cody: Good morning everyone. Thank you for adapting to our conditions here at the building.
As you know I'm Dr. Sara Cody Health Officer for the County of Santa Clara. And today I wanted to just give a little bit more information as you know yesterday we announced that two individuals died with COVID-19 in February and one individual died of COVID-19 in early March.

All three of these cases were before what we had thought was our first death. And I know there's a lot of noise and if you'd like me to start again would you like me to start again? Okay we'll just wait for the ready refresh water delivery. Those of you on audio tell me and I'll just start again whenever you're okay, ready to go again? Maybe they can cut their engine. I know this whole response has highlighted the importance of flexibility.

Okay good morning, I'm Dr. Sara Cody I'm the Health Officer for the County of Santa Clara. Thank you all for joining us this morning.
As you know, last night we announced three deaths from COVID-19, that prior were unknown to us. Two of these individuals died in early February and one died in early March and all three occurred before what we had thought was our first death on March 9th. I just want to take a moment and really highlight and applaud the work of the Medical Examiner. I think that the Office of the Medical Examiner their thoughtfulness and care and really understanding the cause of death for all of the decedent's that they take care of is critically important for us in public health. It helps us better understand the
pace of the epidemic.

So, back in early February as you may remember, we did know that we had COVID-19 in our County but we had not yet identified our first case of community transmission. That didn't happen until February 28th. What these deaths tell us is that we had community transmission probably to a significant
degree far earlier than we had known and that indicates that the virus was probably introduced and circulating in our community again far earlier than we had known.

I want to switch topics and briefly address another facet of our response to COVID-19 and that is the data.  The data that we collect and the data that we share on our website and I wanted to let you know that later today we will be updating our website and including data by race ethnicity.

As you know, race ethnicity data for people who have died of COVID-19 is available on our website.  We've been working very, very hard to obtain missing data for all cases and to present in a way that is meaningful. We still unfortunately have a large amount of data that are missing with regards to race ethnicity but we will present what we have with the caveat that it is not complete data.  One of our core areas of work in the Public Health Department, before COVID, during COVID, and for time to come, is our work on ensuring racial and health equity and understanding the social determinants of health and how they impact our health and our health outcomes.

So social determinants of health are things like education, housing, income, employment, language access, etc and all of those factors as well as structural factors, like structural racism, impact and inform our health and our health outcomes. And what we're seeing across the country is the importance of understanding those social determinants of health and understanding how they can inform our
actions to better prevent, control, and mitigate the impact of COVID-19. And so, we want to make those data available in public and we will be doing so later today.  And I have time for a few questions.

[Inaudible]

Thank you for the question. I don't have the exact dates of when the samples were taken. But the process of an autopsy is a lengthy process. It's sort of like an iterative investigation. So, the pathologist
performing an autopsy might have some findings that they can't quite explain and then go back and get further testing and then begin filling in the picture if there's something they still can't
explain then they would go back and get other tests. So, I don't have the dates what I can tell you is that the Medical Examiner's Office and the Public Health Department, we're working together since the very beginning because the medical examiner definitely wanted to understand the impact of COVID-19 on what they were seeing in their office but as you also remember we didn't have much testing available early on in January and February.

And so, we couldn't we couldn't test we couldn't test everyone. And so, the medical examiner I think had these cases where there was a question whether there may have been an infectious cause and so they just sort of didn't close the cases and kept samples and then ultimately got them tested and confirmed COVID-19.

[Inaudible]

I mean, a couple of take homes from these findings you know in some ways it was not entirely, I mean it was somewhat surprising, but not completely because when we identified our first travel associated cases in late January, we had a very narrow case definition. We were only looking among people who had traveled and we had been wondering how will we detect community transmission if we're not testing people who haven't traveled.  And I think this answers the question in that we didn't
detect community transmission.

[Inaudible]

What I can say is that we know that each of these deaths especially since there are three of them in February and early March they're really like iceberg tips. So, they're indicators when you have an outcome like death or ICU that means that there's some iceberg of cases of unknown size that that underlie those iceberg tips. So, with three of them that tells us that there must have been you
know a somewhat significant degree of community transmission. It was really difficult remember we had a robust influenza season so it had been extraordinarily difficult to pick out what was influenza and what was COVID-19.

[Inaudible]

Our partners through this response have been the California Department of Public Health, who coordinates with the governor's office and the Centers for Disease Control and Prevention because
those are our two public health touch points. Sadly, we do not have CDC staff embedded with us any longer. They were enormously, enormously helpful in both structuring our response and doing the work and being thought partners.

Now that the coronavirus has sprung up in every corner of the country they're needed elsewhere and so we had to let go. So right now, the response is composed of Santa Clara County staff.

[Inaudible]

So, the information that I can share about the three fatalities, the fatality on February 6th was a 57-year-old woman, on February 17th a 69-year-old man, and on March 6th a 70-year-old man.

As far as we understand, none of these cases had a significant travel history. We presume that each of
them represent community transmission and that there was some significant level of virus circulating in our community in early February well probably in late March and who knows how much earlier.

[Inaudible]
What I can say about the pandemic are a number of things. One, is we anticipate that this pandemic is going to be going on for a very, very, very long time. We know that we do not have immunity in the population nor do we have a vaccine. So anytime that we let up on our mitigation measures, we are going to expect to see a spike in cases, hospitalizations, and deaths. That is certain.  I think what these three deaths tell us is that community transmission had arrived much earlier than we were able to detect it and I think it really highlights the importance of the shelter in place and protecting the community and preventing hospitalizations and deaths from COVID-19. So, we don't know I mean we know from other work in other areas of the world that a significant amount of transmission does happen from people who have no symptoms at all or who have very mild symptoms so that you know certainly as a significant contributor.

But we also know that in January and February we must have had the virus circulating but we weren't looking for it and it probably was you know it may have been part of our influenza numbers because it
looks a lot like influenza really difficult to pick those things apart absent confirmatory testing.

Thank you.