05.06.20 COVID-19 Briefing Live Stream Transcript

The County of Santa Clara
May 6, 2020
Live Stream - Live with the County of Santa Clara
10am PT

Evelyn Ho: Good morning, I'm Evelyn Ho with the County of Santa Clara Emergency Operations Center. I'm gonna remove my face covering to make it easier for people to hear me and to support our ASL interpreters.

This morning we wanted to provide you with an update on cases to start off. As the 5:00 p.m. yesterday, there are 2,255 confirmed cases in Santa Clara County and 121 deaths in Santa Clara County. We continue to see a slow increase in the number of cases as is to be expected during the shelter in place order.

We're really excited today because today is National Nurses Day which kicks off National Nurses Week. And I am honored today to be joined by two individuals who are the backbone and the role has been the backbone of the public health department and the public health response to COVID-19. And we know that nurses are on the frontlines of our work, in the health care system and in the public health system, every day and they make tremendous sacrifices in the care of patients and in the care of the community as a whole. And so, today we want to honor and highlight the work that our public health nurses do and share with you the tremendous amount of work that they do as part of this response.

Today, I'm joined by Melissa Schilling and Alison Sikola, who are Public Health nurses. Welcome to you both and thank you for being here

Nurses: Thank you

EH: So, not many people understand what Public Health nurses do. I think people have a great understanding of what clinical nurses do in the bedside and in clinical settings. Can you tell us about your day-to-day work that you do?

Melissa Schilling: Okay so, a general definition of Public Health nursing is the patient really isn't just one person. It's a larger group or it could be the entire population.

So, a Public Health nursing focuses on promoting health, preventing disease, and increasing the quality of life for all groups of people. So, some examples of Public Health nursing activities include identifying at-risk populations such as people are homeless. You would assess their needs and offer them education or information and then also link them to resources that are available or services in their community. And this would all be in the hopes of increasing quality of life.

So, I work as a nurse with the First 5 Home Visiting Program. We have a team of nurses that perform home visits for at-risk children ages zero to five. We administer age-appropriate assessments to monitor children's growth and development and identify any areas of concern. If we see an area of concern, we would make a referral or link the family or the child to services that are available to them to again increase the child's or the family's quality of life and hopefully provide a better health outcome Santa Clara County has more than 80 hard-working, public health nurses who are very passionate about their programs.

Alison Sikola: So, like Melissa said, we have nurses that do home visits. We visit moms and babies, we visit CalWORKS participants, we visit adults, and children with complex health conditions and homeless clients. We provide education and assessments. We help them develop plans that meet their needs. We link them with resources and try to overcome any barriers that they might have to accessing care. We also have nurses that provide case management and care coordination for foster youth, for California Children Services, for our LEAD Program and the Child Health and Disability Prevention Program. We have nurses that provides support and collaboration for perinatal services programs, for our community clinics, for our medical examiner, child care centers and our Maternal Child and Adolescent Health Program. And also besides our involvement in COVID-19 we have nurses that investigate communicable diseases and case manage and control, TB, to prevent to protect our community.

EH: What a broad range of services that Public Health nursing provides within the county. Some of which I do not even know about. So, thank you for sharing that. One of the things as the COVID pandemic began to spread around the globe, you guys were both brought in the early, early response since February. Can you tell us about those early days and what that was like?

AS: So, in the beginning our communicable diseases team handled a lot of the case management and monitoring for the cases in our County but as the cases started to increase, we brought in our entire team and we I was really proud that we were able to really learn very quickly and roll with all the kind of changes in guidance that seemed to be coming, happened daily.

MS: I was involved in a case monitoring unit and we would receive lists of people who were travelers and they had gone to foreign countries where coronavirus was active and returned to Santa Clara County. So, we would call them and ask them to stay home for 14 days. So, this was in the early time of the virus and it was you know we had mixed reviews. We'd call people and ask them to not go to work and to only stay home if unless they needed food or medical attention and then we would ask them about common symptoms or if they had any for coronavirus trying to monitor and really catch any of those early cases.

So, we would, you know, it was it was time intensive and we had you know many people to call and we stuck with that and in the meantime things really started to ramp up. The CDC had staff present to assist the county's efforts and it was a very exciting time. We were, you know, the whole world was fighting the same battle and as cases started to come in, it became apparent that there wasn't always travel history at all and that the virus was, had community spread. So, we transitioned to more of a mitigation phase where we weren't able to call everyone every day and in the unit things would change daily and we would just take the instructions from leadership on how to proceed based on how the virus was spreading in the community.

EH: And as the scale really increased in terms of the number of cases that also led to the Orders the Health Officer orders that then began to restrict at a population level, mass gatherings, and then eventually the shelter-in-place order which allowed us to then transition and pivot some of the work that Public Health nurses were doing. So, currently what are the roles that the Public Health nurses are playing with in the response now?

MS: Okay so, the Public Health nurses are split into four groups. The first one of the groups is a provider intake unit and the provider intake unit receives calls from providers who are seeking guidance on various issues related to coronavirus Some examples of calls might be that a provider will call and ask how do I safely discharge a COVID positive patient back to a skilled nursing facility or congregate setting such as a homeless shelter or a group home or jail? Another question might be after a healthcare worker test positive for coronavirus how many days do they have to wait before returning to work? The providers are also required to report COVID positive deaths to our department and we gather information on that.

AS: So, we also have a team of nurses that do special investigations for people in congregate settings. And congregate settings are any setting where people have trouble socially distancing. So long-term care facilities, jails, dormitories, and homeless shelters. So, our nurses provide guidance to these facilities to try to lessen the spread of infection. They recommend and facilitate testing if needed. And that is one way we can help to control outbreaks in these settings.

MS: Specimen collection is another area and we have two teams of nurses dedicated to taking specimens seven days a week. The focus of the specimens that we take and run through our Public Health lab are first responders, health care workers, and people who reside in skilled nursing facilities or other congregate settings such as the group homes or shelters.

So, the type of specimen that we gather is a nasal pharyngeal swab and it's swabbing the nose going in through the nose to the back of the throat so it goes somewhere in between like the ear and the nose. It's not a pleasant thing and it's interesting sometimes when I hear how many people want the test because it's really not a pleasant thing. But we do that test and so the results will be given in order to get people back to work or appropriately isolate patients and keep the community safe. So, the also the specimens are either collected at a personal residence or at the facility or congregate setting or soon as we set up drive through specimen collecting.

AS: So, we also have a case intake and tracing unit. We call all confirmed cases of people with COVID-19. We provide education, we discuss isolation with them and identify if they need any resources so that they can be they can stay isolated and we also gather important information the public health needs to evaluate how the disease is affecting our community.

Another thing that we've returned to is contact tracing. So, when we talked to COVID positive people we identify anyone they might have had close contact with in a period where they might have been infectious. Then we call those people and we discuss isolation and recommend testing which is necessary so that we can stop the spread of COVID-19.

EH: Great, and that contact tracing piece is one of the key indicators that the Health Officers are using as we continue to monitor the status within the county and their evaluation of our current orders to shelter in place.
So around contact tracing is a key area that the Public Health Department has a priority to really expand the strong capacity that we currently have in contact tracing that public health nurses have been providing since the beginning of this response. Currently, we have the capacity within our public health nurses and our contact tracing team to respond to the cases at the rate that they are increasing currently we are preparing to scale that effort to a very large workforce that will require the partnership of our other public agencies our community-based organizations and other partners and as well as within the county as well to staff large workforce to provide that case investigation and contact tracing.

For any easing of the shelter-in-place order to occur, we expect that cases will increase when that happens and in order to break chains of transmission, to interrupt those chains so that transmission doesn't become exponential and overrun our health care system and leading to eventual significant amounts of death, we have to have a robust contact tracing and case investigation unit. So, the significant work that the Public Health nurses and that unit have begun to build over the last several months will be scaled to a large proportion. We will continue to provide updates to our partners and to the public about that very significant effort. Plans are underway right now to scale that effort, to stand up individuals very, very quickly.

We thank you for those who have reached out to us to partner with us in that effort and we will continue to build on those partnerships. I wanted to close with a, could you reflect on some of the more difficult moments that you've had in this response? Have there have been challenging moments? I'm sure there have been.

AS: I think it's been challenging just to be in our unit sometimes and speak to the nurses that have been talking to families, families have been in very affected, families who have had family members die, family members who have lost their jobs and to hear that day after day has been has been difficult but has really humanized this for all of us and makes our work feel very important.

MS: I remember in particular I was in case monitoring and I was calling. We had lists of patients to go through they were all positive patients and there was one family that had several members that were positive and I called and was checking in with my list you know of symptoms to go through and in talking to one of the family members they had no symptoms at all yet they were positive and one of their family members was in the hospital and the person I was talking to you told me that their other family member was actually going to die and had been intubated. So, they had never talked to them since they had gone into the hospital. And I felt really bad for that patient because we're calling and we have a long list of people to call but I spent you know extra time because I really wanted her to know that and I told her I've been thinking about you since yesterday and that she wasn't just a number. She was, you know, we really do care so that was difficult.

EH: What a powerful reminder that of those cases that we announce every day as that number increases that each one of those is an individual within our community that's connected to family and friends and communities who care about them. Thank you guys for being on that frontline of working with each of these individuals which the providers I'm hearing those stories what important and powerful work that you do that you lead both with the science and the evidence and with the compassion as well. So, we really appreciate that.
So, on that note I mean what do you want the public to know about as we proceed with the shelter-in-place order over the next few weeks?

MS: Well, I think the shelter-in-place order really requires everyone's participation in order to be effective and if we can really pull together and just really hang in there and slow or stop the spread of the virus that hopefully we will be able to resume our regular normal activities with less disruption in the long run and less chance of reoccurrence.

AS: Thank you.

EH: Great, thank you. And we want to take this moment to really thank our Public Health nurses, all our nurses that are working in the county in all sorts of settings you truly are part of the first response in this on the frontlines working with individuals with patients with that touch, of that special nursing touch, that you provide and we are eternally grateful for your work. And we want to invite the public to take the time today to thank a nurse if you can and then this coming week knowing the sacrifices that they make in the protection of our community.

And finally, we want to remind the public as the weather is again beautiful out that the orders to shelter in place still hold. Please try to reduce your contacts to the extent possible reducing even essential activities that may be allowed under the order that all of those choices to reduce contacts help to break those chains of transmission. We may not know that we're infected because of asymptomatic spread so as much as possible to reduce those contacts limit exposure.

If you are out, maintain social distance, provide good hand-washing, wear a face covering, and continue those practices. We know we've been at this for many, many weeks and we have to continue to keep going. And in the meantime, we are here for you we will continue to stand up the Public Health operation more and more to respond and we're constantly growing and evolving as our nurses have shared today.

So, thank you for your partnership with us and have a great day.