Answering Your Questions About Public Health Restrictions And Reopening

KCBS Radio is answering your questions about all things coronavirus every weekday at 9:20 am
By KCBS All News 106.9FM and 740AM

As we continue to navigate these unprecedented times, KCBS Radio is getting the answers to your questions about the coronavirus pandemic. Every morning at 9:20 a.m. Monday-Friday we're doing an "Ask An Expert" segment with a focus on a different aspect of this situation each day.

Today, we're focusing on COVID-19 trends and testing with Dr. Susan Philip, Deputy Health Officer for the San Francisco Department of Public Health and an infectious disease specialist. 

Let me start by kind of having you give a "from where you sit" view of the situation as of today.So I think as we've all been hearing, we have been experiencing in San Francisco and in the Bay Area and in California, unfortunately, a surge of increased infections and increased hospitalizations. And that is impacting both our community's health and also our reopening plans across the economy. And we've had to continue to pause those plans until conditions improve and cases go down. So we're in this period of uncertainty. It's really hard for everyone to be in this place. And we need to know that we can continue and reinforce doing what works. We flattened the curve once, we were an immense success story here in San Francisco and across the Bay Area, and we can do it again. And if we are not able to, if we do not, if we choose not to do that, really the consequences will be dire for people's health as more and more people enter the hospital and become very ill and also for our economy. And so, you know, the stakes are very, very high, but the good news is we have some of the tools in order to be able to do that.Let's talk a little about this state watch list. I know for you folks in the public health community, this is part and parcel of everyday life. For we regular people on the outside, it's in the news and we may not fully understand the process. San Francisco right now is not on that watch list nor is neighboring San Mateo County. But the indicators show that this could change. Can you walk us through that?(Ed. note: San Francisco has since been added to the state's watch list)Sure. Yeah. So the state list - and I think it's really important to preface this by saying that throughout this pandemic, from the very early days in January when we were starting to work on this together, we've been in very close collaboration with the state. So it's a very collaborative partnership. And what the state has done is look at some of the key indicators - and here in San Francisco, people can take a look through the SFDPH website or on SF.gov to link to our data tracker and they can see the same data that the state is looking at and that we're looking at, as we think about how we're doing in San Francisco. They look at those data and if there are counties that seem to be going in the wrong direction, having more cases, more hospitalizations, then they partner with them to say, under state order you have to either roll back or stop your forward expansion plans for those kinds of activities and businesses that bring people together.So that's what it means to go on the watch list. It really means that you're curtailed in your ability to continue opening sectors of your economy and allowing gatherings. And right now in the Bay Area, almost all the counties, as you mentioned, except for San Francisco and San Mateo are on the watch list. And, you know, we're also connected around the region, that we're looking at the same data every day. We see the trends. And so, yes, I think that the distinction is not whether we're on the watch list or not, it's that the trends are going in the wrong direction in San Francisco. And those are the data on which we're acting.Well, let's get to some questions and a reminder to our listeners that questions can be sent in via email to askus@kcbsradio.com. First one I've got here: can you tell us what the transmission rate is in San Francisco and/or the Bay Area right now? I never seem to see much reporting on this.Yeah. So the transmission rate, it's difficult to pin it down exactly, but we have ways of estimating what that can be. And Dr. Grant Colfax, our director of health, has been talking this week about what that evidence has looked like. So we look at the numbers of new cases that we see and the rate at which those new cases are increasing, and we collaborate with some of the expert scientific modelers of infectious diseases - our colleagues at the University of California, Berkeley - and they actually estimate what is called the reproduction number, which says for every infection, how many additional people might that person be infecting? And that number, if it is one, that means that each person infects only one other person. We need it to be less than one to see the overall rate decrease. What we're seeing now is 1.3. So that is going to lead to, as we've seen, a rise in cases. So that reproduction number of 1.3 indicates that every person is going on and infecting additional people. And that's the number that we're watching very closely.And just for reference, do you know what that number is like in a place like Arizona or Florida, which are really battling it right now?Yeah. I mean, those numbers are higher in those areas. I do not know the exact numbers but for everyone, for all areas, the goal is to get it below one. That means that each person is infecting less than one person. And then by definition, the pandemic sort of dies down. And we can talk a little bit later about, you know, we know the ways in which to do that. Face covering is the number one through number 10 ways to get that done.Okay. We've got a couple of different questions about testing and I think they're both fairly sharp and pointed so let me throw them at you. Why is testing still a fiasco? Why weren't these shortages of testing materials anticipated?Yeah, I can sympathize with this question. It is a very reasonable question. I want to point out that the testing challenges are not limited to San Francisco, they're not limited to California. These are nationwide challenges and some of our testing partners are nationwide laboratories that are experiencing delays. And so it is an immense challenge, not only for people's own personal decision making, but for our public health efforts. After a person tests positive, our goal is to reach out to them as quickly as possible in order to help them stay home and prevent other infections and to also find out who they may have come in contact with. So the testing issues are a real challenge.I'll say the other thing is that, you know, our testing has increased dramatically in San Francisco, as far as the number of tests that we do. Now our focus is going to be turning to really making sure that the people who we know are most at risk in San Francisco, including Latinx populations, people that have to do essential work are able to access testing, and we're going to have to enlist the help of all of the health providers in order to give people access, if they have insurance through their own personal doctors and providers.This next one wants to know why test results take so long for average people, but can be obtained quickly for the high profile and many times wealthy people? They may be looking at athletes when they ask that question.Yes, I think that that is a challenge. You know, our goal here in San Francisco is to try to reduce the turnaround time for everyone, no matter who people are, because we know that that's the best way as I said, to be able to do the public health follow up. And I understand that it's really challenging when it seems that there are people who are able to get tests done sooner. Our goal is really focused on the testing turnaround time for everyone, for all of the 3,000-plus tests that we have done everyday and people in San Francisco.This next one actually comes from a colleague who says: you keep seeing trolls on Twitter insist that the testing numbers are inflated and we are being alarmist - we being the news media - because if somebody gets tested three times and tests positive three times, they're counted three different times. I believe that varies by jurisdiction. Some places give each patient a unique number, so they don't duplicate test results. How does San Francisco handle that, and the state?Yes. So I think that that's an important question. What do you do with the people that do duplicate testing? And there are a couple of things that we are measuring and they're not exactly the same thing. One is what is our capacity for doing tests? So then we'd want to count the people that go back and have repeated tests over a period of time, because we're trying to see how many tests are we capable of doing, or are we actually performing; that's an important measure for how we are able to respond to this pandemic. So in that case, yes, those duplicates would be counted in the total number of tests that were done.But when we look at the cases, when we look at the people who test positive from those tests and our positivity rate, those are broken down so that a single person is not counted twice. So there are multiple ways in which we look at the data to measure kind of how we're performing in terms of doing our test results, but then also in counting our cases, which is what helps indicate how well we're doing as a city. We do take out the people that have tested more than once.So the positivity rate's an important thing, a lot of people keep an eye on that. And that right now, I think statewide is around 7.1%. I'm not sure what San Francisco's number would be like.We are closer to 3%. We are lower than that, but we are higher than we have been. And, you know, our goal is to be even even lower. So yes, that's about where we are now.Why does the city not require everyone outside of their home to wear a mask? As a higher risk individual, whenever I go for a walk, I'm being exposed to people who are not wearing masks; they often claim they are exercising and do not have to wear a mask even when they are just walking. Do I not have the right to walk the streets and feel safe?I think this is a really, really good point. And I think one of the key messages that I want to relay this morning from us in the public health department is that we all should be wearing face coverings all the time. There is a health officer order that was written by Dr. Tomas Aragon, and the city has adopted this, that does make it a requirement for people outside of the home to wear a face covering. And we should be doing that at all times. So you know, there are very, very rare situations in which a person is not able to wear a face mask, but that is not the majority of us. And this should become our new normal if we want to move forward, if we want to protect the health of vulnerable people, but also if we want to move our economy forward and see all these sectors be able to open that have had to be on hold.My understanding is the White House has changed the reporting to the CDC and this is now being done through a private company. How can we be sure the numbers we are now hearing about the pandemic are not being "doctored"?Yes. I don't have a particular insight or access or knowledge of that since that is a federal action and a federal decision. Clearly in local public health we have a very strong interest in being able to look at data clearly and we need to be able to see the national picture. Our colleagues at CDC and elsewhere need to be able to do that in order to think about trends. We have clear access to our local data, working with our hospital systems and our state partners and that helps drive our local decision making around public health and coronavirus. So I don't have the specifics about the national plan.When the protests happened a few weeks ago, we heard lots of warnings that there would be a spike in coronavirus cases afterward. Is that what we're seeing now?You know, we don't have the ability to know exactly what is causing the increases. We did have the demonstrations, we did have the protests. Being outside is generally safer than being inside. We don't know if the protests and the demonstrations contributed. What was happening at the same time as those events was that we were starting to reopen sectors of our economy. People were gathering together for multiple reasons, not just the demonstrations and protests. So there were multiple things happening at once. So we cannot pinpoint those as the definitive cause of these increases.A great many people don't believe basic facts about COVID-19 or else they prioritize perceived constitutional liberties above public health, or want to "take their chances" because economic normalcy is just that important. As a public health official, is combating this resistance and noncompliance in its various forms a specific part of an overall public health plan or a strategy with its own funding and personnel, et cetera? It seems this is as difficult, but also as important as fighting back the virus itself.I think that that is correct. And you know, one of the things that we want to do is understand what the challenges are or why people are not using face coverings. Again, as we were talking about, it is the number one thing that all of us have within our control. So much about this pandemic feels like it is out of our control, that there are things that we just don't know how to deal with, but this is something that we can do. We can decrease the number of new infections by covering our face consistently. And we haven't had the vocal anti-mask demonstrations or protests here in San Francisco, so we don't know how much that is contributing to it. But I think there might be a lack of understanding of just how connected we all are. And this virus is so transmissible. It is so easy for it to spread from person to person. And it spreads from people who have no symptoms at all. So the only chance we have of decreasing this on a population level is for each of us to take the responsibility to use face coverings.All right, the next question is a variation of one we get a lot, and I don't know if there's an answer yet, but it's your turn to try to answer it (laughs). How many minutes does it take to catch COVID-19 from someone who has it and is talking to you or breathing next to you?Well that's a great question. So we have a definition in public health of what is considered a close contact, and that is being within six feet of another person for 10 minutes or more. So we don't have an exact precise number, there haven't been studies to exactly show that. But what we know from other respiratory infections and what seems to bear out with this coronavirus infection as well, is that about 10 minutes face to face is enough time to get infected.But what we also know is there's increasing data that if both people are wearing masks and they keep that six foot distance, there's no transmission that happens or very little transmission that happens. So again, there are ways in which this doesn't have to be all or naught. It doesn't have to be "shelter in place" or "completely disregard the virus." The virus is still with us and we can alter our behavior by wearing face coverings and still be able to interact with each other and try to move forward.How can grandparents safely visit a local newborn grandchild?Yeah, this is such an important question. And in public health, we recognize that these important life events are continuing to happen. Babies are being born and people are getting married and people need to visit their relatives who are sick. So what we can say, again, is thinking about the types of behavior and how to decrease risk. So in this instance, I'm going to assume that someone is not traveling on an airplane or from far away, the grandparents live somewhere where they can drive to see the family. It is always a risk to combine households and grandparents and people who are older, above 50 or 60 years old. The risk of a serious illness from COVID-19 increases. So I would say in this instance, probably the thing to do is if it's possible, if the weather is nice and it's okay for the baby to be outside and have that visit outside still maintaining six feet and everyone keeping their face covered, that would be the safest thing. And everyone wants to get back to the point in which they can hug each other, hold each other, all of those things. But at this moment, it's just not safe to fully do those things that we would like to do.Is there data to show this spread is caused by public transmission and not in prisons and jails? I think the point is, is this being spread in the widespread community?You know, unfortunately it is being spread in the widespread community. We're seeing that just with the increasing numbers of cases. And they are not specifically tied to people that have been in prison or have worked in prisons or jails. Those are very high-risk settings for the people that are working there and who are incarcerated there, of course, and we've seen that in San Quentin. So those are very high risk areas that we pay a lot of attention to in public health to try to prevent the introduction of infection. Nursing homes are the same way.But unfortunately, these large numbers of cases, these large increases that we're seeing in San Francisco, the Bay Area and California, that is coming from people like you and me being in the community and unknowingly spreading virus to other people. None of us would willingly make other people sick, but we have to always assume that we might be infected because we know that the virus doesn't always cause symptoms. And we have to keep our face covered because that face covering is highly effective in reducing transmission to other people. And there's some evidence that it may protect our own health as well.This next one couldn't get more precise: should I go to my dental hygiene appointment on Monday? I'm 76 years old.I think that is an important question. If it is a routine check-up, I think that might be something to call and speak to your dental provider or to your primary care provider and talk about, because I don't want to give direct medical advice over the phone not knowing the person's full medical history, because again, there are underlying medical conditions that might make a person more at risk. Having said that, providers, including dentists and dental hygienists are really very skilled at reducing risk of transmission. And they will have full prevention methods in place: cleaning, masking, gloves, all of those things to keep you safe. So if you need to have a dental appointment for some reason, then I'm sure that the dental office will do it in the safest way possible. But it's always good, if it's just a routine cleaning or a checkup, to check with your own health provider and see what that person thinks about your own situation.What's the transmission rate if you're closer than six feet, but both are wearing a mask, for example, when getting hair colored?

So just this week, the CDC put out an evaluation of a situation in Missouri where two hairdressers tested positive for COVID-19 and they had symptoms, they actually didn't feel well. But they were masked, their clients were masked and of 67 people tested, nobody tested positive. So again, a strong argument for facial coverings. Now in San Francisco, because of our overall rise in cases in the community, we have not been able to move forward with opening tattoo shops, hair salons, barbershops. And that's not because we think that those settings are incredibly risky. It's really just because with the community positivity being as high as it is, we have to slow down. We have to try and decrease the rates of infection before we move on. But I think again, that data from the CDC and from Missouri really point to the effectiveness of covering our faces around each other.Is there actual evidence that closing outdoor dining or the zoo brings down infections? It seems to me that if people are wearing masks and staying apart by the right amount, these activities are perfectly safe, yet we keep shutting them down.Thank you so much for the opportunity to address this. To the caller, I completely agree with you. And we are not in San Francisco, shutting down outdoor parts of the zoo. The zoo is open. It's allowed to be open exactly because as the caller said, it is outdoors. Now, the indoor dining, if there's an indoor restaurant at the zoo that is not able to operate. Indoor dining cannot operate, but your favorite local restaurant here in San Francisco that has outdoor dining: still open. Now, what we would say is when you're at the zoo, when you're doing outdoor dining, please keep your face coverings on at all times, unless you are actually eating at that outdoor dining establishment. Keep six feet away. And we know that the zoo and restaurants that have outdoor dining are all doing their best to keep people spaced, to keep surfaces clean and reduce transmission.

This interview has been edited for clarity.