Q&A with SLO County’s health officer: Should we worry about surge in coronavirus cases?

As San Luis Obispo County’s public health officer, Dr. Penny Borenstein has been front and center in coordinating the local response to the COVID-19 crisis, schooling us in everything from the proper way to wear a face mask — “The first thing you need to know is which side is out” — to what terms like “contact tracing” and “shelter at home” actually mean.

A few things you may not know about Dr. Borenstein:

She has two teenage children.

She’s a speed walker — you have to practically run to keep up with her as she strides down the hallways of the County Government Center.

She has a sly sense of humor.

And like many Americans, she’s a big fan of Dr. Anthony Fauci.

Since the pandemic began, Borenstein has been putting in some 12-to-15 hour days, but recently carved out time for a Tribune question-and-answer session. Answers have been edited for brevity and clarity.

Q. We’ve seen the number of SLO County coronavirus cases go up the past week or so. Is that as frightening as a lot of us seem to think it is, or are there other statistics that are more meaningful?

So for me, more meaningful than the number of cases is the number of people in the hospital, the number of people in critical care and ultimately the number of fatalities. It stands to reason, however, that you

have a greater risk of those worse outcomes when you’ve got a higher number of absolute cases.

So, yes, the case numbers definitely have my attention. I would not say that I am worried at this point, as the more critical metrics of hospitalizations and ventilator use and fatalities are really what we’re all trying to prevent, but keeping an eye on those case numbers is very important because it may well be the leading edge of worse outcomes.

Q. Can you tell us exactly what community spread means, and is it valuable to alert the public about places infected people may have visited?

With our case numbers going up, we have not been able to discern any particular event, any particular geography, any particular cohort or age group or demographic. It is all over the board. It is not that we are withholding any information. It is simply a case of lots of different places and people and groups that are being affected by this.

Q. So community spread is simply what it says ... you’re out somewhere and you got it and you don’t know where?

That’s right. Still, for a majority of our cases, because we’re doing 100% contact tracing, (we know) a majority of cases are person-to-person spread, which means you do know where it came from. And a vast majority of those are, ‘Yes, I got it in my household.’

Community spread means I got it somewhere in my community, and I cannot point to a particular person or location.

Q. But if an infected person has been sheltering at home except for, say, going to a particular grocery store, would it ever be appropriate to let people know, “Hey, if you went to this grocery store, you may have been exposed?”

What we look for in contact tracing is close contact. That, by definition, is someone who has had a minimum of 15 minutes of exposure within 6 foot distancing.

Q. You’ve had no indication that mass gatherings, such as the protests or people lining up on the sidewalk outside a bar or restaurant, have resulted in positive cases?

We have not seen numbers coming out of large gatherings. We haven’t seen any, actually.

Q. Let’s talk about masks. Your position has evolved since the beginning of the pandemic. Can you walk us through that?

At the beginning of this pandemic, and through time immemorial with public health, we never really thought about masks as being a protective measure for other people. Masks have always been used in the health care sector to protect the wearer from germs coming their way. With this virus being as nasty as it is and looking for other ways to provide another layer of protection, the idea of using masks to prevent the aereolization of germs became a consideration.

Over time, there’s been a number of studies now that have been done — not just about masks because I continue to maintain that it is important to preserve medical-grade masks for the health care sector and first responders — but the idea of cloth masks now has some information associated with it. Most of that, however, is in the form of watching what the statistics do when you have a widespread masking policy, so it’s not direct evidence of absolute protection from disease, but it is a theoretical construct that has been borne out in a number of studies.

Given that we cannot continue, in my estimation, to be locked down as a society for a long time, it stands to reason we should put into place all the protective measures that come to bear.

Q. Do you agree with the governor’s order mandating masks?

It’s not at odds with my position. With everything in this pandemic, I have tried to strike a balanced approach, in many ways.

Mask wearing has, unfortunately, become the symbol of what side are you on. I wish it weren’t so. It makes no sense to me that there are political positions related to a piece of cloth over your face.

What I would rather see on both sides is for people to understand that it is an important tool in the tool box for mitigating disease spread. It is not the be all and end all. People should not get hysterical about seeing a person in passing who’s not wearing a mask as they maybe go by them in a grocery aisle or they pass them on a path on a outside walk.

On the other hand, there is a whole other swath of our society who thinks it’s a weakness or it is not necessary or it is a political statement, and that is equally untrue. It is a medical countermeasure to an awful disease, and it should be part of how we should be moving as a community to do all the things we want to do in life — to be out and about, to have socialization, to have entertainment, to have financial stability.

But we can’t have perfection. There are many people who can’t wear a mask by virtue of age or medical condition or mental health or even panic disorders, so I would ask of those who feel like it is the most essential and critical means, and a symbol of you’re either on the right side or the wrong side, that there continue to be some understanding that what we want to do is have as many people as possible use face coverings in as many settings where they are potentially putting others at risk, as often as possible and for as long a period of time as possible.

If that requires a state mandate to get that social norm moving, then so be it, but I very much think it should be in the realm of education and advisement and understanding of what it is, rather than a dictate.

Q. Do you have any recommendations for business owners dealing with people who refuse to wear masks?

I support businesses that require mask wearing. It is the law of the land today.

They also need to be cognizant of the fact that some people may not be able to wear one, and I would hope that we don’t get to the point of someone having to have a card or a doctor’s letter or something that says I cannot. Now, if you have an entire community saying we all have asthma, for instance, there’s something obviously wrong there. It is a business owner’s absolute right to say, “I’m not going to allow all of you to enter my business if none of you are wearing masks.”

Q. The state and other counties are providing race/ethnicity data on their dashboards. We understand that SLO County has incomplete data, but would you be able to share that information going forward?

So the state shares it on our behalf. They get the information from all cases when it is available. The reason that we do not have the information in many cases is because, if it is not reported at the time of a lab test, it’s not available. And I don’t imagine that there’s a lot we can do moving forward to get more ethnic or racial demographic information. So the fact that the state has that information and can report it at any time makes it so that’s is one less thing we need to do.

Q. But they’re not sharing a county-by-county breakdown. We asked the state for that information, and they referred us back to the county.

Well, they do that a lot. There is a lot of pointing back to the county for things that the state has either taken control over or has better information or has more staffing. Certainly, we’ve continued to understand that people want to know that information, we did have that one report of what the distribution looks like and we can do that periodically.

It’s just there’s an awful lot of information that a lot of different people ask about, and we simply don’t have the resources. I get questions from individual jurisdictions: Can you tell us was that a community transmission versus person to person? Can you break down the community demographics by whether it was cluster or a party? There are lots and lots of things. .... Every one of those questions requires resources that we simply don’t have.

Q. The reason we’ve been after this information is that, as you know, across the nation a disproportionate number of Black and Latino people have been affected by coronavirus.

Absolutely, and it’s not any different here. Definitely we know that we have disproportionate case rates in our Latino population.

Q. We’ve been getting some mixed messages about travel. Is leisure travel still prohibited at this point?

According to the state order, people should only be engaging in essential travel. I think there is a realistic understanding that there is not universal compliance with that component of the order and that there is no good mechanism for widespread enforcement, and thus I think the narrative has turned somewhat toward if you are not going to comply with that directive, please do it in these ways: Stay closer to home, don’t travel in large groups, use all of the mitigating measures like physical distancing, avoiding crowds, using face coverings, do not travel when you’re sick.

I think there’s sort of a tacit acknowledgment that though it is still part of the state directive that only essential travel should be engaged in, that if individuals choose to go against that they additionally be asked to do all the right things in their travel patterns.

Q. Is it safe to send children back to school in the fall?

I’ve consistently said that our ability to have children in school will again be a difficult decision matrix. It will never be entirely safe. Disease will continue to happen even after we get a vaccine.

So, what our approach is with all manner of communicable diseases, this one included, is to utilize the best infection control measures we have in hand, which is early identification of cases, isolation of cases, quarantine of contacts, hand washing, stay home when you’re sick, hand sanitizing, sanitizing surfaces, all that good stuff is going to be critically important.

The two areas that are going to be most challenging for school operations are physical distancing — we do not have the physical facilities nor the resources to expand the physical facilities — and the second thing is going to be mask wearing on a universal basis, especially amongst the lower-age students. The ability to hear and see the teacher, the ability to engage with other students and the teacher, is going to be challenging with regard to mask use.

So at the end of the day, to your question, will it be safe to go back to schools, I think we need to get away from the narrative of safe and non-safe and talk in terms of what is the safest way we can achieve this with an understanding that we will continue to watch our metrics and when and if locally we get to the place that is unacceptable for our community, we would consider another shutdown.

Q. At this point, based on what we’re seeing now, do you believe it’s OK to reopen schools?

I believe that our community is very open right now, along with lots of protective measures being utilized. I think the same is possible for our schools. I know that schools need to plan and they are planning for multiple approaches, and that decision point will be ongoing. It will be ongoing through the summer and it will be ongoing when and if the students are actually back in classrooms.

Q. What misinformation or misimpression would you like to correct?

Probably the main one is if you’re worried about this disease you need to stay home and let the rest of us go about our business. Communicable diseases cannot be controlled by individual actions. They have to be addressed through community response, because your becoming infected makes you the next risk for someone else.

Your decision that it’s OK to become infected and I will be fine puts your fellow community members at risk.

Q. But just to play devil’s advocate, if I’m sheltering at home all the time and I don’t go out, how does my neighbor who does go out threaten me?

People need to go the doctor’s office. They need to go to pharmacies. Even if you say, OK, stay away from the protests, stay away from the concerts, stay away from the restaurants — and I’m not even going to address that from an equity perspective — people cannot, for months on end, be locked up in their homes. There’s a health implication to that, and I don’t mean just picking up their medications. We all need to leave our houses at some point.

Q. Five county health officers in California have resigned since the pandemic began and at least one reported death threats. What’s this been like for you?

I want to thank our community for being, for the most part, congenial, supportive, understanding that we are all in this together. We definitely have had the same experience that other counties and communities have where people have really taken up sides on how we should be addressing this pandemic, particularly around the issue of mask use, but I would say I feel much more supported than some of my peers have had experiences with.

Q. Do you know these health officers personally?

Oh yes, I know each of the individuals and they are top-notch professionals.

I’m deeply saddened by some of the health officers who felt it was not worth it to them to continue to do the excellent job they were doing because of the threats, the protests, the absolute clamor for their heads.

I’m grateful that I’ve gotten very little of that locally, but it’s less about me than it is about being kind to each other during this very challenging time.

I continue to really request, to the extent that people want to listen to me as a community leader, I think it is critically important that we be as undivided as we can be during a period that is anxiety provoking, fear provoking, with widespread opinions on how we should be addressing the issues before us.

At the end of the day, why it is so challenging is there are simply no good answers, and so we need to all just keep doing our best.

This story was originally published June 26, 2020 at 5:00 AM.