Gov. Gavin Newsom, during his weekly COVID-19 press conference Aug. 3, lauded the successes of the "Imperial Model" in marshaling state and federal resources to control and flatten the curve of cases of novel coronavirus in Imperial County, a model he said is being employed in other counties in California to deal with surges there. | VIDEO SCREEN CAPTURE
IMPERIAL COUNTY — From an outside perspective, the “Imperial Model” probably looks like something that was intentional, designed and carried out in a cohesive and consistent manner, very much the way Gov. Gavin Newsom made it sound when he lauded the way the people of Imperial County and state and federal agencies all worked together to deal with the surge in cases that crested in the region in early to mid-June.
Yet to those inside Imperial County, including elected and public health officials, the “Imperial Model” was anything but, often times seeming haphazard, slow-to-develop, and was a sometimes painful process that unfolded over weeks rather than days.
“The governor made it sound organized and disciplined, but it was not that way,” Imperial County District 4 Supervisor Ryan Kelley said during the Aug. 4 county board meeting. “(But) I’m happy that we have a name being used and applied in other parts of the state of California.”
Supervisors’ Chairman Luis Plancarte agreed, adding that it was good to hear the “Imperial Model” taken in a “positive way.”
“A few weeks ago, the ‘Imperial Model’ was ‘no bueno,’ as some would say,” Plancarte quipped.
To be certain, things are looking up locally. Cases are down, hospitalization rates are down, patient transfers out of the area have all but ended, and the data bears that out.
Although the number of deaths on the county’s COVID dashboard continue to surge due to delayed reporting and the overwhelming susceptibility our seniors citizens are having to the effects of the virus (roughly 73 percent of all recorded COVID deaths are those ages 60 to 89), the number of positive COVID tests from day to day for the past two weeks have been under 100 to 200. Those numbers had been 600 to 700 positive tests a day just three to five weeks ago, Public Health Director Jeanette Angulo has reported.
Even the conservative county Public Health Officer, Dr. Stephen Munday, who said Aug. 4 that its “too soon to say we peaked,” has acknowledged the incrementally improving conditions. He has said it will take a few more weeks of consistently downward movement before he would say the county is on the other side of the curve.
“I know that somebody asked me last week about some comments that have been made by Dr. Tomaszewski with regard to the hospital,” Munday said during county Public Health’s weekly press conference Aug. 3. He was referring to El Centro Regional Medical Center physician Christian Tomaszewski’s comments that the curve has flattened locally.
“The hospitals are still working really hard, no doubt, but clearly doing much better than they were, you know, even a month ago. And if you look at our case rate, even our percentages, all the numbers seem to be moving in the right direction. So again, I’m cautiously optimistic that we’re moving in the right direction, but I want to make sure the trend continues,” Munday said.
“The other part of it, as I’m sure everyone here is aware, we know what’s going on across the state. And we’ve had counties that were doing well and then they reopened and then their cases for each one went up again. So, there’s that to consider as well. But in terms of where we are right now, I do feel that our current trend is downward. And if this continues then I will definitely feel comfortable saying that we have indeed hit our peak and that we’re moving in a good direction.”
That’s exactly where talk of the “Imperial Model” has come in — amid the uncontrolled outbreaks in the Central Valley, and to a lesser degree, neighboring counties like San Diego and Los Angeles, which also been forced to roll back and reinstate closures.
As of Aug. 6, Imperial County had reported 240 deaths, just over 9,600 positive cases, 874 of which were active. Between July 28 (9,359 total cases) and Aug. 4 (9,601 total cases), a little more than a full week of reporting, only 242 positive tests had been reported.
Although epidemiological stability ebbed around 10 percent Aug. 3, it bounced up and down over the course of a few days, settling at 11.59 percent on Aug. 6. Still, it’s been a consistent improvement of testing percentages that were previously between 20 to 30 percent four weeks ago and 13 to 17 percent last week.
Munday on Aug. 3 said the numbers of people getting tested has decreased, yes, but the positive movement can be detected in other ways, including the rates of hospitalization and intensive-care unit utilization, all of which are down.
There were a total of 47 COVID-positive patients in ECRMC and Pioneers Memorial Hospital in Brawley as of Aug. 4, the fewest combined since May 3 (39 patients), and a total of 20 COVID patients in the ICUs, which has consistently been on a downward trend since mid-July.
(It should be noted that a technical problem with the state Department of Public Health’s disease surveillance system, CalREDIE, has led to underreporting of COVID-positive testing numbers on the state dashboard for several days, How that has affected local data has not been made immediately clear as of Aug. 4. Early this week, county officials said they did not think the local dashboard was affected.)
It’s been a fight to get to this point, local officials have indicated all along, when the lauded “Imperial Model” wasn’t so lauded.
Over the course of several weeks, starting within days of the initial May surge of cases that caused local hospitals to push patient transfers out of the county to better-equipped and more well-staffed facilities, state and federal officials incrementally responded to local needs and requests to provide more medical staffing, more personal protective equipment, more ventilators, more testing capacity and supplies, more public health assistance through technical and staffing support, basically more of everything.
Sometimes those things were turned over willingly and quickly, and sometimes Imperial County officials had to practically beg for help.
It seems like the tipping point was an all-hands-on-deck approach that occurred the weekend after Newsom’s June 26 press conference in which he demanded Imperial County officials “reinstate” stay-at-home orders that were never lifted in the first place and that local leaders “toggle back” soft business re-openings.
A day later, Newsom sent down a multi-disciplinary team of state decision-makers to hear from county officials and community leaders and stakeholders about all the ways help was needed to stem the tide of the virus.
To the governor’s credit, by June 29, the state had accepted the county’s plan to return to somewhere between a full Stage 1 shutdown and a modified Stage 2A low-risk re-opening of certain businesses, and the state continued to supply local hospitals with more staffing, the county health department with more teams of contact tracers and case investigators, and increased monitoring capacity so more than just the sickest of the sick could get tested for the illness.
Now, as cases of COVID-19 rage in Fresno, Kern, Kings, Madera, Merced, San Joaquin, Tulare and Stanislaus counties, Newsom is talking up the “Imperial Model” to tamp down what’s happening there.
“We approached our strategy in (Imperial) county more as a strike team, more as a unified command approach, something you would see more traditionally as it relates to how we organize and construct our approach to dealing with other emergencies like wildfires and the like. That process took shape, again, in the beginning of June, at a time when we had transmission rates, positivity rates, north of 30 percent in Imperial County. In fact, it peaked at 30.3 percent,” Newsom said Aug. 3.
“The model now, as we’re referring to it, the Imperial Model, was all about providing supports, building capacity at the local level, filling in gaps, meeting needs both on personal protective gear, not just personnel, meeting the needs of the hospital system, providing additional supports, new strategies, and prevention from PSA campaigns, culturally competent messages that were delivered to individuals as well as businesses and, more broadly, the community at large,” he said.
Newsom said since his prior press conference, around July 27, “I began the process of announcing strategies in the Central Valley, in eight counties,” where he said state officials started to see increases in COVID positivity rates.
“Not where we were in Imperial, but we don’t want to see it go to where Imperial went. And that’s why we felt it was appropriate to intervene using the information, using the experience, the best practice, the data collection, the approach in Imperial and beginning that approach in the Central Valley,” he said.
More Improvement Seen in Mexicali?
Last week, Munday mentioned to the county board that he had heard “through the grapevine” that conditions in Mexicali were improving.
As of Aug. 2, Mexicali had reported 1,230 deaths, 6,928 positive confirmed cases, with 181 active cases and 497 suspected positive cases.
As of midday Aug. 6, Mexicali had 1,273 deaths, 7,147 positive confirmed cases, with 161 active cases and 454 suspected positive cases.
Over the four days, cases did not appear to gain much ground for the city of more than 1 million.
Further indications of Mexicali’s improving conditions seem to be coming from its limited re-openings that started last week. It was reported that malls and other businesses were starting to open, including bars and night clubs next week, but it appears that more accurately, the city is allowing some return to normalcy on a case-by-case, controlled basis.
Mexicali public affairs officials, through a message sent to Calexico City Manager Miguel Figueroa, reported what is happening Aug. 4.
“Any business that intends to re-open approaches us and they provide us with the health protocols corresponding to their business. After this, when both parties agree (local government and business), the protocols are given to the city mayor and discussed with the state health secretary to endorse it. When the state health secretary gives the go-ahead, the mayor asks the City Council and the director of economic development to carry out a physical review of the establishments and then they can decide whether they comply with the sanitary measures for their reopening, and from this point a date is determined for their opening,” a Mexicali public affairs official told Figueroa.
“This procedure lasts two to three weeks,” the Mexicali official said.
What’s Happening with Testing in Imperial County?
Dr. Munday said hospital stays and ICU census are some of the ways he can tell the conditions of COVID in the community are improving, but testing in general is also an important marker, and for some reason, in Imperial County “people are choosing not to test.”
As communities all over the country continue to struggle with continued supply-chain problems associated with materials shortages for testing, Imperial County has largely been unaffected, and part of that might be fewer people are getting tested.
Imperial County still has the largest testing capacity it has had since the pandemic began and testing turnaround is on average two to three days, said Jeff Lamoure, deputy director of county Public Health, who is in charge of testing.
The number of COVID-positive tests were already on a downward trend for a few weeks, but Munday acknowledged that fewer people were getting tested during his Aug. 3 press conference.
“We have clearly noted a large drop-off in the number of people actually choosing to get tested. And that’s most obvious (with) the use of our four OptumServe lanes. For a long period of time, we essentially maxed those out and filled virtually every appointment slot. And now we’re not even using half of the slots that are allotted to us,” he said.
There are three state-sponsored, free-to-the-public OptumServe sites in Imperial, Calexico and Brawley, with a total of four lanes (the two “lanes” at the Imperial site means there is double the capacity of the other locations). In order to justify having four lanes, Munday has said in the past that 85 percent of the OptumServe site capacity has to be utilized. Currently, that number has fallen below 50 percent.
“There’s been a large drop-off in the testing. And that’s not because testing is not available but because people are choosing not to take advantage of it. And of course, that’s their choice. So, there’s currently plenty of testing capacity available, despite the fact that at the end of last week the National Guard lab packed up and left. But the hospitals have increased capacity. The health department has its own internal capacity. And the OptumServe sites are still here. But they’re definitely being used less. And I think that is probably in concert with the drop in the total number of tests,” he said.
“It’s hard to know exactly why that is, because these sites are scattered all over. We’ve tried to make them as convenient as possible. … If I were just to give my opinion, I think that some of it may be driven by the fact that we are seeing our numbers improving and therefore people think it’s less than necessary for them to go get tested and therefore they’re not scheduling the testing. I don’t know that for a fact,” Munday added.
Munday Compares COVID to Conventional Flu
A member of the media asked Munday on Aug. 3 how COVID stacks up against the mortality and virulence of the conventional flu some five months into the pandemic, saying that “we still have the ongoing debate of whether this is a big deal. People (are) still comparing this to the flu.”
“All I can say is that over the last six or seven months, we have collected a lot of data. And so, I think it’s pretty obvious that this is a serious problem,” Munday said.
He said there have been nearly 5 million cases of COVID identified in the U.S. alone, but there have been 157,000 deaths.
“That would be a really, really, really, really, bad flu season. I mean it normally (is) at 30, 50, 60,000, something like that, so the death rate is clearly much, much higher for COVID-19 than it is for influenza,” he said.
He added that, from what we’ve seen, the summer has not affected the virulence or mortality of COVID the way it does with the conventional flu, and with fall and respiratory illness season on the horizon, that one-two punch will be returning.
Dr. Kathy Staats, the medical director for Imperial County’s Emergency Medical Services Agency, provided further insight.
“If you go on the (U.S. Centers for Disease Control and Prevention) website and look for the CDC estimates for deaths from the flu from October 2019 through April 2020, at greatest, they say it’s 62,000 deaths. And as Dr. Munday mentioned, we’re at 157,000 deaths from COVID-19. … I think just by deaths alone, you can see the significance of this illness,” Staats said.
“I frankly don’t understand how anybody can look at the data and try to argue that this is just another flu that’s out there. I mean, the data just don’t show that,” Munday added.
Munday did share some insight into how the county is planning for the return of flu season amid continuing COVID concerns.
He said the county wants to make sure as many people are immunized against the flu as possible but in a safe way to continue to adhere to social distancing and other measures that are still in place to limit COVID transmission.
“We’re looking at different options about how to do that, whether that would be something that we would do outdoors or as potentially a drive-up option or whatever. We’re still working through the logistics,” Munday said.
As a side note, Munday said San Diego County saw an immediate drop-off in flu transmission after it instituted physical distancing and stay-in-place orders.
“The other things that are in place that are meant to try to decrease transmission are also very effective for influenza as well. … I think at least some restrictions on interactions with people is likely going to last to the end of the year, whether that means, you know, mass gatherings won’t be allowed, or masking might be required in certain public situations. … Obviously … that will be advantageous for the spread of flu as well,” Munday said.