County Still Evaluating Goal On COVID-19 Outbreaks (Which It Still Can’t Meet)
School Officials Also Looking At How Outbreaks Influence Reopenings
Editor's note: In an ongoing series, KPBS is examining data tracked by the county to monitor coronavirus in the region, including community outbreaks. The hourly bells at University Christian Church are a familiar tune in the Hillcrest neighborhood. But there used to be another melody ringing from the sanctuary — more than 100 members of the San Diego Gay Men’s Chorus rehearsing at the church for an upcoming Broadway concert series.
The group ceased practicing numbers from “Les Misérables” and “A Chorus Line” in early March. Executive Director Jeff Heine said gathering to sing seemed like a risk as a respiratory illness surged around the globe.
“There was an unknown quantity to this virus back then. I'm not sure if this was the right thing to do or not, but we wanted to be safe,” Heine said.
The last rehearsal was 10 days before Gov. Gavin Newsom ordered Californians to stay home, but COVID was already in the door. Four chorus members would ultimately fall ill in one of the earliest confirmed community outbreaks in San Diego County.
There have been at least 361 community outbreaks in the region. Officials track those clusters, defined as at least three cases among non-household members, to measure how much COVID is spreading. Outbreaks are one of 13 “triggers” the county uses to determine how to adjust public health regulations, and a KPBS review found a complicated and evolving system. For example, there should be no more than six community outbreaks in a week, but the tally has exceeded that number for months — officials reported 17 in one day on Thursday.
County officials acknowledged weeks ago that the threshold could use a second look, but they still haven’t made any changes. The San Diego Unified School District announced early on it wouldn’t reopen until all county metrics met goals but the district has since shifted its stance — an expert advising the district warned that such a shift was possible.
Public health officials won’t name all outbreak locations because doing so “risks unfairly stigmatizing both locations and individuals linked to outbreak sites,” the county’s doctors wrote in a commentary published in the San Diego Union-Tribune. KPBS joined Voice of San Diego in a lawsuit against the county seeking the release of this information.
Heine said he wasn’t afraid to speak to KPBS about the outbreak involving the men’s chorus.
“If by providing this information, we can support the community — either by putting a face to this outbreak or if people can learn from that — I think that's definitely a good thing,” he said.
Piecing it together
Days after cancelling chorus rehearsals, Heine saw a singer’s post on Facebook that they were sick, but well enough to isolate at home.
“It hit me hard,” Heine said.
News circulated among the chorus about more illnesses. Heine contacted the Health and Human Services Agency when he learned officials were tracking clusters of at least three cases. He said he was told the county would verify the identities of chorus members with positive test results.
“They said that if they've been to the doctor already, if they've been told to stay home or if they have tested positive, we have their names already. You're just helping us to connect the dots,” Heine said.
The county’s public health team connects a lot of those dots. The county also tracks how quickly staff members reach out to people who test positive and the contacts they may have exposed to the virus. (Employees who investigate new cases were far below the county’s goal in late July, triggering officials to bring on more staff and improve that data point.)
At one point in early August staff members confirmed 40 community outbreaks in a week. On Thursday, that number was 32 for the past week.
County Public Health Officer Dr. Wilma Wooten said officials set the bar at 6 outbreaks per week in late May when early data showed recorded outbreaks reached only 16 in an entire month. But the frequency of community outbreaks increased after the governor allowed more establishments to open up and Wooten said the county is now reviewing the threshold.
“We have asked two entities to look at modeling to determine going forward if that number should change or remain the same,” she told a Voice of San Diego reporter during a September news conference.
Nearly a month later, a county Health and Human Services Agency spokeswoman told KPBS the threshold is still under review. The county would not grant an interview about its triggers despite weeks of requests.
Spokeswoman Sarah Sweeney said in an email that the vast majority of the county’s coronavirus cases do not stem from outbreaks.
“With more than 95% of COVID cases not related to a community outbreak, it is import to note that community transmission is widespread and that non-pharmaceutical interventions like wearing a face covering over your nose and mouth, maintaining a physical distance of at least 6-feet and washing your hands remain some of the best tools to prevent the spread of COVID-19,” Sweeney said.
Impact on schools
As the county re-examines its stance on community outbreaks, some parents of San Diego Unified students are angry that the school district hasn’t released a full reopening plan.
In August, a group of UC San Diego experts advised the district to keep classrooms closed until the region met all state and local metrics. But consulting physician Dr. Howard Taras said that advice was given back when the county was failing to meet its goals not only on community outbreaks, but also on the rate of new cases. The county had only recently improved how quickly staff were contacting people who tested positive.
Plus, he said the message to stay closed was delivered with the caveat that the plan could change as the data did. Taras said now that the county is failing to only meet the community outbreak threshold, he’s not as alarmed.
“It doesn't worry me to open schools more than we are now in the San Unified School District, if only community outbreaks — especially the type of community outbreaks that we're seeing — is still not quite yet up to par,” Taras said.
The school board recently approved sending 12,000 elementary students — about 12% of its enrollment — back to limited in-person learning next week.
Taras said many outbreaks are occurring in restaurants and other settings where people socialize in groups, but young school children aren’t engaging in those behaviors unsupervised.
“They're more likely to follow parents' guidance and are more likely to be under the direct supervision of parents or other adults between school and home,” Taras said.
San Diego Unified School Board Vice President Richard Barrera said the district is monitoring the effectiveness of its prevention strategies during this first phase to determine if and when the remainder of the district’s more than 100,000 students can return.
“If we felt that the key community spread benchmarks were being met and that our first phase was going well and we were able to contain the virus on campus and not having community outbreaks at schools — if all of that was in place — then we would want to move to the next phase,” Barerra said in a phone interview.
Heine said all four members of the San Diego Gay Men’s Chorus have recovered from COVID, including one who was hospitalized. The executive director said he’s not sure where or how the virus was transmitted, but he thinks at least one singer contracted it from his job in the medical field.
“We believe that's where he probably got it from and not necessarily with the chorus at all,” Heine said.
Sweeney, the county spokeswoman, said in an email that linking an outbreak to a location or organization doesn’t mean “any one person actually contracted illness at the site, only that our surveillance definition of an outbreak location has been met (three lab-confirmed positive cases from different households visiting within a 14-day period).”
But the San Diego Gay Men’s Chorus still hasn’t resumed rehearsals at the University Christian Church. About 30 members did briefly reconnect in June at Balboa Park. They recorded a socially distanced video singing to a recorded track of “Somewhere Over the Rainbow.”
Passersby recognized the group. Some stopped to watch.
Heine said the experience boosted their spirits. The group has had to cancel yet another concert series — its annual holiday show — and forgo the revenue that comes with it.
“It kind of got you wondering, ‘Well, what would stop us from just going out into the park and just singing Christmas carols in December?’” he said.
Their “Return to Broadway” show is scheduled for April but Heine isn’t confident coronavirus data even then will allow the chorus back on stage. Right now, live theater isn’t part of any phase of the governor’s reopening plan.