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Pandemic winter, part 2: 'While we’ve been at this for almost two years we’re still in the thick of things'

During the holidays, COVID-19 cases are expected to increase, but with millions vaccinated this is a different winter than a year ago. KPBS Health Reporter Matt Hoffman sat down with the county officials leading our pandemic response to see where we are at and what else is on their radar.

San Diego's top health officials prepare for a potential winter surge and discuss other countywide priorities including mental health, homelessness and addiction.

This pandemic winter is shaping up to be different than last winter when hospitals were nearly overwhelmed. Since then, cases and hospitalizations have fallen — thanks in large part to more than 75% of eligible county residents, some 2.3 million people getting fully vaccinated.

"Which is higher than the state — which is higher than the nation," said San Diego County public health officer Dr. Wilma Wooten, who noted the vaccination rate would not have been possible without help from hundreds of county partners. "There’s a lot of COVID-19 disease still out there and the path forward again is vaccinations."

Wooten and San Diego County Health and Human Services director Nick Macchione have been leading pandemic efforts in the region.


"I think the biggest gift you can give someone this holiday season coming up — if you love someone, you care about them — is to get vaccinated," Macchione said.

Jim Clark, 86, receives a first dose of Pfizer-BioNTech COVID-19 vaccine from UC Davis Health on Tuesday, Jan. 12, 2021, in Sacramento, Calif.
Noah Berger / AP
Jim Clark, 86, receives a first dose of Pfizer-BioNTech COVID-19 vaccine from UC Davis Health on Tuesday, Jan. 12, 2021, in Sacramento, Calif.

Since Thanksgiving, there have been upticks in COVID-19 cases and hospitalizations. With Christmas and New Year's around the corner, officials are asking people to celebrate responsibly this holiday season.

"If people continue to be careful about their actions, their behavior, we can get through the winter months as well," Wooten said. "But the anticipation of cases going up over the winter months is a significant concern."

Wooten said the county is working with local hospital systems should there be a need to surge up. This winter there are no large vaccination super stations and recently the focus has been on delivering COVID-19 boosters and shots for younger kids.


"Access is not a problem," Wooten said. "What is the primary issue is those people who are not vaccinated making the decision to become vaccinated."

The pandemic revealed disparities in the way people have access to resources and health care. To try and combat this, state officials identified ZIP codes in underserved areas that needed extra attention.

"We’ve just maintained that approach and in fact — not just for COVID this is the work that’s informing what we’re doing more broadly," Macchione said. "Be it for homeless, be it for mental health, housing or children and families in need."

With the help of a new board of supervisors, the county has been investing millions in homeless resources. At existing shelters staff provide mental health services, public health nurses and work to connect people to assistance programs. Now county officials are looking to open their own shelter in the east county and some in partnership with other cities.

"What we’ve done in Fallbrook is different than what we’re doing in El Cajon, which is different than what we’re doing in South Bay or city of San Diego," Macchione said, noting homelessness is on the rise. "We let the cities define what the needs are."

Pandemic winter, part 2: 'While we’ve been at this for almost two years we’re still in the thick of things'

Speaker 1: (00:00)

Even with an expected holiday uptick in cases, the fact that millions in the county are vaccinated will make this a different winter than a year ago. KPBS health reporter, Matt Hoffman sat down with county public health, officer Dr. Wilma Wooten and health and human services director, Nick mash. Who've been leading our pandemic to give us a COVID update. And what else is on their radar?

Speaker 2: (00:25)

What we're coming upon the flu season and winter months. And COVID 19 is not the only thing that's circulating in the community influenza circulating. And it appears to be, um, more, uh, out there than, uh, it, what as this time, uh, last year. So the number of cases we've seen, uh, over the past several months, uh, are greater than the same time last year. So there's that. And then there are other viruses, uh, RSV, uh, respiratory sensual virus. There are ano viruses. There are, are hosts of other virus, is that commonly circulate during the winter months, uh, that we have to be, uh, aware of, but the preventive strategies that we promote for COVID 19, also help with these other, uh, circulating viruses, washing your hands, uh, covering your cough and even, uh, wearing the masks. So if people continue to be careful, uh, about their actions, their behavior, uh, we can get through the, the winter months as well, but the anticipation of, uh, cases going up over the winter months is, uh, a significant concern and worry. So it is, uh, incumbent up hun, all of our partners, our county, uh, efforts as well as individuals, because we can make the resources available. But if individuals don't take advantage of those resources, then it's not going to do them any good. Yeah. You know,

Speaker 3: (01:55)

Uh, you know, I think the, the biggest gift you can give someone this holiday season coming up, if you love someone you care about them, uh, is get vaccinated. You know, if you're eligible and able to, and we have seen that, you know, when we have the holidays, we've seen the rise of folks because they are conscious and they're realizing they, they, they don't want their loved ones to be exposed. So we are proud in San Diego, as, as you know, we, uh, had one of the most vast expansive works of, be it for testing and, and then vaccinations. And to this day we still have testing available, but the vaccinations is readily available and folks can just, you know, go to their nearest pharmacy or their primary care physician, for example, or come, go to two, one to one of the county sites, but it's taking action in the holiday season. And of course, course, uh, doing all the, all the precautions or public health precautions that we have been in NASM, uh, talking about for the last two

Speaker 4: (02:51)

Years. Yeah. I know something. Yeah. You mentioned you guys are very proud of is the vaccination efforts here, 75%, a little bit more than that, of the eligible population, like 2.3 million San Diegos fully vaccinated. Um, but what about booster doses? We saw those come out recently and vaccines for younger kids. Is there an appetite there from San Diegos you guys are seeing?

Speaker 2: (03:09)

Well, certainly those percentages are far less, but we've only been vaccinating the five to 11 year old, uh, age group, uh, for about the past month. So we are continuously, uh, getting the word out through our sector partners and through our contracted partners that are contracted to do outreach and promote vaccinations and the appropriate testing. So it's a continuous, we are continuing those, uh, same efforts that we had in place, uh, at the

Speaker 4: (03:39)

Beginning of the year. Um, but in terms of testing and vaccinations, do you guys think the infrastructure is still there that it's readily available? And is there any scale up or scale down as it relates to that? Now we're approaching like two years into the pandemic here?

Speaker 2: (03:51)

Well, certainly the massive vaccination sites, uh, you know, they were stood down and, but pharmacies have now stepped and, and taking up a large part of the, the pool, if you will, in terms of vaccinating, uh, individuals. And they are the leaders in vaccinations, followed by private providers, followed by hospitals and then followed by our, uh, county partners. Actually the county itself is, uh, fifth big cause our role is to be the safety net and to work with the, the various partners. So, uh, access is not a problem. What is the primary issue? Is those people that are not vaccinated making the decision to become vaccinated?

Speaker 3: (04:36)

Yeah. You know, I, I, I think the, you talk about the ecosystem we built and the reality is we never wa from being really data informed before it was the mass events come to us. Now, our events are more tailored going to almost door to door campaigns in communities where, for example, we have some, some spots in, you know, in north county and Northland that are not as high as clearly as south bay, it's working with those trusted messages, the community partners that we have been doing now, uh, you know, since the pandemic, but focusing on where are those areas that maybe not at 75, maybe they're at 65, maybe 70, how do we get them there? Right. And so, and that is then working through our community partners with, at the county. And so you don't see mass, you know, vac centers because they're really going out into areas of where people live.

Speaker 4: (05:28)

Yeah. I know that you're, as agency turned nearly all of its attention to the pandemic. And last time we talked on the, now that we're on the downward trend, maybe of the pandemic, you talked about, you know, looking at other areas that you guys can go back to in your, in your strategic plan. Um, you guys mentioned efforts to curb homelessness, and we know that since then, there's been a lot of work going on behind the scenes. Uh, maybe a new shelter coming in the east county soon, uh, helping the city of San Diego set up some shelters. Um, how is progress on that front when it comes to you? Guys' homelessness efforts?

Speaker 3: (05:56)

Let me, let me say that, you know, we, we have seen, you know, homelessness on, on the rise, uh, uh, tragically, and it's not for the lack of trying by cities or counties. I think we're just seeing more people that have been sheltered at some point now coming unsheltered, right? And so we have a new board, you know, that started in January. Uh, they established a framework for

Speaker 4: (06:18)

The future. We in October with the new board's framework for the future were directed and came back to the board with a framework to end homelessness. Now I know that's grandiose, but that is in fact what we're shooting for. And that framework was very important because represents almost a billion dollars of investment of county resources. Is there some things in your mind that, you know, we want to get through now, now, now that we're, I know you guys have been pivoting, but we wanna do this, this

Speaker 3: (06:44)

And this, you know, we, um, are seeing, uh, tragedy unfold, right? Not only in our county, our state with, uh, fentanyl and opiate, right. Uh, uh, that is in some cases, in my view equally on, was a pandemic in proportion. So one out of 13 San Diegos experience, a substance use disorder, one out of 13, yet as our nation, we have built the most wonderful hospitals and clinics and, and then maybe public health, right. We're catching up on infrastructure, but alcohol drug treat has not been, it's always been stigmatized as well, and has not been an area that has been invested in as we have been trying to do in California. So this is a priority for us in our region with this board of supervisor framing for the future are really pushing, not leaning in running forward, uh, with us in the staff about how do you build a, a truly a behavioral health continuum of care.

Speaker 3: (07:41)

That is the tentacles that touch not only the homeless, not only the, the opiate fentanyl, uh, uh, uh, uh, pandemic, but also the rising number of mental health challenges we're, we've been seeing. And so that is being led by our behavioral health services. It is a massive undertaking. It's not just bricks and mortars and assessment centers. It's, it's really an idea. And the idea is this, that we wanna make sure we break down the stigma of mental health and drug addiction, that it's no different than if you were COVID positive or you have a heart issue or something else, that idea. And then having the services that support that is critical. And so that is a top priority. We're leading that. And then when you look in that space that has the issues around homeless or people who are, you know, in need of residential treatment and so forth, it's building out then the housing, uh, uh, component and they're not disconnected the concurrent issues that we're developing. So tho those that issue about housing, homeless, behavioral health, in addition, obviously to public health becomes a very large piece and of priorities for us. That was health and human

Speaker 1: (08:55)

Services director, Nick Marshon and county public health officer Dr. Wilma Wooten speaking with K PBS health reporter, Matt Hoffman,

Health officials said the drug crisis is nearly a pandemic.

"We are seeing a tragedy unfold not only in our county but in the state with fentanyl and opioids," Macchione said. "That is in some cases, in my view, equally almost a pandemic."

He reported 1 one 13 San Diegans have a substance abuse disorder and said more resources are desperately needed.

"We have built the most wonderful hospitals and clinics and maybe in public health we’re catching up on infrastructure, but alcohol and drug treatment has not been," he said. "It has always been stigmatized as well and has not been an area that has been invested in as we are trying to do in California. This is a priority for us in our region with this board of supervisors and the framework for the future are really pushing, not leaning in, running forward with us."

County staff are working to overhaul the existing behavioral health system. Macchione said mental health, addiction, even homelessness can be interconnected and should be treated as such.

"How do you build a truly behavior health continuum of care — that is the tentacles that touch not only the homeless, not only the opioid and fentanyl pandemic but also the rising number of mental health challenges we’ve been seeing? That is being led by our behavioral health services, it is a massive undertaking. It’s not just bricks and mortar and assessment centers."

Another focus for health officials is aging San Diegans.

"We’re not going to quite be the new Miami or Florida but let me give you an idea," Macchione said. "In 2010 we had about 600,000 San Diegans 60 and older, but by 2030 it will be pushing about 850,000 — that’s a significant increase — it’s one of the fast-growing age groups."

Officials want to make sure they are prepared and that means more investments in elderly care.

"It's a whole framework when we think about planning — and the planning is not tomorrow — it's now," Macchione said.

Some long-awaited news for prevention efforts: after historically being underfunded, public health departments should be getting a boost from the next state budget.

"Don’t know how much that will be," Wooten said. "That’s what we’re hearing is happening and I think it will go a long way to shore up the infrastructure."

Wooten and Macchione have said that typically funding for public health has been reactive. Wooten said a priority will be updating IT systems to make sure public health efforts are as efficient as possible.