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The Limits Of Contact Tracing

 July 7, 2020 at 2:00 AM PDT

After two weeks of rising numbers of COVID-19 cases, yesterday, San Diego County public health officials ordered a halt to all indoor operations in businesses. So now bars, restaurants, museums, zoos, cardrooms, theaters and other family entertainment centers must close down. Outdoor dining will still be permitted for restaurants, as will delivery and takeout. The restrictions went into effect at 12:01 a.m. today and will be in place for at least three weeks. County Supervisor Nathan Fletcher said ``modest adjustments'' like the ones announced Monday could help prevent full-scale closures once again. we are in a fight to slow the spread of coronavirus, uh, and we win that fight by physical distance by utilizing face covers by hand-washing. Uh, we win that fight, uh, by adhering to the public health orders. All of us coming together collectively to keep our numbers in check. Uh, we fight every single day to preserve the integrity of our healthcare system. We fight to save lives, uh, and we have to fight to slow the spread to save our economy. The changes in San Diego County are in line with restrictions imposed last week by Gov. Gavin Newsom on counties on the state's coronavirus monitoring list. San Diego County was added to that list Friday due to these rising COVID numbers. *** An average of one of every four people tested for coronavirus in Imperial County tested positive. That’s the highest per-capita rate in the state. The statewide average is 5.7%. There have been 100 deaths in the county thus far from COVID-19, according to public health officials. Last week, Governor Newsom told Imperial county to re-impose its stay-at-home order. But...The county’s stay-at-home order had actually never been rescinded -- according to Janette Angulo, director of the Imperial Çounty Public Health Department. She told KPBS Midday Edition last week that now they’re scaling back even more and working to remind the community of the rules. We are closing further in store shopping and limiting businesses to curbside only….faith is outdoor services only...we also closed county parks and are working with city officials so they can do the same and we’re also doing reminders. Reminders to the community that we have a stay at home order, a face covering...we all need to come together so that there’s some stability in Imperial County. *** US Immigration and Customs Enforcement announced Monday that international students who remain in the US at universities where courses are entirely online -- may face deportation. In order to remain in the country for the fall semester, international students must take in-person classes at their schools. The new regulation is one of multiple actions that the Trump administration has taken recently to restrict immigration in the midst of the COVID-19 pandemic. *** From KPBS, I’m Kinsee Morlan and you’re listening to San Diego News Matters, a podcast powered by our reporters, producers and editors. It’s Tuesday, July 7. Stay with me for more of the local news you need. The South Bay remains the epicenter of San Diego's coronavirus outbreak--there are still more cases there than anywhere else in the county. But KPBS reporter Claire Trageser says if you want to know where cases are increasing the most--look no further than Pacific Beach. Toward the end of May, County Supervisor Nathan Fletcher specifically called out a Pacific Beach restaurant, El Prez, for having huge crowds of people not wearing masks. The bar was then shut down. But that hasn't stopped big crowds from gathering on the Pacific Beach boardwalk and beach as well as in its bars and restaurants. And along with the crowds has come a spike in cases. On June 15, the Pacific Beach zip code had 70 cases. By June 30, the number had jumped to 181. Eyal Oren, an epidemiologist at San Diego State University, urged caution in drawing any hard conclusions from the analysis. But, he says, the trends align with the news about outbreaks in bars and restaurants. CASES 1A "If places are not following practices that have been shown to minimize risk, that puts people at increased risk." Still, the South Bay, including Chula Vista, National City and Southeast San Diego still have by far the highest number of cases in the county. Experts say the county should still be concerned with flattening the curve in those areas, as well. *** AS Coronavirus cases rise sharply across the country and here in San Diego. local researchers are innovating to help ease the situation. UC San Diego physician Lonnie Peterson says there are a lot of ventilators, for instance, that are either very expensive, or are low cost but don't meet all the needs of patients. So they designed a middle variety that costs only a few hundred dollars and can be put together by hand: Prices vary depending according to how sophisticated and advanced the device is. This device is actually a low cost and still is sophisticated enough to meet the needs of the patient's uprising. KPBS science and technology reporter Shalina Chatlani has details. Ventilators are critical for treating severe coronavirus cases. But they can cost thousands of dollars and are large and clunky. So a number of UCSD researchers thought -- why not construct a ventilator that's a few hundred dollars and can be put together quickly by hand? 11:49 FRIEND: The whole intent behind the design really is to make sure that even as a resource, with limited settings, even during a pandemic, you can get your hands on the parts to put one of these together. James Friend is an engineer at UC San Diego and lead on this project. The team was able to make this ventilator by removing parts- like air flow sensors- that were expensive-- while constructing a device that could still match the patient's breathing and airflow. James Friend is also an engineer at UC San Diego. UCSD physician Lonnie Peterson says it fills a gap. PETERSON: It's advanced even though it's low tech and low cost and easy to create and easy to use it's still advanced enough to meet those requirements so it really fills that gap. Now the team is hoping to get these do it yourself ventilators approved by the Food Drug Administration for emergency use. The research is published in a peer-reviewed journal. *** San Diego County’s effort to flatten the coronavirus curve is so far failing, with this surge in cases since mid June. This is happening as the county continues to ramp up its contact tracing program in hopes of slowing the spread. But KPBS investigative reporter Claire Trageser found it has some big limitations. Every day, Asma Al Sabag goes to work and gives people bad news. Asma Al Sabag San Diego County Contact Tracer SOT "I'll say, 'Hi, I'm calling because you were recently exposed to someone who tested positive for COVID-19." Al Sabag is one of nearly 500 contact tracers working for San Diego County. It's her job to find and notify people who were likely in contact with someone who’s tested positive for the coronavirus. SOT "We tell them to monitor their symptoms twice a day, check for fever, a whole list of symptoms, not do things like share utensils, bedding." Al Sabag estimates that she’s made hundreds of phone calls. But all her hard work may not be having the desired effect. Cases have been surging in the county, with daily counts approaching 500 and the total tally over 15,000. Yet, the county’s contact tracers have only reached about 9,000 county residents who were identified as a close contact of someone with the virus. Graphic San Diego Contact Tracing Called so far: 9,000 Estimate of contacts needing a call: 140,000 That’s probably only about 6 percent of all county residents who’ve been exposed. Plus, the county does not know how many of the people contacted actually followed the public health order and went into quarantine. Andrea LaCroix UCSD Epidemiologist SOT "At first, San Diego County and the state were saying it was a very high priority to have a robust contact tracing program." Andrea LaCroix is an epidemiologist at UC San Diego. SOT con't "It turned out to be much more difficult than they thought to standardize programs across the state, and sew together different institutions. I wish we were farther along." She and other epidemiologists say a regime of widespread wearing of face coverings, social distancing, testing and contact tracing is the only safe way to slow the spread of the disease until a vaccine is available. Contact tracing has proven effective in countries with authoritarian systems like China and those with populations that are generally more compliant with government authority like South Korea and Germany. But in the U.S., San Diego County’s program is just one of many that are struggling. An NPR survey found that only seven states and Washington DC have enough contact tracers to contain outbreaks. California currently has 6,000 contact tracers statewide, about half of what it would need, according to the survey. NAT POP Al Sabag Back at her desk, the contact tracer Al Sabag is working the phones again. She says 90% of the time, the person she's calling already knows the news she will give. SOT "Most times people say, 'yes I know who it is'" That's because the person with COVID-19 is a family member or close friend. But other times, she's greeted with real anger. SOT "They'll refuse to complete the interview until we tell them who they were exposed to. So they may hang up on us." This is just one of the limitations on contact tracer's power. They are not reaching all the people they need to reach, they can't force the people they do reach to give them information and they can't force those who've been exposed to stay home. Jeff Johnson, the head of the county's contact tracing program, acknowledges the limitations. Jeff Johnson Head of San Diego Contact Tracing SOT "We tell them we really want them to quarantine themselves, and if they're threatening to go to work, we'll have to talk with them and advise them otherwise. If we become aware someone has threatened to leave, we'd have to verify that first, and if they went to work, we'd call their employer, work with their HR, and keep giving friendly recommendations." If a person does develop symptoms or tests positive for COVID-19, the county then has the authority to force that person into quarantine. And if the person refuses... SOT "It's very rare but in those very few situations, we'll have law enforcement get involved." (Cut for TV Another reality that could be limiting the program’s effectiveness is a lack of bilingual contact tracers. Al Sabag speaks Arabic in addition to English, but not many other contact tracers speak a second language. There is currently one other contact tracer on staff at the county who speaks Arabic, and 41 who speak Spanish—just under 10% of all the contact tracers. Three contact tracers speak Chinese, one speaks Vietnamese and eight speak Tagalog or Filipino. Al Sabag said many of the calls she makes are to people who speak Spanish, so she uses software called Language Line that does translation for her.) As for Al Sabag, she plans to continue going to work and helping people through the challenging phone calls they received. SOT "I'll keep doing this until contact tracing is no longer a thing, until there's a vaccine." That story from KPBS investigative reporter Claire Trageser. *** Coming up….as the country approaches the 100th anniversary of women getting the right to vote, we rewind back to how San Diego played a part. After the break...the successful strategies San Diego women used to secure victory and more local news. Stick with me. A group of San Diego County racial justice organizations MONDAY unveiled a package of proposals intended to increase police accountability. Activist Genevieve (jen-a-vi-ev) Jones-Wright says cities need more robust and independent oversight of police departments — and that she's glad San Diego city voters will likely have the chance to enact that in November. GJW: But the city of San Diego is not the only city that should adopt an independent and community led commission on police practices. Every city in San Diego County must follow suit. KPBS metro reporter Andrew Bowen has more. AB: The Coalition for Police Accountability and Transparency, or CPAT, says their recommendations are about preventing the over-policing of minority communities. One of the changes the group wants to see is a ban on "pretext stops." This happens when an officer stops someone on suspicion of criminal activity, but doesn't have probable cause to arrest them. Bishop Cornelius Bowser is director of Shaphat Outreach. CB: We know that in our community, especially in black and brown and brown communities, we have a lot — that's the way the police use, to pull people over to racially profile, is through a pretext stop. We see that quite often in the city of San Diego. AB: The group is asking supporters to join a week of activism, which includes contacting elected officials to gain their support for the reform proposals. *** The right to vote is something many treasure, some take for granted, and many more don't use. But how that vote came to be for women, goes back more than a century in this country. As we celebrate the 100th anniversary of the 19th amendment, KPBS's Maya Trabulsi takes a look back at how San Diegans played a part. VO: Inside the Women's Museum of California. In a room lined with clothes, buttons, postcards, and political signs. President of the museum, Anne Hoiberg reads from a poem written by a Suffragist more than a century ago. HOIBERG:"'For the long work day, for the laws we obey, for the taxes we pay, we want something to say.' Isn't that perfect?" CG: Anne Hoiberg, Women's Museum of California VO: But who were these trailblazers fighting for women's right to vote, and more specifically, how did San Diegans play a part? VO: In 1895, Susan B. Anthony, the famous leader of the national suffrage movement, paid a visit to the then sleepy town of San Diego, HOIBERG: "And the town was so excited. The famous Susan B. Anthony. She spoke at the Methodist church, standing room only." VO: Determined that California women would get the right to vote, in 1896 Anthony led the first local campaign. The amendment passed in San Diego, but for the state… HOIBERG:"It went down to failure, which was very disappointing." VO: At that time, women were considered to be morally superior to men, and there was a fear of what steps they would take in society should they be able to vote, particularly on the issue of prohibition. Women's suffrage could hurt the liquor industry. VO: It wasn't for another 15 years, in 1911, that women would seize another opportunity, this time led by a local - Point Loma resident, Dr. Charlotte Baker. HOIBERG: "She would deliver a baby in the morning and then the afternoon she would dedicate to civic duties. And so she became president of the San Diego Woman Suffrage Association." VO: Suffragists got organized. With support from other prominent women like Flora Kimball of National City, Ellen Browning Scripps, and Attorney Clara Shortridge Foltz, the local suffragists used a 3-pronged strategy they believed was sure to work. (GRAPHIC) For starters, instead of protest, the women used the power of persuasion. HOIBERG: "And these women would go into a man's home and they would sit with that man and talk about the importance of women getting the right to vote. And they wouldn't leave until they convinced him. And they even said they were conducting invasions, invasions of men's home." VO: The women took advantage of the times. The California Exposition was coming to San Diego and Balboa Park was having a groundbreaking ceremony in July 1911. For their second strategy, the suffragists would parade. They decorated a float with yellow ribbon, promoting their message of equality. HOIBERG: "And they call it the modern Boston Tea Party float. And that also had on their 'taxation without representation is tyranny. Now, as it was in 1773'" VO: For the most part, San Diego County was still a rural town. Agriculture was highly dependent on the labor of women. The suffragists knew they had to reach the outlying communities by using their third strategy: automobile campaigning. (GRAPHIC). The campaign started on a monday morning. (Animated MAP GRAPHIC) HOIBERG: "Four women left San Diego for Oceanside. It probably took them several hours to get there. The roads were probably rutted, dusty, dirty." VO: From there they drove to speak to men in Escondido, then to Fallbrook, and finally to Ramona. HOIBERG: "Can you imagine? It took three days to cover our county and it was highly successful. And then October 1911and that was the big election day, was it going to go down to defeat like it did in 1896 or would it be successful? VO: It was a win. The final statewide vote was close with a margin less than 1.5%. In San Diego, the margin was wider, with more than 57% of men voting yes to grant women the right to vote. HOIBERG: "When you think of the determination of those suffragists...It just seems unbelievable that the numbers weren't higher." VO: But the votes were high enough and California became the 6th state in the country to give women the right to vote, all of which were Western states. HOIBERG: "Now, how do you explain that? But I do think it has to do with the sense of equality between men and women, the pioneer spirit, the progressiveness of people who would venture from the East Coast to come out here. To me, that's fascinating" All American women won the right to vote when Congress passed the 19th amendment in June of 1919. It was ratified in August 1920. You can learn more about the suffrage movement in a new 2-part series on the American Experience. It's called The Vote, and you can watch part two tonight)at 9pm on KPBS TV, and on the PBS video app. *** That’s all for today. Thanks for listening.

The county continues to ramp up its contact tracing program in hopes of slowing the spread of the coronavirus, but the program has some big limitations. Also on KPBS’ San Diego News Matters podcast: San Diego County public health officials ordered a halt to all indoor operations in several businesses, a rise in COVID-19 cases in Pacific Beach and more local news you need.