COVID-19

Battling A Pandemic Across 4,750 Square Miles And 10 Million People

Barbara Ferrer, head of LA County Department of Public Health. (KHN Illustration; Photo courtesy of LA County Department of Public Health)

LOS ANGELES — Barbara Ferrer, Los Angeles County’s top health official, is in the hot seat as the COVID-19 pandemic exacts its rising toll.

With over 10 million residents, the county is by far California’s largest, and it has the most confirmed coronavirus cases. Ferrer, who has been director of the Department of Public Health for three years, leads a daily press briefing in which she tries to keep up morale while dutifully reciting the latest sobering statistics.

On Thursday, she reported 7,955 confirmed COVID-19 infections countywide, up from 16 a month ago. Twenty-five new deaths brought the county total to 223.

Ferrer intersperses the grim news with words of empathy for health care workers on the front lines and low-wage workers who can’t afford to leave their jobs, as well as advice for people hunkering down at home, as many sectors of the economy grind to a virtual standstill.

“All of us are feeling somewhat anxious and stressed, because these are unprecedented times and it’s very easy to feel overwhelmed,” she said at a news conference this week. “So it’s very important you try to keep your connections, even though we’re all at home. Call, video, email, text or chat with the people in your life. Reach out every day.”

Some hope has emerged that California may be spared the kind of nightmare scenario playing out in New York and other hot spots like New Orleans. But Ferrer warned this is no time to lower one’s guard. She expects cases to rise as the county ramps up testing.

“There’s absolutely no evidence that indicates conclusively that we’ve hit our peak. I don’t think we have,” Ferrer told California Healthline in an interview Wednesday. And that means no relaxing of social distancing requirements, and no reopening of businesses or beaches, she said.

The following excerpts from the interview with Ferrer have been edited for length and clarity:

Q: The number of confirmed COVID-19 cases in L.A. County is about 40% of California’s total, while the county accounts for 25% of the state’s population. Is  the county being disproportionately affected by the virus, or does the lack of widespread testing make the data inconclusive?

There’s definitely a testing issue. The rate of testing across the state — I think this is from April 5— is 364 for every 100,000 people, and in L.A. County, while we’re not doing great, the tests run per 100,000 is 429. We’re running more tests, so we have more positives.

Q: How does not having accurate data complicate your job of planning for the care of infected people? 

I use a lot of information from other places to guide our thinking on what we ought to be doing and how we can be best prepared.

We are throwing every single tool we have at slowing the spread. We have a team of 350 people whose job it is to talk to the cases, find out close contacts, determine if there are any high-risk close contacts, and contact them. And we investigate every single case in an institutional setting. Right now we have 150-plus investigations in institutional settings, and we still try to do the basic work of isolating people who are positive and quarantining people who have been exposed.

Q: Gov. Gavin Newsom said he is confident California will have the supplies and equipment it will need to meet demand for hospitalization at the peak, and he donated 500 ventilators to the national stockpile. Do you share that confidence as it relates to L.A. County?

We still have a very short supply of personal protective equipment. I think everyone is working really hard to make sure we have enough ventilators. But it is complicated by the fact that you have to have enough ventilators in the places where people show up very sick and needing ventilators. It’s not just a matter of the sheer numbers; it’s about what our capacity is to distribute and redistribute quickly.

Q: Do you have a working estimate of when L.A. County will hit its COVID-19 peak?

We should see an increase in cases by the end of this month. If we get to the point where we’re testing 10,000 people a day, which is what we’re hoping to have soon, and we hold at 10% of test results being positive, that gives us 1,000 new cases every day.

The name of the game is to try not to have every positive person infect three other people — to try to get that number down to like 1½ people. We’ll still get a lot of cases, but we’ll slow it down so it’s at a reasonable rate of increase that hospitals can accommodate.

Q: You released numbers showing African Americans are dying of COVID-19 at nearly double their percentage of the population of L.A. County. It is based on  incomplete data, a big caveat, but why do you think African Americans may have a higher death rate in this pandemic?

It’s got much to do with the experience of racism and discrimination, both on a daily basis and a historical basis. The impact of racism as a cumulative stressor has a biological impact on people’s bodies. It’s like being stressed out every single day.

They are more likely to have a whole host of chronic health conditions that are associated with starting life disadvantaged in your health status and ending your life earlier than everyone else because of the cumulative impact of all of that inequity. And 84% of the people who have died in L.A. County to date are people who have had serious underlying health conditions.

Q: At a nursing home in Riverside, dozens of residents tested positive for the virus and were being evacuated after most of the staff failed to show up for work. Is this the kind of stuff that keeps you up at night?

I feel grateful to all the workers who do show up to work. Our job is to make sure that they all have PPE, to be honest. But obviously, the more illness there is in a facility, the more masks you are going to use up. We get calls constantly saying, “I’m out of masks.”

Q: Then there’s the fact that the people who work in those homes are generally low-paid.

Yeah — they work, like, three jobs. And when you have an outbreak, you often can trace it to an employee who worked in three different places.

It’s a big worry. I’d like to say that some of the ills we tolerate in normal times really are haunting us in the pandemic. The fact that this is low-paid work for so many people, and that they’re doing some of the hardest work ever, taking care of very frail and often elderly people with lots and lots of limitations — it’s heartbreaking.

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