April 23, 2020
Eden Health District COVID-19 Bulletin
"Living with the pandemic is about change: changing our behavior, changing our interactions, changing our institutions, and changing our systems for caring for another." 
Mark Friedman, CEO of Eden Health District, 4/23/20
By the Numbers
CONFIRMED CASES
Alameda County: 1,282

Contra Costa County: 763

California: 37,784

U.S.: 845,959
DEATHS
Alameda County: 45

Contra Costa County: 22

California: 1,438

U.S.: 46,972
County Dashboards: Alameda & Contra Costa
For Bay Area case and death trends visit the SF Chronicle coronavirus tracker .
We are proud to partner with the East Bay Community Foundation in publishing this bulletin. Through donations to its COVID-19 Response Fund, the EBCF provides grants to East Bay nonprofit organizations delivering essential services to those most impacted by the economic fallout from the pandemic.
Bay Area News
East Bay Times, April 23, 2020
Contra Costa residents who have symptoms of COVID-19 can now get a free drive-through test at one of four drive-through sites around the county. The sites, which Contra Costa Health Services opened on Wednesday, are available to anyone even if they don’t have health insurance. Those with a fever, cough, shortness of breath, and fatigue can get the COVID-19 testing if they make an appointment, officials said.

Berkeleyside, April 22, 2020
Kaiser Permanente is converting an existing Berkeley warehouse into a $14 million testing site that will be able to process 70,000 tests for COVID-19 each week. Berkeley staff worked through the weekend and approved the building permit in just five days after Kaiser submitted its application on March 16. The city’s planning department will provide building inspections around the clock, day or night, to maintain the accelerated timeline and have the facility completed in a month, said Timothy Burroughs, director of the city planning and development department. “This is a project that has the potential to impact the entire region with critical tools in the midst of an unprecedented time,” Burroughs said. “We’re doing everything we can to help Kaiser move this forward.” The new lab is expected to be fully operational by June 1 and will serve as Kaiser’s main testing site in Northern California.

Mercury News, April 22, 2020
Santa Clara County’s revelation of three previously undiagnosed COVID-19 deaths in February and early March shows how early the pathogen gained a crucial foothold in the Bay Area, and how authorities lost precious time, due to lack of testing, to protect us. “If we had understood then that people were already dying… we probably would have acted earlier than we did,” said Santa Clara County Health Officer Dr. Sara Cody at a Wednesday press briefing.

Mercury News, April 22, 2020
New data released to this news organization shows that deaths recorded by the Santa Clara County Medical Examiner-Coroner’s Office rose 20% last month, compared with March of 2019, an increase that includes a 17% rise in the number of people who died at home. Overall, COVID-19 was listed as the cause of death or a significant condition for 32 people who died in the county in March, about half of the overall increase, though county officials acknowledge many more infections likely went undiagnosed.

Mercury News, April 22, 2020
After visiting Highland Hospital in Oakland to donate masks on Tuesday, Lynch spent his birthday on Wednesday driving around a small cart near Lake Merritt and Pine Knoll Park handing out face coverings. Lynch’s decision to spend Wednesday handing out masks in Oakland coincided with an order from several Bay Area counties including Alameda County requiring face coverings be worn in public.
Health News
Reuters, April 23, 2020
Reuters interviewed 30 doctors and medical professionals in countries including China, Italy, Spain, Germany and the United States, who have experience of dealing with COVID-19 patients. Nearly all agreed that ventilators are vitally important and have helped save lives. At the same time, many highlighted the risks from using the most invasive types of them, mechanical ventilators, too early or too frequently, or from non-specialists using them without proper training in overwhelmed hospitals.

NY Times, April 22, 2020
On Jan. 15, a 35-year-old man returned to Seattle from visiting his family in the Wuhan region of China. Using advanced technology that allows them to rapidly identify the tiny mutations that the virus makes, scientists discovered the virus brought in by the man from Wuhan, or perhaps, as new data has suggested, by someone else who arrived carrying a nearly identical strain, settled into the population undetected. It spread and became responsible for all known cases of community transmission in Washington in the month of February. And it had jumped. A genetically similar version of the virus, directly linked to the first case in Washington, was identified across 14 other states, as far away as Connecticut. The unique signature of the virus that reached America’s shores in Seattle now accounts for a quarter of all US cases made public by genomic sequencers.

CNN, April 22, 2020
There's growing evidence that Covid-19 infection  can cause the blood to clot  in unusual ways, and stroke would be an expected consequence of that. Dr. Thomas Oxley, a neurosurgeon at Mount Sinai Health System in New York, and colleagues gave details of five people they treated. All were under the age of 50, and all had either mild symptoms of Covid-19 infection or no symptoms at all.

Washington Post, April 22, 2020
Once thought a relatively straightforward respiratory virus, Covid-19 is proving to be much more complex. “The problem we are having is that while we understand that there is a clot, we don’t yet understand  why  there is a clot,” Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine. “We don’t know. And therefore, we are scared.”

STAT, April 23, 2020
A survey of nine major hospitals earlier this month showed the number of severe heart attacks being treated in U.S hospitals had  dropped by nearly 40%  since the novel coronavirus took hold in March, leaving cardiologists worried about a second wave of deaths caused indirectly by Covid-19: patients so afraid to enter hospitals that they are dying at home or waiting so long to seek care that they’re going to suffer massive damage to their hearts or brains. Some call it “a virus of fear.”
California News
LA Times, April 23, 2020
Despite  more positive developments  in the fight against the coronavirus in California, state and local officials said Wednesday that there is still no firm timetable for easing stay-at-home restrictions that have helped slow the  spread of COVID-19. California reported more than 100 new deaths linked to COVID-19 on Wednesday, including 66 in Los Angeles County, which has seen a surge in fatalities in recent weeks. Though hospitals are not being overwhelmed, they continue to see a steady flow of patients.

LA Times, April 22, 2020
California will have to test 60,000 to 80,000 people for the coronavirus each day to reopen the state, Gov. Gavin Newsom said Wednesday as he outlined new testing goals that are triple the number he had previously talked about, and far more than those currently performed. As recently as last week, Newsom said 25,000 daily tests would have to be conducted across the state by this week. Currently, just about 16,000 tests are done each day. The range of 60,000 to 80,000 is in line with estimates from Harvard University researchers, who say 152 tests a day for every 100,000 people are needed in the U.S. to safely reopen.

East Bay Times, April 23, 2020
Following an announcement from the Santa Clara County Public Health Department Tuesday that two individuals  who posthumously tested positive for COVID-19 died  at their homes in February, Gov. Newsom said he has instructed coroners around the state to “dig even deeper” and perform autopsies on individuals who may have died from the novel coronavirus as far back as December, 2019.

SF Chronicle, April 22, 2020
According to data collected by the Chronicle, California recorded its highest number of deaths, 118, in a day on Wednesday since the coronavirus pandemic began.

‘Second wave’ of coronavirus could be far worse for California than the first, officials warn
LA Times, April 22, 2020
Even as California continues to bend the coronavirus curve, a rise in the number of COVID-19 cases and deaths as well as concerns about a second wave of the outbreak are reasons to stay vigilant, officials say. “If we all pull back, we could see a second wave that makes this pale in comparison,” Gov. Newsom  told CBS News .  “I don’t anticipate that normalcy that many of us wish for happening anytime soon.”

Cal Matters, April 22, 2020
For all the talk of ventilators and new-fangled serological tests, it’s the shortage of glorified Q-tips that has brought California to its knees. But that may be about to change. Fresh off a phone call with President Trump, Gov. Gavin Newsom said today that the Trump administration would be sending hundreds of thousands of nasopharyngeal swabs to California in the coming weeks, providing enough to alleviate a statewide shortage of a primitive but essential coronavirus testing tool.
U.S. News
Associated Press, April 23, 2020
More than 4.4 million laid-off workers applied for U.S. unemployment benefits last week as job cuts escalated across an economy that remains all but shut down, the government said Thursday. Roughly 26 million people have now filed for jobless aid in the five weeks since the coronavirus outbreak began forcing millions of employers to close their doors. About one in six American workers have now lost their jobs since mid-March, plunging the U.S. economy into the worst economic crisis since the Great Depression of the 1930s.

NBC News, April 22, 2020
President Donald Trump said Wednesday he "strongly disagrees" with  Georgia Gov. Brian Kemp's decision to allow businesses like barbershops and nail salons to reopen, a day after he praised him during the White House briefing. Kemp  tweeted  after the president's remarks that he appreciated Trump's "bold leadership and insight during these difficult times," but he didn't back down. 

Bloomberg, April 22, 2020
As Americans chafe under coronavirus lockdowns, states are accelerating in two very different directions. The governors of California and New York on Wednesday detailed plans for creating armies of workers to track and trace new infections, calling the work essential to restarting their stalled economies. But in Georgia, Governor Brian Kemp on Wednesday stood by his decision to let some businesses -- including gyms, bowling alleys and nail salons -- reopen by the end of the week, despite opposition from some mayors.

Wall Street Journal, April 22, 2020
The number of U.S. coronavirus-linked deaths in long-term care facilities including nursing homes has eclipsed 10,000, as nursing-home owners said they are still struggling to access the testing they need to detect and curb outbreaks. A growing number of state health departments are reporting data, including fatalities, linked to facilities that primarily house older people who often are in frail health and particularly vulnerable to infection from the new coronavirus.

Reuters, April 22, 2020
In January, Alex Azar, the secretary of the Department of Health and Human Services tapped a trusted aide, Brian Harrison, to lead the agency’s day-to-day response to COVID-19. Harrison, 37, was an unusual choice, with no formal education in public health, management, or medicine and with only limited experience in the fields. Harrison had joined the department after running a dog-breeding business for six years. “Everyone had to report up through him,” said one HHS official. In a statement, Azar said Harrison has been an asset. “From day one, Brian has demonstrated remarkable leadership and managerial talents,” Azar wrote.

NBC Boston News, April 22, 2020
On Wednesday, Massachusetts became the fourth state to in the U.S. to record more than 2,000 coronavirus deaths. It also announced that 1,744 more people tested positive.
Butter, Sugar and Generosity
San Franciscan Norma Smith purchased hundreds of dollars of baked goods from Butter Love Bakeshop, intending to donate the treats to workers at nearby Cal Pacific Medical Center.

When CPMC graciously turned it down for administrative reasons, Norma turned to two local firehouses, who joyfully said yes to boxes of bacon-cheddar and spinach-parmesan quiche, apple and pecan pies, and jalapeno-cheddar and blueberry-chocolate scones. The firefighters were planning to share the food with local charities, after enjoying a few delicacies themselves.

Source: SF Chronicle
International News
NY Times, April 23, 2020
The pandemic sweeping the globe has done more than take lives and livelihoods from New Delhi to New York. It is shaking fundamental assumptions about American exceptionalism, the special role the United States played for decades after World War II as the reach of its values and power made it a global leader and example to the world. “America prepared for the wrong kind of war,” Dominique Moïsi, a political scientist and senior adviser at the Paris-based Institut, said. “It prepared for a new 9/11, but instead a virus came.

LA Times, April 23, 2020
Offering a rare and surprising bright spot in the COVID-19 pandemic, Vietnam began easing its nationwide lockdown Thursday following an aggressive containment campaign that has meant few infections and no deaths in an Asian nation initially believed to be at great risk from the coronavirus.
The communist-ruled country has sealed its borders, quarantined masses of people, used soldiers and police to track down potential infections and fined social media users for spreading misinformation. After deploying the full arsenal of a single-party state, the sprawling nation of 95 million people has now gone a full week without recording a new infection.

The Korea Herald, April 23, 2020
Korean health authorities are stocking medical equipment against a potential massive coronavirus outbreak, saying the country could face another round worse than what has been seen in Daegu. Korea Centers for Disease Control and Prevention Deputy Director Kwon Joon-wook stated, “COVID-19 spreads through those who do not show symptoms and during incubation. It has a relatively low fatality rate and a relatively high basic reproduction number, which make it a virus with characteristics optimal to trigger a global pandemic. There is a high possibility of a second wave of infections.”

Reuters, April 21, 2020
Harbin, a city of 10 million people, is grappling with what is now China’s biggest coronavirus outbreak. Officials further restricted inbound traffic on Wednesday to contain the spread of the highly contagious disease. Harbin, which has air links with Russia, reported seven new confirmed cases on Tuesday, taking its local infections to 52, excluding recoveries discharged from hospital.

BBC, April 22, 2020
Germany's federal vaccines institute approved clinical trials for a possible vaccine involving humans on Wednesday. About 200 healthy volunteers aged between 18 and 55 will be tested with variants of the drug, developed by US pharmaceutical giant Pfizer and German company BioNTech.

BBC, April 22, 2020
The UK will have to live with some disruptive social measures for at least the rest of the year, the government's chief medical adviser has said. Professor Chris Whitty said it was "wholly unrealistic" to expect life would suddenly return to normal soon. He said "in the long run" the ideal way out would be via a "highly effective vaccine" or drugs to treat the disease. But Whitty warned that the chance of having those within the next calendar year was "incredibly small".

Folha De S.Paulo, April 22, 2020
Facing the collapse of the Amazonas health system and an explosion in the number of burials, the largest cemetery in Manaus had to open mass graves to bury victims of the novel coronavirus. Before the pandemic, officials at the Nossa Senhora Aparecida cemetery buried about 30 bodies daily. In the past few days, there have been over a hundred burials daily.
Analysis/Opinion
NPR, April 23, 2020
A month ago, President Trump went on Fox News for a virtual town hall and downplayed the potential lethality of the novel coronavirus and compared it to the seasonal flu. "We've had horrible flus," Trump   said   March 24. "But we've never closed down the country for the flu. So you say to yourself, 'What is this all about?'" As of March 24, just   706 Americans had died   from the virus and there were just under 54,000 cases. Since then, the number of Americans who have died from it has gone up 65 times. In April alone, the number of deaths has gone up almost tenfold ,  from 4,780   to more than 46,000.

Washington Post, April 22, 2020
As several states, including Georgia, South Carolina, Tennessee and Florida, rush to reopen businesses, the sudden relaxation of restrictions will supply new targets for the coronavirus that has kept the United States largely closed down, according to experts. “The math is unfortunately pretty simple. It’s not a matter of whether infections will increase but by how much,” said Jeffrey Shaman, a  leading epidemiologis t  at Columbia University.

Kaiser Health Network, April 22, 2020
Doctors know that people with  underlying health conditions , such as  the 40% of Americans  who live with diabetes, hypertension, asthma and other chronic diseases, are more vulnerable to COVID-19. Yet some public health experts contend that social and economic conditions are even more powerful indicators of who will survive the pandemic. A toxic mix of racial, financial and geographic disadvantage can prove deadly.

Washington Post, April 22, 2020
Those who challenge the president’s erratic and often inaccurate coronavirus views will be punished, or made to atone. In a statement Wednesday, for example, Rick Bright, who until recently led the agency working on a coronavirus vaccine, said he was removed from his post for resisting efforts to “provide an unproven drug on demand to the American public.”

Wall Street Journal, April 22, 2020
Many factors muddled the administration’s early response to the coronavirus as officials debated the severity of the threat, including comments from President Trump that minimized the risk. But Health and Human Services Secretary Alex Azar waited for weeks to brief the president on the threat, oversold his agency’s progress in the early days and didn’t coordinate effectively across the health-care divisions under his purview.

Tomas Pueyo, technologist, Medium, April 20, 2020
A primer on lessons from other nations in controlling COVID-19 and opening up their economies and society.

George Packer, staff writer, The Atlantic, June 2020 (preview)
With no national plan, no coherent instructions at all, families, schools, and offices were left to decide on their own whether to shut down and take shelter. When test kits, masks, gowns, and ventilators were found to be in desperately short supply, governors pleaded for them from the White House, which stalled, then called on private enterprise, which couldn’t deliver. States and cities were forced into bidding wars that left them prey to price gouging and corporate profiteering. 
Answers to Common Questions on Wearing Face Coverings
Last week, the public health officers of several Bay Area counties, including Alameda and Contra Costa, issued an order requiring the wearing of face coverings in public. As of yesterday, residents must comply with the order. The order is in addition to the Shelter-in-Place order which requires people to stay home as much as possible and maintain physical distancing. Below are answers to common questions on the mask order. Answers to additional questions can be found here .

Why are masks required?

A key way COVID-19 spreads is via respiratory droplets expelled when a person sneezes or coughs. While not a substitute for frequent hand washing and maintaining at least 6-feet of physical distance from others, masks can help reduce the spread of these droplets. Keep in mind, an infected person can transmit the coronavirus even without having any, or only mild, symptoms.

What types of masks are required?

  • Basic nonmedical, cloth masks, including scarves and bandannas, without holes are required.
  • The mask must cover your nose and mouth but, of course, make sure you can breathe through it.

Are medical grade masks or ones with a one-way valve recommended?

No. As long as medical grade masks such as N95 masks and surgical masks are in short supply, the public health officers ask that we not purchase and use them. Any mask that incorporates a one-way valve (typically a raised plastic cylinder about the size of a quarter on the front or side of the mask) does not comply with the order. Masks with these valves permit the release of droplets. Plastic masks and ski masks with holes for nose or mouth also do not comply with the order.

When must masks be worn?

Face coverings are required to be worn:
  • While inside or waiting in line to enter essential businesses, like a grocery store or pharmacy;
  • When seeking health care;
  • When waiting for or riding on public transit, or in a taxi, ride share vehicle or private town car; and
  • When entering facilities allowed to operate under the Shelter in Place Order.

What are the exceptions to the order?

  • The order does not apply to when driving alone or with members of your own household.
  • Masks are not required when engaged in outdoor recreation such as walking, bicycling, or running, though it is recommended to have a mask with you and practice physical distancing.
  • Children age 12 and younger are not required to wear masks or anyone that has trouble breathing or been advised by a medical professional to not wear a mask.

What's the best way to wear and care for a mask?

First, wash your hands before putting on the mask. The CDC recommends that cloth face coverings should
  • fit snugly but comfortably against the side of the face
  • be secured with ties or ear loops
  • include multiple layers of fabric
  • allow for breathing without restriction

Cloth masks should be washed after daily use, in hot water with regular detergent, and dried completely on a high heat setting. Always sanitize your hands after handling masks and do not touch your face.

How can I make a mask?

The CDC offers instructions on making masks by sewing and without sewing.

In the video below, Jeremy Howard, a University of San Francisco researcher and the co-founder of  Masks 4 All , explains how to create your own, with no sewing required.
Donate PPE To Area Hospitals
Hospitals throughout the East Bay are experiencing a shortage of medical supplies. They are seeking donations of new Protective Personal Equipment (masks, gowns and other products). For more information visit:

Your feedback is welcome. Please share the Bulletin.
The Eden Health District is committed to ensuring that policy makers and community members receive accurate and timely information to help make the best policy and personal choices to meet and overcome the challenges posed by the COVID-19 pandemic.

Please share our bulletin with your contacts. If you would like to submit feedback or stories on the local response to the pandemic, please contact bulletin editor Stephen Cassidy at stephen.cassidy@ethd.org . And if you are operating a local food bank and would like your organization profiled in our nonprofit spotlight, please contact us.

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The Eden Health District Board of Directors are Gordon Galvan, Chair, Mariellen Faria, Vice Chair, Charles Gilcrest, Secretary, Roxann Lewis and Pam Russo. The Chief Executive Officer is Mark Friedman.