Barbara Ferrer: ‘We have a lot of spread still, and we have a lot of vulnerability’

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After months of lockdown, many things have been reopening in LA. Parks, restaurants, gyms, and museums are allowed to open with restrictions. But it can be tough to stay on top of what’s open and what isn’t, what people are allowed to do and what they can’t, and what the rules are about masks and spacing.

KCRW speaks with Dr. Barbara Ferrer, director of the Los Angeles County Department of Public Health.

KCRW: We're up to more than 75,000 people who've tested positive in LA County since the counting began. About 3000 have died. What numbers are you most concerned about? What are you watching most closely?

Barbara Ferrer: “I do always watch deaths. We cannot have a situation where we're seeing an increase every day in the number of deaths. And I'm glad to report for the last few weeks, we've actually started seeing a decrease. 

The other numbers that I watch carefully are what's happening in our hospitals. We can have more cases. But if it starts resulting in too many people needing care in a hospital, you could easily get to a situation where the hospitals would be overwhelmed, and that would make it hard not just to care for people with COVID-19, but it makes it hard to care for everybody. All the other people who need hospital care would be affected if our hospitals got overwhelmed with patients with COVID-19. 

… We were at about 1700-1800 people a day were hospitalized for COVID-19. Now we hover around 1400. And again we want to continue to see either that number remaining fairly steady, or that number also declining. 

Our cases are going up. We have more people getting tested. And we also have more spread. We have more people who are infected, and those people are infecting other people as well. 

… What's the reproduction rate of this virus? That's how I think of it. When we started … for every person who was infected, they were likely to infect somewhere between two and three people. And we're now down to about every person infected infects on average about one person. But even if you’re infecting just one other person, you're going to see why our numbers will continue to go up. 

So it's important for us to do everything we can to actually get that number to below one. And to actually continue to see that we're taking every possible precaution that's available to us right now to just continue to slow the spread. 

You know, we're not going to get rid of this virus right now — impossible without a vaccine. And we're also not going to be able to prevent some devastating outcomes until we have some good therapeutic medicines. 

But what we can do is we can definitely slow the spread, and we've done it. I mean, when people stayed home, and we didn't have a lot of people out and about, we consistently were slowing the spread. 

And now is our big test. We have a lot open. We have a lot of people going back to work. And I know there's a lot of relief. But we have to do it safely. We have to make sure that we're doing all of the distancing possible, all of the infection control possible at every single site that's reopening.

And it's why I'm so serious about the fact that when we do reopen, we issue directives for the sectors as they're reopening. They're not really recommendations. It's not like, ‘Let's look at the list of what public health says and let's pick and choose what we're going to do.’ It's really, ‘No, these are the directives you need to do, all of them.’ And the reason we need to do all of them is so that we can continue on the recovery journey, not have to pause, not have to go back. That would be absolutely disastrous.”

What phase of reopening are we in? 

“We're in phase three. Yes, solidly.”

The state of California says we must have fewer than 8% positive tests over a seven-day period in order to reopen.

“We're at 8%, when we look at from the beginning of time for everybody who got tested, what percent of people ended up being positive? When we do our seven-day rolling averages, which is how we report to the state, we're down below...last time I looked, a couple of days ago, we were at like 5.5%. But we've been between 7% and about 5% for the last couple of weeks. I think it's an important number — that positivity rate.

… If I were to look for the last two weeks, I would say the average is 6%.”

But how do we get to that 5-6% — if over the past 20 days, there hasn’t been a single day that’s 5-6%? 

“Because it's what you call a rolling average of seven days. And when we get the rolling average, we actually use the real data from that day. What you're seeing when you see like a number for Thursday, it's the rolling average for the last seven days. What you don't see is what was the actual data for the last seven days. I see that data. And that's how I get the rolling average. … You can't get it off our website, but we're happy to give them to somebody who needs them. … It's not like a secret.”

You're confident in the numbers that you have? 

“I'm as confident as I can get — when in fact we've got a lot of issues with how testing is still being reported to us. And it doesn't help when labs are reporting five days later with 600 cases. And that information didn't come in a timely way to go into those rolling averages. So what we can do right now is as good as the data we have.”

Nursing home patients and workers have accounted for nearly half of the coronavirus deaths in LA County — more than 1300. You've taken some of the blame, saying you were too slow to order testing in those facilities. Where are you in efforts to control the virus in nursing homes — and also in the jail system, where people really have no choice but to be in such close quarters?

“It would take longer than we're going to have to sort out all of the issues at the nursing homes. I do want to point out that once we understood that there was asymptomatic spread, which really wasn't until some testing had already been done, because I need to go back to when we actually had no idea how much asymptomatic spread there was, and [we] weren't really concerned about it. 

Most coronaviruses, that's not a major route of transmission. As a matter of fact, we spent all of February and a good part of March putting in place a whole set of protocols at nursing homes, that really was predicated on making sure sick people did not come in; a lot of screening for workers twice a day. We were spending a lot of time isolating sick people who had symptoms from people who didn't. 

And it wasn't until there was a nursing home that actually tested everybody, and shared those results, and they were astounding. And they really showed that there were a lot of people who are positive, who were asymptomatic, both among staff and among residents. That was a big game changer for us. Our strategy is not going to work with asymptomatic spreads. 

Two things had to change. One is we had to require that everybody had to wear a mask all of the time. That was never the requirement. I mean, if you've ever been in a skilled nursing facility before the pandemic, hardly anybody's wearing a mask. That needed to change because we now have asymptomatic people, and we're not really sure who they are. 

And then it was this job of trying to get everyone tested. I know it seems really simple to test everyone. And it's actually not so simple. If you remember back in the early days, we didn't have enough test kits. We didn't have enough swabs. We didn't have enough people who would go in and do the testing. We didn't have reagents. I mean, there was problem after problem after problem. 

I think it's so not helpful to start looking at who to blame. And so more instructive to look at what did we learn, and how does that help us move forward in a better way? 

I mean, I've had staff working pretty much around the clock on trying to make sure that we're doing the best job we possibly can at the skilled nursing facilities. And the challenges for a public health department were huge. And some of them have to do with a long history of underinvestment in our nursing homes, with having workers that are not paid so well, and working two/three places, making it very easy for spread. 

So I'm not trying to say we did everything right. I'm sure we did not. But I'm trying to say at the time we did all the best we could do. And in many cases, the work that people did here did save lives. And in some cases, unfortunately, the work that we did was not successful. And you know, we're always going to regret that.”

Your counterpart in Orange County quit over a mask fight. The mask is almost a political issue now.

“I'm glad I don't work in a county that doesn't understand the importance of masking. We're a huge county. And we have a lot of spread still, and we have a lot of vulnerability. And I'm so grateful for the leadership here. … Once we recognized asymptomatic spread, we had a lot of support for the masking. And I know it's hard. I mean, I'm one of the people. I just hate wearing them. I totally appreciate how uncomfortable it is, and how much it takes getting used to it. But I also know I'm saving somebody else's life potentially every time I put it on, when I have to go out, and that's the world we're in right now. 

This is … a hand that we didn't want to have to play, none of us. But this is what we were dealt. And this is where we are right now. And nothing is as we wish it could be. 

But I think even when nothing is as you wish it could be, you do your very best to do everything you can to protect other people. And I think that's what the team here has been trying to do. I think that's what all of you are trying to do. And it's challenging. But we have to be up for the task. There's no other option than to sort of step up and try to do the task in front of us.”

—Written by Amy Ta, produced by Christian Bordal