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Mono Public Health Officer Orders All Essential Workers to Wear Masks

April 13, 2020 – Effective immediately, all individuals working in essential sectors throughout Mono County and the Town of Mammoth Lakes are required to wear a face covering or mask to reduce the chance of spreading COVID-19. Under Governor Newsom’s Stay At Home Order issued on March 19 2020, only workers in essential sectors should be currently working and this order applies to all, from essential retail operations, construction, utilities, medical, food service, etc., to public safety and government personnel.

Physical distancing and staying at home is the most effective way to control the spread of COVID-19, and it is working both locally and across the state. Mono County experienced a dramatic 55 – 70% decrease in the average mobility (based on distance traveled) of residents during the past few weeks that has drastically new infections. Masking or wearing cloth face covers is expected to further diminish the number of new infections, primarily by reducing the spread by infected people who have no symptoms. The CDC states that about twenty-five percent of people with COVID-19 have no symptoms.

LOOKING AHEAD

Mono County Public Health Officer, Dr. Tom Boo, anticipates issuing a follow-up order requiring everyone to cover their nose and mouth with a face covering when in public, which should go into effect before the Stay At Home Order expires.

We anticipate masking to become our new normal in the time of the pandemic, and that physical distancing and other mitigation must continue even after the Stay At Home Order is lifted. We are experiencing some respite, but we are clearly not out of the woods yet. You may say we have a bit of a cease fire, but the war is not over,” stated Dr. Boo.

Dr Boo further stated that “The virus is still out there and can be expected to rebound with diminishing physical distance measures and vigilant hand washing, as we try to get more people back to work. We cannot eliminate the virus without a highly effective vaccine. When we move into the next phase, some social restrictions must stay in place. We are still a long way from being able to go back to normal life.”

In anticipation of the continued spread of the virus through Mono County and the impacts to our residents, the Health Department has increased staffing levels. The Nurse Hotline, accessible by calling 211, combined with improved testing capacity will be essential to our combined efforts to identify people affected by COVID-19. In addition, Mammoth Hospital continues to work with public agencies to coordinate hospital care with follow-up monitoring and patient support at home. A primary area of focus for Mammoth Hospital and medical teams across the country is the expansion of testing for quick results to know if someone is ill and antibody testing to know if some has already had the disease. To determine the effectiveness of these aggressive mitigation measures, the Mono County IT Department has built a new database for tracking cases that will greatly enhance a well-coordinated response enhancing our level of patient and family care

Coronavirus Town Hall Recap: When Will Normal Life Return?

On Thursday, April 9, 2020, Inyo County hosted a virtual town hall meeting to discuss the coronavirus. Officials from all healthcare facilities including, Toiyabe, Northern Inyo Hospital, and Southern Inyo Hospital, along with key figures from the City of Bishop and Inyo County were in attendance.

In total, twelve panelists were present during the discussion, with over 250 citizens tuning in to the town hall.

Inyo County Administrative Officer, Clint Quilter, served as the moderator, fielding questions from the public, and allowing each panel participant to give an update on where things stand when it comes to managing the COVID-19 crisis.

Southern Inyo Hospital CEO, Peter Spiers, was one of the first people to speak. Spiers, who has been in the Eastern Sierra for about eight months, talked about how he believes the community has enough strength and resolve to overcome the coronavirus pandemic. Spiers said, “I truly believe that by the grace of God, we have met this challenge with a resolve and commitment as a hospital. This is a unique place. From first day I was here, everyone was committed to making the hospital survive and thrive.”

Spiers also says the healthcare district has been taking a proactive approach since February to prepare for the pandemic. He went on to say, “We took aggressive measures starting in February, and made sure to screen all of our employees before they came to work.”

Chief Operating Officer of Toiyabe, Ethan Dexter, said that the health clinic is taking extra precautions when it comes to helping the public. Dexter remarked that all public health workers are sanitizing and wearing masks when doing wellness checks for patients.

Representing Northern Inyo Healthcare District during the discussion, was Dr. William Timbers, the newly appointed Interim Chief Medical Officer. Timbers gave a fifteen-minute PowerPoint presentation to attendees explaining the background of COVID-19 and told where things stand as far as the latest research on the virus.

After the healthcare officials finished speaking, Quilter turned the presentation over to local government officials from Inyo County and Bishop.

Bishop Mayor, Laura Smith, talked about the need for the city and the Eastern Sierra region to come together and embrace sacrifice for the greater good. Smith said, “City Council officials are elected by the people, and our hearts are with the people who are suffering. We need to band together as an Eastern Sierra community. That is how we are going to move past this problem.”

When it comes to sacrifices, Mayor Smith says the city will meet on April 13, 2020 to discuss what can be done to help the citizens of Bishop, even if it hurts the city fiscally. “There is going to be some sacrifice involved in order to combat this crisis. We are meeting as a city to see what sacrifices need to be made,” Smith remarked.

Chairman of the Inyo County Board of Supervisors, Matt Kingsley spoke after Mayor Smith, and commended the community for the job it has done helping those in need. The fifth district supervisor said, “I first wanted to recognize the efforts of our county staff, and the medical workers and volunteers around the community. Lunches are being served to kids and senior citizens, quilting clubs are making masks, and community activities are being organized like Easter Bunny drive-bys,”

Though pleased with the efforts of the community, Kingsley expressed displeasure with the fact that he can only provide a limited amount of help to his south county constituents during this pandemic. “My biggest frustration is not being able to communicate with my constituents. This is a great effort that we are doing in helping the community. But we have to realize that not all constituents have internet, so we have to find a way to help them.”

Inyo County Public Health Officer, Dr. James Richardson, was one of the panelists who had the most to say during the event.

To start things off, Richardson said, “As a public health officer, my goal is to protect the health of the citizens. Right now, the goal is to limit the impact of disease on local healthcare systems so they are not overwhelmed.”

Most of what Richardson discussed related to the importance of covering up with a cloth mask when going out in public, washing hands, and social distancing.

However, the Inyo County Public Health Officer stated that if an outbreak of coronavirus gets bad enough in the area, he will order the construction of alternative sites to help treat patients. “We are willing to develop alternative sites if needed along with increasing beds if things get bad.”

According to Dr. Richardson, there may be light at the end of the tunnel when it comes to life going back to some semblance of normal. “I have noticed recently in the latest predictive models, the estimation of deaths has gone down,” Richardson said. “I suspect in mid to late May, things will start lightening up. There may be an undercurrent of this virus in our community for a while though.”

CA Fish and Game Commission Set to Discuss Postponing Trout Opener

The California Fish and Game Commission will remotely meet to discuss delegating temporary authority to the California Department of Fish and Wildlife (CDFW) to delay, suspend or restrict sport or recreational fishing if the director of CDFW, in consultation with the president of the Commission, finds that such action is necessary to protect against the threat from COVID-19 based on state, federal, local, and tribal public health guidance and public safety needs.
 
When: Thursday, April 9, 2020 at 8:30 a.m.
 
Where: Via teleconference and webinar
Members of the public will have the opportunity to comment on the proposed emergency regulation by calling (877) 402-9753 or (636) 651-3141; access code 832 4310. Webinar details are on the agenda.
 

More: The meeting agenda and documents are available on the

Commission’s website at https://fgc.ca.gov/Meetings/2020
Due to the global COVID-19 pandemic, the Commission will discuss whether or not to temporarily grant authority to CDFW to decide whether to delay, restrict, or suspend sport or recreational fishing in order to prevent and mitigate public health risks that may arise when people travel for fishing trips or congregate while participating in available fishing opportunities. CDFW and the Commission have received requests from county representatives and local health authorities requesting delays to recreational fish openers such as the Eastern Sierra trout opener scheduled for April 25, 2020.

11th COVID-19 Case Confirmed in Inyo County

INYO COUNTY, April 5, 2020 – Inyo County’s Public Health Officer, Dr. James Richardson, received notification this morning from Northern Inyo Healthcare District regarding a positive COVID-19 test for an Inyo County resident. This is the 11th positive COVID-19 case in Inyo County. The patient presented to Northern Inyo Healthcare District’s Rural Health Clinic with symptoms associated with COVID-19, and was tested for COVID19 based on symptoms and other risk-factors.

Inyo County Public Health is working to determine the source of the infection, and conducting a thorough investigation to identify potential exposures and notify contacts. At this time the patient is currently isolated at home. As of April 4, Inyo County has 12 tests pending and 101 negative cases. Due to the volume of tests being analyzed currently in California, the turnaround time can take several days.

The public must continue to practice preventative measures such as wearing a cloth or fabric face mask when conducting essential activities outside the home, avoiding contact with sick individuals, wash hands often with soap and warm water for at least 20 seconds, practicing social distancing, and adherence to State and County Orders. If you are experiencing symptoms of COVID-19, such as fever, coughing or shortness of breath, and think you may have had contact with a person with COVID-19, call your health care provider before seeking medical care so that appropriate precautions can be taken.

The County of Inyo, Northern Inyo Healthcare District, and Unified Command partners are committed to keeping Inyo County residents up to date with the most accurate information. You are encouraged to visit https://www.inyocounty.us/covid-19 for the most recent press releases and community updates. You can also register your email so you receive all Inyo County COVID-19 information by clicking either Situation Update or Press Releases from the left-side menu.

Body Discovered in Death Valley

DEATH VALLEY, CA. April 6, 2020 – On April 4, in the afternoon, Inyo County Sheriff’s Dispatch was notified of a possible deceased person found by a hiking party of three near the base of Manly Beacon out of the Zabriskie Point trailhead, Death Valley National Park.

An Inyo County Sheriff’s Deputy and Death Valley Rangers responded. Rangers located the body and determined the subject was deceased. It is believed that the individual fell approximately 300 feet from Manly Beacon.  Due to lack of sufficient resources and time, a recovery was not attempted that evening.

On April 5, Inyo County Sheriff’s Search and Rescue Coordinators, Inyo County Search and Rescue, and Death Valley National Park Rangers responded.  CHP Inland Division Air Operations (H-82) from Apple Valley also responded to assist.  Ground teams recovered the body from its position up a steep and loose draw.  H-82 hoisted the decedent by air and transferred the body to the Inyo County Coroner’s Office.

A rental vehicle was located at the trailhead; NPS Rangers reported the vehicle as being there for about three days prior to the discovery of the decedent.  The identity of the recovered body is still pending positive identification by the Inyo County Coroner’s office.

Currently, Death Valley National Park is closed to all recreation other than highway through-travel.  A reminder: do not participate in risky outdoor recreation at this time due to emergency medical care being prioritized by COVID-19 patients and limited rescue resources.

Caltrans Working on 4-Lane Project in Olancha

INYO COUNTY — Caltrans is in the final stages of design and right-of-way acquisition for the Olancha-Cartago 4-Lane project. The project will upgrade 12.6 miles of the current two-lane highway to a four-lane access-controlled expressway. The new alignment will begin four miles south of Olancha to four miles north of Cartago and will close the gap between the existing four-lane sections to the north and the south.

 

This project will increase roadway safety, accommodate present and future traffic demands for goods movement and motorists and bring the highway up to current design standards. The new expressway will feature wider shoulders, a class-III bike route, a non-motorized multi-use undercrossing, and intersection improvements that will benefit pedestrian and bicycle mobility.

 

Some preconstruction activities beginning soon include utility verification and relocation, vegetation removal and/or relocation, staking the new alignment, installing desert tortoise exclusion fence, and other various preliminary items.

 

This $83 million-dollar project is jointly funded by Inyo and Mono Counties’ Local Transportation Commissions, Kern Council of Governments, and Caltrans with State Transportation Improvement Program funds. Project completion is tentatively scheduled for late 2023.

 

Inyo County Supervisors Seek to Bolster EMT Crews Due to Coronavirus

At the Inyo County Board of Supervisors meeting on Tuesday, March 31, 2020, the board unanimously approved a motion to request a waiver of the National Registry Test for Emergency Medical Technicians in response to the COVID-19 crisis.

This would allow the current group of individuals who are close to graduating from the EMT course at Cerro Coso College, to enter the workforce on an emergency basis without having to take the test.

Before students are allowed to become EMTs, the emergency waiver must be approved by the State of California.

The reason why the Inyo County Supervisors believe there is a dire need to reinforce the current EMT workforce is based out of the fear that there is a shortage of qualified technicians in the area. If some of the workers contract coronavirus, it could strap the already scarce resources.

Second District Inyo County Supervisor, Jeff Griffiths, spoke about the need for the waiver to get approved saying, “The state has stringent requirements on finishing the test in order to be licensed. The thing is, we are worried about if an EMT crew picks up a patient and are exposed to COVID-19. The crew would then need to be isolated, and we could run out of people to staff the ambulances. What we are asking is that the state waives the requirements, so we can get these people ready to help as soon as possible.”

Usually, the county could request additional resources in case there is a shortage of essential workers. However, Griffiths does not believe neighboring counties will be able to answer the call. The supervisor expressed, “We can reach out for additional help, but the problem is that everyone else is stretched pretty thin as well.”

Jeff Griffiths says the approximate twenty-three students who would be available to help out are a few weeks away from being fit for work. “It is hard to predict how quickly things will go with the state, but things are going faster during this time of emergency,” Griffiths expressed. “Students still have a little while left to complete coursework, but I am thinking it will be a few weeks till these students are ready to go. If the crisis drags out, we would like to have those resources available.”

Northern Inyo Hospital Preparing for ‘Surge’ of COVID-19 Cases

Northern Inyo Hospital gave its weekly COVID-19 update on Monday afternoon, March 30, 2020, with Dr. Stacey Brown taking the lead in updating the media.

“We have eight total positive cases of COVID-19 in the county. Six of the eight cases were confirmed at NIHD, while Toiyabe confirmed the other two. In addition, thirteen of the eighty-one total tests administered are pending,” Brown told members of the media.

There is good news for Inyo County when it comes to testing. The Rural Health Clinic Director said the hospital is receiving coronavirus testing results from a LabCorp facility based in Phoenix, which will greatly reduce the amount of time it takes to determine if a patient has the virus. On average, test results will be available in 2-3 days. Up until recently, NIHD had to send their samples to a testing location in North Carolina, which took about seven days on average for the hospital to receive the results.

Brown also added that testing is expected to get even faster in the coming weeks when the FDA approves use of a high-tech machine called the “Cepheid Xpert Xpress SARS-CoV2 test.”

The RHC director spoke about the new machine saying, “The hospital is still waiting for approval for our in-house COVID testing machine that will be able to do tests in an hour. Approval for testing should happen by around mid-April.”

This does not mean that testing will be available for the general public. Brown says the new testing system will target essential workers first, then vulnerable populations second. “We are going to follow a priority scheme, so the testing for the general public is going to be reduced.  If it looks and smells like COVID, it is probably COVID, so we are not going to use those tests on general public. We are saving the tests for healthcare workers, first responders, and critically ill patients. They are priority number one. Next would be high risk individuals like people with underlying medical conditions and older people.”

Antibody testing is expected to be readily available across the country soon as well. This type of testing will be used to see if those who have already had COVID-19 have built up an immunity to the virus.

Inyo County already has its fair share of coronavirus cases, but Brown expects a surge of cases to happen in the near future. With that being said, Dr. Brown says the hospital is doing everything it can to prepare.  “We are looking at a surge plan for when things get much busier. Right now, though, we are working well within our capacity as a hospital.”

Though there is an expectation from local medical professionals that there will be a vast increase in cases, Dr. Will Timbers, who works in the hospital’s Emergency Room, says the general public is doing a nice job of staying home. This is lessening the amount of viral cases, and also preventing other acute injuries not related to coronavirus. “There are two things that I think should be said,” Timbers remarked. “I think the community at large should be commended for staying home. We have seen a drop in acute injuries also, because people are not going out and instead electing to stay home.”

Mammoth Hospital Seeking Medical Equipment Donations

Mammoth Hospital is asking for donations of medical personal protective equipment (PPE) and other equipment to help with its treatment of COVID-19 cases.

The hospital is requesting donations of N95 or surgical masks, unopened boxes of nitrate gloves, oxygen tanks and oxygen concentrators that plug into the wall and unused vacuum cleaner bags.

Hospital employees will be at the Cast Off to collect donations on the following dates:

  • Monday, March 30 between 11 a.m. and 1 p.m.
  • Wednesday, April 1 between 8 a.m. to 10 a.m.
  • Friday, April 3 between 3 p.m. and 5 p.m.

Mammoth Hospital is also looking for volunteers to sew masks. Anyone wishing to volunteer should send a private message to the hospital here.

Teamwork and Preparation Most Important in NIHD’s Response to COVID-19

It is an overused analogy, the war against novel coronavirus, but as any employee at Northern Inyo Healthcare District will tell you, the battle is real. Ironically, it is a battle most have prepared for throughout their respective careers.

“Every team member brings something to the fight,” says Dr. Stacey Brown, Medical Director of NIHD’s Rural Health Clinic and current Vice Chief of Staff. “Every department plays a role.”

For NIHD Board President Jean Turner, the show of teamwork fits right into the District’s operational design. “When I came onto the Board, I was told our basic structure is that of an inverted pyramid,”
Turner says. “Leadership at the bottom, the workforce at the top. The top is where the real work goes on; it’s where things really matter. If I wanted our community to remember one thing at this point in time, it’s this: Our staff is disciplined, well-trained, and ready for this challenge.”

The District’s fight against coronavirus began in mid-January. For weeks, Infection Preventionist Robin Christensen, RN BSN HIC, kept an eye on what was transpiring in China. On January 28, she called the first team meeting to talk about coronavirus and its potential impact on NIHD and the community. Everyone in the room knew the odds, had watched the numbers coming in from China.

“It is safe to say we wished for the best, but as healthcare workers, we always prepare for the worst,” Christensen says. “It’s who we are; it’s what we do; it is what the community expects from us at a time like this.”’

As the NIHD team developed needed plans, they carried on with providing day-to-day care. Hallway conversations and internal emails began to refer to coronavirus more frequently. The District conducted a pandemic disaster drill on February 13. The tipping point came March 6 when a two-hour coronavirus meeting gave way to a day-long review of staffing levels, supplies, policies, plans, and shared concerns.

The group met the next afternoon again for several hours. They got a late start, beginning at noon. It gave those who volunteered to help at the Eastern Sierra Cancer Alliance’s Blue Ribbon Walk & Run a chance to meet their commitment. For many at NIHD, it was the last “normal” day of the month.

NIHD initiated an internal Incident Command on March 10 and continues working under it today. Incident Commands use a standardized approach to direct, control, and coordinate emergency response. More importantly, it brings people together to reach a common goal.

Like her co-workers, this was not the first time Allison Partridge, RN MSN, worked under an Incident Command. Partridge, the Director of Nursing for the Emergency and Medical-Surgical departments, knows the system well and aids Chief Nursing Officer Tracy Aspel in keeping the daily meetings on task.

Partridge now spends much of her days working with others to put together workflows for the departments that will be most affected. With guidance from Infection Preventionist Christensen, Partridge
and others closely watch the Centers for Disease Control and Prevention and the California Public Health Department for direction. No area or service escaped review.

“We track daily our current availability of Personal Protective Equipment (PPE), and the recommendations for use,” Partridge says. “Additionally, we have made modifications in how we provide services and how visitors access the campus. All of these measures are in place to protect our teams and community. We encourage all employees to adhere both while at work and at home to the recommendations issued by national, state, and local government.”

Carefully crafted plans address the care of Patients Under Investigation (PUIs). Partridge says the standardized workflows are based on the patient’s level of care, whether that be critical care at the hospital or self-isolation at home. Care of multiple positive COVID-19 patients within the hospital remains an area of concern for the small 25-bed hospital.

“A great amount of planning and preparation has gone into every action, and it’s still ongoing,” Partridge says. She notes that just this week, the team was searching every square inch of the facility for places to place more beds. No space is overlooked. An unused and unfinished room located in the two-story hospital was turned into a four-bed safe patient care area within hours.

As for staffing, the level is adequate at this time. The District is working closely with the American Federation of State, County, and Municipal Employees Union on staffing plans should the virus take hold of the community.

As non-essential services are scaled back, staff in those areas become available for use in others. Nurses and caregivers were surveyed to see if they would be OK to serve in other departments they were cross-trained to work in. Recently retired nurses may be considered for voluntary return to bolster staffing numbers. The dedicated care given by generations of NIHD nurses is legendary in the community.

They were also asked who would be willing to work with critical coronavirus cases. No one will be asked to step into a situation they are uncomfortable with — and to date, no one has opted out.

As for the physicians, Dr. Brown and Dr. William Timbers, NIHD’s Chief of Staff, are relying on the aid and advice of many of the District’s Medical Chiefs – Dr. Richard Meredick (Orthopedics), Dr. Charlotte Helvie (Pediatrics), Dr. Sierra Bourne (Emergency), and others. The Medical Support Staff office issued emergency credentials for other physicians in the area should their aid be required at bedsides.

The Rural Health Clinic team launched drive-in coronavirus testing well before some larger, urban hospitals did. The move was based on when the RHC offered drive-in flu shots more than a decade ago.
“Hometown health care can work anywhere, even in the big city,” Dr. Brown smiles.

Dr. Brown’s reliance on RHC Directors Paul Connolly and Jannalyn Lawrence, RN, is evident. Both work closely with the District’s outpatient clinics and played critical roles in clearing barriers for drive-in testing. When offered kudos for the work, Lawrence scoffed. “One Team, One Goal,” she says, incurring the closing line of the District’s mission statement.

Later, as Director of Nursing Partridge studies the endless worklists that paper the walls of Incident Command, she agreed with Lawrence. “Teamwork has played a huge role in managing every aspect of this situation,” she says. “This collaboration has taken place across all disciplines and has included a multiagency approach across Inyo and Mono counties. This great work truly exemplifies our mission of ‘One Team, One Goal, Your Health.’”

Meanwhile, as another day ends for the District team, Infection Preventionist Christensen is in her office. It is quiet in the usually bustling hallway; the result of the District’s temporary telework plan. Almost 80 employees are working from home, practicing social distancing.

Laying across Christensen’s desk are signs of a community lending its support to its healthcare workers: Packages of the valued N95 masks recovered from businesses and home garages, plus several handcrafted face masks. The handcrafted masks, with bright patterns of cacti, cats, and paisley, are especially touching
to Christensen.

NIHD is looking into options that could allow the homemade masks to be used as covers for approved personal protective equipment. That would occur if, and only if, NIHD’s supply of approved masks is
depleted. The covers would help keep the N95 masks free of transferred hand oils, possibly extending the life of the N95s.

“One team,” Christensen says, circling her index finger, gesturing from east to west, north to south. “It’s all of us in the community. Together, we will get through this.”