By Mark Gutglueck
Increasingly large numbers of San Bernardino County residents evincing symptoms of the coronavirus have found themselves isolated and without assistance, hemmed in by governmental orders to remain at home, unable to access medical care of any sort, as medical professionals and the county’s overmatched Department of Public Health have been gripped by paralysis which has rendered the most logical providers of medical care seemingly incapable of dealing with the burgeoning crisis.
Meanwhile, the number of confirmed cases of coronavirus within the county has continued to escalate, even as medical professionals confide that the actual numbers of the afflicted are well in excess of what is being officially acknowledged, with estimates on the low side being that the real number of those infected are certainly no less than double that being reported and more likely four to five times the rate laid out by the San Bernardino County Department of Public Health, and perhaps at levels exceeding ten times the official number.
Over the last several days, the known infection rate and both the death toll and death rate have been climbing.
As of early this evening, 353 cases of coronavirus have been confirmed within the county and 13 deaths have been attributed to the virus. Based on those numbers, the death rate among those known to have contracted the disease is put at 3.683 percent.
As of early yesterday, the figures provided by the San Bernardino County Department of Public Health was that there were 254 confirmed cases and six deaths within the county’s confines, pegged at a fatality rate of 2.362 percent. When those numbers were updated at 5 p.m. last night, Thursday April 2, the number had jumped to 304 people positively known to have the virus with eight having died, a death rate of 2.632 percent.
The medical community has been flying blind throughout the escalating crisis, unable to measure with any certainty the extent of the true infection rate, a circumstance brought on by a dearth of testing equipment and capability.
The precise number of San Bernardino County residents who have requested testing from either their medical care providers or the health department is unknown but projected to have exceeded 10,000 by this point. The vast majority of those requests have been turned down because of a shortage of not only test kits but an even larger shortage of the reagent needed to process the samples taken.
Last week, the county undertook what at first seemed to be a promising, but which proved to be a token, testing program offered to the public at large. Those seeking the tests had to complete an application in which they answered questions which the county health department used to evaluate their qualification for the testing. The answers on the applications were compared against a set of criteria to prioritize who would be placed on the testing list and in what order. Applicants meeting the symptomology and age criteria believed to number in the thousands were denied the tests. On March 26, between 380 and 400 tests were administered in a drive-through testing clinic involving mouth swabbings at the Orange Show grounds in San Bernardino.
County officials say they utilized a reasonable screening process to determine the eligibility of the applicants to be provided with the test, which used as a bare minimum qualifier that the individual evince the symptoms of cough, fever, sore throat and fatigue, while giving priority to those age 65 or over, those who had traveled internationally or those who had contact with someone confirmed to have been diagnosed with coronavirus. The San Bernardino County Department of Health has not disclosed how many, or what percentage, of those tested that day were confirmed to be infected, and it has declined to disclose either how many individuals applied for testing nor the number of those applicants who were experiencing coronavirus symptoms. Nor has the Department of Public Health followed up with those individuals showing signs of being infected who had applied for testing with the county and were turned down because of the testing kit/reagent shortage, despite having contact information for the those applicants.
The death rate among those known to be infected in San Bernardino County is alarming both statistically and historically. During the 1918/1919 Spanish Influenza pandemic, the deadliest flu outbreak in known history, roughly 28 percent of the planet’s estimated 1.8 billion population contracted the malady. Of the roughly 500 million people worldwide infected, at least 17 million deaths were directly and indisputably attributable to the disease, while 50 million deaths known to have occurred during the 35-month outbreak from January 1918 to December 1920 were potentially attributed to it. Because of inexact tracking in parts of Asia and South America as well as most of Africa, an unreliable high estimate of close to 100 million deaths has been connected to the disease. This puts the mortality rate for the Spanish flu at 3.4 percent at the low end with 10 percent at the most commonly accepted high end, and a less-accepted 20 percent at the high end. Thus, the mortality rate approaching 3.7 percent among known coronavirus sufferers in San Bernardino County falls close to the most conservative percentage given for the Spanish flu.
Medical professionals have expressed doubt, however, that the 3.7 percent mortality rate from coronavirus in San Bernardino extrapolated from the San Bernardino County Department of Public Health’s figures is accurate, based on the recognition that the number of confirmed coronavirus cases runs significantly below the number of actual cases. The underreporting of the degree to which the virus has actually spread is a direct outgrowth of the inadequate testing that has been carried out.
This would seem to be borne out in the consideration that as of early this afternoon, only 4,003 of the county’s 2.2 million residents had been tested. The 353 shown to have the virus equates to 8.82 percent of the 4,003 tested. Given that most of the 4,003 tested in the county had either shown symptoms or were in a risk category such as having traveled internationally or being in contact with an infected party, it is not a fair assumption that 8.82 percent of San Bernardino County’s 2.2 million residents – 194,040 – are infected. Nevertheless, given the large number of individuals who have evinced symptoms who have not been able to be tested, it is extremely likely, indeed certain, that the actual number of those infected with the virus residing in the county substantially exceeds the county’s officials figures.
This county health department’s reliance upon inaccurate figures and its inability to arrive at a baseline against which to make reliable ongoing and future deductions as is reflected in the county health department’s inaccurate official count, medical professionals and statistical analysts told the Sentinel, has resulted in the medical community being unable to define the parameters of the problem. That reality, they say, represents the first of two alarming failures on the part of the county public health department, the second being its personnel’s apparent unwillingness to actively engage with and thus leave isolated that unknown percentage of the county’s population now dealing with being infected.
Favoritism is clearly apparent in the fashion in which treatment for those afflicted with the coronavirus in San Bernardino County is apportioned. While those of average or below average social standing manifesting symptoms are finding it difficult to get tested to verify their coronavirus status, the well-heeled are not subject to the same limitations. Two weeks ago, anyone willing to pay an extra $500 on top of the other costs associated with a visit to a doctor or medical facility could be tested. That “black market” cost has now risen to around $700. In addition, county government employees have favored status that entitles them to preferential treatment. As of this morning, 15 county employees who work in six different county locations or buildings had tested positive for the coronavirus. One of those is a nurse employed at the Arrowhead Regional Medical Center, the main campus of the county hospital. The nurse and his wife had recently sojourned to New Orleans. He is under care at Redlands Community Hospital.
The six county buildings where infected employees worked do not include the county’s five story administrative headquarters at 385 North Arrowhead Avenue in downtown San Bernardino, in which the offices of the board of supervisors are located along with those of the county chief executive officer and his staff, county counsel, the clerk of the board and county land use services. The areas within the six county buildings where the infected employees worked have been thoroughly cleaned using disinfectant while those workers who came into contact with those infected have been quarantined. To the extent possible, the workforce in those buildings has begun telecommuting in carrying out the majority of job assignments. Attending the reports of the county workers contracting coronavirus was information suggesting that those who worked with or were around the 15 infected employees have been tested for coronavirus, and that all county employees wishing to be tested have either been tested or put into a fast-track queue to be tested.
The vast majority of county residents have gone untested, and have little prospect of being tested for the next several weeks.
There is some conflicting wisdom as to where the blame for that circumstance falls and who bears rightful responsibility for it. How and why the region’s hospitals, medical providers and county public health officials failed to secure sufficient test kits is not something those institutions’ leadership is willing to publicly discuss at this time.
Similarly doctors and small-scale, medium-scale and large-scale providers of medical service in San Bernardino County are husbanding their limited testing resources, making it very difficult for residents of the county to be tested.
Kaiser Permanente, one of the largest providers of medical services in San Bernardino County and Southern California generally, made a decision last week to shutter several of its satellite office in the county, making it more difficult for those who may have contracted the disease to obtain assistance. The shuttered Kaiser facilities include ones in Chino, Colton, San Bernardino, Upland and Victorville.
Neither Julie Miller-Phipps, Kaiser Permanente’s Southern California regional president, nor Dr. Edward M. Ellison, MD, the executive medical director/chairman of the board for the Southern California Permanente Medical Group, deigned to answer questions about Kaiser’s decision to shutter its local medical offices or Kaiser having been left in a position where it is at present unable to provide testing to the vast number of those it provides service to.
Nor was the Sentinel able to reach Jarrod McNaughton, the chief executive officer of the Inland Empire Health Plan, or Karen Hansberger, the chief medical officer of the Inland Empire Health Plan, to speak with them in regard to the failure of regional health service providers to facilitate the provision of treatment to the significant numbers of people within San Bernardino County’s population who are isolated as a consequence of the precautionary sequestering now taking place who yet may have contracted the coronavirus and whose survival is now an issue.
Trudy Raymundo is the director of the San Bernardino County Department of Public Health and Dr. Erin Gustafson is San Bernardino County’s public health officer. Some have sought to lay the county’s inadequate response to the coronavirus crisis at their feet. Neither Raymundo nor Gustafson by this week had formulated a pro-active program to identify let alone make contact with or otherwise gain access to the at-risk isolated portion of the county population to check on those residents’ condition or welfare.
It is unknown whether Gustafson had sought to have the county, the Department of Public Health or Raymundo secure testing kits and quantities of reagent to give her staff and the county, as well as the Arrowhead Regional Medical Center, the main campus of the county hospital, adequate testing capability.
Raymundo is not a health professional, per se, but rather an administrative/managerial functionary. She has been an employee with San Bernardino County since 1990 and moved into a position within the Department of Public Health as a program coordinator in 1997. Over the next 12 years she served in the capacity of administrative analyst in the department and then promoted into the position of assistant director. In 2010, she was elevated to serve as interim director of the department. In 2012, the qualifier “interim” was dropped from her title and she became the Department of Public Health’s director. She is neither a nurse nor a doctor, and she has no extensive training in the field of medicine or the biological sciences. Rather, she holds a bachelor’s degree in accounting and business management from California State San Bernardino.
There have been suggestions that Raymundo, who is provided with a base annual salary of $175,000 together with $125,000 in benefits and add-ons for a total yearly compensation of $300,000, failed to act with alacrity during the early stages of the coronavirus outbreak to use her hard-nosed business acumen and the negotiating leverage she had as a department head with California’s fifth largest county population-wise to purchase adequate reserves of equipment, devices, materials and medicine to meet the crisis head on. Some have suggested that the board of supervisors, which has co-existed with Raymundo as the head of the Department of Public Health for a decade because of her ability and willingness to live within the budget provided to her department, is now scapegoating her because through the board’s tightfisted approach it had failed to appropriate an adequate amount of funding to her department in time for Raymundo to go out onto the open market and purchase, using the economies of scale that large bulk orders of the needed testing products would have made for, the needed kits and quantities of reagent.
County Spokesman David Wert referenced Raymundo as “a competent, hard-working, and accomplished professional whose department under her leadership has earned national accreditation and won numerous state and national awards for innovation and public service; someone who is putting in long hours seven days a week to protect our community when she could easily walk away and retire comfortably.”
Wert said, “The shortage of testing materials is a national problem that has been experienced equally in every county in the nation. No one in this country has all the testing components they need. Our county follows the testing criteria set by the Centers for Disease Control and California State Public Health, which dictate only those with active symptoms of COVID-19 [coronavirus] shall be tested. The San Bernardino County Department of Public Health doesn’t decide who gets tested and who doesn’t. Private doctors decide which of their patients meet the criteria and will be tested, and the public health department or one of the two commercial labs operating in the county conduct the tests.”
Efforts by the Sentinel to reach both Raymundo and Gustafson were unsuccessful.
Meanwhile, feverish and in pain, in some cases finding it difficult to breathe, having contracted a virus that could kill them, cowed by the governmental imposition of a lockdown and threats of arrest for the breach of that restriction, unable to get treatment for their condition or a determination of whether they are indeed infected with the coronavirus or not, a segment of the county’s population yet in confused isolation awaits those agencies of their government chartered to protect them and their health to shake off their indolence and actuate themselves to carry out the mission the county’s taxpayers have employed them to perform.