In January 2020 the United States watched as a threat, unknown to modern man, swept the globe.

The majority of US residents probably remember the Avian Flu scare, and Swine Flu pandemic. But the novel coronavirus spread faster with much greater health consequences. Scientists spent the first several months of the pandemic studying the virus to better understand the threat it posed.

It wasn’t an influenza virus like the Avian or Swine Flu.

It presented as a deadly viral pneumonia caused by an unfamiliar coronavirus.

Like SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) which are also coronavirus diseases, COVID-19 attacks the respiratory tract similarly to the common cold. But COVID-19 -- SARS-COV-2 -- caused severe illness rather than the mild symptoms that were more often seen in previous coronavirus infections.

A press release from the World Health Organization on Jan. 12, 2020 states, “At this stage, there is no infection among healthcare workers, and no clear evidence of human to human transmission.” At the time there were 41 confirmed cases and one death attributed to the novel coronavirus, now most often referred to as COVID-19. That singular death was noted in the WHO’s press release as having occurred in a person with, “serious underlying medical conditions.” All known cases at the time were confined to the city of Wuhan, in Hubei Province, China with the first symptom onset having been reported as early as Dec. 8, 2020.

At the time of the release the WHO reported that no new cases had been detected since Jan. 3, 2020.

Information from the WHO recommended that travel restrictions not be placed. “International traffic: no restrictions recommended.” Further, “WHO does not recommend any specific health measures for travellers. It is generally considered that entry screening offers little benefit, while requiring considerable resources.” The statement goes on to say, “WHO advises against the application of any travel or trade restrictions on China based on the information currently available on this event.”

The world was told that between Jan. 3 and Jan. 12, 2020 no new cases had been reported inside or outside of China.

Knowing what we know now about the replication rate of the COVID-19 virus -- for every COVID-19 positive person taking no health safety precautions two to four other people could be infected per day -- and having lived through the death and social destruction of the virus for more than a year since, the data released by China was inaccurate at best.

According to an archived COVID-19 timeline on the WHO website, on Jan. 22-23 “The WHO Director-General convened an Emergency Committee (EC) under the International Health Regulations (IHR 2005) to assess whether the outbreak constituted a public health emergency of international concern.The independent members from around the world could not reach a consensus based on the evidence available at the time. They asked to be reconvened within 10 days after receiving more information.”

The Emergency Committee reconvened on Jan. 30, sooner than the expected 10-day period. “This time, the EC reached consensus and advised the Director-General that the outbreak constituted a Public Health Emergency of International Concern.” In that timeframe, Jan. 12 to Jan. 30 there were nearly 8,000 new confirmed cases spread across 19 countries.

COVID-19 in America

The declaration of a Public Health Emergency came from the U.S. Department of Health and Human Services on Jan. 31, 2020.

The emergency declaration was made by then HHS Secretary Alex M. Azar II under the legal authority of the Public Health Service Act. “The PHS Act forms the foundation of HHS’ legal authority for responding to public health emergencies. Among other things, it authorizes the HHS Secretary to lead all Federal public health and medical response to public health emergencies and incidents covered by the National Response Framework; to direct the U.S. PHS and other components of the Department to respond to a public health emergency; to declare a public health emergency (PHE) and take such actions as may be appropriate to respond to the PHE consistent with existing authorities; to assist states in meeting health emergencies; to control communicable diseases; to maintain the Strategic National Stockpile; to provide for the operation of the National Disaster Medical System; to establish and maintain a Medical Reserve Corps; and to potentially provide targeted immunity for covered countermeasures to manufacturers, distributors, certain classes of people involved in the administration of a program to deliver covered treatments to patients, and their employees.”

The declaration allowed the release of federal disaster relief funds to support states’ requests for emergency assistance in response to the public health crisis, and was the catalyst for the FDA’s issuance of Emergency Use Authorization for the vaccines that are currently being administered world wide.

Where are we now?

The state of our nation, and on a much smaller scale our own community, is still soaked in uncertainty.

There is no Public Health Emergency end date. In fact, the “Renewal of Determination That A Public Health Emergency Exists” that will take effect on April 21 was posted in advance on the US DHHS website awaiting Secretary Xavier Becerra’s signature.

A letter dated Jan. 22, 2021 was sent to state Governors by then acting Secretary of HHS Norris Cochran that stated, “To assure you of our commitment to the ongoing response, we have determined that the PHE will likely remain in place for the entirety of 2021, and when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.” The reasoning behind this decision is to maintain “Predictability and stability...”

What’s next?

There are no specific criteria or data targets that we can aim for that would offer a sense of hope in this temporarily permanent existence of continued vigilance against a virus that remains uncontrolled even in the face of extended social isolation, physical distancing, mask wearing, increased education, and now mass vaccination.

“A PHE declaration lasts until the Secretary declares that the PHE no longer exists...The Secretary may extend the PHE declaration for subsequent 90-day periods for as long as the PHE continues to exist, and may terminate the declaration whenever he determines that the PHE has ceased to exist.”

As of April 20 California’s COVID dashboard, https://covid19.ca.gov/state-dashboard/, lists 3.62 million total COVID-19 positive cases, approximately 11% of the nationwide total of 31,484,148. More than 26 million vaccine doses have been administered in California, approximately 12% of the national total that was reported by the CDC as 211,581,309.

Of the fully vaccinated individuals nationwide there have been 6,000 reports of breakthrough virus. Instances of vaccinated individuals that have become infected after receiving a vaccine is not unheard of, nor are the numbers high enough to be considered abnormal or concerning. Similarly, those who have received the vaccine and had a negative reaction to it or suffered a secondary health condition post vaccine have so far been within a normal accepted range in comparison to the same illnesses occurring naturally in the population.

The office of California Governor Gavin Newsom posted to Twitter on April 15, “We are on track to fully reopen by June 15, if hospitalizations stay low and Californians continue to get vaccinated.” A statement that certainly offers some semblance of hope that Californian society could return to a much less restrictive and healthier state sooner rather than later.

It also provides some optimism that local government bodies that are still operating via video and teleconference in accordance with Newsom’s Executive Order N-29-20 will return to in-person meetings. An event that has been anticipated by Patterson residents for several months now.

Stanislaus County Board of Supervisors has been holding in-person meetings following social distancing and mask protocols, as well as providing live-stream access to meetings. Patterson Joint Unified School District has also held socially distanced in-person meetings with live streamed Web-Ex access throughout the pandemic.

However, Patterson City Council has refrained from meeting in the chamber at City Hall, electing instead to attend meetings completely virtually. An action that hasn’t been well received by all residents who would prefer in-person attendance. Dale Torres, a Patterson resident, has repeatedly asked the council during public comment periods over multiple meetings when in-person meetings would resume. And the only answer he has received publicly has been various iterations of, ‘We’re following state and county guidelines due to the public health crisis,’ from City Manager Ken Irwin. An answer that has yet to satisfy Mr. Torres and others.

The Irrigator contacted Stanislaus County Public Health on April 13 to get clarification for this article. Several questions were sent to their public information officer via e-mail.

Questions asked included: “What criteria, specifically, constitutes StanCo's continued public health emergency? And is there a stationary target that we can anticipate meeting that will end the emergency status?”

At the time of publication, no response had been received.

It’s unknown what exactly will bring an end to the public health crisis, but the light at the end of the COVID-19 tunnel seems to be getting brighter.

Author’s note:

This article has been an attempt to share with our readers information about the public health crisis that is clear and easily understood.

Unfortunately, recapping an ongoing public health emergency that has lasted for 15 months with a focus on how the PHE will end has been anything but clear or easily understood.

Some of the information shared in this article is vague and could be interpreted as being included by the author to purposefully only share what suits a singular narrative. This is not the intention of the author or of the Irrigator.

It is the opinion of the author that the questions that remain unanswered by public health officials remain unanswered because they don’t know what the answer is. I would go even further to say that there is no firm answer.

Government agencies work from the top down. Federal officials direct state officials direct county officials direct city officials.

If our city manager and county public health officials don’t know an answer to a question, it’s likely because no one at the state and federal levels have told them what the answer is.

For a question as commonly discussed as, “When will the public health crisis end?” to remain unanswered but for the vague, ‘When the public health director feels like it’s no longer a crisis,’ it seems less likely that the answer is being withheld with ill intent and more likely that there simply isn’t an answer to give.

The human brain is hardwired to solve problems. And when no answer is forthcoming, conjecture takes the place of certainty.

What comes next? What criteria needs to be met to end the public health emergency? I don’t think anyone really knows.

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