County of Ventura COVID-19 update for March 28

March 28, 2020

County of Ventura Doctors:

Daniel Cox, MD, Palliative Care

Nessa Meshkaty, MD, Infectious Disease

Melissa Barger, MD, Infectious Disease

In the near future we are going to experience a coronavirus surge here in Ventura County. We don’t know exactly what it will look like or feel like, but it will affect all of us.

Here’s what we all need to understand: this virus is dangerous. For many of us – including younger people who are indeed contracting the virus at a high rate – coronavirus will feel like a bad flu. With luck, rest, and fluids, one could ride out the fever, cough, and body aches and start to improve over a period of weeks. However, if our experience in Ventura County is similar to other areas, up to twenty percent of confirmed cases will have a different experience.

Let’s put this in perspective for our county, population ~850,000. In a worst-case scenario, 1 in 5 confirmed cases of COVID-19 will progress to serious illness requiring hospitalization. One quarter of those hospitalized patients with COVID-19 will further decline to the point where they need a ventilator and life support to survive. Using an epidemiologic model recommended by the California Department of Public Health, we find that without strict social distancing, we will need 18,000 ventilators to take care of the sickest patients at the peak of the surge on day 58 of the outbreak. Yet we have only an estimated 180 ventilators across the 8 hospitals in Ventura County. Hospitals in Italy, Iran and now New York City have been overwhelmed when the infection rate spiked, and many have died that would otherwise have had a chance at surviving.

We realize that what we are saying is difficult to hear, but we also want to be very clear. These patients are not going to remain abstract statistics. This may well be someone you love, someone you know. Nonetheless, as your community health care providers, we wish to share this message: we are here for you. We are preparing for the surge every second of every day. We will care for you. We take our responsibility to the community seriously. But you have a responsibility to our community as well. Ultimately, despite our best efforts, we cannot adequately care for a sick population that exceeds our capacity. If the rates of coronavirus spike and our county residents all need acute care simultaneously – there will not be enough beds, and many will be denied the care that we would all expect to receive, leading to loss of life.

We understand why most people struggle with the idea of sheltering in place. It imposes limits on our basic freedoms. We are social animals by nature and our joy is tied to our interpersonal connections. Layer on top of that the real need to earn a living to support our families and it can feel like an impossible ask to stay at home. And yet human interaction is the fuel that spreads this virus. Everything we do and everywhere we go – the sum of our normal activities – are like dry brush in a forest fire for coronavirus. But by staying home – when we deny the virus pathways and carriers to spread – the virus starves. Ironically, after weeks of sheltering in place, if we see that nothing much has happened – that’s when we’ll know that our sacrifice made all the difference.

So here is the good news. If we are able to sustainably reduce social contact by 60%-70% and improve testing and treatment, the aforementioned epidemiologic model suggests we could improve from that worst-case scenario of 18,000 ventilators needed on day 58 to a much more manageable peak of 475 ventilators on day 170 of the outbreak. That extra time is critical for our hospitals to build ventilator capacity and allow for the developments of novel treatments. Thousands of lives would be saved. The key is sustaining the recommended reduction in social contact for that prolonged period of time.

As your physicians in Ventura County, we care deeply about our community and providing the best care possible to our patients. That is why we are asking you to honor Governor Newsom’s order to stay home. Each week that we shelter in place gives our health care system a chance to adapt and build our defenses to better prepare for the coronavirus surge. Your efforts and sacrifice now will save lives of people you know and love in the future. We thank you.