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What it’s like in California’s worst hot spot as cases stay low elsewhere

San Francisco Chronicle logo San Francisco Chronicle 11/25/2021 By Katie Licari

Jessica Sharkey has been teaching for 19 years. This one is the hardest.

Not only is the fourth-grade teacher at Bishop Elementary School again facing a roomful of wriggling, masked children every day, but as many as six have been absent in a given week, making it difficult to keep all students caught up as COVID-19 surges around them in rural Inyo County. The county has had the state’s the highest coronavirus case rate for much of the fall.

With challenges like having students out in quarantine for extended periods, Sharkey, whose school is in Bishop Unified School District at the northern end of the county, says the past several months have been “emotional and draining.”

“You know more is being asked of us and you don’t have more hours in the day,” said Sharkey. “You are trying to be here for all of these kids and be here emotionally and physically.”

Inyo, a vast, rugged county of 18,000 that adjoins the Nevada border and includes Death Valley as well as eastern slopes of the Sierra Nevada and towering Mount Whitney, has struggled like a number of California’s rural counties with the pandemic ravages that affect schoolchildren and adults alike. In September and October, while much of the state saw cases taper off, Inyo’s case rate continued to soar — surpassing even the peak of last winter’s surge, which in most places marked the worst period of the pandemic.

In October, the county reported a larger number of pediatric and adult cases, by far, than any other month. As of Wednesday, Inyo’s case rate has fallen to a seven-day average of 43 cases per 100,000 people per day, but it remains among the highest in the state and is well above the state daily average of 12 cases per 100,000 people.

County hospitals, with 29 beds total, have struggled to appropriately isolate COVID patients, said county Deputy Director of Public Health Anna Scott. Staff levels have been strained. With limited specialist and intensive care resources in the county, and neighboring rural counties struggling as well, severely ill patients have been transferred to hospitals as far away as the Bay Area, Los Angeles and western Nevada, officials said.

“Once we start getting a little strained in our hospital systems, we are concerned about (being able to) move people out fast enough if we have higher severity cases that need a higher level of care,” said Scott.

It got so bad that on Oct. 26 the county’s public health officer imposed a mask mandate for nearly all indoor public settings for the first time since California’s statewide mask mandate was lifted in June. Such restrictions have been commonplace in the Bay Area and much of the state for months, but the mandate drew objection from some residents who complained at Board of Supervisors’ meetings about government heavy-handedness, often referencing conspiracy theories.

“You’ve heard repeatedly from the public, trying to wake the board up out of a slumber concerning government overreach with COVID masks, PCR tests and pseudo-vaccines,” resident Wes French said during the board’s public comment session on Nov. 16. He compared vaccine and public health mandates to human experimentation.

Other residents, however, backed the mask mandate, including Frances Hunt, who wrote the board that it was a “small price to pay.”

The “mask mandate supports our goal of keeping businesses open and allowing kids to attend schools,” she wrote.

County Supervisor Matt Kinsley asked the county health team to explain what caused the spike. Dr. James Richardson, the county health officer, did not have a specific answer, but said the recent drop in cases was likely due to people wearing masks.

Scott, the deputy health director, said in an interview that the county’s situation likely is tied to factors including the highly transmissible delta variant, school reopenings and larger community events in the summer compared to last spring. While the county sees increasing compliance with the new mask mandate, “We are hearing some reports of individuals who are observing that people are not always wearing their face coverings in indoor public settings,” Scott said.

The county’s many visitors, who come for its phenomenal outdoor recreation, may have also have contributed to the spread, she said. Death Valley National Park, for example, saw a nearly 50% increase in visitors this year through August compared to the same stretch of last year, though it is not quite back to pre-pandemic levels.

About 63% of Inyo residents 5 and older are fully vaccinated, according to county figures updated Monday. That is slightly lower than the state’s 5-and-older vaccination rate of 67%, and significantly lower than the Bay Area’s most highly vaccinated counties. In Marin County, 87% of residents 5 and older are fully vaccinated, and in San Francisco it’s 80%.

But Inyo’s vaccination rates are higher than some other, mostly rural, counties that currently have lower case rates. In Kings and Madera counties, for example, less than 50% of residents 5 and older are fully vaccinated, yet both counties have lower case rates than Inyo.

Rural counties like Inyo, with their limited health care resources, face unique challenges with patient loads that while not numerically large by metropolitan standards still strain the local capabilities, said Dr. Joy Engblade, chief medical officer and hospitalist at North Inyo Hospital, which serves Bishop — Inyo’s largest town, with a population just under 4,000 — and surrounding communities.

“We have to do a lot more and different triages than you would have to do in the city,” Engblade said. She often faces a situation in which, she said, “I kind of have to have a crystal ball to think if this person is going to get worse quickly.”

During the height of the surge, the county tried to keep the hospital patient load down by using an oxygen delivery program for patients residing within 30 minutes of the Bishop hospital who could get by with smaller amounts of oxygen.

“The goal is to decrease exposure for everyone involved — the patient, their family, and all of our staff — so if the patient needs a little bit of oxygen and are otherwise mentally alert and doing OK and [they] live fairly close to the hospital, we try to discharge them home,” said Engblade.

Other challenges include patients, especially older longtime residents, who are reluctant to be transferred out of the area when their condition warrants more elaborate care.

“They don’t want to be put on a ventilator or die alone in a far-off hospital,” Engblade said.

One patient, whose children went to local schools, stays in her mind. “He didn’t want to be transferred. He just wanted to try and fight it, and you know I had to stay and watch him die, slowly over two weeks.”

“It is not the volume of death that is difficult, it is the connectedness we have to the patient,” Engblade said.

The cases in the schools also have been painful. Infections have risen this fall, along with the spike in cases in the adult population, said Scott.

Between when children returned to school in August and Nov. 10, 4.8% of Bishop Unified’s 1,941 students tested positive for COVID. By comparison, San Francisco Unified’s positives were 1.8% of students. The first letter to Bishop Unified parents announcing an exposure at school came four days into the school year. The district has sent out close to 100 more of these parent notifications as of this week.

“What we are seeing is a lot of transmission within households and schools even though schools have a lot of safety measures in place,” said Scott. “It is somewhat perplexing because all the schools have good protocols in place, but they only have so much control.”

County health officials work closely with the school districts on state public health guidelines, Scott said, but they don’t control activities away from school.

According to Bishop Unified’s superintendent, Katie Kolker, students have mostly complied with wearing masks, as mandated by the state for all schools.

The district has on-site COVID testing three times per week and beefed up contact tracing.

“We have tried really hard to be as least restrictive as possible while keeping students in seats, but the contact tracing has been overwhelming and hard to keep up with” as infections have escalated in the community, Kolker said.

Despite pandemic-related absences for both students and staff, school goes on.

“I can’t stop teaching,” Sharkey said.

As case rates drop, Scott predicts two possible scenarios for the winter in Inyo — one more hopeful and the other darker.

“On the rosy side my projection is that we’re increasing our vaccination rates, week by week, and many people have potentially some natural immunity from this outbreak so we are hoping to keep our case rates low throughout the winter,” she said. “There is light at the end of the tunnel.”

County officials will continue to urge cautious behavior, she added, in hopes of avoiding the bleaker scenario: “We could easily bump our case rates up again as people get together and celebrate through the winter season (based on) what we saw last year.”

“We are hoping it won’t spike to that level again.”

San Francisco Chronicle staff writer Catherine Ho contributed to this story

Katie Licari is a San Francisco Chronicle staff writer. Email: katie.licari-kozak@sfchronicle.com

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