Two years ago, on March 6, 2020, an elderly man in Madera County who had returned from a cruise became the first confirmed coronavirus patient reported in the central San Joaquin Valley. That’s the day that his test came back positive for the virus.
Few local medical officials at that time could predict that his case, and another that surfaced a day later in Fresno County, would mark the start of a health crisis that, as of its second anniversary, has sickened nearly half a million residents in the Valley and claimed almost 5,600 lives.
Before that day, what had already been declared a global pandemic seemed very distant from Fresno, Madera, Mariposa, Merced and Tulare counties. But since that time, the pandemic has touched hundreds of thousands of people in the region — either directly by illness or indirectly through the many health orders and business restrictions that ensued in an effort to stem the spread of COVID-19.
The past two years have provided a never-ending series of lessons learned for public health officials.
“I was naive like all of us were; we thought this would end sooner than it is,” said Dr. Rais Vohra, interim health officer for the Fresno County Department of Public Health. “All of us have been through a generational event that’s going to impact us in many different ways and leave us with a lot of memories that we need to work through and grow from.”
“We’ve learned over and over again throughout this pandemic … we can’t take our eye off the ball or else we end up paying a price,” Vohra said of surgeries in cases, hospitalizations and deaths that have followed when officials eased up on measures intended to slow the transmission of the virus within the community.
He particularly noted the social stress in the community of on-again, off-again limitations on businesses and gatherings, requirements for people to wear masks and distance themselves from one another, and pandemic fatigue as weeks turned into months and months into years.
“This started as a respiratory pandemic with a few people having psychological implications. But somewhere along the way it seems to have shifted to a psychological pandemic with people having respiratory complications,” he said. “Even if you’re not hospitalized, every single one of us has had a psychological cost or mental strain.”
A transitional stage for COVID-19
Just two months ago, Fresno County and the Valley were being hit with record numbers of new COVID-19 cases each week in a winter surge fueled largely by the highly contagious omicron variant of coronavirus. New cases in January outpaced previous waves in the summer of 2020, the winter of 2020-21, and last fall’s upswing blamed on another very contagious variant, the delta strain.
In recent weeks, cases have calmed to levels similar to the lull in December, between the delta and omicron surges. The reduced rate of new cases signal that Fresno County and the Valley are “transitioning to a more endemic phase” of COVID-19, Vohra said.
“We know that COVID will still be circulating and still be around,” he said. “We’re just hoping that we’ve done enough preparation and protection of our vulnerable populations to where we can have a minimal number of disruptions to our health care system and obviously minimize the number of hospitalizations and fatalities.”
“We need to understand that ‘endemic’ doesn’t mean ‘end of the pandemic,'” Vohra added. “It just means another type of way that this virus will continue to affect our lives. But we feel very optimism that we can actually reclaim a lot of the activities and a lot of the things that we’ve had to set aside for the last couple of years.”
One lesson learned is that the public and health officials ought not let down their guard against the coronavirus, even after the murky, imprecise point point at which “pandemic” becomes “endemic.”
“We will see another uptick sooner or later in COVID,” Vorha said. “It’s still around, and we know that when the stars align against us, whether it’s a new variant or seasonal changes, … we will see cases going back up. We just hope it’s a very gentle rise … but in order for it to be a gentle rise, we do need to prepare for it.”
Joe Prado, assistant director of Fresno County’s health department, said the pandemic forced public health officials to find new ways to ensure that critical services such as coronavirus testing and, later, vaccinations could be made available to everyone in the county — particularly to people in rural or disadvantaged communities and neighborhoods that have historically had limited access to health care.
Increased collaboration needed to fight coronavirus in Valley
“It’s been phenomenal how this community has come together in a common goal and a common focus,” Prado said. He acknowledged that there have been disagreements within the community on courses of action, but praised the overall collaboration of community organizations, government agencies, school districts and the business community.
“There has been a lot of foundational trust and strength through this response, and I am excited to see what we can do to continue to build on that,” Prado added.
That level of cooperation among agencies and community-based organizations is something that can serve as a model for expanding health care access and other social services to those traditionally underserved residents, said Dr. John Zweifler, a consulting physician with Fresno County who has written and researched on public health services and practices.
“We have much greater awareness of how social determinants of health impact our health and lead to disparities and health inequities,” Zweifler told The Bee in a video interview Friday. He pointed to rates of COVID cases and deaths that were higher among essential workers who were expected to continue coming to work during the pandemic and who are “predominantly over-represented by lower socioeconomic status.”
As a result of the pandemic, public health agencies in Fresno and elsewhere are discovering that addressing social factors affecting health — issues such as housing, food, transportation, domestic violence and others — requires a partnership between health care providers, community organizations and governmental agencies “in a way that’s not really happened before,” Zweifler said.
The key now is to carry on that collaborative momentum rather than resuming business as usual in the aftermath of the crisis response.
“There is certainly that danger,” Zweifler said. “We have to have our fingers crossed a little bit. … There are some really positive things that are occurring, but I think we need to remain targeted in what we do.”
Zweifler also noted that health officials now have a greater understanding of large-scale planning for health crises.
“It’s been two long years, but when you think back to the beginning, there was not an adequate amount of personal protective equipment (such as medical-quality N95 filter masks), there were issues with allocations of resources and staff,” he said .
It also indicated the importance of thinking about public health for a population rather than for individuals.
In the early stages of the pandemic, “if you wanted to get tested and seen, it was hard to go to the doctor’s office. … We had to do it at a population level,” Zweifler added.
“The testing sites that sprang up, the vaccine clinics that were established, shone a light on the fact that thinking in terms of populations instead of individuals was really more effective in providing services in an efficient, effective manner.”
Hospital capacity was a challenge in Fresno County
Local hospitals have also learned to adapt when they were confronted by large numbers of COVID-19 patients, even as they dealt with their normal workload of other illnesses, injuries and maladies not only in their emergency rooms, but in their intensive care units as well .
“One of the things that was not necessarily understood at the beginning was what the impact of staffing would be for hospitals and the entire health care system,” said Dan Lynch, emergency medical services director for Fresno County. “I don’t think hospitals were prepared for the numbers of missing staff” from employees becoming infected or exposed to COVID-19.
Still, he said, hospitals were able to maintain continuity in their operations. Medical facilities were also able to expand into areas of their buildings that weren’t designed for patient care, and to maximize the resources they had available.
COVID-19 was unlike any other type of disaster that hospitals and emergency services had prepared for. In a traditional disaster response, Lynch said, a jurisdiction like Fresno County would ask for help from other counties or from the state or federal government.
“But when the local area, the state and the feds are all having the same disaster, there’s no resources to be had,” he added. “So we have to learn what resources can we depend on locally. We’re on our own. That was something I don’t think we were prepared for.”
A historical perspective on the pandemic
Ethan Kytle, a history professor at Fresno State, researched another pandemic that preceded COVID-19 by more than 100 years — the global Spanish flu pandemic of 1918-19 — and noted in a series of blog posts some interesting parallels between the responses to each crisis.
One major difference is the improvement in science and health care compared to the earlier pandemic.
“We have anti-viral medications and vaccines” that didn’t exist in the late 1910s, Kytle said. “Absent those, we could be looking at more people dead. That’s the miracle of modern medicine.”
And there are some remarkable similarities, too. In two years of the coronavirus pandemic, California imposed stay-at-home orders, severely limited indoor gatherings and businesses and issued a series of mandates for social distancing and face masks. Those are the same restrictions imposed by health officials 103 years ago, “even though they didn’t understand (then) how the disease worked.”
As some in the community have defied or rebelled against mask and vaccine mandates over the past 24 months, the limitations imposed in 1918 and 1919 “sparked the same sort of pushback from various forces in the community who didn’t like them and felt inconvenienced by them,” Kytle said. “It’s striking how many of the things we’ve experienced, from the suffering and death to the social discord, is very similar to what went on 100 years earlier.”