Marin health leaders say COVID-19 helped fortify system

Mar. 17—Something was odd at the public meeting convened by the Marin County Office of Education on March 9, 2020. The chairs for attendees were spaced an ominous 6 feet apart.

At the meeting, Dr. Matt Willis, Marin County's public health officer, announced that if a case of coronavirus were to occur in a school, it would be closed for 14 days.

"This is likely something that will be part of our response as a community for the next couple months," Willis said at the time.

Looking back today, four years after COVID-19 was declared a national emergency and a global pandemic by the World Health Organization, Willis said, "What I didn't recognize and none of us did was how long the pandemic would last. At that point, we weren't aware that the virus would continue to evolve in ways that would evade our immune systems."

"The pandemic has obviously impacted everyone and caused a lot of grief and loss for everyone in different ways," Willis said. "That being said, it could have been a lot worse, actually."

To date, there have been 359 deaths in Marin County due to COVID-19, and the disease has sent 3,605 Marin residents to the hospital. California, however, had twice the number of deaths per 100,000 residents, and the nation as a whole had 2.5 times the number of deaths per 100,000.

Over the last four years, more than 908,000 COVID-19 vaccine doses have been given to Marin's populace of about 260,000 residents. Ninety-one percent of the county's residents have received their primary series of COVID-19 vaccinations, compared to 72.9% statewide, and 31% of Marin residents are up to date with their vaccinations, compared with 13.9% statewide.

In fact, Willis himself became the 39th person in Marin to become infected with COVID-19. He believes he caught the virus when Bay Area public health officials met in San Jose on March 15, 2020, to decide to issue a regional stay-home order. This was before vaccines or any treatments became available.

"I had never been more sick in my life," said Willis. "I had pneumonia and was laid out for almost three weeks."

Willis said COVID-19 has resulted in several changes that have strengthened Marin County's public health system and made it better prepared for the next major outbreak or medical challenge.

First of all, the pandemic has resulted in the county receiving about $1.1 million annually in additional state and federal funding for public health.

"Part of the lesson learned nationally," Willis said, "was that public health as a sector had been under-resourced historically."

The county now has an outbreak prevention and infection control team that focuses on outbreaks in nursing homes and residential care centers. The team conducted 81 site visits in 2023.

"We now have permanent ongoing funding for a staff of nurses to be liaisons with those facilities," Willis said.

Early on in the pandemic, some of the highest mortality rates occurred in nursing homes. Dr. Elizabeth Lowe, who was MarinHealth Medical Center's director of primary care at the time, was one of the first to recognize the need for more testing of Marin nursing home residents.

"I basically took over a van that we had been using for patient transport, put supplies from the COVID clinic we had opened up recently in the van and started driving to the facilities," Lowe recalled.

Later she would receive funding from the Marin Healthcare District and assemble a team that included six college volunteers.

"Every day was a new day at the improv, because you never knew what you were doing," Lowe said. "You just tried to do the next best thing."

Lowe said the experience resulted in a new level of cooperation among MarinHealth, its competitor, Kaiser Permanente, and the county public health office.

Willis said the pandemic has also led his office to develop more external partnerships.

Every public school in Marin now has certain members of the staff designated to serve as liaisons with public health officials and meet regularly with them.

In addition, Marin County is working with community-based organizations, faith-based organizations and schools in Marin City, San Rafael's Canal neighborhood, Novato and western Marin on an ongoing basis to address COVID-19 and other health threats such as opioids.

Two issues in these areas with low-income, minority populations sparked the initiative. Early in the pandemic, infection rates in the Canal neighborhood were disproportionately high because of the inability of the predominantly low-income Latino population to miss work and access vaccinations. In addition, vaccination rates in Marin City remained low even after community vaccinations were offered.

Willis said the county formed community-based response teams to address both of these issues, but perhaps could have done so earlier.

The county has also pioneered the analysis of wastewater as a means of spotting the emergence of new viruses in the community.

"That wasn't anywhere on our radar screen before the pandemic," Willis said.

Willis noted that more than a century passed between the 1918 flu pandemic and COVID-19. He said that because of a number of factors, including international travel and global supply networks, the next pandemic will likely occur sooner.

Willis said public health funding and infrastructure provided during the pandemic is nearing a funding cliff as the nation seems to be lapsing into a "pandemic fatigue."

"It could leave us more vulnerable, not just to a pandemic, but to other threats," he said.

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