San Diego County officials give inconsistent, confusing COVID-19 statements

San Diego County officials have held daily news conferences since the beginning of March to update the public on the coronavirus pandemic. Almost every day, they provide the latest numbers of COVID-19 cases and deaths, recite the newest guidelines and rules for residents to follow, and explain the ever-changing steps they’re taking to curtail the spread of the highly contagious virus and the deadly disease it causes.

The briefings offer real-time insights into how the county is tackling one of its largest-ever public health crises. Officials are learning new information every day from research papers, news articles and federal agencies, and they use what they learn to try to inform and protect San Diego County’s 3.3 million residents.

But while most of the facts presented in the briefings have been accurate and thoughtful, some of the officials’ statements have caused confusion and concern.

inewsource reviewed all of the county’s news conferences from March 3 to April 14, and we found that officials have repeatedly made assertions that are incorrect and contradictory. We’ve compiled nine examples and explained the county’s inconsistencies using information from local, national and international sources to ensure the public has the most precise and updated information possible.

Many of the questionable comments were made by Public Health Officer Dr. Wilma Wooten, who oversees a staff of roughly 500 employees and operates a budget that’s larger than $100 million. She received the national public health heroes award for coordinating the county’s response to the H1N1 influenza outbreak in 2009.

Wooten didn’t directly respond to inewsource’s fact check, but county spokesman Michael Workman did, providing comments that we incorporated throughout this story.

“Before going to the responses, it bears repeating that we have been in and remain in a highly fluid situation,” Workman said in an email. “An emerging disease. A novel virus. That reality often involves an evolution in recommendations, facts and opinions from health experts.”

Workman said the county is adhering to guidelines from the Centers for Disease Control and Prevention and doing its best to provide the most accurate information it can.

“The County is being as conscientious as possible in balancing the need to inform the public with the demand for accuracy and timeliness,” he added. “When facts need to be updated or corrected, we have done so via press conferences, CNC stories (posts on the county’s website), social media and other available means.”

1. Six feet of social distance

San Diego County enacted a public health order on March 18 that drastically changed the lives of its citizens: It closed non-essential businesses, limited gatherings to 10 people or fewer and advised residents to stay home when possible, all in an effort to slow the transmission of the new coronavirus.

Since the county didn’t provide a detailed list of what an “essential” business is, it left some business owners guessing whether they qualify.

At a news conference the next day, a reporter asked Wooten to explain whether hair and nail salons should remain open, because some had decided to do so. Wooten said those businesses “might be considered essential” and wouldn’t have to shut down if workers maintained social distance and wore face coverings.

“If you get a pedicure, the person is at your feet — that’s about six feet,” Wooten said. “If you get a manicure, you are across from a table. That might not be exactly six feet, but many of the operators are wearing masks.”

Wooten’s answer didn’t align with guidance from the CDC, which has said proper social distancing entails six feet of physical distance.

Touching someone’s feet or hands for extended periods of time, like a manicure-pedicure that could last an hour or more, could actually fall into the category of “close contact,” which the CDC defines as being less than six feet away from someone for a “prolonged period of time.”

The CDC has said that close contact is the main way the coronavirus is spreading.

Gov. Gavin Newsom issued an executive order the day after Wooten made her comments on nail salons that required Californians to stay inside. He provided a list of “critical infrastructure” businesses that could continue to operate, but hair and nail salons were not on it.

Three days later, Wooten said the county would be complying with the state’s order and all nail and barber shops would close.

2. Asymptomatic transmission

During a March 15 interview with Pastor Miles McPherson of The Rock Church, Wooten said people who are infected with the coronavirus but do not show symptoms cannot spread it to others.

“If you don’t have symptoms, that means that you cannot transmit it to other individuals,” Wooten said. “If you are not actively displaying symptoms, the thinking right now is you cannot spread that to another person.”

McPherson responded, “That makes me feel good. So if people are healthy, at least feeling healthy and they don’t have symptoms, they don’t have to worry about passing it to somebody?”

“That is correct,” Wooten replied.

Yet at the time of the conversation, multiple international research studies and an outbreak in Massachusetts had already provided evidence that asymptomatic transmission was commonplace.

In January and February, scientists used mathematical models to better understand the path of the coronavirus in Tianjin, China, and Singapore, CNN reported. Each study found that asymptomatic spread was responsible for a significant amount of the virus’s transmission.

An example of possible asymptomatic transmission hit the U.S. in February. After workers at a Cambridge, Mass., biotechnology company attended a business meeting, three employees soon tested positive for the virus, even though none had symptoms when the conference began. Within weeks, at least 82 attendees had contracted it.

On March 16, the day after Wooten’s interview with the pastor, a reporter asked the public health officer at a news conference to clarify her statements about asymptomatic transmission. She repeated what she had previously said.

“There are a lot of myths out there, and based on the evidence and the research that we have today, we are not aware that people can transmit the disease without symptoms,” Wooten said.

“People think that if you don’t have symptoms, you can transmit the disease,” she added. “There are studies going on where asymptomatic people are being tested to determine if that in fact is true, but we do not have the results of those research data at this time.”

Workman, the county spokesman, told inewsource the county was following the CDC’s guidance at the time.

“While you are correct that at that time a small number (of) studies were beginning to show asymptomatic spread was a possibility, the CDC did not confirm or endorse that as a possibility until later,” he wrote.

However, at the time of Wooten’s statement, the federal agency had already acknowledged that asymptomatic transmission was possible.

“Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads,” the CDC’s website said in early March.

Since then, it’s become much clearer that carriers without symptoms are fueling the pandemic, and they may be responsible for upwards of 1 in 4 coronavirus infections. The realization has prompted the CDC and officials in California and San Diego County to recommend residents wear face coverings whenever in public.

3. Mail germs

On April 3, a reporter from CBS News 8 asked the county to confirm that employees at a Chula Vista UPS had tested positive for the virus.

“Shouldn’t the public be informed (since) these packages are being delivered around the county?” the journalist asked.

Wooten would not confirm an outbreak at the mail facility.

Instead, she said, “Well, newsflash, packages that were delivered before COVID-19 had germs on them. So this is not the first germ that is being detected on packages, and we don’t know that that indeed is the case here. As I think it was cited in an earlier media briefing, you should wash your hands.”

But the novel coronavirus isn’t identical to the other “germs” that came before it. For one thing, the coronavirus is also considered more contagious than the flu: Estimates suggest that each person with the virus could infect two to four people, while those with the flu infect an average of 1.3 people. Plus, the death rate of the pandemic-causing virus is roughly 10 times that of the flu.

New research that came out more than two weeks before Wooten’s comments shows the coronavirus can last on surfaces for extended periods of time. The study published on March 17 in the New England Journal of Medicine found that COVID-19 can survive on cardboard, such as shipping boxes, for up to 24 hours.

4. Case breakdowns

Officials have been inconsistent in the kind of details they’re willing to provide about COVID-19 patients.

They’ve repeatedly said that the county won’t tell reporters what industry the patients work in or where they are employed, citing privacy concerns and stating that employers are the ones who can release that information to the public if they wish.

Health officers have declined to confirm or answer questions about COVID-19 positive cases that have occurred at specific restaurants, shopping centers and mail facilities, nor would they provide the number of cases among military personnel or healthcare workers.

However, on some occasions, the county has provided employer- and industry-level specifics, including when an outbreak occurred at a San Diego VA counseling center and when a worker at an Albertsons grocery store in Escondido contracted the virus.

On March 28, when asked how many pharmacy workers have tested positive for COVID-19, Dr. Eric McDonald said, “We do follow the occupational roles of each of our individuals who are positive for COVID,” confirming “a couple of pharmacy technicians” have contracted the disease.

McDonald is the county’s medical director of epidemiology and immunizations services. Three days after his comment, when asked to confirm a cluster of cases at an El Cajon pharmacy, he declined, saying, “We will confirm a specific location when there is a need to inform the public to take a different action to protect themselves and the actions the public needs to protect themselves.”

Workman told us the county only speaks about outbreaks at locations where employers publicly disclosed them first.

“We are constantly balancing what information the public needs to make informed decisions to protect their health, while concurrently respecting the privacy of individuals who are the subject of infectious disease investigations,” he wrote.

5. Homeless patients

Officials have also been inconsistent when it comes to releasing the housing status of COVID-19 patients. On March 31, county Supervisor Nathan Fletcher announced the first three cases of homeless people contracting COVID-19. The unsheltered residents were moved to nearby motel rooms, he said.

The next day, Fletcher announced the county would no longer be providing the housing status of people with COVID-19.

“We shared yesterday that a handful of (homeless) individuals had tested positive to make sure it was clear from the day before the change that had happened.” Fletcher said. “But moving forward into the future, we don’t plan to break out and classify the percentage of positive cases by sheltered or unsheltered.”

He repeated that language at a briefing the following week, saying the county doesn’t track whether people with COVID-19 are homeless, even though it was able to track cases by race, age, ZIP code and other demographic information.

“We’re doing everything we can to identify early any unsheltered individual who may have symptoms, and to make sure we get them in to treat them. But we don’t track the total number of tests by that breakdown,” Fletcher said on April 7.

Fletcher’s office wouldn’t explain on Friday why the county wasn’t tracking the number of homeless people with COVID-19.

On Monday, Fletcher’s position abruptly changed. In response to multiple questions on the topic, the county would now provide COVID-19 case breakdowns based on housing status, he said.

“We’ve been asked several times about the number of positive tests for the homeless,” Fletcher said. “And while we previously have not reported these as separate from the overall numbers, we do believe that it is appropriate to share them on an ongoing basis given the challenges coronavirus presents to this population and the wide variety of efforts that are in place to try and help these individuals.”

Fletcher said the county has recorded 13 cases of COVID-19 among the homeless, and four of those individuals were living in shelters. Of all the homeless patients, 11 have been moved to motels for isolation, and two are in hospitals.

When an inewsource reporter asked why the county wasn’t providing this level of detail before Monday, Fletcher said the county wanted to ensure the data was correct before giving it out.

“We never want to be in a situation where we are sharing something with you that we don’t have the highest degree possible confidence that that information is accurate,” he said.

6. Drugs to help with COVID-19

On April 7, McDonald said that a controversial malaria drug is not recommended by the FDA to treat COVID-19 symptoms.

“Specifically with hydroxychloroquine, that is not recommended by us or by the FDA,” McDonald said.

“I would caution anyone to be specifically describing any of these drugs as being specifically useful at this time,” he added. “Drug therapy is something that will be very useful later on during our epidemic when it’s based on evidence that it works.”

But in a news release the next day, the county clarified that the FDA issued an “emergency use authorization” on March 30 so the drug can be used on some hospitalized COVID-19 patients.

However, as McDonald correctly pointed out, the efficacy of the drug for treating these patients is in question, and more research is needed to know whether it works.

7. Protective gear shortages

Over the past month, San Diego County’s healthcare workers have feared a potential shortage of N95 respirator masks, highly protective face coverings that filter out 95 percent of particles in the air.

On March 14, following new guidelines from the CDC for restricting protective gear during shortages, the county announced that the respirators would be conserved for staff conducting “aerosolizing” procedures, such as intubation and bronchoscopies, because they are more likely to make the virus airborne. Other medical staff were told to rely on simple surgical masks, which don’t protect from airborne viruses but can block the droplets produced when a patient coughs or sneezes.

Despite the restrictions, the county has said many times since then that there is no shortage of N95 masks, and all the facilities asking for this equipment have received them.

“There are no shortages,” Chief Medical Officer Dr. Nick Yphantides said on March 18. “Everybody in this region has what they need.”

Wooten followed up the next day, saying, “I can tell you (with) 100% assurance that for N95 masks, there is no supply issue there.”

Three days after that, Rob Sills, director of the county Medical Operations Center, said, “Currently we have enough personal protective equipment to handle all of the healthcare entities within San Diego County. We are not at the point that we have to turn (anyone) away.”

Meanwhile, local medical workers have held news conferences, written a petition signed by medical staff around the country and told news outlets, including inewsource, that they were not able to access the respirators they needed to stay safe.

Family Health Centers of San Diego, which offers medical services to thousands of low-income and uninsured families at clinics in the county, told us that when its workers asked the county for personal protective equipment in mid-March, including N95 masks, it didn’t receive most of what was requested.

In response to our fact check, Workman said the reason Family Health Centers didn’t receive everything it asked for was because it requested a large volume of items that “was vastly disproportionate to the services they provide that would require use of an N95.”

He also said that Sills was speaking about access to N95 masks at hospitals, not other healthcare facilities. And while the county “assures that hospitals have a 3 to 4 week supply,” Workman said, each hospital decides “who within their organization gets what supplies and how and where those supplies are accessed.”

On March 27, after a group of UC San Diego hospital nurses decried restrictions on N95 masks, a reporter asked Sills whether local hospitals would receive more of them from the county’s stockpile.

“I asked each of the (hospital) command centers, their emergency managers, do you have what you need? Are you getting what you need? And the answer was yes,” Sills responded. “And we are in daily communication and we monitor the usage as well as the need on a daily basis.”

“We push out the resources as we get them,” he added. “And to date we have not turned down any of those (requests) to any of our hospitals.”

Four days later, Sills acknowledged that not every medical facility asking for N95 masks will be able to get one.

“Are we able to fill absolutely every request? No, we’re not,” he said. “But we’re doing a very judicial and thoughtful process to get the resources to our first responders, our clinicians, our healthcare workers and those that need it.”

8. Access to testing

Since the new coronavirus hit the U.S. in January, the nation has struggled to supply enough tests to track the growing number of people with the virus, resulting in tight restrictions on who can be tested in hard-hit areas of the country.

San Diego County’s guidelines have changed over the course of the pandemic, which has led to frequent updates from health officials, and in some cases, contradictory information.

At a March 17 briefing, Wooten outlined the county’s testing criteria and procedures at the time, including limiting the tests to people with serious symptoms who were referred by healthcare providers.

She also tried to reassure the public, explaining that there had been a limited number of tests taking place the week before, but “we have more supply now.”

“We have worked out several strategies so that people, if they want to get tested, they can get tested,” she said.

However, the next day, other public health officers made clear that was not the case.

“There is, in fact, today a shortage of the tests, to be able to conduct all the tests that we want,” McDonald said.

Yphantides added, “Everybody who wants a test will not necessarily get a test.”

The county spokesman told inewsource that Wooten was referring to the ability of people with referrals from doctors to access testing, while the other county officials were speaking about the ability of the general public to be tested.

The county still does not have enough resources to test every person in San Diego County who wants to receive one. The county instructed healthcare providers on April 1 not to test people without symptoms or patients who can manage their symptoms at home.

9. Following the rules

Three days in a row, Wooten told reporters that businesses and residents don’t have to be perfect in complying with the county’s stay-at-home and social distancing rules, which were put in place to make the contagious disease harder to jump from one person to the next.

“Everyone is doing their part, and if everyone does their part, we will get through this,” Wooten said on March 18. “And we know that it won’t be 100%, but at least if 80 to 85, 90% of people cooperate, we will get through this together.”

The next day, Wooten said, “We’re not going to be 100% perfect, but if 80%, 90% of the businesses adhere to what we are asking them to do, we will make a significant impact for the community of San Diego.”

On the following day, March 20, she made the same statement, this time attributing it to her colleague McDonald.

“I think Dr. McDonald has said this in the past, if we can get 80 to 90% of the people to comply with the orders, we consider that a success.”

After she finished speaking, McDonald came to the podium.

“We really need to have 100% of people do it,” he said.

“We really need to look to each other, support each other to protect the least able to protect themselves in our community,” he explained. “Really, we’re aiming for 100%, and we would expect, frankly, that San Diegans can do that.”

Workman told inewsource that the county corrected this statement because it “became apparent that they needed to clarify that 100 percent was not just aspirational, but vital to public health.”

inewsource intern Natallie Rocha contributed to this story.