Earlier this month, Santa Clara County Health Officer Dr. Sara Cody said she cannot begin easing restrictions until it's certain that hospitals have enough room to treat all those who need care, and that there is enough personal protective equipment for medical staff to safely work.

Public health officials caution that the county is not out of the woods yet despite the good news, but the focus has nevertheless shifted away from the immediate disaster response toward what to do next.

Santa Clara County is entering its fifth week of shutdown in response to the spread of the coronavirus, which causes COVID-19 and has infected nearly 2,000 county residents. The deeply disruptive public health order appears to be working, with the number of new reported cases leveling off even as testing ramps up.

The Santa Clara County Board of Supervisors voted Tuesday to create a comprehensive recovery plan laying out exactly how and when to begin peeling back restrictions imposed to prevent the spread of the new coronavirus.

Castro Street in Mountain View, along with business districts across Santa Clara County, are virtually deserted since the stay-at-home order was imposed last month. Santa Clara County supervisors voted to create a roadmap to guide the eventual rolling back of restrictions due to the coronavirus pandemic. Photo by Sammy Dallal

Supervisor Susan Ellenberg said the county is asking its residents to make enormous sacrifices in order to stop the spread of the virus, and that it has an obligation to clearly outline how close the county is to recovery. People are losing their jobs and families are being separated, she said, and yet there are no objective benchmarks showing when it will end.

Along with outreach, the county will detail precisely what staffing and funds are needed to boost testing, disease surveillance and contact tracing in order to create a "smooth and safe transition" out of the shelter-in-place order.

Though the decision on when those requirements are met ultimately falls on Cody, supervisors voted to craft a recovery plan for "future phases" of the response to the global pandemic, drawing on expertise from health officials, local governments, businesses and school leaders. The county is partnering with the company Innovative Emergency Management (IEM), which is already doing similar work for San Mateo County, to do public outreach.

Once the rate of transmission is low enough, the county must have the infrastructure and staffing needed for contact tracing, giving health officials a clear idea of who came in contact with those who test positive for COVID-19, Cody said. Some emerging technologies may be helpful in doing that tracking work, she said, but some of that is going to be "good old-fashioned" talking to people on the phone.

At the same time, Cody said the county needs to ramp up testing capabilities so they are broadly available to test anyone with symptoms, including expansive testing in jails, homeless encampments, nursing facilities and other places where "accelerated transmission" is possible.

"I am a member of this board, one of five in Santa Clara County out of nearly 2 million, and I don't know the answer to this," she said.

"Put yourself in the shoes of a construction worker or a waitress or a small business owner, counting down to May 3 to potentially no longer be laid off through the shelter-in-place order," she said. "How can we justify adding to that uncertainty of simply not knowing how close we are or when we might get there?

Ellenberg said that needs to change, and at some point the public trust is going to hinge on numbers that people can use to measure progress.

Earlier in the meeting, Ellenberg pressed county health staff on how they will know when there is enough personal protective equipment for hospital workers and enough tests for everyone who is suspected of having the coronavirus. In both cases, the answers were the same -- it's a moving target, and there is no set metric.

"If (the) government asks its residents to make unprecedented sacrifice for public health, we must hold ourselves to the highest levels of transparency and accountability," she said.

"We're helping as much as we can, we can gather and convene people, but very soon the county itself is going to be struggling for its own survival," he said.

Santa Clara County Supervisor Dave Cortese said he supports broad-based outreach to create something resembling a Marshall Plan for recovery from the global pandemic, but he cautioned against giving residents the impression that the county is on the cusp of bouncing back any time soon. He said he also worried that the county won't have any money left to help with the rebuild, fearing that the virus will cause economic devastation "an order of magnitude" worse than anything he has seen before, including the 2008 recession and the dot-com bust.

In a Monday announcement, Newsom said the number of new cases in California is flattening but still rising, and that he isn't seeing the "downward trend" needed to start reopening California. The shelter-in-place restrictions are still in effect for good reason, he said, and rolling back the public health order needs to happen gradually.

Gov. Gavin Newsom, who is set to release details of the state's own roadmap for recovery on Wednesday, is following similar guidelines to ease restrictions, based largely on hospital surge capacity, the availability of ventilators and N95 masks and the ability of businesses, schools and child care facilities to support "physical distancing," typically referred to as a 6-foot buffer between people.

Santa Clara County seeks a roadmap for recovery as COVID-19 cases level off