County supervisors unanimously approved a local emergency declaration regarding the coronavirus Wednesday, as the number of people under self-supervised home quarantine across the region continued to grow.

A few hours after the board’s vote, UC San Diego Health announced that one of the two COVID-19 patients it has cared for since last week has been discharged after several subsequent negative tests showed they are no longer infected. Additional details were not available Wednesday evening.

Meanwhile, Dr. Wilma Wooten, the county’s public health officer, said that approximately 63 of the 65 remaining federal quarantine patients at Marine Corps Air Station Miramar will finish their 14 days in isolation Thursday and be sent to their homes just as 166 from the first group to arrive at the base on Feb. 5 were released Tuesday. One person, she said, has had their quarantine period extended to Feb. 24 due to contact with one of the two people who tested positive.

Just because Miramar will soon have no evacuees on its premises doesn’t mean that local vigilance will end.


Shortly before the county board took its vote, Wooten gave the latest count of those who have returned to San Diego County after visiting China but who did not visit Hubei – the high-risk province where the novel coronavirus outbreak has been widespread among the populace. Wooten said her department has now been notified by federal authorities of 249 low- and medium-risk travelers who returned to San Diego County after being in China either as visitors or expatriates.

That’s 55 more than the county said it was supervising last Friday when it made its initial public health emergency declaration.

While travel restrictions have drastically reduced the number of people moving between China and the United States, the flow has not been entirely shut off, and Wooten noted that the county health department is charged with monitoring all who return for COVID-19 symptoms.

“We continue to obtain a daily list of approximately 20 to 30 names of individuals who are at medium risk and require public health supervision,” Wooten said.


She and her colleagues in the county health department made the case on Valentine’s Day, and again on Wednesday, that declaring a local public health emergency can deliver funding sources and authority necessary to keep up with the demands for monitoring and oversight needed to make sure that, if a few travelers do end up getting sick, their infections don’t end up inadvertently spreading to others in the community.

Though they praised the physician and her colleagues for their diligence so far, supervisors did have a few questions. Supervisor Jim Desmond cast his gaze south toward the border, noting that it is one of the busiest land crossings in the nation and remains so even as this new health threat spreads rapidly beyond China’s borders.

“We’re a bi-national region, and we’ve got about 100,000 people coming across the border every day,” Desmond said. “What is the federal government doing to ensure that we have enough resources available at our border for screenings that are necessary to make sure that we keep San Diegans well?”

Dr. Eric McDonald, medical director of the county’s epidemiology and immunization services branch, said he had just finished a joint conference call with the medical director of the Department of Homeland Security as well as representatives from the U.S. Border Patrol, U.S. Immigration and Customs Enforcement and public health representatives from every border state to discuss that very issue.


He noted that basic health status questions have long been routine for border agents and all of the agencies involved have been working to make sure that everyone working on the border knows what to do if they encounter someone who says they’ve recently traveled to China.

“We are working together with our state to make sure that those policies and procedures are in sync so that people just don’t show up at local (emergency departments) and cause any difficulties, but I think there is a strong effort occurring there,” McDonald said.

Supervisor Nathan Fletcher asked for an update on progress toward the county’s public health lab being able to test local patients for COVID-19 infection rather than having to send samples to CDC headquarters in Atlanta as is the current practice. Wooten said that, so far, an issue with test kits sent out by the CDC to local health departments across the nation continues.

“Currently, there is a hold up from CDC with obtaining all of the components necessary to run the tests,” Wooten said. “Until we get all of those components and then conduct validation studies to ensure that the tests are reliable, we will not be ready. We anticipate it will be several weeks yet.”


Most under local home quarantine, however, are never tested.

McDonald explained that, as has been the case for the 232 people quarantined over the last two weeks at Miramar, testing is only performed if someone with quantified COVID-19 risk starts showing symptoms such as fever, cough or difficulty breathing. Risk is defined as those who were in China or who had significant contact with someone who got sick or had contact with a person who visited a high-risk area such as Wuhan City.

How often local public health workers check in, McDonald added, comes down to the specific level of risk assigned after a preliminary interview with each person under home quarantine. Those interviews, the physician said, are as fine grained as possible and are designed to make sure that the most resources flow to those deemed to have the greatest potential to get sick.

Treating everyone who recently passed through China the same, after all, would quickly become quite inefficient.


“Let’s say somebody, for example, was on a meditation trip to Nepal and then they had a three-hour layover in Beijing where they never left one part of the airport before they got on another plane,” McDonald said. “That’s a different kind of risk than somebody who has been teaching English for months and had lots of interactions in a province just south of Hubei Province.”

The second hypothetical person, McDonald said, would likely be classified as having a moderate risk of infection and receive a check-up call from a public health worker roughly every other day while the first person would be classified as a low risk and would receive less interaction during their 14-day hiatus.

And it’s not just about checking symptoms.

Workers also check to make sure that a person is getting everything they need, from access to health care to regular meals, so that they have no pressing reason to leave their homes. So far, he said, a few serving home quarantines have suffered other health problems not related to possible COVID-19 infection that have required them to be admitted to local hospitals. In those cases, McDonald said, much attention is given to maintaining additional precautions designed to keep any kind of communicable disease from spreading.


In the end, it is this bread-and-butter work currently being performed by every local public health department across the nation that is America’s best chance for keeping COVID-19 infection from becoming widespread in communities in the same way that other respiratory viruses such as influenza already are. As to whether there is any public health process capable of stopping novel coronavirus cold, McDonald and many in the public health community have their doubts.

“It is entirely possible that this virus will come to the United States and it will cause person-to-person transmission, but the things that we’re doing now certainly are going to slow that down enough so that things like development of a vaccine may be useful if and when this hits our local system,” McDonald said.