San Mateo County was put on the list Wednesday after weeks of being on high alert because of its case rate.
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Since being put on the list, Dr. Bela Matyas says his team has been using the only tool they have to try to reduce their cases and stop the surge -- education. But, it's not working.
According to Matyas, 95 percent of the county's new cases in recent weeks are as a result of private, social gatherings.
"It is possible that our county may remain on the watch list for a very long time because we aren't going to be able to change those behaviors adequately to reduce the numbers," said Dr. Matyas. "The cause of the outbreak is something we have very little control over."
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On paper, getting off the list seems simple enough, according to the state -- after a county is within threshold for all metrics for three days, it is removed from the county monitoring list the following day.
But even that gets complicated because the state still has to conduct its investigation on a case by case basis. Adding to the complication, a county could meet one metric one day and not another, making it very difficult to meet all three metrics for three consecutive days.
Dr. Matyas says even after meeting all metrics, it's possible that the county would have to reapply for a new variance which adds new hoops to jump through before getting the green light to reopen.
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"It really is up to the state to either change its narrative from containment to mitigation or to recognize that the metrics are too harsh given the way the disease is currently spreading," he said.
He says neither choice is easy.
"You have to simultaneously recognize that what we're doing is harming businesses without getting any benefit but at the same time we're going to have to endure a high level of disease if we changed the metrics," he said.
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In San Mateo County, Supervisor David Canepa pleaded for different metrics too. But after weeks of being on high alert, the county was put on the watch list Wednesday.
"If you look at other indicators, we are doing rather well. Deaths within facilities was zero," he said, adding that the county has done a lot of work trying to isolate cases and doing contact tracing.
Matyas says he is in daily contact with state public health officials as the county refocuses its messaging on harm reduction.
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"It's not as clear as it could be from the state but I don't challenge them on this because this has been a very dynamic disease," Matyas said.
Matyas suggests that metrics would be less punitive on businesses if shutdown orders were specific to where outbreaks were happening.
"I would focus on the realm specific metrics and I would acknowledge that we can't control what people are doing their personal lives," he said. "I've been through a lot of outbreaks and I know that what we're doing is unsustainable."
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