By Heidi Simmons
“The Corona virus is not going to disappear,” said Representative, Raul Ruiz, M.D., 36th Congressional District. “We need to reduce the transmission rate until we have a safe vaccine and stop the spread around the globe. We need to focus right now, because we haven’t reached the levels for containment.”
Ruiz has stepped up as a leader not only for the district he serves, but also for the country.
It may be great luck that our Representative is also a M.D. from Harvard Medical School, a former emergency room physician, and has a Master of Public Policy from the John F. Kennedy School of Government, and a Master of Public Health from Harvard School of Public Health. It doesn’t hurt that he is the first Latino to earn three graduate degrees from Harvard University – all with honors.
When Ruiz has something to say about public health, he is credible. Maybe even more important, on his Curriculum Vitae, is that he is a local graduated from Coachella Valley High School.
Ruiz knows the people here, our communities, and the significance of our valley and its industries.
Busy these days, Ruiz is in demand as a leader, medical expert and media spokes person. He is also a man of science and faith. Ruiz is not intimidating and he is generous with his time and is never condescending. He believes in education and telling people the truth.
If you want to know the truth about the Corona virus and what scientists actually know, he can tell you with as much detail as you want to hear.
When Ruiz talks about the nature of Covid-19 and its evolution, he is describing a monster lying in wait to invade your body and spread itself throughout your system.
That is exactly what Covid does.
The Corona virus requires a host, and while the strangely invisible and beautiful floret–like sphere loiters on surfaces or disperses tiny droplets in the air, it bides its time when it can get close enough to enter your body without you knowing, multiply until it steals your breath away depriving your brain and organs of oxygen.
As health care professionals, virologists and a myriad of scientists and genome specialist try to get a handle on the nature of this deadly invader it moves around the globe unimpeded. It currently has no know natural enemies making it very powerful.
I asked the Congressman about the evolution and life span of the virus.
So, as I listened to Doctor Ruiz explain in layperson terminology how humans have been able to survive these sophisticated organisms, I begin to see the only way to stop it is to out smart it. But how? You already know the answer.
Stay away from it! Don’t let the virus anywhere near you! Pretty simple.
But, it is not that simple. As Aftab Dada said in the CVW story “Surviving Covid-19: The Health and Wealth of the CV” (see this issue), “We are a society that likes to move, to get out and around.”
The good doctor explained the me that the Corona virus is just beginning to get its footing as it explores its evolutionary path towards mass duplication and global take over.
But Ruiz was much more scientific. He wasn’t just telling me a scary bedtime story or waxing poetic pandemic.
With a few examples, Ruiz explained what scientists call the “Ro” pronounced R-naught — the rate of transmission. He shared with ease the “Ro” as a basic reproduction ratio, a metric used by scientists to evaluate how a pathogen can spread — and how it can be stopped.
Ruiz made perfect sense as I listened carefully about the nature of a virus like Corona. The “Ro” formula determines the rate of transmission as well as containment.
The virus is clever, efficient, and even elegant. If one person has it, then it can move to another.
When Ruiz made the “Ro” perfectly clear, I diligently wrote it all down so I could share this amazing bit of human ingenuity. Then, he kindly simplified it —
“It’s strategy,” he said in his impish enthusiasm. “It is a way to stop the spread. We want active immunity.”
Ruiz clarified how we can stop the Corona virus monster.
“Two things,” Ruiz said, like he was holding up his fingers to me even though we were on a phone conversation.
“One: Use of a vaccine here and around the globe.”
“Two: Bring down the “Ro” so individuals cannot infect someone else and it just stays with that person, and they don’t infect other people.
Those are the only two scenarios to eradicate the virus.”
I get this, and it isn’t too challenging for a right- brain person.
“Of course, the challenge is the virus can mutate,” said Ruiz. “Once it mutates, it’s a whole new threat, because the vaccine can be rendered non-effective for the mutated virus, but also,” he said like a science fiction writer, “Our own immune system can be rendered non-effective, therefore people who got sick with the first virus, can get re-infected with the mutated virus. So that is how it is always evolving. There are reports that there is a second more aggressive corona virus out there.”
I ask about similarities to the flu?
“The flu has many different strains and every year based on early infections, epidemiologists pick a handful of strains with an educated guess, put it in a vaccine so you are protected from those strains and it decreases the severity if you get sick.”
“In this case, there are not dozens of corona virus,” he said making perfect sense.
I think to myself, “novel” Corona virus. It means unique.
“If we [Ruiz, doctors, scientists, Coachella Valley residents?] can get it right and get the one predominate strain, then we can make a bigger difference with a vaccine for this virus. “In terms of its lifespan, the corona virus is not going to disappear.”
I had to ask. We live in a desert where temperatures reach triple digits. Does heat stop the spread?
“Heat does not kill the virus and is not a form of treatment,” Ruiz says definitively. “Those who are carriers, and if they sneeze, cough, or spittle lands on your face, you may get infected and the heat won’t change that.
If droplets land on a surface of something, extreme heat may shorten the lifespan on some objects based on bench studies, not case studies. Even with our heat, we are still seeing people get infected, and still seeing deaths. Other areas around the globe with warm environments are not seeing any change just because it’s hot. We can’t lower our guard or have a false sense of security during summer because the virus is still going to be in our community even at 100 to 125 degree heat.”
In the companion article “Surviving Covid19,” Palm Desert Mayor, Nestande, is compelled to get an antibody test for her community in hopes to lower the denominator, which could reveal a lower death rate, and hopefully put things right again.
“There are numerous types of platforms to test for antibodies. It’s very important to understand that while we are still increasing in the cases of new positives with the antigen — the PCR test which is to see if someone is actually infected. The reason is because, if they have the Corona virus, then they are infectious. That test [PCR] is the most helpful right now because we need to determine if someone is infectious and they can quarantine to prevent others from getting infected.”
The antibody test is more for prevalence studies in the downslope, or when we contain the virus. A current antibody test does not mean if you are positive or you are immune, and therefore, you’re safe to go back to work and you won’t get infected.
The reason is this: We do not have the science and don’t now if there is a certain level of antibodies that a person needs to render them immune towards the Corona virus. There is a possibility that a minimal infection or the viral load in the body, which produces a small amount of antibodies, and that small amount does not render you immune to the Corona virus, in case you get it at a higher load.
Those studies still need to happen and we need to determine what those levels of antibodies are to say you are immune to the virus. These antibody tests are qualitative test that tell you whether or not you have been exposed to the virus, doesn’t tell you if you are actively infectious, or if you are immune to the virus.”
Ruiz turned to his alma mater, Harvard University to seek out a professor there and brainstorm about how he could simplify a metric for cities to deal with such a severe pandemic like they do for governments, important scientists, and big pharmaceutical companies. He titled it “Five Point Plan” (see this issue).
“The Five Point Plan follows a national strategy treatment standards and vaccine development,” he said, a little of his nerd-self coming through the airwaves.
“I wanted something that was useful at a local level for cities and counties and for people to understand what it means to have the framework in place to safely open business and ease up on precautions. First thing to ask is it the right time? The right timing is always based on do you have the current levels of Corona virus in your community under control and is it at a safe level.
There are different criteria’s for that. The White House states we should be on the downward slope and every public health official will agree with that. Meaning, we have at least two weeks with consistently decreasing new cases. That’s the downward slope.
The Governor chose 14 days — no new deaths, which means you are pretty much near the bottom and a plateau consistently and no higher than 1 case per 10,000 population. The common sense is that you don’t want to remove precautions until you are at the downward slope and a safer area of the transmission curve. So far it seems we cannot say we are at a downward slope in the valley or Riverside County consistently.”
“The other spec is the ICU bed capacity,” said the M.D. Ruiz on the other side of the call. “We use all the patients in ICU because we want is to know how many ICU beds are available in the event there is a surge at any moment when we reopen, and hospitals are back to normal. It doesn’t matter if the patients are Covid-19 or not. It’s the amount of beds available that is the determining factor. The Governor said, we should have 35 percent more beds on reserve to handle a surge. That’s different because we are in a different context. This time last year, we weren’t under a pandemic where we could easily have an outbreak and a surge at any moment. How we best handle an outbreak proposes a month and a half of enough tests and the use of contact tracers. Resource managers are essential to help make sure people have what they need. Without “tracers” we can’t contain the virus.”
“We have been under the third component,” he said regarding his steps. “Are we undercounting the rate of corona virus positive cases? To what extent is unclear. It’s about prevalence. We need testing to get an accurate picture of the Corona virus in our communities.”
Metaphorically, my head spins. And, like a good doctor, he senses I need clarity. He is focused and articulate.
“This is what is important to understand,” Ruiz said.
“This virus is real and very contagious. It effects more systems – organs—than the flu and is more lethal than the flu,” Ruiz spoke with authority maybe a little frustrated after repeating it for the last two months.
“As evident, that we’ve had 80,000 deaths in three months! Even with aggressive social distancing practice in different states. Anyone who is trying to minimize the lethality due to any kind of formula or equation, put the calculator down and count the dead bodies of Americans who succumbed to Covid-19. There are those who have died even with aggressive treatment and then you can understand that if we loosen the interventions prematurely and without the safeguards in place you will see the mortality rates increase across the county.”
Doctor Ruiz gets quiet. I wonder if my cell phone died. Then, I hear Representative Ruiz continue:
“This is a public health crisis. Our economy depends on how well we address the public health crisis. When you hear politicians saying there needs to be a balance then they have subscribed to a false and erroneous way of handling the economy, because then they define our public health response, and our economy as mutually exclusive. That is false! In fact, our economy is dependent on how we address the public health crisis. If you open the economy too soon without the safeguards in place, you will have an exponential rise in new cases and we will get a surge that will require businesses to shut down again. Keep doing that and there will be repeated opening and closings, which will hurt workers and delay our economic recovery and in addition, you will have more loss of life.”
Now I’m the one who is quiet, maybe for the first time I truly comprehend the seriousness and the consequences of the pandemic. The doctor/politician finishes, either way I have received his message and continue to listen with respect and gratitude for his expertise and passion.
“Balance is the wrong way of opening our businesses. The right way is to practice social distancing, and bring the numbers of new cases down so we can contain and make sure flair-ups don’t become surges.”
For a bit, I wonder why people haven’t been listening, or heard this succinct message. Why would anyone want to take unnecessary risks?
“When you create the public health safeguards, you build a resilient business community where they don’t have to shut down. In the long-term, that is going to help our business and workers and community.
It is not an either or, it is both at the same time. If you do not address the public health crisis, adequately with the scientific safeguards then you are going to hurt businesses, and the economy, and have an increase in spread and more deaths.”
Ruiz makes his point crystal clear.
“The no deaths in14 days is one of the safest criteria. Overall, the point is we shouldn’t be removing precautions and opening businesses until we are on the downslope of the transmission curve and we are clearly on a consistent decrease of new cases throughout the county. Some counties can indeed meet those benchmarks, like the rural communities where there haven’t been outbreaks.”
I flash back to all the information I gleaned from the Mayors, CEO and community leaders for the article about “Surviving Covid19”.
Riverside County Supervisor Manual Perez and others told me the Governor’s 14 days no deaths was impossible or unattainable. I mention this to the Congressman. There is a pause.
“I don’t subscribe to the idea that the 14 days without a death is impossible or unattainable,” he said, without any hesitation.
“What the criteria elucidates, is the fact that Riverside County has a higher than average vulnerability towards transmission as well as death due to our demographics. We should plan our preparations and precautions according to our local risks and vulnerabilities — not drop our precautions to the bottom floor that the state provides for all counties.
The fact that it is difficult for the county to meet the criteria, just highlights indeed we have a bigger issue with the Corona virus than other counties. Our vulnerability is this: We have the fourth largest population; we know that density increases transmission because the virus depends on human interactions at close proximity.
There are other serious issues that put us at risk especially in the Coachella Valley where we have an older population. We are higher than the national average in cardio pulmonary illnesses, diabetes, and many of our communities live in poverty and do not have the luxury of quarantining. Many of the workers in those communities, due to our industries, have to go to work and are more exposed and vulnerable. If anything, the county should reflect on not reducing their precautions but actually increase them to reflect the vulnerabilities, risks of transmission, and those dying from Covid19 in the county.”
I get it. I have other questions. I ask about Federal funding and if the amount dispersed in the CV can be quantified? Ruiz rattles a list of entities that received money: Palm Springs International Airport– $11 million; food bank – a lot as well.
“Federal aid has been coming into our county and valley, but we need more. The bill I am going to vote in favor for on Friday, is going to provide up to $3 trillion for the American people. The focus is another stimulus check $1,200 per person including children. It will extend unemployment through January, and provides a trillion dollars for cities, counties and states. This time cities that have a population that is less then 500,000 will receive benefits that will reach essential workers and lost revenue based on city projections.
“It highlights how important it is to have the public health safeguards in place. We want to be able to safely open our businesses and provide consumer confidence and keep workers protected. Otherwise, we could hurt tourism. Imagine if we reported surges and deaths in the Coachella Valley because we opened too early. Who is going to want to come and vacation here?”
I hear what he is saying and I can’t imagine the repercussions on the lives and livelihoods of those of us in CV.
I mention that Indo Mayor Miller told me that he is confident that the festivals will take place in fall. I think I hear Ruiz exhale.
“Fall is going to be when most public health experts predict another surge due to, not only the winter environment, but also the concomitant burden that our health system is going to have due to other respiratory illnesses.
Already in the fall and winter, we see our emergency departments full due to the cold and flu, then add the Corona virus and we are going to have to accommodate for that.
There are a lot of milestones we need to create in order to safely have the festivals. If we meet the milestones, in terms of local cases, and transition the airports and hotels, the festivals will have to implement accountable and enforceable precautions. What we don’t want is a massive increase in our density with people congregating in a very vulnerable community. We don’t want that.”
I agree with the congressman. But he used the word “enforceable” in his step number four which has language that concerns me – or at least the freedom-loving hippy who has a little problem with authority and government over reaching, stepping on my civil liberties.
I ask him what he says to people who fear – or hope – this global pandemic is a sign of the “end times.” I mention plagues, volcanoes, the destruction of the earth, how people can’t buy or sell. Briefly, it makes sense and I get why people are protesting and afraid.
“There is no conspiracy theory here that many have touted to bring fear of some of these orders. This is simply a way to help people stay healthy and a way for the vulnerable to stay healthy during a pandemic. What we don’t want is everybody, due to misunderstanding, misinformation, or biased beliefs that are not based in science to make decisions that jeopardize individuals who are taking all the precautions and making an effort to weather this storm.
The more we can encourage people with incentives through community to follow the public health recommendation and the orders to do so, and the more people who do it, the better our economy. And, we prevent loss of life. That’s the whole point of it.”
I am sure he is right and I believe in science. But still, some people are behaving crazy.
“How do we influence behavior in order to get a sense of social responsibility to everyone in the community. This is not a virus where the consequences are solely on the individual who chooses to engage in risky behavior. That’s not the case with this virus. Unfortunately, people may be virus positive without symptoms and may spread it in the grocery store, wherever they go and the virus spreads to some one who has underlying condition. Then that patient puts the hospital’s frontline workers at risk if they don’t have enough PPEs to help that patient. That needs to be understood. A public health approach is to protect the public’s health in a population based structure.”
Congressman Ruiz knows what he is talking about. I squeeze in another question I promised a mayor I would ask anonymously. I don’t mention his/her name but I am pretty sure the Congressman knows who I am talking about. It’s about the manufacturing business opportunities in the City of Coachella.
Ruiz answers the question about the Federal government working with existing US companies to make more PPE, but it is clearly not enough.
“We are dependent on importing these products from other countries. I am all in favor for internalizing our production process and manufacturing, and am supportive if a business wants to ramp up their production and I can connect them with resources from the federal government. I am here to help all I can.”
Yes, indeed, he is helping. I thank the Congressman for his public service and wish him well.
I feel grateful our valley has Doctor Ruiz as our Representative during this difficult global pandemic and economic crisis.