University HealthCare Alliance

September 24, 2020

Stanford Medicine | A Conversation with Santa Clara County Health Officer Sara Cody

Santa Clara County public health chief Sara Cody, MD, was in her kitchen sipping coffee at 6:49 a.m. on Jan. 31 when she received a phone call from a colleague. The number was from the county’s emergency operations center, so she had a feeling the news would be bad. It was.

“Confirmed,” she was told. Santa Clara had its first case of COVID-19.

Cody, a Stanford University biology major who earned her medical degree at Yale and did her residency at Stanford Medicine, has since worked around the clock with a broad coalition of government and community leaders to curtail the impact of the deadly virus on residents.

Cody was the first public health commissioner in the nation to order a countywide shelter in place, which undoubtedly saved lives but was, nonetheless, controversial. As officials continue to weigh the impact of public health orders and restrictions against the social and economic hardships they cause, she admits the balancing act is difficult.

In mid-July, as Cody began a conversation with contributing editor Paul Costello, she stopped and offered, “I’m going to take my mask off. I think you’ll be able to hear me better,” before detailing the successes, difficulties and her hopes for the future in the battle against the coronavirus pandemic.

This Q&A is edited and condensed from that conversation.

Costello: Is this moment an inflection point for COVID-19?

Cody: It certainly is. I have to tell you, to be candid, June was an incredibly depressing month for us here in the local response because I had my heart set on full containment. In Santa Clara County, the community came together. For the most part, everybody really was working together. We had our infection rates pretty darn low. We held them low.

We built up the infrastructure that we needed as far as testing, case investigation and contact tracing. I really, honestly, thought in my heart that we were going to be able to get pretty close to identifying enough cases and interrupting enough chains of transmission that we were going to continue to bend the curve down. I really felt it in my heart.

Costello: What happened?

Cody: The rest of the world happened. We’re not an island. We’re not New Zealand. We’re not Taiwan. We are part of a big ecosystem. The rest of the ecosystem was not playing the same, not working from the same playbook.

Costello: Where are the new cases coming from? Do you know?

Cody: I am not sure that I can tell you what’s driving this increase, because it’s not clear to me yet. The truth is that I’m not really sure, because things took off starting in mid-June and really started to accelerate the last week in June.

We saw that pattern here, and a similar pattern in San Francisco, Contra Costa, Alameda, all around the Bay Area. Something happened. It could have been fatigue with shelter‑in‑place, coupled with maybe a little bit of acceleration from Memorial Day weekend gatherings or graduation gatherings. We’ve not had indoor dining, indoor bars, religious ceremonies or things like that. That’s not what’s driving the epidemic here. The honest truth is we don’t quite know.

Costello: Nursing homes and assisted living facilities have been hit hard in Santa Clara County and around the country. Are they in any better shape today than earlier in the pandemic? 

Cody: I would say in somewhat better shape. The really critical thing to remember is that we have to be constantly vigilant because long‑term care facilities and nursing facilities are so vulnerable. If a staff member, or anyone working and caring for patients there, comes in infected and doesn’t know it, the infection can spread to the residents. We see much higher rates of hospitalizations and death there than in any other settings.

The only way we’ve figured out to prevent this is to ensure that staff are frequently screened. If we see a signal, and it doesn’t have to be a very large signal, then we have teams go out and test everyone in the facility, staff and residents.

We are continually seeing the introduction of the virus into skilled nursing facilities and other long-term care facilities. The greater the prevalence in the community, the higher the number of long-term care facilities that pop up with cases. Not surprisingly, the staff represents the community around the facility. 

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