Like many rural communities, Amador County went months with only single-digit COVID-19 cases reported. By mid-June, theyd slowly crawled up to a dozen.

There have now been 156 reported cases of the illness, as of Aug. 5.

The foothills community is grappling with its own version of the summertime surge thats preventing 38 California counties from reopening their economies. But Amador is not on the states watch list, so its gyms, salons and other non-essential businesses are still open.

Dr. Bob Hartmann, deputy health director for the county, said he expects theyll be added to that list any day now.

Our gyms are very enthusiastic about keeping open, and they'll be able to do that if we remain off the monitoring list, Hartmann said. But we are teetering on the borderline.

Amador County has just one hospital with six intensive care unit beds. It has a substantial homeless population and a large number of seniors. Many of them live among the areas hills and winding roads, far from services and other people. The countys spotty internet access has made communicating about the virus a challenge, Hartmann said.

Faced with a dramatic spike in cases, health officials are trying to promote mask-wearing, discourage social gatherings and educate the tourists who flock to the area for summertime wine tasting and recreation.

CapRadio chatted with Dr. Hartmann about those efforts.

This interview has been edited for clarity and brevity.

On whats behind the surge

One is more people getting together. Getting together weekends, getting together Fourth of July, over the holidays. Also, I think there's sort of a quarantine fatigue, people just getting tired of being at home, getting tired of being told not to go out. And then there's travel that is involved. A number of our cases have come from people who traveled out of the county or came back into the county with coronavirus, and then then there was community transmission. So travel really has made a difference, and people are just tired of not traveling so they're doing so more. And it's a combination of all of those.

I think people had mask fatigue a couple of months ago. And now with our rise in cases, there are more people wearing masks. It's still not as high a percentage as it should be. It's been estimated that if 90 to 95% of people wore masks when there was any interaction with someone outside their household, that in four weeks we would see a dramatic decline in the number of cases. But that's not happening at that rate.

On prisons and senior homes

Note: Amadors case count does not include inmates at Mule Creek State Prison in Ione

In congregate care facilities, it's not only the inmates or the residents that we worry about, but it's the staff that we worry about. Unfortunately, staff are the ones who frequently will bring coronavirus into those settings. And then particularly where elderly populations are involved, it can spread like wildfire. We have one skilled nursing facility in Amador County. We've seen a dramatic, dramatic rise in cases there, and some of the residents have gotten very, very sick. A few of the staff have gotten sick also. But it seems like every day, every week we are reporting more and more from those congregate living settings.

On hospital capacity

Our capacity in the hospital is adequate at this point. We peaked this last weekend with 12 coronavirus patients in the hospital. Our ICU was full, about half of the people in the ICU were coronavirus positive. We had a step-down unit and that was full, and half of the people in the step-down unit also had coronavirus. We do have surge capacities in place. They have not had to be called on yet at the hospital ... Sutter Amador Hospital is part of the Sutter Health system, so patients can be transferred to other Sutter facilities. For instance, our ICU this last weekend was full and a patient was transferred to Sutter Roseville.

We keep our fingers crossed, we know that this is surging, its ongoing. We don't expect that we're going to be out of the woods for a while. But with all the protocols in place, we're pretty confident that we can keep up with it at the hospital.

On public health messaging

In rural areas, there are always parts of communities that you have trouble reaching. There are people that don't have Internet access. There are certain areas that dont have cell phone access in the county. And a large percentage of our elderly population, if they have computers, dont really know how to work them. And so we're constantly challenged with, how do you get information out in rural areas? Certainly radio helps. There is a local newspaper thats published one day a week, that helps. Social media has made a difference But as you know, social media can be used in many ways. And so there's so many falsehoods that go out regarding treatments of coronavirus or regarding masks and usage or not using. And that can really complicate the situation.

What we try to do is be as consistent as possible with our messages. And our messages are: avoid gatherings of people outside of your household, don't go to dinner over at people's houses where you're less than six feet, where you're indoors, where people aren't wearing masks. You know, avoid gatherings. Thats a very basic tenet in trying to prevent the spread of coronavirus.

On masks

Masking is so important and masking is not political. It's not red versus blue. It's not 100% effective either. But it is very good in preventing coronavirus, both for the person wearing the mask and somebody in the vicinity of that person. So I think wearing masks is really a humane concern about our family, our friends, our community, and it should not at all cross political lines. If you choose not to wear a mask, you should choose to stay home or choose to stay away from others. People would do anything and everything they could to keep their children safe and happy. Yet, I see moms going around the grocery store not wearing masks and their kids not wearing masks. There's a gap here that I don't clearly understand.

It's no secret that Amador Countys a conservative area, and a number of people in the county do not believe in masking. A smaller number don't believe the coronavirus is real. I would ask them to come and stand outside the window of the hospital and watch what goes on inside there. And it makes delivering our message in the rural area and message acceptance more difficult. And again, as I said earlier, the masking message is not a political message, it's a health message. That's what's frustrating to those of us working in public health.

On tourism

It does worry us that there's so many people that come into our beautiful, beautiful county and head up to the mountains. However a lot of those people are outdoors. And outdoor recreation, if you follow certain guidelines, is really good. It's good for you. It's good for your psyche. It's good for you physically. But our trails are packed. The parking areas around the trails are packed with people. So we just encourage anyone coming in the county to follow that physical distancing and masking We in the past have noticed when school gets back in session, the number of visitors on weekends drops significantly.

However, without sports activities and with the majority of kids doing distance learning, we anticipate that there'll still be a pretty heavy number of people coming up into our county to recreate. Another area is the number of people coming to the county to visit the wineries. Our county has absolutely wonderful wineries. The tasting rooms can be open at this point for outdoor tasting and associated with food. But our county is in danger of going on the county monitoring list. We're kind of borderline right now. We're waiting for more word from the state later this week and there are going to be more restrictions. And those restrictions probably will decrease the number of people coming from out of county.

On community services

Its been more difficult to get services out to the homeless. There's a group of mask makers that actually live in my neighborhood. They supply me with homemade cloth masks that are very high quality masks, and Ive been able to get them to people and distribute them to the homeless, to some vineyard workers, child protective services, adult protective services, to try to reach some of the harder-to-get-to populations.

But so many of the safety nets we had here in the county just havent been able to continue at a very robust stage with the coronavirus and people staying at home. For instance, STARS, the cancer support group with their drivers that take people to and fro tooncology visits in Sacramento, to surgical procedures, infusion center here, so forth. Most of their drivers are older and so the number of drivers available dropped by 75%. So things like that that are there that don't really hit you in the face when you're reading the newspapers or listening to the radio. Almost every segment of our population has been affected and the most vulnerable have been affected even more.

Editor's Note: A previous version of this story included a transcription error in one ofDr. Bob Hartmann's responses. It has been updated.

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Amador County Is 'Teetering On The Borderline' Of More Closures Amid COVID-19 Spike - Capital Public Radio News