The wave of COVID-19 contagion in Truckee may have already crested but the tsunami of consequences from the shelter-in-place order is gathering force.

North Lake Tahoe’s cases peaked between late March and early April, according to data from the Centers for Disease Control. Now public health officials and doctors are gearing up for a new challenge — the secondary effects of the pandemic and the stay-at-home order.

As of May 7, the CDC reported approximately 1.2 million cases and 71,000 deaths from the coronavirus in the United States. The nation averages 30,000 new recorded cases and just under 2,500 deaths each day.

---

---

The first recorded COVID-19 fatality in California was a Placer County resident, who had been aboard a Princess Cruise ship a few weeks before his death in early March. On March 4, California declared a state of emergency, and on March 19 Gov. Gavin Newsom issued a shelter-in-place order.

“Complications in the household, family providers lose their job or start to lose their businesses, that will impact the types of calls we’re getting.” — Truckee Chief of Police Robert Leftwich

Two months later, the state has 58,815 confirmed cases and 2,412 deaths. Of those, 41 cases and one death were from Nevada County, 162 cases and eight deaths were from Placer County, 47 cases came from El Dorado. Sierra County reportedly remains coronavirus-free.

---

---

As of May 1, the Tahoe Forest Health System — which serves Truckee, North Lake Tahoe, Donner Summit, the Sierra Valley in California and Incline Village in Nevada — had conducted 651 lab tests in Truckee and the health system’s testing site in Incline Village. It recorded 56 positive results, said CEO and President Harry Weis.

These are patients who come from any surrounding county to seek treatment in the Tahoe Forest Health System. They could be coming from Nevada, Placer and Washoe counties, Weis said, adding, “Eight of those 56 cases are from Incline Village.”

Weis said the number of positive lab tests discludes COVID rule-outs, or patients who physicians confirm exhibit all the virus’s symptoms but await the lab’s confirmation. It can take one to seven days, sometimes up to 10 days, to get the results.

Even when the virus’s spread was ramping up, the Tahoe Forest Hospital never reached capacity — 25 acute care beds and 36 long-term care beds. Weis said the hospital’s case census ran up to seven patients early on, plateaued and then dwindled to one to two patients a day in the last week.

“We never had the peak in-patient census predicted. I’m not really aware that most hospitals in America reached the peak census surge that was forecasted for them,” Weis said, referencing the University of Washington’s Institute for Health Metrics and Evaluation model.

IHME’s model for the COVID-19 death toll in the U.S. changes with new data each day but still illustrates an arc that peaked mid-April. Recorded cases validated the prediction until May 1, when the 2,343 deaths surpassed the original April 16 apex at 2,216 deaths.

Weis said before the shelter-in-place order was announced, Tahoe Forest Health System had a seven-days a week nurse hotline. Soon after, it created a drive-by testing center where physicians swabbed patients in their cars for both COVID-19 and the flu.

“We set that up in the middle of the snowstorms we were having, and the physicians did an amazing job,” Weis said.

Weis said Placer and Nevada County Public Health officials helped supply Tahoe Forest Health with the necessary protocol, testing kits and equipment from private entities in-state and out-of-state. Weis said his team used the CDC guidelines to provide referrals and optimize the use of a limited number of tests available.

“We’ve always had enough tests. It doesn’t mean we’ve had a lot left over,” Weis said.

Weis said the contagion peaked in Truckee between March 31 to April 3. Even then, with ventilator patients and medical-surgical patients, the maximum number of cases recorded in a single day was eight, and the hospital never lost any patients to the virus in-house, Weis said.

AHEAD OF THE CURVE

The IHME model assumes individuals’ consistent and comprehensive adoption of social distancing recommendations, including nonessential business and school closures, through August. California, the largest economy in the U.S., was the first state to implement the sweeping safety measures recommended to combat COVID-19.

Weis partially credits the community’s receptiveness to those measures, alongside his competent medical staff, to North Lake Tahoe’s relatively low case numbers.

“In our communication with the community we stressed sheltering in place,” Weis said. “We stressed it in a holistic way, where you’re really focused on mental and physical health, eating in nutritional ways and avoiding excessive alcoholic beverages.”

Weis said although one of the staff’s biggest concerns is securing the rapid 15-minute COVID-19 test, the dwindling case numbers offer the medical providers’ capacity to reopen and prepare the region for the best and worst possible long term outcomes.

The hospital will take extra measures to ensure the safety of its workers and patients, Weis said, including additional screening prior to patient interviews and more frequent changes of protective wear for health workers. He said the hospital and clinic he oversees want to minimize the unintended health consequences of the long-term shelter-in-place order.

“Diseases don’t sit idle while this shelter-in-place is happening,” Weis said, adding Truckee’s astounding unemployment rate makes its residents especially vulnerable to coronavirus ripple effects.

He identified poverty as an issue that needs to be addressed from a public health perspective as well.

“We’re also concerned about disease of job insecurity, food insecurity and house insecurity,” Weis said. “If a person is missing one or two or three of those it’s difficult to have good health.”

Reckoning with ‘Disease’ of Fear

Weis and Truckee Chief of Police Robert Leftwich share a common concern — Truckee’s health.

“The governor’s shelter-in-place order was very clearly not intended to be enforced by law enforcement,” Leftwich explained. “The social pressure was meant to inspire community-wide behavior change. He meant that we would stay at home and look out for each other.”

Some residents seemed to fixate on issues outside of their of control. Early on, Leftwich said he received demands to close down the Interstate 80. More recently, he received a call to apprehend two boys at the Rocker Memorial Skate Park.

“Stop fighting me on the nuances of the stay-at-home order, and the legalities and all these things you think should be happening but I’m telling you legally aren’t possible,” Leftwich said.

Leftwich urged locals to focus on their hygiene and “really try” to not participate in high-risk adventure activities.

“Focus on our core values which will drive down our numbers, which will keep you healthier, which will not stress you out, get you depressed or cause you to lash out on other community members,” the chief said.

Leftwich quoted Jerry Maguire’s “Help me help you” and said his role in flattening the curve was never to take a strong-arm approach.

“I can’t arrest my way out of this kind of problem,” Leftwich said. “Anyway, it’s a misdemeanor, not an arrest. It’s the psychology of how I steer our community into proper priorities.”

Leftwich said Truckee needs all of its emotional capacity for itself, especially because community members will likely be dealing with stress from this time four to six months out.

“I don’t think you’re gonna see substance abuse issues right away, obviously we can definitely feel the emotional well-being of our community waning,” he said. “It takes a while to tear a family apart.”

Leftwich said stress has a negative impact on the family unit. He said since the Governor’s order, there’s been a noticeable and predictable uptick in domestic dispute cases, though not domestic violence.

“Complications in the household, family providers lose their job or start to lose their businesses, that will impact the types of calls we’re getting,” Leftwich said.

Leftwich said he’s eager for community and state leaders to conceptualize economics link to emotional, mental and family health, and the impact those consequences have on future generations.

Looking Down the Line

University of Nevada-Reno Professor Steven Hayes is a clinical psychologist and a researcher on cognition in emotion. He specializes in trauma studies and his subjects include soldiers returning from war and survivors of school shootings. Hayes said the virus and the shelter-in-place order will have traumatizing effects on the community.

“You suddenly are in a very challenging situation where you may not have adequate supplies, there’s no consistent information, you’re socially isolated, you’re told you’re physically at risk, and you clearly have economic problems,” said Hayes. “It’s not clear when those will resolve so there’s a sense of uncertainty.”

Hayes said all those factors combined are a formula for emotional problems, especially anxiety, depression and the exacerbation of substance abuse issues.

“You see a lot of sales in terms of the marijuana shops and liquor stores,” Hayes said. “People shelter in place while using substances to self-soothe.”

Hayes said quarantine situations exacerbate people’s anxiety about misinformation, familial and platonic relationships and limited financial resources.

“Social isolation is really toxic for people,” Hayes said, adding “If we mishandle this we have multi-month, multi-year exacerbation of mental problems of all sorts.”

Hayes’ clinical recommendation is communal-wide honesty about the realities of present hardships with a strong dose of generosity.

“Support each other, call your friends and your family, listen — don’t just talk, try to make sure people have the reassurance that they need, supplies,” Hayes said.

Hayes said Tahoe Basin residents ought to reflect deeply about the situation of their gardeners and housecleaners and consider continuing to paying them.

Truckee’s income disparity will harm everyone in the recovery process, he said.

“When we see other people’s suffering we suffer because we’re social primates,” Hayes said. “We’re constantly being exposed to disparities, but data reveals that on a basic, primitive, neuron-level response to witnessing something wrong creates literal health problems for the wealthy.”

Hayes said this is the time to be especially charitable. The psychology professor echoed the plea of Truckee’s chief of police’s for value oriented-action. Staying true to oneself while remaining open, aware and cognitively engaged predicts post-traumatic growth, Hayes said.

Truckee offers a very basic connection with nature, he said, that is profound in these kinds of situations.

“You have incredible, world-renowned beauty around you which grounds you,” Hayes said.

There is no sense in putting on a hollowing show to save face in this trying time.

“We need to be more open with each other about how hard it is to be human.”

Rebecca O’Neil is a reporter for the Sierra Sun. Contact her at roneil@theunion.com.