By Elizabeth Aguilera, CalMatters

Californians struggling to juggle going to work at hospitals, fire stations and grocery stores while worrying about child care are the intended beneficiaries of a new executive order Gov. Gavin Newsom signed over the weekend.

Amid the COVID-19 pandemic, the order will allow state agencies to waive regulations, offer state-subsidized child care and placement priority to parents deemed essential workers, and allow some after-school child care options to be open during what used to be regular school hours.

“This is a matter of paying for it or matching up child care with essential workers who need it,” said Kim Kruckel, executive director of the Child Care Law Center in Berkeley. “What the governor’s order does is make it possible for our state agencies to use federal and state child care money to pay for the child care of the children of essential workers.”

Essential workers are responsible for hundreds of thousands of children in California. Health care workers alone have more than 305,000 children under the age of 12, according to an analysis using U.S. Census data done by researchers from Yale University and Colorado State University. And all those children require care.

(Image: Joshua Martin and his two children, 4-year-old Olivia and 9-year-old Matthew, play Jumanji with their grandmother Shelley McCall. Photo courtesy the Martin Family)

Kruckel said she thinks there are enough licensed child care operators to meet the need without waiting for new pop-up centers. There are 10,770 licensed child care centers and 25,940 licensed family child care homes in California, according to statistics from Kids Data, a clearinghouse of child health information in Palo Alto.

It’s unclear if child care for these critical workers will be entirely free — but this opens a pathway for many to qualify for help, Kruckel said. To be financially eligible for state-subsidized child care in California, a household can’t exceed 85% of the state’s median income, or about $70,000 for a family of three, she said.

Under the order, the state departments of Education and Social Services must release specific guidance by Tuesday.  Social Services oversees all licensing for child care centers and family day care sites.

The state will allow agencies to waive administrative and other rules — cutting paperwork for example — for child care programs, and funding tied to eligibility that might prohibit some families from enrolling.

One thing that won’t change: the pre-existing priority for children who have been abused or neglected.

Newsom’s executive order aims to provide clarity for child care providers who’ve asked the state for help figuring out whether to stay open, if they can prioritize the kids of essential workers, and if they can expand their licenses intended for younger kids to also take in school-aged children.

State agencies now say they’ll provide detailed guidance to child care providers about how to limit the number of children grouped together under their care, keep meals and snacks safe, screen the health of staff and children, and ensure the kids practice physical distancing.

“The Executive Order aims to give health care workers and other critical infrastructure workers peace of mind, knowing child care services are considered part of the essential infrastructure and programs are available,” emailed Scott Murray, spokesman for the Social Services Department. “Most importantly, this will reduce disruption to California’s children, who will continue to have access to child care and development opportunities, with stable and consistent routines to minimize and reduce stress in uncertain times when children and families are enduring life changing adverse experiences.”

Whether school districts will use the executive order to provide child care is unknown. Los Angeles Unified School District had planned to open 40 child care centers when it first announced the closure of regular school, but the district quickly canceled that plan, instead opening “grab and go” sites to distribute food. District leaders have said they changed direction under the advisement of public health officials. District spokeswoman Barbara Jones said in an email Sunday that the district had no response yet to the governor’s order.

Health care and other essential workers have been scrambling for child care since schools shut down several weeks ago and many child care and preschool centers closed their doors. Some parents who have to care for coronavirus patients or who are driving ambulances or delivering food have left their kids with extended family members or relied on a partner now working from home, among other stopgap measures. If those options aren’t available, some may also be taking time away from work if they have no other options, experts said.

“Obviously having resources that haven’t been an option to our nurses and other health care workers is always helpful, especially when nurses work odd hours and late nights,” said Stephanie Roberson, spokeswoman for the California Nurses Association. She said ensuring flexibility is vital because nurses often work varying shifts and can be called in on a moment’s notice.

For health care workers, this could be a great relief, said Joshua Martin, a licensed vocational nurse working in a Kaiser hospital. He and his wife Stacy McCall-Martin, a mental health therapist, are both essential workers. They struggled to arrange child care options for their two kids the first two weeks school was out.

First, they traded taking days off. Then they tried finding a sitter or nanny but discovered that was going to be too expensive. Finally, McCall-Martin’s mother ended up watching the children, although Joshua and Stacy worry about her health because she is over 60.

Martin said the help from the state is welcome, but he would still be very careful about selecting a center to care for his children.

“It would take away from having to spend the money, and my mother-in-law would be safer. It would be a blessing,” he said. “It’s very stressful wondering about the children and worrying about how long this is going to go on.”

Steve Trossman, spokesman for SEIU-United Health Care Workers, which represents 97,000 hospital workers across the state including Martin, said members are waiting for the details of the order.

“We are glad to see the governor taking action on a problem that has created high levels of stress and anxiety among health care workers and other essential employees, who in too many cases are being asked to choose between taking care of people with COVID-19 and making sure their kids are safe,” Trossman said.

Last week the union released the results of a survey of 565 workers across the state that showed 80% of the health care workers said child care is one of their top challenges and undermining their ability to work, along with senior care. Eight in 10 of the respondents said they have kids younger than 14 at home and 63% said they are “scrambling” to find child care daily.

Other states have faced similar challenges and suspended certain regulations like zoning requirements in order to ease the burden. Here, the city of San Francisco has opened child care centers for essential workers in libraries and recreation centers. 

“It’s incredibly important for child care to be opened up for essential health care workers,” said Walter Gilliam, a professor of child psychiatry and psychology at the Child Study Center at the Yale School of Medicine. “We need to make sure that our health care providers who are going to work worried about how to protect themselves are not additionally saddled with the burden of who is taking care of their children.”

 Gilliam said he applauds Newsom’s order, but said any efforts to do this still need to ensure the safety of children and staff.

“If you don’t do this right, you won’t be doing it long,” Gilliam said.

He also warned that the state also needs to have a Plan B ready when teachers and other child care workers get sick.

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

By Julie Cart, CalMatters

The Centers for Disease Control and Prevention on Friday recommended every American wear a face mask while in public to protect against contracting coronavirus. 

The agency announced that non-medical fabric masks – even scarves or bandannas – could help slow the spread of the infection. State health officials earlier in the week made the same recommendation. 

The ever-evolving response to the coronavirus pandemic has amped up the need for keeping everyone safe from the virus.

That means wearing masks.

(Image: Food bank volunteer Betty Kimmel wears a protective mask as she hands out oranges to seniors at Teamsters 315 Hall in Martinez on March 19, 2020. Photo by Anne Wernikoff for CalMatters)

What is the purpose of a face mask?

It depends on who is wearing it.

Humans have long covered their faces to ward off disease, and medical masks have a long and colorful history .

For most of the public and some healthcare workers, “the main purpose of a mask is not to protect yourself from others, but to protect others from you,” said Bill Padula, an assistant professor at the University of Southern California’s School of Pharmacy.

Padula, who studies patient and worker safety in hospitals, said medical masks are designed to protect the wearer from contact with an infected patient.

“It isn’t simply thinking about what I have to do for this patient sitting in front of me, but ‘How do I treat this patient, with respect to the next  10 patients who walk into this clinic?’” he said.

In its new guidelines set Friday, the CDC said studies have shown that “a significant portion” of people with the virus have no symptoms and can still spread the virus. “In light of this new evidence, CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.”

Which masks are in short supply?

The highly-contagious coronavirus requires doctors, nurses and other clinicians to take extra precautions when treating patients. With more than 1 million people worldwide infected, there is a critical shortage of N95 masks and surgical masks — the types worn by healthcare providers.

The N95 respirator mask is a polymer cup designed to fit snugly to the face to form a seal, and filters out nearly 95% of airborne particles. The federal government suggests they not be reused or shared.

In contrast, surgical masks are made with multi-layered fabric, commonly pleated, with bands that hook over ears, and are worn loosely. They are designed to provide a physical barrier that prevents the spread of germs from person to person.

They also are not intended to be used more than once.

But in both cases, hospital officials in hard-hit cities such as New York have rationed the masks and are washing and reusing them.

The situation is made worse by the fact that about half of the world’s supply of medical masks is manufactured in China, with many of the factories located in Wuhan, thought to be the epicenter of the coronavirus outbreak.

What about other types of masks, will they work?

In many fire-prone communities around California, homeowners and local community emergency agencies maintain stocks of masks intended to protect the wearer from wildfire smoke.

Some of these are known as P95 masks, often recommended by fire officials for use by residents during wildfires. The masks — sometimes referred to as dust masks — are fitted with a small carbon filter, designed to protect against oil-based particles.

They work well in many applications, but are not considered medical-grade masks and are “not commensurate with current U.S. standards of care,” according to the Centers for Disease Control and Prevention. 

Federal guidelines go on to say, however, that P95 masks, alone or in combination with other measures, are acceptable when there are shortages of N95 respirators. “These devices are expected to be suitable alternatives to provide protection during the COVID-19 response when supplies are short,” the CDC guidelines say. 

The guidelines do not say why P95 masks, which block the same percentage of particles as the others, do not meet federal standards for health care workers. It is likely that they have not been fully studied to ensure that their filtration ability, seal and other factors meet the needs of hospitals, since they were not designed for that use.

How about donating those wildfire masks to hospitals and local clinics?

Napa City Council Member Liz Alessio organized a local donation drive that gleaned some 45,000 masks, the bulk of them surgical masks but some from people’s stocks of P95 masks.

The region’s vulnerability to wildfire meant that “folks had masks in their homes and businesses,” Allesio said. “There’s a lot more out there.”

Health care officials are most appreciative.

“We are humbled by the outpouring of support we have received from our communities and business partners to help source additional supplies,” healthcare HMO Kaiser Permanente said in a statement to CalMatters.

But the company said it was organizing a donation network and discouraged people from bringing donations directly to medical centers.

The California Department of Public Health told CalMatters that while the P95 fire masks are “highly effective,”  it is “up to the individual medical institution to decide if they are acceptable for use by personnel.”

At least one hospital told Allesio that it would not be able to use the donated P95 masks because they didn’t meet the hospital’s requirements. 

Medical masks are regulated by the Centers for Disease Control and Prevention, the National Institute for Occupational Safety and Health and the federal Occupational Safety and Health Administration.

The state launched a website where individuals and companies can donate or sell scarce medical supplies, including masks. The site specifically mentions N95 and surgical masks only.

Ok, what are the rest of us supposed to do?

Before this week, officials downplayed the need for most people to wear masks when they are out in public, provided they practice appropriate physical distancing. Then, as it became more clear that there are unknown numbers of asymptomatic people officials are now urging everyone to use face coverings, as well as remain at least six feet apart.

There is a wide variety and many gradations of face masks anyone can use, including rudimentary paper dust masks, often used for home DIY projects.

Barbara Ferrer, director of the Los Angeles County Public Health Department, said that for most people, a homemade mask using tightly woven cotton fabric, a bandanna or scarf affords sufficient protection.

“There really is no need for anyone in the public to go and secure N95 masks, I beg you not to,” she said.  “They are needed by medical workers or health care workers.”

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.

New models of the spread of coronavirus in Sonoma County show that the local shelter-in-place order will help reduce the number of deaths and hospitalizations in the county. But when infections peak about two months from now, patients could still exceed the capacity of county hospitals.

Sonoma County contracted with an epidemiologist at Imperial College London to model the effectiveness of local mitigation efforts and predict how the spread of the virus might impact hospital resources. The predictions, released Thursday, show that without the shelter-in-place order, more than 10,000 people would need hospital beds. The county currently has around 1,500.

Barbie Robinson, director of the Department of Health Services, says the goal of the projections “is to make sure that we are mitigating and flattening the curve as much as possible with respect to our more robust increased testing, more robust contact tracing, as well as strict isolation orders.”

Sonoma County began sheltering in place on March 18 and the order has been extended to at least May 3. The projections show that the current shelter-in-place order will likely improve the mortality rate for those 65 and older from 0.8% to 0.28% (of people infected). For those between ages 18 and 64, the mortality rate went from 0.18% to 0.1%. 

The shelter-in-place will also likely reduce the number of hospitalizations in the county. The modeling mapped two different scenarios: one where each person infected with the coronavirus infected 2.5 other people, and another where each infected person gave the virus to 3 other people.

In the first scenario, the number of hospitalizations in the county would near, but not exceed, the number of hospital beds available in the county during the peak of the virus. In the second scenario, the number of hospitalizations would challenge healthcare capacity, with over 5,000 residents requiring hospitalization during the peak — and that’s with the home isolation order in effect. 

The model also predicts a second surge in the number of cases once the shelter-in-place order is lifted. The county plans on leaving additional mitigation measures in place, such as robust testing and contract tracing. A vaccine would be the ultimate mitigation measure, according to Dr. Sundari Mase, interim health officer for Sonoma County. 

For people experiencing domestic violence, stay-at-home orders may be trapping them with their abusers.

California Assemblymember Jim Wood (D-Santa Rosa) is asking the public to raise awareness about these dangers as directives to shelter-in-place to slow the spread of COVID-19 continue throughout the state. 

“The recent passing of a woman from Mendocino County, allegedly from an attack by her husband who had been arrested numerous times for domestic abuse, is a grim reminder of the tragedy of domestic abuse and sexual assault,” Wood said in a press release. “We are now asking people to isolate and shelter in place in their homes, which should be a place we rely on to be safe.”

According to the release, the National Domestic Violence Hotline says they’ve seen an increase in the number of callers reporting that their abusers are using COVID-19 to increase their isolation from friends and family. In a statement on the hotline website, they say, “In a time where companies may be encouraging that their employees work remotely, and the CDC is encouraging social distancing, an abuser may take advantage of an already stressful situation to gain more control.”

According to Legal Aid of Sonoma County, the courts are still filing temporary restraining orders online during this time. Temporary restraining orders that are set to expire will be automatically renewed. Visit Legal Aid of Sonoma County's website for more help filing a restraining order.  

“Every county in the district I represent – Del Norte, Humboldt, Trinity, Mendocino, and Sonoma – has resources to help both victims and the public,” Wood said. “I have put many of them here on my website, along with other COVID-19 resources, and would ask that if you know of someone or see someone experiencing or vulnerable to this abuse or assault, please seek advice about how you can help.”

General resources and advice:

• Interactive map of California resources: https://www.cpedv.org/domestic-violence-organizations-california
• National Domestic Violence Hotline: 800-799-7233 or TTY 800-787-3224 or text LOVEIS to 22-522
• Tips for talking to a friend: https://www.domesticviolenceinfo.ca/tips-for-helping-a-friend/
• In emergencies, call 911