The buck arguably stops with Dr. Wilma Wooten as the San Diego region starts to reopen its economy amid the worst pandemic in a century.
Wooten, the countys public health officer, cleared the way this week for resuming in-person dining at restaurants, as well as shopping at retail stores and swap meets. Her plan, which received state approval on Wednesday, makes San Diego the largest county in California to move ahead on Gov. Gavin Newsoms official timeline for easing lockdown conditions.
So far, the region has fared notably well under Wootens leadership when it comes to fending off the new coronavirus. Hospitals have not been overwhelmed with sick patients, and while its taken time, testing capacity and contact tracing appear to be ramping up.
Still, the largest challenge for the 63-year-old Alabama native may lie ahead. As corporate heavyweights and small business owners push for commerce to resume, health experts have said hospitals should brace for a spike in illnesses and deaths.
Wooten is a widely respected medical professional who received high praise for her handling of the 2009 swine flu outbreak that started in San Diego, but her political skills could be tested. Four years ago, she was thrust into the spotlight when a rash of hepatitis A cases ripped through the local homeless community. A state audit found she mishandled the crisis by not forcing the city to deal with the outbreak sooner and more forcefully.
A spate of new COVID-19 cases could force Wooten into a faceoff with elected leaders eager to please their out-of-work constituents something she says shes prepared for.
It will be difficult to dial back, but we will have to if things get out of hand, she said during an interview Thursday. This is a challenge of all health officers across the nation.
So far, disagreements over tackling the coronavirus pandemic have been relatively minor, such as when conservative Supervisor Jim Desmond recently downplayed the seriousness of the coronavirus outbreak by pointing out that all but six of the countys fatalities involved underlying health conditions.
Dr. Wilma Wooten, San Diego County public health officer
Wooten quickly rebutted the supervisors comments at one of the countys regular press briefings, saying that the lives of those with existing medical conditions were no less valuable than others.
Still, Desmond is not alone in his push to loosen restrictions far beyond what Newsom and his team in Sacramento have called for. San Diego Mayor Kevin Faulconer and the entire Board of Supervisors save its lone progressive, Supervisor Nathan Fletcher have called for reopening the economy far beyond what the state and the health officer appear comfortable with.
Wooten, with Fletchers support, has repeatedly called for following the guidance of state leaders as well as the Centers for Disease Control and Prevention.
We are very sensitive of the importance to balance protection of the publics health with economic viability, and we are following the governors guidance, she said.
That message comes in contrast to a letter recently penned by San Diego Mayor Kevin Faulconer and Supervisor Greg Cox urging the governor to allow local jurisdictions to control the speed at which they reopen.
Our businesses are ready to thoughtfully reopen and adapt with necessary protective measure, but they need to be provided that opportunity, the letter reads in part.
Wooten grew up with what she described as meager means in Thomaston, Ala., a rural town of fewer than 1,000 people and one streetlight.
Raised by her great grandparents, she and her brother spent a lot of time helping the local elderly community. She said the experience helped her develop an enduring sense of public service, and from a young age, she knew she wanted to get into medicine.
Valedictorian of her high school class, she attended Spelman College in Atlanta. Before graduating from the historical black college for women in 1978, she met Roslyn Crisp, who would become her lifelong friend.
Crisp, a 63-year-old pediatric dentist from North Carolina, said they mostly avoided parties and focused on their academic careers. They still see each other a few times a year and regularly vacation together.
She has the qualities that I think anybody would want in a friend, Crisp said of Wooten. Shes very compassionate. Shes understanding. Shes a good listener.
If she gives you an opinion, honestly, I really feel like she has thought it out, and shes done her homework.
Wooten went on to attended the University of North Carolina School of Medicine, where she graduated with a degree in medicine in 1986. She did her residency at the recently closed Providence Hospital in Washington, D.C.
She came to San Diego in 1989 to do her residency in preventative medicine at San Diego State University under Dr. Kevin Patrick, now a professor emeritus of family medicine and public health at the UC San Diego School of Medicine.
A year later on Patricks advice, Wooten applied to work at UCSD and was hired to, among other things, research family and preventive medicine.
She was very practical in her approach to things and very hard working, Patrick recalls. Obviously, she cares for the community. I think the social justice component was really important for Wilma.
Wooten was hired by San Diego County in 2001 to serve as deputy health officer. At the time, she was also volunteering on medical trips to Jamaica, Kenya and Ghana to treat and educate patients vulnerable to communicable diseases, such as AIDS.
In 2007, she was elevated to public health officer, overseeing the countys Public Health Services agency, which currently has about 500 employees and a $100 million budget. She currently makes a salary of $270,836 a year.
Her first big challenge came in 2009, when San Diego became ground zero for the countrys H1N1 swine-flu epidemic. Wooten would later win a national Public Health Heroes award for her work.
She is one of my public-health heroes, said Dr. Ron Chapman, public health officer for Californias Yolo County. He serves with her on the Public Health Accreditation Board. Dr. Wooten is brilliant, insightful, caring, and a strategic thinker.
Dr. Wilma Wooten showed the proper way to cough during a 2009 briefing on the H1N1 flu death of a county resident.
In March 2017, Wooten declared an outbreak of hepatitis A, which was infecting homeless people and illegal drug users through feces. Nobody knew at the time, but it would become the countrys worst eruption of the disease since a vaccine was introduced in 1995.
What happened over the next six months led to intense media scrutiny and finger pointing between county officials and San Diego Mayor Kevin Faulconers team.
While the county would later suggest the city dragged its feet on sanitation, the mayors team faulted the county for not taking charge during the outbreak.
This is a dark stain on our communitys civic record, said Assemblyman Todd Gloria, D-San Diego. Hepatitis is a disease that we know a lot about, that we have tests for, that we have a vaccine for. The fact that it killed 20 people and infected over 500 more was a real indictment of our public health infrastructure.
At the time, the city much like other parts of Southern California that experienced simultaneous, albeit smaller outbreaks of hepatitis A had long been entwined in a debate about whether homeless communities had adequate access to toilets and proper sanitation.
Advocates had routinely criticized Faulconer for not increasing the number of public toilets downtown, citing grand jury reports from 2010 and 2015 that warned unsanitary conditions in the city could lead to an outbreak of disease.
The issue became a political hot potato, with residents and local business owners complaining that public toilets invited unsavory behavior. In 2015, the mayor removed one of two metal toilets downtown, known as Portland Loos, which had cost the city roughly $560,000. The second loo was then removed at the height of the hepatitis outbreak.
Assemblyman Todd Gloria, D-San Diego
Wooten issued the first public health directive of her career on Aug. 31, 2017, calling on the city of San Diego to expand access to public restrooms and hand-washing stations, as well as to ramp up street-cleaning efforts.
The next day she declared a health emergency, and Faulconer made his first public statements on the issue, despite that fact that the city had quietly warned its own workers for months about the danger of infection.
Nobody wanted to take the lead, recalled Michael McConnell, a prominent local advocate for the homeless. Nobody wanted to be in charge of this thing, and on the ground it was just a train wreck.
Wooten and her team ramped up a vaccination program that eventually helped stem the outbreak.
However, California State Auditor Elaine Howle released a report in 2018 that found they should have acted faster. It faulted both the city and the county for not tackling sanitation earlier, but called out the county for being too lenient with Faulconers team.
The county health officer did not issue a directive sooner because she wanted to collaborate with the city instead of mandating its compliance, the report read. However, by exercising her legal authority before August 31, 2017, the county health officer likely would have prompted the city to implement the important sanitation measures sooner.
Gloria and Assemblywoman Lorena Gonzalez, D-San Diego, co-authored a bill in response to the audit report that cemented a local health officers authority to compel other government agencies to take action to curb the spread of disease.
According to the audit report, the countys own legal counsel questioned Wootens authority to issue Faulconer the health directive.
Neither Wooten nor Faulconer want to relitigate the hepatitis A crisis, citing the need to collaborate during the current pandemic.
That happened, and were in a different place now, and we have a great relationship with actually all of the municipalities that are in San Diego County, Wooten said.
Wooten has been much more visible in the current crisis, and the stakes are much higher due to the weeks-long shutdown of the economy and pressure to reopen it. She and other officials are giving regular video updates on Facebook and Twitter concerning issues that intimately impact the lives of nearly everyone in the county, from wearing face masks to opening local beaches.
The relationships been a bit rocky at times.
Wooten, for example, suggested in a press briefing this month that she would block casinos on tribal lands from reopening, saying: We feel that the health officers order does extend to our tribal nations in this particular situation.
Wooten reversed her position the next day after meetings with tribal leaders, acknowledging that, Tribal nations have sovereign authority, so our plan is to provide guidance and advice where possible.
In an appearance at the Rock Church on March 15, Wooten dismissed the idea that the virus could be spread by those without symptoms.
Oh, I heard that it was that you could without symptoms, said Pastor Miles McPherson during an exchange.
There are a lot of rumors and misinformation out there, Wooten responded. Even if theyve been exposed to someone who did have symptoms, if they do not have symptoms, others who have come in contact with that individual should be at low or no risk for developing the disease.
At the time, evidence of asymptomatic transmission was just starting to percolate. Its now believed that has played a significant role in spreading the virus. Wooten was not technically wrong about the state of research at the time, as shes quick to point out.
That was not a misstep, Wooten told the Union-Tribune. That was based on the facts that we had that day.
County public health officer Wilma Wooten M.D., and other officials, provide the latest updates on COVID-19 Coronavirus at the County Operations Center on February 14, 2020 in San Diego, California.
(Eduardo Contreras/The San Diego Union-Tribune)
Now Wooten has taken another bold leap into the unknown.
On Tuesday, she submitted a plan to the state for reopening restaurants, retail businesses and swap meets. Officials in Sacramento approved the plan the next day, making San Diego a test case for lifting stay-at-home orders in a highly urbanized area.
While Los Angeles County doesnt currently appear to meet the states requirements for reopening such businesses, several Bay Area counties seemingly do but have chosen to remain under lockdown, including Marin, San Mateo, Contra Costa, Sonoma and San Francisco.
San Diego has fared reasonably well during the pandemic, with about 6,300 cases and about 240 deaths as of Friday. Still, the decision to reopen comes at a time when the region is barely meeting the states benchmarks for doing so.
For example, the state has required as a condition for reopening such businesses that San Diego County be testing at least 4,950 people for the virus a day, or 1.5 people per 1,000 residents. The county reports that its currently testing only about 4,000 people a day on average, although it expects to meet or exceed the states benchmark by June.
The state has also called for counties to have enough open hospital beds to accommodate a surge in COVID-19 patients of roughly 35 percent. San Diego County currently has just enough free space across its 24 hospitals to meet the requirement, according to the report.
Theres also a question about whether the San Diego has enough contact tracers to be able to isolate infection clusters before they get out of control.
The state has called on counties to have at least 15 contact tracers for every 100,000 residents in order to open shops and eateries. That would be roughly 500 trained professionals for the San Diego region. Currently, the county reports that it has only 87 tracers, although its says the county has hired another 329 tracers that are currently completing their training. San Diego State University will also provide another 100 tracers at some point, according to the county.
Still, Wootens plan for reopening certain businesses appears to have the support of the local medical community. UC San Diego Health CEO Patty Maysent called the plan on Tuesday incredibly thoughtful.
I think it addresses the main issues that we need to follow, she said. The metrics that are laid out in the plan are in my mind pretty factually based.
The plan also has the backing of Fletcher, who appears to be Wootens firewall against politicians who would swing the doors open on the economy tomorrow if they could.
Dr. Wooten is one of the hardest-working public servants that Ive encountered in my time working in government, he said. She works on these issues of public health every single day, seven days a week, all day long.
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Meet Dr. Wilma Wooten, who wrote the plan to open San Diego restaurants and shops - The San Diego Union-Tribune