[Leftcoast]

Has anyone else been following San Mateo's recent moves?  On one hand they have some of the strictest mask rules in the state including fines for not wearing masks in public (including open air).  On the other, the county health officer is publicly blasting the state health office for enforcing triggers that shut down San Mateo businesses like Hair/Nail Salons and Gyms.  He's also been outspoken against including forced transfers in the county numbers, and frequently brings up San Quentin transfers as an example.

His basic premise is that he knows better than the state what's happening in his county and they should lean on his judgement vs a one size fits all metric.

Some samples:

"I wish to apologize to all the businesses that were closed this week. I am not supportive of these actions and, for San Mateo County, I believe they are misdirected and will cause more harm than good. This action is a bit like looking for your lost keys under a streetlight even though you lost them miles away."

" I feel the State has made the wrong “diagnosis” and therefore is prescribing the wrong “treatment” for San Mateo County."

What do you think?


https://inmenlo.com/2020/08/07/san-mateo...this-week/

[Leftcoast]

Has anyone else been following San Mateo's recent moves?  On one hand they have some of the strictest mask rules in the state including fines for not wearing masks in public (including open air).  On the other, the county health officer is publicly blasting the state health office for enforcing triggers that shut down San Mateo businesses like Hair/Nail Salons and Gyms.  He's also been outspoken against including forced transfers in the county numbers, and frequently brings up San Quentin transfers as an example.

His basic premise is that he knows better than the state what's happening in his county and they should lean on his judgement vs a one size fits all metric.

Some samples:

"I wish to apologize to all the businesses that were closed this week. I am not supportive of these actions and, for San Mateo County, I believe they are misdirected and will cause more harm than good. This action is a bit like looking for your lost keys under a streetlight even though you lost them miles away."

" I feel the State has made the wrong “diagnosis” and therefore is prescribing the wrong “treatment” for San Mateo County."

What do you think?


https://inmenlo.com/2020/08/07/san-mateo...this-week/

[teejers1]

Has anyone else been following San Mateo's recent moves?  On one hand they have some of the strictest mask rules in the state including fines for not wearing masks in public (including open air).  On the other, the county health officer is publicly blasting the state health office for enforcing triggers that shut down San Mateo businesses like Hair/Nail Salons and Gyms.  He's also been outspoken against including forced transfers in the county numbers, and frequently brings up San Quentin transfers as an example.

His basic premise is that he knows better than the state what's happening in his county and they should lean on his judgement vs a one size fits all metric.

Some samples:

"I wish to apologize to all the businesses that were closed this week. I am not supportive of these actions and, for San Mateo County, I believe they are misdirected and will cause more harm than good. This action is a bit like looking for your lost keys under a streetlight even though you lost them miles away."

" I feel the State has made the wrong “diagnosis” and therefore is prescribing the wrong “treatment” for San Mateo County."

What do you think?


https://inmenlo.com/2020/08/07/san-mateo...this-week/

I think the SMC person is probably correct; however, I happen to think the SCC person is incorrect (based on what I think should be the most important indicators of SiP controls).  Thus, although as a policy matter "local control" has a better chance of being correct than state or federal control (when it comes to the needs of a particular community), it is no guarantee of being "right!"

Query:  if the teacher's union has Gavin's ear; and if the teacher's union emphatically does not like the prospect of prominent private high schools in SMC (Menlo and Woodside Priory) opening up this fall with in-person classes (because it would make the public teachers' union look bad . . . and it very well might); do you think Gavin might just find a way to put SMC on the Watch List to prevent in-person classes?  

I'm not saying that's how it went down, but it wouldn't surprise me if it did.  A friend of mine in San Diego, whose kids attend LJCD, said the headmaster there and teachers were all on board with a plan to re-open in-person.  (His words were: "this guy is an ex-military guy and he was not effing around" when it came to safety-first protocols).  Then seemingly out of the blue SD gets hit with some order out of Sacramento that prevents that on campus education for the kids.  

If that is what's driving Sacto, Newsom should be ashamed.  I'm from a public school family (and my kids attend public schools).  And I'm resigned to the reality that our public schools will not re-open this year, perhaps not this school year . . . which is a travesty.  Still, I think it's outrageous that public school advocates would try and block private school education from proceeding down the course they (and their paying customers) deem advisable.  (Of course, I've never been a big fan of equalizing by bringing everybody down, either).  

I really hope this is NOT what is going on when it comes to educating K-12 in the state of California.  And I'd love to see some investigative reporting on this topic.  But alas . . .

[teejers1]

Has anyone else been following San Mateo's recent moves?  On one hand they have some of the strictest mask rules in the state including fines for not wearing masks in public (including open air).  On the other, the county health officer is publicly blasting the state health office for enforcing triggers that shut down San Mateo businesses like Hair/Nail Salons and Gyms.  He's also been outspoken against including forced transfers in the county numbers, and frequently brings up San Quentin transfers as an example.

His basic premise is that he knows better than the state what's happening in his county and they should lean on his judgement vs a one size fits all metric.

Some samples:

"I wish to apologize to all the businesses that were closed this week. I am not supportive of these actions and, for San Mateo County, I believe they are misdirected and will cause more harm than good. This action is a bit like looking for your lost keys under a streetlight even though you lost them miles away."

" I feel the State has made the wrong “diagnosis” and therefore is prescribing the wrong “treatment” for San Mateo County."

What do you think?


https://inmenlo.com/2020/08/07/san-mateo...this-week/

I think the SMC person is probably correct; however, I happen to think the SCC person is incorrect (based on what I think should be the most important indicators of SiP controls).  Thus, although as a policy matter "local control" has a better chance of being correct than state or federal control (when it comes to the needs of a particular community), it is no guarantee of being "right!"

Query:  if the teacher's union has Gavin's ear; and if the teacher's union emphatically does not like the prospect of prominent private high schools in SMC (Menlo and Woodside Priory) opening up this fall with in-person classes (because it would make the public teachers' union look bad . . . and it very well might); do you think Gavin might just find a way to put SMC on the Watch List to prevent in-person classes?  

I'm not saying that's how it went down, but it wouldn't surprise me if it did.  A friend of mine in San Diego, whose kids attend LJCD, said the headmaster there and teachers were all on board with a plan to re-open in-person.  (His words were: "this guy is an ex-military guy and he was not effing around" when it came to safety-first protocols).  Then seemingly out of the blue SD gets hit with some order out of Sacramento that prevents that on campus education for the kids.  

If that is what's driving Sacto, Newsom should be ashamed.  I'm from a public school family (and my kids attend public schools).  And I'm resigned to the reality that our public schools will not re-open this year, perhaps not this school year . . . which is a travesty.  Still, I think it's outrageous that public school advocates would try and block private school education from proceeding down the course they (and their paying customers) deem advisable.  (Of course, I've never been a big fan of equalizing by bringing everybody down, either).  

I really hope this is NOT what is going on when it comes to educating K-12 in the state of California.  And I'd love to see some investigative reporting on this topic.  But alas . . .

[OutsiderFan]

Obviously, it's a complicated situation, not in terms of what the proper risk mitigation tactics are, but what is the right combination of them in a given area or type of setting. This must also balanced out by the need to act in unison to be most effective.  And as it relates to private schools vs. public, there is another factor at play that has nothing to do with teachers unions. 

This is not wanting to allow wealthy private schools that can afford extra safety measures to open, while underfunded public schools have to stay closed because they can't afford them. If public school parents, know in-person instruction is more effective, and private schools open while their kids' school must remain closed do to financial concerns, they see a privilege gap that already exists, getting even wider. This can lead to a lot of angry parents and ultimately social unrest.

So there is a socioeconomic reason to treat all schools in a given area the same way. Maybe if private schools want to open, they can help the public schools in their area put practices in place and provide supplies that get them on par with themselves, as a price to get them open. It just is not  good policy to have private schools give privileged kids a clear path from the virus and its impact, while less privileged take on damage from it.

[OutsiderFan]

Obviously, it's a complicated situation, not in terms of what the proper risk mitigation tactics are, but what is the right combination of them in a given area or type of setting. This must also balanced out by the need to act in unison to be most effective.  And as it relates to private schools vs. public, there is another factor at play that has nothing to do with teachers unions. 

This is not wanting to allow wealthy private schools that can afford extra safety measures to open, while underfunded public schools have to stay closed because they can't afford them. If public school parents, know in-person instruction is more effective, and private schools open while their kids' school must remain closed do to financial concerns, they see a privilege gap that already exists, getting even wider. This can lead to a lot of angry parents and ultimately social unrest.

So there is a socioeconomic reason to treat all schools in a given area the same way. Maybe if private schools want to open, they can help the public schools in their area put practices in place and provide supplies that get them on par with themselves, as a price to get them open. It just is not  good policy to have private schools give privileged kids a clear path from the virus and its impact, while less privileged take on damage from it.

[teejers1]

 It just is not  good policy to have private schools give privileged kids a clear path from the virus and its impact, while less privileged take on damage from it.

Why not?  We've been told here that in-person instruction isn't all that important to educating our youth . . . Obviously, it's not deemed "essential."

More seriously, at least you own your position.  I'd love to hear that out of the governor's office (and the public teachers' union), if this is, in fact, what's going on.  More fundamentally, I'd at least like the question asked by reporters.  You know . . . try to do your job by getting to the factors leading to policy decisions.

One last question:  do you think correlating mask wearing and lower hospital usage (which you figure must be valid, if it correlates with reduced spread), and then stating that counties with X% hospital capacity will be allowed to have in-person instruction, would create societally positive incentives?

I would think that would be an overwhelming incentive for families to have everyone wear masks, irrespective of political views or socioeconomic status.  Almost everyone wants their kids to be educated at schools with peers (and those that don't are not really relevant to this discussion, anyway).

[teejers1]

 It just is not  good policy to have private schools give privileged kids a clear path from the virus and its impact, while less privileged take on damage from it.

Why not?  We've been told here that in-person instruction isn't all that important to educating our youth . . . Obviously, it's not deemed "essential."

More seriously, at least you own your position.  I'd love to hear that out of the governor's office (and the public teachers' union), if this is, in fact, what's going on.  More fundamentally, I'd at least like the question asked by reporters.  You know . . . try to do your job by getting to the factors leading to policy decisions.

One last question:  do you think correlating mask wearing and lower hospital usage (which you figure must be valid, if it correlates with reduced spread), and then stating that counties with X% hospital capacity will be allowed to have in-person instruction, would create societally positive incentives?

I would think that would be an overwhelming incentive for families to have everyone wear masks, irrespective of political views or socioeconomic status.  Almost everyone wants their kids to be educated at schools with peers (and those that don't are not really relevant to this discussion, anyway).

[Goose]

As many of you know, I have been contacting the San Mateo County Health Department since 9 April regarding their contact tracing efforts. Initially, I received mostly "all is well" responses. As time went on, I became more and more concerned that there was no data available about this on the SMCHealth web site. After getting what I would call the "run around" for a while, I contacted my Board of Supervisors representative. After a couple of e-mails back and forth (starting on 7 July), San Mateo County finally added most of the requested data during the week of 27 July. That data revealed that all was very much not well in the San Mateo County tracking and tracing program.

Dr. Scott Morrow also issued a statement on 20 July that was partially in response to questions regarding the increasing numbers in San Mateo County.
https://www.smchealth.org/health-officer...-statement
This statement is interesting and does provide significant context to his subsequent actions. Some somewhat unfavorable newspaper coverage and comments by the Board of Supervisors may have prompted issuing this statement, as it was relatively direct in tone. In this statement he cites three basic reasons for the increase in spread. I personally have to be somewhat careful in my reaction to this statement because it "confirms" what I believed about the cause of spread, although with some differences in emphasis.

Unfortunately, the statement of July 20 totally lacks numbers to support the idea that

A majority of people we are seeing infected now are front line workers (people who allow the rest of us to eat, and have electricity, and have our garbage picked up, etc), live in crowded multigenerational conditions, live with lack of trust in, and in fact have downright fear of, government.

I don't doubt that is the case. I have some anecdotal information I could add. I believe construction workers also are a major part of this spread. However, I have no numbers and no access to numbers that would prove/disprove that. The County Health Department is saying "a majority". Why no numbers? Presumably they have them.
Disturbingly, Dr. Morrow added

Try getting compliance with isolation and quarantine when the infected person is the breadwinner for the family and the family will be out on the street if they don’t go to work.  And when they go to work they will, perhaps, interact at that job with you.  There is not enough enforcement capacity in the world to stop this from happening.

I believe he is wrong. Such enforcement capacity operates in Italy and Singapore in examples we all know about. I do believe that no such capacity exists in San Mateo County. I also believe that nowhere in California does the will to use such capacity exist. However, Dr. Morrow has been aware of this problem for quite a while. There are other ways San Mateo County could approach this issue. One way would be County provided isolation housing coupled with direct payments to anyone whose breadwinner is isolated if they fall below a certain income. Isolation is only for two weeks or so. It is not for years. If San Mateo County had to minimally support 1400 additional families continuously and that would allow us to open up economically, it would be well worth it. Not simple to set up, and possibly won't work if nobody will cooperate. However, complete "surrender monkey" should not be an option.
Similarly, the statement

Complacency is the other majority factor enabling spread.  This is either born of belief systems (this is all a hoax, this isn’t that bad for me, let’s go to a party and get infected), or born of just not paying attention.  Many, many of our infections are related to fairly small gatherings of family and friends.  Birthday parties, picnics, eating at restaurants with mixed households, etc, without the basic precautions being taken.

Again, I totally expect that is an important issue. I have posted anecdotal evidence on this board. However, exactly how many is "many, many". No numbers again.

I agree with Dr. Scott Morrow that the local health agency is usually give the latitude to decide what is necessary. The State intervening from "left field" is unusual. We have been upset with Governors that have weakened prudent local actions in Georgia, Texas, and Arizona. I think it only fair to believe that SMCHealth is right and that Gyms, nail salons etc. have not contributed to spread in San Mateo County significantly. So I think the State should defer to SMCHealth here until proven otherwise. I think his eight points are "right on".

However, I think Dr Morrow has a couple of serious issues. He appears to believe he can calculate an accurate Re without knowing the number of total cases in a given area. I can think of several ways to do that, but they all involve sampling assumptions that I am not sure are valid. When he says Re never got below 0.9 when San Mateo County was full SIP I believe him. That is not good enough IMHO, but I do believe him. However, I would like to know how he is calculating Re today without knowing the number of cases per unit time, or at any time. As he points out in his point #1, it is a GIGO problem. Why does he "trust" his current estimates? Possibly does he have another source of what he believes are accurate case counts? Today, the estimate is 0.91. So in 10 days we should have only 0.4 times as many cases as we do today. When that happens I will believe the number. Until then, we have a problem.

The second problem is that San Mateo County Health has removed ALL of the data regarding contact tracking and tracing allegedly due to the problems with the State's data. If Dr. Morrow can still estimate Re, he still can report the contact tracing data. Clearly, the County knows how many cases with names and contact info they are receiving from the State, or from other sources. That list may be "incomplete", but that just gives them less to do. They can report the percentage they contacted, the percentage that can and will isolate, the number of exposed contacts reported to the County, the percentage of the exposed contacts they were able to reach, and the percentage of exposed contacts that can and will quarantine. However they aren't doing it. Why? I fear it is because they have largely given up believing they will get enough compliance to do much good, and they don't want to "fess up" to that fact.

[Goose]

As many of you know, I have been contacting the San Mateo County Health Department since 9 April regarding their contact tracing efforts. Initially, I received mostly "all is well" responses. As time went on, I became more and more concerned that there was no data available about this on the SMCHealth web site. After getting what I would call the "run around" for a while, I contacted my Board of Supervisors representative. After a couple of e-mails back and forth (starting on 7 July), San Mateo County finally added most of the requested data during the week of 27 July. That data revealed that all was very much not well in the San Mateo County tracking and tracing program.

Dr. Scott Morrow also issued a statement on 20 July that was partially in response to questions regarding the increasing numbers in San Mateo County.
https://www.smchealth.org/health-officer...-statement
This statement is interesting and does provide significant context to his subsequent actions. Some somewhat unfavorable newspaper coverage and comments by the Board of Supervisors may have prompted issuing this statement, as it was relatively direct in tone. In this statement he cites three basic reasons for the increase in spread. I personally have to be somewhat careful in my reaction to this statement because it "confirms" what I believed about the cause of spread, although with some differences in emphasis.

Unfortunately, the statement of July 20 totally lacks numbers to support the idea that

A majority of people we are seeing infected now are front line workers (people who allow the rest of us to eat, and have electricity, and have our garbage picked up, etc), live in crowded multigenerational conditions, live with lack of trust in, and in fact have downright fear of, government.

I don't doubt that is the case. I have some anecdotal information I could add. I believe construction workers also are a major part of this spread. However, I have no numbers and no access to numbers that would prove/disprove that. The County Health Department is saying "a majority". Why no numbers? Presumably they have them.
Disturbingly, Dr. Morrow added

Try getting compliance with isolation and quarantine when the infected person is the breadwinner for the family and the family will be out on the street if they don’t go to work.  And when they go to work they will, perhaps, interact at that job with you.  There is not enough enforcement capacity in the world to stop this from happening.

I believe he is wrong. Such enforcement capacity operates in Italy and Singapore in examples we all know about. I do believe that no such capacity exists in San Mateo County. I also believe that nowhere in California does the will to use such capacity exist. However, Dr. Morrow has been aware of this problem for quite a while. There are other ways San Mateo County could approach this issue. One way would be County provided isolation housing coupled with direct payments to anyone whose breadwinner is isolated if they fall below a certain income. Isolation is only for two weeks or so. It is not for years. If San Mateo County had to minimally support 1400 additional families continuously and that would allow us to open up economically, it would be well worth it. Not simple to set up, and possibly won't work if nobody will cooperate. However, complete "surrender monkey" should not be an option.
Similarly, the statement

Complacency is the other majority factor enabling spread.  This is either born of belief systems (this is all a hoax, this isn’t that bad for me, let’s go to a party and get infected), or born of just not paying attention.  Many, many of our infections are related to fairly small gatherings of family and friends.  Birthday parties, picnics, eating at restaurants with mixed households, etc, without the basic precautions being taken.

Again, I totally expect that is an important issue. I have posted anecdotal evidence on this board. However, exactly how many is "many, many". No numbers again.

I agree with Dr. Scott Morrow that the local health agency is usually give the latitude to decide what is necessary. The State intervening from "left field" is unusual. We have been upset with Governors that have weakened prudent local actions in Georgia, Texas, and Arizona. I think it only fair to believe that SMCHealth is right and that Gyms, nail salons etc. have not contributed to spread in San Mateo County significantly. So I think the State should defer to SMCHealth here until proven otherwise. I think his eight points are "right on".

However, I think Dr Morrow has a couple of serious issues. He appears to believe he can calculate an accurate Re without knowing the number of total cases in a given area. I can think of several ways to do that, but they all involve sampling assumptions that I am not sure are valid. When he says Re never got below 0.9 when San Mateo County was full SIP I believe him. That is not good enough IMHO, but I do believe him. However, I would like to know how he is calculating Re today without knowing the number of cases per unit time, or at any time. As he points out in his point #1, it is a GIGO problem. Why does he "trust" his current estimates? Possibly does he have another source of what he believes are accurate case counts? Today, the estimate is 0.91. So in 10 days we should have only 0.4 times as many cases as we do today. When that happens I will believe the number. Until then, we have a problem.

The second problem is that San Mateo County Health has removed ALL of the data regarding contact tracking and tracing allegedly due to the problems with the State's data. If Dr. Morrow can still estimate Re, he still can report the contact tracing data. Clearly, the County knows how many cases with names and contact info they are receiving from the State, or from other sources. That list may be "incomplete", but that just gives them less to do. They can report the percentage they contacted, the percentage that can and will isolate, the number of exposed contacts reported to the County, the percentage of the exposed contacts they were able to reach, and the percentage of exposed contacts that can and will quarantine. However they aren't doing it. Why? I fear it is because they have largely given up believing they will get enough compliance to do much good, and they don't want to "fess up" to that fact.

[BostonCard]

Why does he "trust" his current estimates? Possibly does he have another source of what he believes are accurate case counts? Today, the estimate is 0.91. So in 10 days we should have only 0.4 times as many cases as we do today. When that happens I will believe the number. Until then, we have a problem.

Your math is wrong.  R refers to the reproductive number over the entire infectious cycle of a pathogen not a daily number.  So in your equation, you need to divide the number of days by the average time between infections (about 10 days for COVID-19), so to get 40% as many cases as today, you need about 100 days (0.91^100/10).

BC

[BostonCard]

Why does he "trust" his current estimates? Possibly does he have another source of what he believes are accurate case counts? Today, the estimate is 0.91. So in 10 days we should have only 0.4 times as many cases as we do today. When that happens I will believe the number. Until then, we have a problem.

Your math is wrong.  R refers to the reproductive number over the entire infectious cycle of a pathogen not a daily number.  So in your equation, you need to divide the number of days by the average time between infections (about 10 days for COVID-19), so to get 40% as many cases as today, you need about 100 days (0.91^100/10).

BC

[lex24]

From day one, I have not liked the power wielded by these unelected officials. Without question, the Health directors should have a significant say.  But the Board of Supes should be the ones issuing orders.  They have to answer their constituents.  

Teejers raises, however, a good point vis a vis Newsom.  Certainly I could see him doing this to satisfy the teachers union.  I am very pro teacher. But not a fan of the Union.

[lex24]

From day one, I have not liked the power wielded by these unelected officials. Without question, the Health directors should have a significant say.  But the Board of Supes should be the ones issuing orders.  They have to answer their constituents.  

Teejers raises, however, a good point vis a vis Newsom.  Certainly I could see him doing this to satisfy the teachers union.  I am very pro teacher. But not a fan of the Union.

[Goose]

Why does he "trust" his current estimates? Possibly does he have another source of what he believes are accurate case counts? Today, the estimate is 0.91. So in 10 days we should have only 0.4 times as many cases as we do today. When that happens I will believe the number. Until then, we have a problem.

Your math is wrong.  R refers to the reproductive number over the entire infectious cycle of a pathogen not a daily number.  So in your equation, you need to divide the number of days by the average time between infections (about 10 days for COVID-19), so to get 40% as many cases as today, you need about 100 days (0.91^100/10).

BC

Your totally correct. I was doing it for a disease duration of one day. Well, at least someone read it =)

[Goose]

Why does he "trust" his current estimates? Possibly does he have another source of what he believes are accurate case counts? Today, the estimate is 0.91. So in 10 days we should have only 0.4 times as many cases as we do today. When that happens I will believe the number. Until then, we have a problem.

Your math is wrong.  R refers to the reproductive number over the entire infectious cycle of a pathogen not a daily number.  So in your equation, you need to divide the number of days by the average time between infections (about 10 days for COVID-19), so to get 40% as many cases as today, you need about 100 days (0.91^100/10).

BC

Your totally correct. I was doing it for a disease duration of one day. Well, at least someone read it =)

[Leftcoast]

Aren’t school closures a logical nonsequitor in the San Mateo case?  The health officer doesn’t deny his county hit the pre-arranged targets instead he believes the preset responses when a trigger is hit are wrong.

[Leftcoast]

Aren’t school closures a logical nonsequitor in the San Mateo case?  The health officer doesn’t deny his county hit the pre-arranged targets instead he believes the preset responses when a trigger is hit are wrong.

[Goose]

From day one, I have not liked the power wielded by these unelected officials. Without question, the Health directors should have a significant say.  But the Board of Supes should be the ones issuing orders.  They have to answer their constituents.

Yes they do. And that is the problem. What the constituents want may be (often is) exactly the wrong thing. Giving the power to the County Health Officer gives the Board of Supervisors political cover. They can say "We didn't do it. It was the Health Department" and not be fibbing. It also protects to some degree against Supervisors being idiots. They may disagree with the Health Officer, but if they want to override him they have to fire him. That is a big deal and would bring scrutiny. It will not be done lightly.
This system has been around since the days that epidemics were common. It works much better than relying on the politicians to do the right thing. Historically, when it comes to disease, they often won't.

[Goose]

From day one, I have not liked the power wielded by these unelected officials. Without question, the Health directors should have a significant say.  But the Board of Supes should be the ones issuing orders.  They have to answer their constituents.

Yes they do. And that is the problem. What the constituents want may be (often is) exactly the wrong thing. Giving the power to the County Health Officer gives the Board of Supervisors political cover. They can say "We didn't do it. It was the Health Department" and not be fibbing. It also protects to some degree against Supervisors being idiots. They may disagree with the Health Officer, but if they want to override him they have to fire him. That is a big deal and would bring scrutiny. It will not be done lightly.
This system has been around since the days that epidemics were common. It works much better than relying on the politicians to do the right thing. Historically, when it comes to disease, they often won't.

[lex24]

From day one, I have not liked the power wielded by these unelected officials. Without question, the Health directors should have a significant say.  But the Board of Supes should be the ones issuing orders.  They have to answer their constituents.

Yes they do. And that is the problem. What the constituents want may be (often is) exactly the wrong thing. Giving the power to the County Health Officer gives the Board of Supervisors political cover. They can say "We didn't do it. It was the Health Department" and not be fibbing. It also protects to some degree against Supervisors being idiots. They may disagree with the Health Officer, but if they want to override him they have to fire him. That is a big deal and would bring scrutiny. It will not be done lightly.
This system has been around since the days that epidemics were common. It works much better than relying on the politicians to do the right thing. Historically, when it comes to disease, they often won't.

So what protects us from health officers being idiots? Or are they exempt. Sorry but if the board of supes don’t have the courage to make the tough decisions and undertake their jobs they shouldn’t be there in the first place. I think the system has served us poorly throughout this pandemic and I hope it changes.

[lex24]

From day one, I have not liked the power wielded by these unelected officials. Without question, the Health directors should have a significant say.  But the Board of Supes should be the ones issuing orders.  They have to answer their constituents.

Yes they do. And that is the problem. What the constituents want may be (often is) exactly the wrong thing. Giving the power to the County Health Officer gives the Board of Supervisors political cover. They can say "We didn't do it. It was the Health Department" and not be fibbing. It also protects to some degree against Supervisors being idiots. They may disagree with the Health Officer, but if they want to override him they have to fire him. That is a big deal and would bring scrutiny. It will not be done lightly.
This system has been around since the days that epidemics were common. It works much better than relying on the politicians to do the right thing. Historically, when it comes to disease, they often won't.

So what protects us from health officers being idiots? Or are they exempt. Sorry but if the board of supes don’t have the courage to make the tough decisions and undertake their jobs they shouldn’t be there in the first place. I think the system has served us poorly throughout this pandemic and I hope it changes.