Q&A: San Benito County Health Officer David Ghilarducci

He shares views on a rise in COVID cases, the rise of the Delta variant and the importance of getting vaccinated.

Editor’s note: This article was edited for lentgh. 

San Benito County has experienced an uptick of COVID-19 positive cases since June 15 when California permitted the widespread reopening of businesses. San Benito County logged 98 COVID cases over almost the past month, according to the Health and Human Services Agency COVID-19 dashboard. 

Of those cases, 79 cases were reported in the first 15 days of July, while the county logged 33 positive cases in the entire month of June.

As of July 15, San Benito County had recorded a cumulative 6,200 positive cases, 6,091 patient recoveries and 46 active patients. There has not been a COVID-related death since April 14, when the county reported its 63rd fatality.

On July 9, BenitoLink interviewed San Benito County’s interim Health Officer Dr. David Ghilarducci on the county’s COVID-19 situation and vaccination status. 


BenitoLink: What is the status COVID-19 in San Benito County?

Ghilarducci: We are starting to see more and more cases of the Delta variant. I think right now we are at three but we expect that to go up pretty quickly. We’re investigating 19 cases right now and we’ll see if those turn out to be the Delta variant. But we expect that the Delta, because of how efficient and how infectious it is, will become a main type that we’ll be seeing going forward. 

The Delta variant is twice as infectious as the original coronavirus. It has about 100 times more virus particles in the respiratory tract than somebody who was infected with the original coronavirus. The spike protein appears to attach to the human cells much more efficiently. So it’s much stickier, if you will. Sometimes it could be just a brief interaction [that results in an infection]. 

There is even a report of a case in Australia of one person passing another person and getting infected that way. 

We are starting to see some cases start to uptick now, probably since beyond the blueprint was retired on June 15 and also we’ve had Father’s Day and now of course Independence Day. We are two, three weeks out now, and I would expect cases to start to go up. 


Editor’s note: The county released new data on July 8 showing eight cases of the Delta variant in the county. On July 15, there were 20 Delta cases confirmed.


How effective are current vaccines against variants?

It turns out that current vaccines are extremely effective against the Delta variant, which is great news. But we have to make sure we understand what effective means—these vaccines were tested against keeping you from getting seriously ill or from dying. So keeping you out of the hospital or keeping you alive—they are extremely effective that way. But we are seeing now that the Delta variant is pretty clever and it turns out the vaccines are a little bit less effective in keeping you from getting infected. You can still catch COVID even though you are vaccinated. And we are seeing more cases of that. Fortunately, what that means is it’s a very mild illness that is gone in a day or two and nothing to worry about. 99.5% of the COVID deaths right now are in the unvaccinated population, which I think it’s just remarkable that this pandemic is now a major threat to a subset of our population that has not gotten vaccinated yet or has only gotten a partial vaccination because the vaccines appear to be not nearly as effective with a single shot. Unless of course it’s a single-shot vaccine. 


Among the positive cases in San Benito County since June 15, can you break down the number of people who were vaccinated and unvaccinated?

I don’t have that data in front of me but I can refer you to our epidemiologist if that’s okay. I can tell you that we know of at least one case of a vaccinated person who tested positive. In fact we have two [patients] in the ICU. They were both transferred out of county to a higher level of care and both of those people are in their 60s and both were unvaccinated. They are both seriously ill. Had they gotten vaccinated, they’d probably be home right now with the sniffles and that’s it, but instead they are fighting for their lives. 

Ghilarducci provided the following information on July 16: Yes a majority of recent “surge” have been unvaccinated. There have been a total of 97 cases since June 15. Of those, 17 (17.5%) were fully vaccinated and 80 (82.5%) were unvaccinated.


How many are hospitalized, either in or out of the county?

It looks like there are none in Hazel Hawkins Hospital as of yesterday [July 8]. I think that points out an important thing here. Last winter we were on the precipice of a medical disaster—our hospitals were full, we were running out of ventilators. I think with the Delta we’re not going to see that because most of our older population are vaccinated and most of our healthcare providers are vaccinated, but we’re still going to see serious illness and death in the unvaccinated group. I don’t think it’s going to overwhelm our hospitals but it’s going to get bad again. I think we can guarantee that.

We have other countries that have taught us this lesson. Britain and Israel are reporting that they are seeing more and more infections. Fortunately their hospitals are not overwhelmed yet. Israel had to reinstitute distancing and masking measures. 

We have significant pockets in our population in San Benito and across the country that have very low vaccination rates. That concerns us because these pockets are areas of vulnerability for us. Also, our youngest kids who are going back to school in the next month or two, if they are going to be fully vaccinated by the time they get to school, they need to do it now. Unfortunately, our vaccination rates are still fairly low with that group too.


Among people recently infected, what are the differences in symptoms between those who were vaccinated and those who were not vaccinated?

The main difference between the two is that if you are unvaccinated, you’re likely to experience very high fevers, you’re going to be dehydrated, very weak, the typical thing is shortness of breath where you’re not able to get enough oxygen—essentially suffocating. These folks who get very sick when they are unvaccinated are suffocating and it’s a horrible thing to watch. You can give oxygen and it helps a little bit, but what a way to suffer, being air hungry. So typically when that happens these folks need to be put on a ventilator and they have to be sedated and you hope they come out of it. 

Most people who get infected after vaccination either have no symptoms whatsoever—they feel completely normal—or they might feel a little bit of a runny nose, maybe a slight headache. Usually it’s gone in a day or so. It would be just like a very, very mild cold. So the difference between the two is just remarkable.


What is the status of booster shots?

I just read today Pfizer is applying for FDA approval for a booster shot. Right now the CDC does not believe a booster shot is necessary. There is some evidence that the immunity for the two-dose series may start to fade after 6 months but that’s only in keeping you from getting infected. There is still robust protection against hospitalizations and death well beyond six months and perhaps longer. Right now, no booster shots, but I would not be surprised if we see the need for booster shots going forward, especially as more variants come out.

There are two different variant versions of Delta that we’re really worried about. They are called the Delta plus. There is some slight difference between them. Each successive variant gets more efficient and more able to spread, and also probably escape immunity, either through shots or prior infection.

We don’t have Delta pluses in San Benito County. We are starting to see them in Los Angeles County so we think it’s just a matter of time. We are typically three weeks behind Los Angeles County when these things crop up. We may start seeing some Delta plus, which means basically it’s like Delta on steroids. If that happens, especially statewide, we may see masking orders again or some other advice and we may also at some point see booster shots being necessary.


Can the virus eventually mutate to where the vaccines are no longer effective?

We think they can. Viruses do this naturally. They evolve. When the virus is in a person’s body it replicates. 

Imagine going to the hardware store and you’re looking to make a key for a lock, but you don’t have the original. So the guy in the hardware store makes a million keys because eventually you’re going to find one that fits. That’s what a virus does every day. Eventually a virus will find a way around it.

The good news is that with the newer technology in vaccines, it’s relatively fast and easy to make a new one that is essentially changing the lock on your door. We can do it relatively quickly so that the key no longer fits. It’s a battle between the virus in our immune system and our ability to put up new defenses to combat the virus with newer vaccines. 

The current vaccines work really well. If most of our population were vaccinated today you and I would not be having this conversation right now. 


Is San Benito County near the vaccination rate it ought to have? If not, why do you think people are not getting vaccinated?

We’re not far enough along as I would like to see. We’re roughly overall around 61% and the state is more like 67%, so we’re lagging behind the rest of the state. If you compare us to the rest of the Bay Area we are 20% behind. We can do much better.

When you break it down by age, I’m really concerned about people 34 and younger. Those groups are still less than 50%, even partially vaccinated. The 12-15 age group is still only about 35% that had one shot. The bulk of our younger people who are eligible still have not received even one shot. I worry about this.

We’re going to see outbreaks in schools. We also have really big pockets of vulnerability. The other thing you have to remember for those [not vaccinated] are probably clustered with other people who’ve chosen not to get shots. For various reasons people tend to be distributed that way. Vaccinated people are more likely to hang out with other vaccinated people and vice versa. We’re going to see significant outbreaks going forward. I know that’s going to happen.

You ask why. I could tell you generally that rural areas tend to have lowered vaccination rates. That might be partly because of access to healthcare, it may also have to do with people who are on the margins who are afraid of vaccine side effects. They may think they might miss a few days of work and they can’t afford to do that. They are essentially living from paycheck to paycheck. 

There is also a significant amount of misinformation out there that we are always combating. Most of this is on social media. Misinformation about the vaccines altering your DNA, which it does not do. The vaccine does not affect your fertility—your ability to have a child. It does not involve the use of field cells—sometimes religious objections. It continues to be recommended by all major religious leaders and it’s also recommended by the American College of Obstetrics and Gynecology for pregnant women. 

People are worried that these vaccines came out too quickly. They feel they haven’t been out long enough to understand the potential side effects. Like any medical therapy there have been some rare side effects that we expect to see. We see this with any medications, we see it with any vaccine. This is no different. But it boils down to whether the benefits outweigh the risks. Not only are you potentially going to hurt yourself but you could harm somebody who you love. Somebody near you—a friend, a family. Even if your infection might turn out to be mild and there is no guarantee that might be the case, you may pass that virus on to somebody else who then passes away from that. 

I’m sympathetic to people who have second thoughts. I urge them to get information from reputable sources, from their own doctors, not from sources that are not vetted. Social media in particular has been a real disservice here.


What are the rare side effects you referred to earlier?

We’ve seen some issues with clotting, especially with Johnson & Johnson vaccines. Something called vaccine-induced thrombocytopenia— a condition that has happened in I think six cases in a million. Very very rare. We have seen that with the J&J vaccine. Also they noticed it with AstraZeneca in Europe—we don’t have AstraZeneca in this country. But AstraZeneca and J&J are using similar technology. Also with the mRNA vaccines, the Pfizer and the Moderna, we’ve seen inflammation of the heart, especially in young males. These have typically been very mild cases that are resolved on their own. The numbers are somewhere around five per 100,000. We have roughly 5,000 people, maybe 10,000, under the age of 24, and we would expect maybe less than one case of mild myocarditis—or inflammation of heart. The benefit of the vaccine and avoiding a serious infection far outweigh the risk of that side effect. 


Anything else that you would like to add that we didn’t cover regarding COVID or vaccines?

I’ll say this, and I think I’ve said it before, we have two pandemics going on right now. There is a pandemic for the vaccinated population, which I would call mild and not concerning at all. And then there is a very concerning pandemic involving the unvaccinated group. For them it’s getting more dangerous every day. It’s getting more dangerous because of the variants that are much easier to pass and it’s getting more dangerous because now we don’t have universal masking like we used to. The chances of you catching it, the chances of you ending up in the hospital or even dying from it are going up every day. This is a warning and an appeal. I’m very worried about our unvaccinated population in San Benito County. I ask that they really look at it seriously and consider getting vaccinated. 

The other thing I would say is some of those folks may feel that if they caught COVID last year that they are immune and they are fine. We are seeing now that the Delta is really changing that. If you’ve had COVID before you can easily get infected again, with the Delta variant in particular. You are still at risk. The vaccines are safe, they are effective, free and widely available. You can go to any drug store right now in San Benito County and just get one today. That’s the best thing you can do for yourself. 


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Noe Magaña

Noe Magaña is a BenitoLink reporter. He also experiments with videography and photography. A San Benito High School alumnus with a bachelor's in journalism from San Jose State and a Liberal Arts Associate's Degree from Gavilan College. Noe also attended San Jose City College and was the managing editor for the City College Times, the school's newspaper. He also was a reporter and later a copy editor for San Jose State's Spartan Daily.