How the pandemic divided the California county where 1 in 300 people died of COVID

In September 2021, in the midst of the delta wave, the board convened to discuss, among other subjects, the state’s recent vaccine mandates for certain public-sector workers.

Health and Human Service Director Rebecca Espino addressed the board early in the meeting. She noted at the time that a fire had threatened downtown Sonora, a city of fewer than 5,000 and the county seat. The community had come together in the face of the blaze, she said. “We were one team. We were one county. And we had one fight.” But now, in the face of the surging pandemic, she was worried. Her voice seemed to quake as she noted one of the department’s employees, a young mother of two, had recently died from the disease.

“Unlike fire, this virus has attempted to destroy the unity of our community,” she said. “We care for each other. It’s always ‘we’ before ‘me.’” This landed like a plea as much as it did a statement.

County Supervisor Kathleen Haff spoke shortly after Espino. “I share your grief in the loss of two employees,” she told Espino, before moving on to make a bold claim. “It’s unnecessary to be fearful of COVID. It is treatable.”

Haff spent the next few minutes briefly outlining a 10-page position paper she had released that day, in which she questioned the efficacy of the coronavirus vaccines and compared possible mandates to Japanese internment during World War II — both violations of inalienable rights, she said. She received a standing ovation. Two other supervisors would also express, at the very least, discomfort with enforcing the state’s vaccine mandate for county employees.

Meanwhile, just a few miles away, Adventist Health Sonora, the county’s only hospital and its largest employer, was buckling under the weight of the surge. Espino’s wildfire comparison was an apt one. Though vaccines had been widely available for months at that point, only 50% of county residents had received at least one dose (compared with 70% statewide). The virus had plenty of room to burn, which meant hospital beds were so full, some patients had to be treated in the hallways.

One hospital manager said the experience with delta, and later omicron, was “far beyond” anything she had ever experienced in her decades-long career, including the AIDS epidemic.

It was as though two realities existed at once.

As of April 2022, COVID infections, hospitalizations and deaths have all reached record lows in Tuolumne County and protests have faded away. But in the months since the supervisor meeting, the community remains just as divided and residents don’t know if it will ever be the same — or if another wave might push the county’s death count higher still.

The drive from San Francisco to Tuolumne County takes somewhere between two-and-a-half to three hours, cutting east through the Central Valley before heading into the Sierra Nevada. Sonora, the county’s only incorporated city, named after the Mexican miners who founded it, rests on the western slopes of the mountain range. Winding roads, shaded by ponderosa pines, connect the city to other, smaller towns, like Twain Harte (population 2,300), Mi-Wuk Village (941) and Groveland (600).

Most of the county is designated as the Stanislaus National Forest or Yosemite National Park — the latter drew 3.29 million visitors to the area last year, a major source of income for the county.

During the pandemic, Tuolumne County saw a slight increase in new residents fleeing the major metro areas, enough anyway that homes are selling fast and housing stock is way down. Longtime residents have a name for the new people (and visitors in general): flatlanders.

Different people have different ideas about how long you have to live in the mountains before you can shake the title, though 20 years is a common one. Diane Dunnigan, who has owned a pub in Twain Harte called The Rock for exactly 20 years, thinks it has more to do with an attitude than anything else. If you’re “laid back, you’re a cool person,” you’ll fit right in, she says.

The heart of downtown Sonora is South Washington Street and it’s lined with shops and restaurants that assume a certain Wild West aesthetic for tourists. The county’s paper of record, the Union Democrat, keeps an office on South Washington Street — and the Board of Supervisors meets every Tuesday in a beige administration building just a couple of blocks (and a small courtyard) away.

By March 2020, when it became clear that the county would have to brace for the incoming pandemic, officials followed the usual playbooks: Gatherings were limited until they weren’t allowed at all; supervisors sat farther apart at meetings; schools were closed and community members made sack lunches with peanut butter and jelly sandwiches for students who would otherwise go without.

At the hospital, a three-floor campus with 152 beds (five in the ICU), staff was busy developing best practices for the inevitable surge of patients coming in. “And then no one did,” says Dr. Sarah Dunn, who works in the hospital’s emergency department and serves as the current chief of medical staff. “It was kind of that quiet lull, that nervous feeling, we knew it was coming. It was just a matter of when.”

The first wave finally came in late 2020, and the hospital built a white tent in the parking lot to add additional beds. “We didn’t want to scare the community,” Dunn says, “but at the same time, we weren’t going to be able to handle a surge with just five ICU beds.”

Eventually, the hospital was full of patients struggling to breathe, and the real shape of the pandemic became clear. “You get your first patients, and you’re watching people, I mean, they’re here for three weeks,” said Kim Diaz, the hospital’s medical surgical director. “You just watch them deteriorate slowly, slowly and it became so burdensome, not caring for them, but watching this. Watching this process.”

As grim as it was, Diaz would try to psyche her team up. “You guys, this is what we were created for,” she told them. “You know, we are ready. This is why we took on this job.

“Well,” she says now, “that was popular for the first couple months.”

There are certain challenges for small hospitals operating in rural counties, in particular, a lack of local specialists. Dunn remembers calling 50 different hospitals, trying to find somewhere to send a patient with a bad kidney infection. During the worst times, helicopters were a constant — landing on and taking off of the hospital’s helipad to fly patients to other care centers. When they weren’t, Dunn would walk the pad’s circular outline, trying to focus and calm herself.

“Initially, we were the heroes,” Diaz says. Church groups would bring in cards and lunches. But as people began to die, some grew angry. “Now, we’re killing people,” Diaz says. Now, they were telling families they couldn’t see their loved ones for a final goodbye or turning away pleas to administer untested (and ultimately discredited) COVID treatments like ivermectin.

There was also a growing resentment around mask mandates and later vaccination mandates. Even close friends and family didn’t always listen to her. Eventually, Diaz realized, all she could do was her job. She would drive by protesters, people holding signs that questioned whether COVID-19 was real at all. “You need to see what I see,” she would think. “We had three deaths today. … That’s not what the community sees.”

After a while, Dunn stopped going to grocery stores — she was always running into patients. She remembers seeing someone she had treated for chronic obstructive pulmonary disease walking around the Walmart with no mask. “It was the most heartbreaking.”

Then there was a moment earlier this year, during the omicron wave, the hardest of them all. Dunn remembers treating a patient, one of the sickest she had seen. “She was blue, she was panting, she just couldn’t get any words out.” All she could manage was a “yes” or a “no.” Dunn asked her if she had been able to get her flu shot or her COVID shot. “She looked at me and the only words she was able to say was ‘I don’t believe in vaccines.’ ”

Depending on whom you ask, you’ll get different answers about when the community seemed to split. Some say it started a couple of months into the pandemic when the worst promises hadn’t yet materialized. Others will point to the second set of shutdowns as delta arrived, or the moment when vaccines became widely available.

Whatever the answer, there’s wide agreement that something changed. Dunnigan, the Rock of Twain Harte pub owner, “saw it happen right at the very beginning.”

Like many business owners, Dunnigan grappled with how to stay afloat during the closures. She started running a mini-market out of the pub, selling meat and produce and rub mixes, along with take out orders. During the first months, when restaurants were closed for dining, people would occasionally take their burgers to go and eat them on the restaurant’s patio. Then a man started biking by and calling in complaints to the county. Eventually a police officer stopped by. Folks could eat together outside, across the street, he told Dunnigan, but not on the restaurant’s deck.

Later, when the restaurant reopened, employees found themselves arguing with customers, people they knew, about masking requirements.

Personal relationships frayed, too. Neighbors stopped waving to one another or turned the other way when they saw somebody they disagreed with come walking down the street. “I’ve seen it, especially on social media,” Dunnigan says. “People not being friends anymore because of those views, or those views.”

One of the last things Dr. Terrill “Terry” Spitze did from his hospital bed, was write a letter to the Union Democrat, denouncing the Jan. 6 riot at the U.S. Capitol as “a scene out of the worst banana republic you might be able to imagine.” The letter caught his wife, Karen Spitze, by surprise when she saw it in the Sunday paper. But it also made sense for Terry — the internist who had treated patients for 37 years out of his office in Sonora was a “politically minded” man, she says. He was also “a great doctor, the greatest father, a super wonderful husband.”

He died on Jan. 17, 2021 due to complications from COVID-19

Karen will never know for sure how or where Terry caught COVID, though she wonders about whether it might have been during a trip to their timeshare in Mexico. She hadn’t gone with, too nervous about the pandemic. Not long after he got back, on Dec. 30, 2020, he tested positive for the virus, and in the days that followed he grew sicker and sicker. Karen and other doctors he knew tried to persuade him to go in, but Terry could be, along with all those other things, stubborn. He was a doctor after all and active at age 70. He golfed and snow skied and traveled often. Terry thought he could manage on his own, with help from an oxygen machine.

Eventually, though, on Jan. 4, 2021, an ambulance arrived at his house to take him to the hospital. “I love you so much,” he told Karen before the van began to drive away. The following weekend was when she spotted his letter in the paper. Looking back, she can’t help but feel a little sad that he hadn’t written anything to her. “I would have liked a love letter,” she says. But at the time, “I still thought he would be around for Valentine’s Day.”

She saw Terry one last time, shortly before he died, though at that point, he was ventilated and “hooked up to 15 different things,” she says. “I talked to him, and there was no response. That was just very strange” — her voice breaks — “very sad.”

The community rallied around Karen following Terry’s death — friends and family, but also the people she worked with at the elementary school where she taught, the members of her sorority, the doctors and staff at the hospital. “They sustained me,” she says. But she, too, began to see cracks in the broader community, folks arguing about masks and vaccines. She didn’t like that, didn’t think it helped anyone.

“It’s been tough on everyone, and a real scary thing to go through, and some of us have suffered losses — it’s been a tragedy for my family,” Karen says. “Everybody has been touched by this, it seems, in one way or another.”

One hundred and eighty-one people dead. “I can’t think of any other single event that’s claimed that many lives in our county’s history,” says Supervisor Ryan Campbell, who chaired the board last year.

There’s an analogy he likes to make, to put that sort of loss in perspective. “Imagine,” he says, “if we had an intersection in our county where there were 181 traffic accidents in the span of two years. Our community would be demanding that the Board of Supervisors do something immediately and resolve that.”

There’s no such agreement around what to do with the pandemic. “It’s been pretty acrimonious in Tuolumne County,” he says. “And honestly, it’s been a struggle to sift through all the misinformation and policies that have been going on.”

Sometimes, he wonders, if maybe the Board of Supervisors is partly responsible. “When it was clear that there was a disagreement on the board, it pushed people into camps. And that’s really unfortunate. And it’s really something that I regret.”

The meeting during which members debated the merits of the state’s vaccine mandates felt to him like “a major turning point away from science and best practices, and toward political theater.”

That day, Supervisor Haff had released her 10-page white paper on COVID, questioning the efficacy of vaccines and the ethics of mandates. The paper began with a reference to the Nuremberg Code, a collection of guiding principals around human experimentation developed following Nazi war crimes committed during World War II. After a lengthy discussion, the board voted to table the subject of vaccine mandates, while staff looked into the issue.

The topic made its way back on the agenda two months later. During public comment, a man associated with the Proud Boys, a group of white nationalists and neo-Nazis, confronted the supervisors. He was there “to serve notice that you guys are all in very close violation of the Nuremberg Code,” the same reference Haff has used in her paper. The penalty for that, he told them, “is death.” He left shortly after without incident, but not before singing a neo-fascist anthem.

The board eventually voted 3-2 in favor of approving the state’s mandates (with Haff and Supervisor Anaiah Kirk voting against) but in Campbell’s view, the damage had been done. Once “board members began to publicly undermine Public Health, it opened the floodgates to conspiracy theorists. Angry citizens were targeting the very people responsible for fighting the virus.”

To hear Haff and Kirk explain it, they were doing their due diligence. During separate interviews with The Chronicle, they both bristled at the idea that they should simply follow the guidelines laid out by county, state and national health officials. They prefer, they say, to do their own research and reach their own conclusions.

Often they arrived at the same place by way of different paths. Kirk, a tried and true conservative, thought early projections had overstated the danger the pandemic posed and he couldn’t support vaccine mandates. At one point, Haff, who used to own a health food store in Oregon, questioned the very nature of the pandemic. “I don’t call it a virus because they’ve never found the virus,” she says. “But whatever it is, it has killed people.”

There’s plenty of evidence to rebut these positions. For starters, there exist microscopic images of SARS-CoV-2, fuzzy and two-dimensional as they are. It’s also true that more than 8 in every 10 people who died from COVID in Tuolumne during the past year, after vaccines became widely available, were unvaccinated — proof of the vaccines at work.

Dr. Eric Sergienko, who worked double time during the pandemic as the health officer for both Tuolumne and Mariposa counties, would go over these facts in detail during supervisor meetings. “By the time the delta wave hit, anyone who had wanted a vaccine had the opportunity to get it,” he said. “This was kind of a proof-of-the-pudding moment. You’re actually seeing the value of vaccines in terms of hospitalization and death.” But what he found is people dug in their heels, a particularly dangerous proposition in one of the state’s “grayest” counties — 27% of residents are 65 years or older, compared with the 14.8% statewide.

For others on the board, these sorts of public debates were farcical. “They professed during the meetings that they did their own research and it was directly contradictory to what our own public health department was saying,” says Supervisor David Goldemberg, who lost at least four close friends during the pandemic.

He wonders, maybe if the board had been more united, and the community more united, more diligent, how many lives could have been saved? “I struggle with that … you can’t change history.”

On a recent afternoon, Betsy Hurst-Younger drove to Sugar Pine Ridge, a place with sweeping views of Tuolumne County. This is where she held her daughter’s celebration of life. It was quiet, and heavy clouds had built up in the sky. In the distance, a few beams of sunlight had managed to pierce through, making golden the hills below. Whenever that happens, she likes to tell her grandkids, it means the angels are visiting.

When Hailey Younger tested positive for the coronavirus, Betsy wasn’t much worried. Hailey was young, just 33. She’d been one of the first people in the county to get vaccinated and her symptoms seemed mild. A week into Hailey’s diagnosis, she held a drive-by birthday party for her youngest son, William. He was turning 10, so she had family and friends come by and honk and cheer, while they watched from the porch. Betsy came by and left a cake and a bunch presents at the bottom of the stairs.

“They were all waving and having fun,” Betsy says. Five days later, the father of Hailey’s two sons called for an ambulance. Her organs were failing. Her blood sugar was so low she was nearly in a coma. They let Betsy visit for a while, she squeezed Hailey’s hand, and she’s certain her daughter squeezed back.

Eventually, though, it became clear that Hailey would need dialysis, a specialized treatment Adventist doesn’t offer. Staff called around to 32 different hospitals while a church group had 100 people on a prayer chain. Eventually they found a bed at Stanford Hospital and flew her there by helicopter. Betsy told her grandchildren about how their mother was going to one of the best hospitals in the world.

But not even the doctors there could save her. Not long after Hailey got to Stanford, Betsy got the call. Hailey’s fever had grown so high they weren’t sure she’d have brain activity if she survived.

Hailey died on Sept. 3, 2021, while her mother held her hand.

Everyone says you never expect to lose a child, and they’re right of course. There’s no written plan about what to do with everything and everyone left behind. For a while Betsy didn’t go anywhere, really. She’s a real-estate agent, so it goes without saying she knows a lot of people, and she’s pretty easy to recognize with her shock-blond hair and piercing blue eyes. When she finally went grocery shopping, the manager cried when she told him what had happened. She cried, too. “I talked with someone for about 15 minutes in the meat section. I go to another aisle, and somebody would say, ‘Oh, I heard,’ and then I’m at the checkout and the girl in front of me was friends with Hailey.”

And it was hard to see the anti-mask protests outside the elementary school or gathered in downtown Sonora. “I miss the days when we didn’t choose between public safety, the health of our children and politics.”

For the most part, people in Tuolumne County don’t talk much about those the pandemic took and all the threads they left behind.

Alex MacLean, the editor of the Union Democrat, says staff tried to write as much as they could about those who passed, “It’s important to show the toll. You might know this person. It might be your doctor.” But as the pandemic stretched on, it became harder and harder to find people willing to talk. “Really, it drove home to me how divisive and toxic this discussion had gotten within the community.”

For the most part, at least for now, as the nation nears the millionth death, the pandemic feels like a thing of the past in Tuolumne County. Infection rates have dropped, no new deaths have been added for weeks and as mandates have lifted, protests have faded. Whether that means the divide is healing is anybody’s guess, and certainly there’s always a chance of yet another crushing wave making its way to the Sierra Nevada.

But here’s one promising sign: A few months ago, a grief group formed in Sonora, inviting all those who have lost loved ones to meet and share stories and process the loss. The group started off small — just one person at the first meeting, by one account — but each month since, it’s grown.

Ryan Kost is a San Francisco Chronicle staff writer. Email: rkost@sfchronicle.com Twitter: @RyanKost