Q&A: San Diego Supervisor Nathan Fletcher

Nathan Fletcher is the County Supervisor for San Diego’s 4th Supervisorial District. Fletcher was sworn into office in January 2019 and is the only Democrat on the Board of Supervisors. In this Q&A, Fletcher describes his experience as a county leader during the time of COVID, behavioral health investments, addressing health inequities, and what gives him hope during this time. 



Emily Boerger: How do you navigate and lead as a county leader in the time of COVID? What has the experience been like?

Nathan Fletcher: “I think the key things that drive me every day are we need to be very transparent in terms of telling people what we know and what we don’t know. If things change, we need to be very transparent: this is what we thought, now we’ve got this new information and now this is what we think and here’s why. I think we have to be very clear, very concise.

And I think you have to be very compassionate in that this is a very difficult time. [You have to] really show genuine empathy for the senior citizen who’s isolated and worried, genuine empathy for the parent who’s got three kids and not a good Wi Fi connection who’s trying to teach and work, and empathy for the small business owner who has seen, you know, what they worked their life to build crumble before their eyes.

[And you have to have] a sense of resilience that we will get through this…This is a time where we have to come together to protect life and protect our ability to have an economic recovery. So I would say being transparent, clear, concise, very candid and honest, and then definitely empathetic with the real challenges people are going through.”

EB: What data points are you looking at and how do you know when to pull the trigger on decision-making?

NF: “Well, one of the most frustrating things about coronavirus is the significant delay between when the virus is actually spreading and when you will know. And so one of the most challenging aspects of this is you often have to take action before it is obvious to the general public that you need to take action.

An analogy, Emily, I use a lot, is I spend a lot of my life hiking and backcountry mountaineering, and you know, when it comes to being hydrated we always say, if you’re thirsty, it’s too late. By the time you’re thirsty, you’re dehydrated. You have to drink before you’re thirsty in order to stay hydrated. So, we often have to take action, you know, before the hospitals are overwhelmed, before we’re seeing an increase in ICU utilization, and before we’re seeing a spike in death.

The numbers that we really look at and that I look at most are the percentage of positive cases on a daily basis because day-to-day, you’re testing numbers fluctuate so the raw number of positives is not a great indication… And it’s the trend. It’s not one day, it’s where is that trend line going?

I think that there’s some promising things perhaps around wastewater testing, you know, and some other things that may give you some more active surveillance of what that virus is doing in real time. But, I heard a great analogy this morning – that one of the problems is that coronavirus is like a big heavy freight train and when it really starts moving, it’s moving. And you can put the brakes on, but it’s going to take a considerable amount of time — it’s not going to stop instantly. So, when we put in place additional tightenings or restrictions, you’re not going to see the impact of those for several weeks. So, that’s a challenge.” 

EB: The COVID-19 pandemic is likely to have significant impacts on behavioral and mental health. Since behavioral health has long been a focus of yours, what strategies are you looking at to prepare for this? 

NF: “Prior to COVID, behavioral Health was our highest priority. So, we’re continuing all of the actions that we had initiated around really building out a better way to deliver behavioral health services. But in direct response to COVID, I authored a Board Action where we allocated $15 million of CARES Act money specifically for behavioral health, both mental health and drug treatment services. And we did that to focus in particular on the opportunities around telehealth, around care coordination, around reaching out to folks who may not have been able to access their regular treatment.

And, you know, I’ve long thought that there was great opportunity around telehealth in all of health care, but in particular, behavioral health services. And so, we’re making a significant investment to increase our ability to deliver those.

We’ve also put $25 million — my office created a behavioral health impact fund where we will go out and acquire properties. And it appears that there is an increasing number of, kind of, small independent motels that are not having guests or not having tourists that we may be able to acquire and convert those into residential drug treatment settings. We’re working on that as well.” 

EB: Outside of behavioral health, what are some of the other trends or impacts from COVID that you will be monitoring and focusing your energy on?

NF: “One is we’re spending a lot of time around outdoors settings. We have an incredible opportunity in San Diego with the nature of our weather here that a huge percentage of daily life can be converted into outdoor settings…We’re really thinking differently about open space and outdoor opportunities. Because I think that one: this can be with us for the duration. But two: it’s a good thing to do anyway.

And then a real focus in my office is we created a COVID-19 equity task force around the recovery. And I think it’s important to point out that coronavirus did not create the inequities in our society, but it has definitely highlighted the inequities in our society. It highlighted communities that don’t have access to health care. There was a Harvard study that if you live in an environmental justice community with dirty air, polluted air, you’re 15% more likely to die from coronavirus because of the underlying health conditions that have been caused by the polluted air.

And I represent a lot of those environmental justice communities. I have neighborhoods… You know, a child in Barrio Logan is eight times more likely to have asthma than a child in La Jolla. That is morally wrong. The air should not be eight times dirtier because you’re a person of color or you’re poor.  And so, we’re thinking about how do we build back better as we move forward in terms of trying to address some of those underlying inequities that are present in our society?” 

EB: My last question for you is what successes are you proud of in the time of COVID? Or perhaps related, what gives you hope during this time? 

NF: “Well, what gives me hope is that we are a very resilient people. We’ve been through a lot of difficulties and we’ve been through a lot of challenges and it feels in the moment like, you know, this is the greatest challenge we’ve ever encountered. But you go back and you look at the social strife around the late 60s, you go back and you look at what folks went through in the Great Depression. You know, you go back and look at what folks went through in 1918, 1919 and 1920, with the most similar thing to this. And you know, what gives me hope is the small business owner I talked to, who tells me, ‘Look, I built something incredibly difficult and it was hard, because I am resilient. And because of that, I will rebuild’…

And that is the same spirit I see in the ICU doctor who says, ‘If I’ve got to work a double shift, I’ve got to work a double shift. But I’m here to save people’s lives and I’m going to save people’s lives.’

And I see that in the public health staff that we have here at the county and the contact tracers who are out there doing the unheralded work of the day-to-day blocking and tackling and efforts, you know, around what it takes.

And so, despite all of the very divided nature of our country today, I see people get up every single day and figure out: how do we make this work? How do we lift up one another and how do we hold one another and get through this together?”

This interview has been edited for length and clarity.