March 25, 2020
For Immediate Release
Thomas Locke, MD, MPH, Jefferson County Health Officer
Jefferson County Public Health
360-385-9400 Main Clinic
Stay Home, Stay Healthy – Governor Inslee Intensifies Community Mitigation Measures to Decrease Coronavirus Transmission
As of today, 10 Jefferson County residents have tested positive for the SARS-CoV-2 virus. No deaths have yet occurred. A total of 436 test specimens have been collected, 235 tested negative, and 191 are pending. Turnaround time for submitted specimens has been as long as one week.
Testing Availability: Access to testing for COVID-19 infection continues to be seriously limited: it has been over 8 weeks since the novel coronavirus was first detected in a resident of Snohomish County and shortages still exist. While the liquid reagents used in the test (referred to in the national media as “Test Kits”) are no longer in short supply, the current limiting factors are a lack of the Dacron swabs and viral transport media necessary to collect specimens and send them to testing labs and lab capacity. Overloaded public and private labs can only process a finite number of tests per day, producing reporting delays that compromise our ability to identify and notify contacts of infected individuals before those contacts become infectious themselves. Jefferson Healthcare is prioritizing testing in accordance with State guidelines with the hope that testing access will improve with each passing week.
Isolation and Quarantine: One of the most important strategies Public Health has to control infectious disease outbreaks is to quickly detect new cases of an infection, place them in isolation to prevent further spread, and then notify all exposed contacts before they become infectious and place them in quarantine. The delays in availability and restricted access to COVID-19 testing have seriously compromised our ability to maximize the impact of isolation and quarantine. Making the best of a very bad situation, all persons being tested for COVID-19 have been advised to self-isolate until they receive their test results. Close contacts of people awaiting test results have been advised they should restrict their activities as much as possible until it can be determined whether they have been exposed to the coronavirus.
Need for Maximum Social Distancing and Community Mitigation Measures: On March 16, Governor Inslee issued a broad range of orders closing schools, bars, restaurants, and prohibiting large gatherings along with a number of measures to reduce coronavirus transmission through social distancing. While this action has had some impact in slowing the spread of the virus, it is insufficient to prevent the expected surge of critically ill patients that could overwhelm the capacity of the health care system to take care of them. People continued to gather, travel around the state, pack into retail stores, and use the pandemic emergency as a vacation opportunity. On March 24, the order was expanded to a full “shelter in place”-type directive, prohibiting leaving the home for all but essential services. State parks have been closed, additional businesses are being closed, and criminal enforcement is being considered for those that violate the Governor’s order. All Jefferson County residents must realize that this is a deadly serious initiative. While COVID-19 is a relatively mild infection for 80% of those infected, 20% of confirmed cases develop severe illness requiring hospitalization and around 6% are in need of intensive care and mechanical ventilation. Those with mild infection who refuse to alter their activities end up infecting multiple people, driving the spread of the pandemic. High risk populations (over age 60, pregnant women, or those with chronic heart and lung disease, diabetes, or immune suppression) are at greatest risk of severe disease and life threatening complications. And those in lower risk groups are not immune from complications. Acute respiratory distress syndrome, the deadly complication of COVID-19, can occur in adults of all ages.
Governor Inslee’s “Stay Home, Stay Healthy” order is our community’s best chance to avoid an unmanageable surge of COVID-19 patients in need of hospitalization. This pandemic cannot be stopped–testing alone is too limited to effectively identify most cases. It can only be slowed and the number of people infected reduced. This is known as “flattening the curve.” Failure to accomplish this goal will have deadly consequences. Community members whose lives might have been saved by access to hospital-based resources will die for lack of that care.
Essential Services: The unprecedented closures of schools, restaurants, bars, entertainment venues, businesses, and other gathering places comes at an enormous economic cost. Closing essential services is not really an option. Power outages, food shortages and lack of essential transportation would magnify the social impacts. Cessation of essential medical, emergency, public safety, and public health functions would have unthinkable consequences. Essential workers, especially hospital and emergency medical workers are putting their health on the line to save lives. Healthcare workers are trained to deal with infectious diseases and, with adequate personal protective equipment (PPE), can safely deliver care of COVID-19 patients. The shortages of PPE at this early stage of the pandemic is a national disgrace. We do not have time for finger pointing. Urgent wartime-level surges in production are critically necessary. While efforts are being made to increase production of PPE, projected increases do not yet match the estimates of what we will need for the duration of this pandemic. Reuse and local production of masks will be necessary. Healthcare workers, emergency responders, caregivers of COVID-19 positive patients deserve access to PPE. And they deserve the respect and support of their community. One of the most difficult challenges of the coronavirus pandemic will be dealing with the surge of sick patients in need of hospital care. And after hospitalization, convalescent patients will need home-based care. At some point in the pandemic, every county resident willing to lend a hand will become an essential service provider.
Why Social Distancing Works: Coronavirus is both highly contagious and causes mild, even asymptomatic illness in the majority of people infected. These two factors cause it to spread undetected in communities for several weeks before it becomes apparent. When it does cause symptoms, it is indistinguishable from influenza or the common cold virus. The pandemic coronavirus strain was introduced into the U.S. at the peak of the influenza season. Early outbreaks of COVID-19 in the Seattle-area were thought to be due to influenza and no state testing was available until the end of February to determine the true cause. With widespread coronavirus moving silently through the community, the only effective strategy is to severely limit transmission by separating the infected from the uninfected through “social distancing” – closures of virtually all activities where people gather and using strict infection control (hand washing, respiratory hygiene) for essential services workers and for those rare times people need to venture out in public. The goal of these extreme measures is to break the chain of transmission – 80% of infected people will recover in 2-3 weeks, 20% will need hospital care. At the point that the epidemic curve is flattened, business activity can cautiously resume with many changes to maintain social distancing and prevent coronavirus transmission. The process, if successful, will stretch over 3-4 months but could potentially be much longer. The alternative is a deadly surge of cases, overwhelming health care facilities, and turning a public health emergency into a desperate struggle to save as many lives as possible. The United States is at a cross-road. Will we take the path of South Korea (who have employed radical social distancing coupled with widespread testing) or will we suffer the fate of Italy where a catastrophic surge of illness has overwhelmed the health care system? Please think about that fateful choice when you ignore the early signs of illness and decide to go to work, visit friends, or, worst of all, visit elderly parents and relatives. Also think twice as you move about the community doing essential tasks – will your unwashed hands be the ones that spread coronavirus from one surface to the next, leading to an infection of yourself or someone else?
A Note on Personal Protective Equipment Outside Healthcare Settings: It is not surprising to see more and more individuals in the community wearing masks. Masks are certainly justified for those with respiratory symptoms who need to catch droplet secretions. Those who are an identified contact of a COVID-19 case should not be out in the community, even with a mask. Friends or family should be getting your groceries. For those not infected with COVID-19, wearing masks offers no real protection (other than preventing you from putting your unwashed fingers in your mouth or nose) unless you are in close proximity to someone who is coughing. Strict handwashing or sanitizing before touching your face or eating food with your hands is the key to preventing infection while in public along with maintaining a safe distance (3-6 feet) from someone who might be infected with coronavirus. Wearing disposable gloves offers no protection and could actually increase the spread of infection. Coronavirus is not absorbed through the skin. For disposable gloves to be effective you must remove and dispose of them each time you touch a contaminated surface. Wearing gloves continuously gives people a false sense of security and reduces hand washing. Gloves become increasingly contaminated and, since they are non-porous, they provide an even better environment for coronavirus than hands. Touching your face or eating food with gloves on is even more dangerous than bare hand contact unless the gloves are new or have been sanitized. People wearing gloves in public should change the gloves frequently or, at the very least, wash or sanitize them as you would bare hands. Better yet, unless you have an unlimited supply of disposable gloves and change them frequently, abandon the illusion of safety and use your bare hands recognizing that it is our HANDS, gloved or ungloved, that spreads coronavirus. It is picked up from the environment and put into our bodies through our eyes, nose, or mouth or deposited on the food we eat with our unwashed fingers. Trust your health to clean hands, not gloves you wear all day and seldom sanitize.
A Time for Maximum Social Distancing, Infection Control, and Community Mobilization: Coronavirus is spreading in Jefferson County and will continue to do so. If transmission is successfully limited, i.e. if those who are infected do not spread the infection to anyone else, then recover, and become immune to reinfection, the spread of COVID-19 can be substantially modified. People at risk for infection complications, especially the frail elderly, must be protected from infection. If infected, they are at greatest risk of life threatening complications and will create the bulk of the surge impacting the health care system. All high-risk individuals should remain strictly isolated at home, avoid close contact with visitors, and practice strict hand hygiene before eating or touching their face. Despite these efforts, we will still see a surge in community members with this infection. Most will recover at home. Some of those who are home bound will need help from neighbors – food, beverages, and psychological support. Special efforts to help and shelter the homeless are underway. This will require volunteers – healthy adults under age 50 are the lowest risk group to provide these volunteer services. I urge all Jefferson County residents to keep informed, get involved, stay connected, and for those who are not essential service providers – STAY HOME, STAY HEALTHY.
Jefferson County Public Health
Always Working for a Safer and Healthier Community