Don’t plan a big party for May 4.
Although the governor’s stay-home order is set to expire that day, health officials and state leaders warned last week that a host of factors will determine whether Washington’s social distancing measures can be cut short or will need to be prolonged in the coming weeks.
John Wiesman, the state secretary of health, has repeatedly attempted to temper expectations, cautioning that the next few months will mark a “new normal” for Washington residents.
“The behavior changes we will need to make will need to be sustained for some time – certainly until we have a vaccine,” Wiesman said on a national press call with other public health officials this week, noting that things like physical distancing and frequent hand hygiene practices will be important. “Nobody, I mean nobody, should think we are going back to what this looked like before we implemented these measures.”
With President Donald Trump offering a roadmap to states for “Opening Up America Again,” governors have been left in the driver’s seat to work out the details and take their states in the direction they deem best.
Gov. Jay Inslee’s current “Stay Home, Stay Healthy” order is in effect through May 4, but whether he loosens those restrictions earlier or extends it later than that date depends on multiple factors. Under the guidance of state health officials, Inslee has said he envisions the loosening of mitigation strategies through a phased-in approach, not all at once.
“This transition will not be a light switch: on and off. It will be a dial, and we will dial it up and down as the data suggests and as our community responds,” Inslee said at a press conference this week.
“It will be a phased approach. The phasing will probably be the reverse as it was when we went into the effort,” Inslee said. “We started by prohibiting large gatherings, we then closed on-site education in schools, then (issued) a stay home order, then closed non-essential businesses. As we come out of this, we presume that it will be in an inverse order.”
Spokane County Health Officer Dr. Bob Lutz said he will work with the governor and the state health department’s guidance to re-open parts of society when the time comes.
“We’ve talked about a regional approach,” Lutz said, noting there are certain metrics to consider within different regions in the state. “We’re still concerned. All because it happened in a much greater capacity on the West Side, doesn’t mean it couldn’t happen here if we let down our guard.”
In Spokane and other parts of Eastern Washington, the Idaho and Oregon borders present different challenges to loosening Washington regulations than in the Puget Sound area. Inslee acknowledged that the virus could come back or spread from multiple sources in or out of state, which emphasizes the need for robust preparations to combat these potential threats, he said.
The governor and health officials have not released a detailed plan yet, but the tenants of what health officials and the governor will look for before loosening mitigation efforts have been discussed at length in recent days.
First, the numbers of new COVID-19 cases and deaths per day need to begin declining.
“Social distancing has to be successful enough that we drive down the number of infected people where we can be confident that we don’t think the curve will rebound and go up again,” Inslee said at an April 15 news conference. “Our social distancing effort has to be successful to a given level to reduce the number of people who are actually actively infected.”
Washington state has seen a decrease in the rate of new cases and deaths reported each day since late March, but those numbers have, so far, plateaued, not declined. The number of new cases and deaths reported on a single day peaked in late March, for now.
On March 25, 27 Washington residents died of COVID-19. On April 8, 14 state residents died of the respiratory virus.
Health officials will also look at hospitalizations and the number of people in intensive care units statewide with reported COVID-like symptoms. Current models from the University of Washington Institute for Health Metrics and Evaluation estimate a rebound in the number of cases if Washington state were to ease social distancing as early as next week.
Referring to this model, Inslee said this week, “If we do take off social distancing, we will see a rebound of this virus and more fatalities than we are experiencing today.”
Washington also needs to drastically ramp up testing and contact-tracing capabilities before re-opening parts of the state, health officials and the governor said this week.
Inslee envisions testing and contact tracing as a part of a coordinated response, “where we test people rapidly, isolate them rapidly, treat them rapidly,” he said.
“You might think of this as, to get to this second stage we have to build the equivalent of a fire brigade,” Inslee said.
Current testing and contact-tracing capabilities are not robust enough because of the high supply demands and the need to coordinate and organize a workforce to respond.
The governor said procuring the supplies needed to test people for COVID-19 is the state’s greatest challenge at this point.
Statewide labs have the capacity to run about 13,000 samples per day, but currently are only running about 4,500 per day due to a shortage of supplies, from swabs to the medium needed to transport samples.
The problem is not just nationwide, but global in scope. Washington state has ordered thousands of test kits, which leaders hope will alleviate some of this problem at a state level.
At a federal level, some Washington lawmakers are far from satisfied with the testing support from the government.
“What we don’t have yet that makes me so angry is the testing and the personal protective equipment we need to keep this from spreading again,” Sen. Patty Murray told reporters on a news call this week.
She said federal officials claim there are enough testing supplies, although everyone she has talked to back in Washington has said the opposite.
Scott Becker, chief executive officer of the Association of Public Health Laboratories, believes the companies creating the testing materials are doing as much as they can. The demand for testing supplies has never been so high and so widespread.
“We’re at a really critical juncture, and the supply chain has not caught up,” he said on a press call this week.
Murray is spearheading Senate Democrats’ efforts to call for a robust testing plan, which includes asking Congress for $30 billion to expand testing nationwide. Trump lists testing abilities as state responsibilities in the plan he released this week, however.
Testing will become even more important in the first phase of re-opening society in order to triage COVID-19 cases in the community to prevent rebounding case numbers. Wiesman told reporters last week that the goal would be to test anyone with symptoms.
If a person tests positive, they would be interviewed within 24 hours and the people they’ve been around would be contacted. Household members of a person who tests positive would be quarantined immediately, too.
Beyond testing, Washington needs to urgently ramp up its ability to contact trace confirmed cases of COVID-19. Contact tracing involves reaching out to the people someone was in recently touch with who might have been exposed to the virus, ensuring that they stay in quarantine to monitor their symptoms.
Local health districts traditionally conduct these investigations, but the Washington State Department of Health has offered any local jurisdiction its help during the pandemic.
“We want to make sure we can get a hold of every contact and case within 24 hours of that report and get the contacts with them within 24 hours,” Wiesman told reporters this week. “We’re doing some planning now as a system to make sure we could do contact tracing and case interviews for at least 1,000 cases a day if we had to.”
In order to prepare to implement contact tracing statewide, Inslee said they have identified 550 state employees to deploy into that effort in the coming weeks.
The limited ability of some local health departments to do contact tracing has to do with scaled-back staffing as public health budgets have been underfunded in recent years.
“Over time that (contact tracing) capacity has eroded as the public health system across the nation has had decreased funding, and certainly has not kept up with inflation or population growth,” Wiesman said.
Before moving into re-opening the state, leaders also want to ensure that those at higher risk for developing serious illness from COVID-19 are protected, and this week Inslee issued a proclamation advising employers to accommodate and protect these workers by offering tele-work or socially distant options for their work environments.
Ensuring that health care systems throughout the state not only maintain their capacity but also have enough PPE to treat COVID-19 patients will also play a role in determining how prepared the state is for gradual re-opening.
“We are also, like the rest of the country, very concerned about having adequate PPE supplies to protect our health care workers,” Wiesman said on a national press call this week.
That supply is vital to control the transmission of COVID-19, which is possible even if a person is pre-symptomatic or asymptomatic.
Ultimately, Inslee said he and health officials will evaluate COVID-19 activity data for declines, which the White House recommends should occur for at least two weeks before states take steps to re-open and scale back mitigation efforts. That data, combined with adequate testing and contact tracing capabilities, will guide decision-makers as they determine whether May 4 is too soon to begin scaling back some of the statewide orders.
“Both those things have to exist before we can push the go button for this transition,” Inslee said this week.
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