Dr. Bob Lutz is getting ready to try and put the coronavirus in a box.
That, he says, is ultimately how we will reopen public life safely – by having a strategy to quickly identify, trace and quarantine new cases. Spokane County is not there yet in terms of equipment or volunteer resources, but Lutz, the health officer for the Spokane Regional Health District, said he’s working to get there by next week.
That means ramping up a volunteer force that could be available to reinforce the professional staff at the district. It means having enough testing and personal protective equipment, which is far from certain. And it means tracking a new series of metrics from the governor’s office that is just now beginning.
“I will allow the data to make my decisions for me,” Lutz said Tuesday.
The ability to identify and squelch new cases will be crucial for reopening, because Lutz expects that as we return to normalcy, even in small steps, the number of cases is almost certainly going to rise as a result of increased person-to-person contact. When that happens, we’ll end up locking down again if we can’t quickly box in the new cases.
He likens it to “slowly opening the door. We want to make sure we can quickly slam it shut.”
The political pressure to reopen the economy in Spokane County grows daily. Mayor Nadine Woodward and the County Commission are pushing Gov. Jay Inslee to grant us a special dispensation here to reopen more quickly, because our case numbers have been low for weeks. Inslee’s most recent plan to phase in a reopening – which has already begun in some sectors of the economy – includes the possibility of a waiver for small counties with even lower numbers of deaths than Spokane County.
Whether we eventually are able to open any sooner here than the rest of the state may be a moot point. Lutz said we should be cautious about it, in any case.
“Should we be on a different trajectory than the governor has recommended?” he said. “Caution is recommended.”
He acknowledges that our situation is good in many ways. Our caseloads are low, and have been low for weeks now. Our hospitalizations were never numerous, and have fluctuated around zero for weeks.
Yet Lutz cautions that those are not the only measures we should consider. Our “case fatality rate” – the number of fatalities as a proportion of all cases of a disease – is at 5.9, which is higher than Snohomish and Pierce counties, and not much below King County’s rate of 7.
And he’s concerned that a lot of us are in higher-risk populations here, such as the high percentage living in poverty. Testing remains insufficient, which means we have an incomplete picture and which affects the quality of the information we have. There’s a lot to consider – more than just a caseload total – and balance in making decisions.
“My approach has been to be very cautious and look at the data,” Lutz said.
And what he wants to see in the data are trends over time – “consistent, consistent, consistent trends.”
Whenever we open, we should expect a rise in cases. An opening that’s too early could mean a significant jump – as happened in Georgia.
We are in a moment of tension between the desire to reopen and the many voices in epidemiology urging caution. The White House – in a series of recommendations that are far from the most draconian – recommended that states only begin reopening after meeting six metrics that measure everything from declining case numbers to supplies of personal protective equipment. And yet the growing impatience to reopen has swamped those recommendations, as state after state reopens without having met those standards, and with the president’s explicit blessing.
Many are arguing to reopen based on nothing but a kind of barstool argument that unemployment is worse than the virus. As much as we chafe at these increasingly tedious stay-home rules, our decision-making has to be better-grounded than that, given that hastily relaxed social distancing is expected to cost lives.
The University of Washington’s Institute for Health Metrics and Evaluations issued a new model on Monday that predicted more than 135,000 Americans will die of COVID-19 by August – more than twice its earlier projections. (That prediction has a range of about 95,000 to 242,000.)
“The revised projections reflect rising mobility in most U.S. states as well as the easing of social distancing measures expected in 31 states by May 11, indicating that growing contacts among people will promote transmission of the coronavirus,” the institute said in a news release.
Whenever we open up here, it will only succeed if health officials can immediately identify and squelch the number of new cases that are all but certain to appear as people have more contact with others. The health district is aiming to be ready to go with such an effort by Monday, Lutz said.
One piece of that involves better, broader data. Lutz said the health district is creating its own information dashboard to publish our county’s performance in the areas the governor has identified as key to guiding reopening – from raw case numbers to testing capacity to risk to vulnerable populations. (You can view the state dashboard on the governor’s website.)
Many of the categories remain inexact at this point. It’s impossible to tell, for example, at what point a county’s system for contact tracing would move from high risk to low risk on the state dashboard. Lutz said his agency is working to get those firmer metrics now.
He said the district is recruiting volunteers to help in a testing-tracing-quarantine effort, and trying to line up the actual physical tests and protective gear. Both of those remain in great demand.
Lutz said Tuesday that he’d just received a shipping confirmation for an order of tests that he placed weeks ago. It’s the same story for the masks and gloves and other gear front-line medical workers need to be safe – as of last week, the state had received about 5% of the PPE it had ordered, Lutz said.
It will all be critical for a safe, successful, eventual reopening.
“This is how you box in the virus,” Lutz said.
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