Indoor events filled with many unvaccinated people have sparked the quick spread of COVID-19 in Republic, Washington, making Ferry County one of the country’s worst COVID-19 hot spots.

The first death from the superspreader events at the Fraternal Order of the Eagles in Republic April 10 and 11 was reported Friday. Health officials say the situation is a warning to other communities about hosting large indoor events with unvaccinated people.

Ferry County Hospital officials have confirmed 106 cases of COVID-19 in the last few weeks, and seven residents have been hospitalized and then transferred outside the county for treatment.

About 10% of the population of Republic, a tight-knit community of a little over 1,000 people, has tested positive for the virus in the last few weeks.

“In Ferry County especially, we’re seeing really sick young people showing up in the emergency room to get care,” Northeast Tri County Health Officer Dr. Sam Artzis said.

Local health officials moved Ferry County back to Phase 2 of the governor’s reopening plan on Friday, to hopefully keep the health care system and Ferry County Hospital from being further overwhelmed.

The hospital transferred COVID-19 patients who need intensive treatment, oxygen or ventilation to keep the emergency room open and flowing. COVID-19 patients with underlying health conditions can be hospitalized for several weeks.

“I don’t think the volume and flow will be suitable for maintaining patients here,” Dr. Richard Garcia, chief of medicine there, said in an interview.

He said the surge in patients seeking treatment, as well as the need for testing and vaccinations, has been stressful on the hospital’s small staff.

The Eagles superspreader event could serve as a warning to other rural parts of the state, including in the Northeast Tri County region and other pockets throughout Eastern Washington with low vaccination rates.

Artzis said the Eagles’ superspreader events were similar to a restaurant setting.

“I don’t think there’s anyone who meant to do wrong,” he said. “They wore a mask when they came in, then took it off to eat and drink. Then there was singing and live music.”

Variants and low vaccination rates are likely two factors impacting the rapid spread and intense symptoms of patients showing at up to Ferry County Hospital, according to hospital and public health officials.

“It is possible this will happen elsewhere, especially with variants we’re seeing at this time, which are highly transmissible and more severe,” Artzis said.

Ferry County Hospital has sent some positive COVID-19 test samples to the state to see if they are from variants, and administrators expect results back in a few days.

Garcia said patients showing up to the emergency room have more severe symptoms, different from COVID-19 patients earlier in the pandemic. He said there’s a pattern of nausea, vomiting and pneumonia. There also are many young people, including some in their 20s, who are displaying shortness of breath and viral pneumonia.

The hospital is receiving backup support from Department of Health staff to help with infection prevention, as well as from local nurses, who are slammed with phone calls from community members asking about their symptoms and when they should seek care. Community members who are testing negative are being referred for vaccine appointments, which the hospital also is offering.

Artzis said they have had to send patients outside the Inland Northwest due to tight capacity at surrounding hospitals, which also are seeing an uptick in COVID-19 hospitalizations. Artzis could not transfer patients to Colville, Chewelah, Spokane or Kootenai County last week, forcing him to look to other regions in Eastern Washington, like Yakima and Wenatchee.

“The situation is fairly dire,” he told reporters Friday. “(Hospital staff) have done a remarkable job handling this situation, so far, from a testing aspect, and they’re doing vaccines and they’re taking care of patients.”

Still, Ferry County Hospital has just 25 beds, some of which are for long-term care patients in their own wing, which has been locked down to visitors with the recent surge.

Artzis, who is also an emergency room physician at the hospital, said if more patients need to be hospitalized, he anticipates calling the statewide coordinator at Harborview Medical Center to send both COVID-19 and non-COVID patients elsewhere.

Community Impact

The Fraternal Order of the Eagles in Republic has been closed since the outbreak but will reopen next week to give back and support the community.

Darcy Dougherty, head trustee of the ladies’ auxiliary, called the outbreak the “perfect storm” and said it has been sad for the community.

The members of the Eagles who are not impacted are jumping into action. Teams will deliver meals to community members again starting next week, as they have been throughout the pandemic, and they are planning to host a drive-through vaccination clinic.

Dougherty, who already is vaccinated, said many of the kitchen crew and drivers at the Eagles have also gotten their shots.

“I respect everybody’s opinions, but I also respect the fact that if you have pre-existing conditions … it’s better to be safe than sorry,” she said.

She said the Eagles have “taken a lot of heat” for their events.

“It’s sad, but we’ll get beyond it, and we’ll hope for the best with everybody that got really sick,” she added.

During the outbreak, about a third of students in Republic were quarantined at home after the school district’s contact tracing identified them as at risk of being infected, Superintendent Kevin Young said. Sixty of 300 students have been studying from home all year, while another 60 or so were sent home after contact tracing, he said.

When the outbreak began, a call about an infected student came in around 2 p.m. on a school day. Young said by the next morning, two secretaries had pored over classroom, bus and cafeteria seating charts and contacted more than 50 parents about their children being in close contact with infected kids, he said.

Certain classrooms hit the hardest had only three or four students in attendance for the last two weeks, Young said.

Morgen Chase, an employee of Republic Market, said he and his fiancée have been grocery shopping for their quarantined neighbors.

“A hundred cases in a place where there’s only 1,000 people in the area – my next-door neighbors have it, everybody’s got it around me,” Chase said.

Chase said he’s still on the fence about getting the vaccine and feels staying home is a safer bet to avoid infecting people.

He said it seems about half of people in Republic are vaccinated or certain they want a vaccine, while the other half aren’t convinced. He said he doesn’t feel personally in crisis over the outbreak because he had time to prepare for it.

“The entire world’s been dealing with this for the last year,” Chase said. “It hit the entire world, but we’re hidden up here. We’re a year or two years behind with everything, music or movies or whatever. So I was anticipating something like this happening at some point.”

Young said despite the warning, the outbreak still took him off guard. After more than a year with so few cases, Young said he started to feel like the pandemic might skip Republic altogether. Now that it has hit, he feels the school district and community have handled it gracefully.

“People here are pretty resilient,” Young said. “It’s only my second year, but it’s an interesting place. People are very resilient and people take care of themselves and make things work, and there’s not a lot of complaining.”

‘Big Paradigm Change’

If there is a silver lining to the superspreader event, it is a renewed interest in the vaccine.

“We have boosters scheduled for next week and the following week, and we have a renewed demand for vaccine,” said Aaron Edwards, Ferry County Hospital CEO.

With the demand that testing and triaging COVID-19 patients has had on staff, Edwards is asking for help to seize on the new demand for vaccine. He is meeting with staff from WSU’s Range Health mobile clinic next week in the hope that they can offer vaccine clinics for community members.

Edwards has encouraged his own staff to get vaccinated. Currently, about 60% of hospital staff has gotten the shot, which both Edwards and Garcia are thankful for in light of the current outbreak. Edwards wants that number to increase, however, and the hospital board approved $500 bonuses for every employee who got or will get vaccinated.

“We need the whole community together,” Edwards said.

Garcia said the outbreak has seemed to impact some of the community’s perception of the pandemic.

“A lot of community members have seen the severity and been personally touched by it somehow,” he said. “I’ve heard this again and again from COVID-positive patients: ‘I wish I would have been vaccinated.’ ”

The worst cases of COVID-19 seen in Ferry County are in people who are not vaccinated, Artzis said. Only two breakthrough cases have been detected so far in people who were fully vaccinated, and those individuals have not been hospitalized.

In Ferry County, 77% of residents have not received the vaccine to date, according to data from the health district.

The Republic outbreak is also a warning to those relying on natural herd immunity to keep them safe, as well as younger people who think the virus won’t impact them.

“I would challenge those (who believe the) herd immunity theory to come watch the toll it takes on these young people who did not know they were vulnerable, to determine whether vaccines are important or not,” he added.

Ultimately, Garcia said this outbreak has led to the recognition that social gatherings and large events happened too fast, especially with so few people vaccinated.

“There’s been a pretty big paradigm change in the community with the reality of COVID-19 and its impacts,” he said.