It’s a new year, with a new state system of COVID-19 restrictions, but Spokane-area officials are feeling familiar frustrations.

After the sustained and highest level of COVID-19 activity in Spokane County started in November, elected leaders here have seized on a downturn since mid-January to push Gov. Jay Inslee and the state Department of Health to hasten the reopening of the economy.

Since last year, the state’s reopening template has changed, with a regional approach now enjoining Spokane County’s fate with eight other counties in Eastern Washington that make up the “East” region. The conditions on the ground have shifted as well, with daily COVID-19 case counts reaching levels, previously unthinkable, that now pass with little notice.

Still, local officials’ arguments largely mirror those they made in mid-2020, when they pushed then-Spokane County Health Officer Dr. Bob Lutz to endorse an advancement in the governor’s now-retired Safe Start Washington reopening plan.

“This has been an extinction-level event for so many of our small businesses in our community, and I think we need to look at how we can safely open up more of our community,” Spokane County Commissioner Josh Kerns told The Spokesman-Review last week. “You get attacked for that view sometimes, but quite frankly, I don’t hear anybody saying, ‘Open everything up and disregard all public health guidance.’ Utilize your (personal protective equipment), exercise social distancing, wash your hands.”

Regional approach

After reimposing strict limits on social gatherings and businesses in November, Inslee announced in January that the state’s reopening approach would be determined by region, not on a county-by-county basis as it was last year.

The state set four criteria that a region would need to meet before advancing to Phase Two of the reopening plan, with thresholds set for new COVID-19 cases per capita, new hospitalizations per capita, the occupancy percentage of staffed intensive care unit beds, and the percent of COVID-19 tests that are  positive. The first two would be based on a 14-day trend and the latter two a 7-day average .

Inslee announced on Jan. 28 that he would loosen the standards, requiring a region to meet only three of the benchmarks instead of all four.

If Inslee expected adulation after announcing the change, he did not receive it in Eastern Washington.

Although the shift ostensibly made advancement easier for Spokane County, Mayor Nadine Woodward vented her frustration on Twitter, accusing Inslee of moving “the goalposts” again.

What irked Woodward was that the state will only consider advancement every other week instead of on a weekly basis. Before the tweak, Woodward had hoped the East region could move ahead as early as Feb. 5.

Inslee defended the two-week time period between when regions are eligible to move.

“We’ve attempted to provide some degree of stability to the system,” he told reporters Thursday.

“We thought it’s better to have two weeks because one week you might have a bad week or a bad couple of weeks, so this reduces the chance that we have an aberration that would knock you down a peg if you have a bad week, it’s less likely you have to regress,” he said.

Woodward suggested that regions be allowed to move forward based on weekly data, but be forced to regress only on biweekly numbers.

For local officials and the businesses that deluge them with complaints, perhaps the most frustrating facet of the restrictions is how unpredictable they can feel.

Had Inslee narrowed the number of benchmarks a region needs to hit from four to three just a few weeks earlier, Spokane’s region may have been able to move ahead weeks ago, Kerns said. But now it only meets two of the four criteria.

“It’s nice to see we only need to meet three of the four metrics, but at the same time it’s disappointing that again we’re seeing the playing field kind of shifted,” Kerns said.

Woodward said she appreciates the governor’s flexibility, but the standards have already changed twice since he announced the reopening plan in January. She expressed gratitude for an adjustment allowing restaurants with permeable walls to open at 25% capacity, but noted “businesses need to be able to plan.”

“It’s challenging for businesses to respond to all of these changes,” Woodward said.

Rural frustrations

The East region has double the percent positivity that the Puget Sound region does, with 18% of people who get a nose swab that  testing positive for COVID-19. This percentage is driven by the number of people testing positive in Spokane County, where efforts to expand testing are underway but remain mostly limited to symptomatic or exposed individuals, not the general public.

When asked whether the county could fund or provide expanded testing for asymptomatic people, which would likely reduce the positivity rate, Kerns said testing is outside the scope of what local officials can mandate. Individual providers set their own standards for testing, not the health district, and the largest in Spokane County continue to reserve tests for symptomatic and exposed people.

“We don’t dictate (to) health care providers how they deliver the service,” said Kerns, who serves on the county health board .

Rural health officials argue that case rates should be determined on a county basis, not a regional basis.

While Spokane’s elected officials have voiced concerns about the governor’s Roadmap to Recovery, counties attached to Spokane County in the East region also have concerns about being held back by the most populous county.

The Northeast Tri County Health District wrote to the governor and Secretary of Health Dr. Umair Shah about their ongoing concerns with the Roadmap plan even after the governor loosened requirements on Jan. 28.

Matt Schanz, administrator at the district, said they understand a regional approach to reopening when it comes to hospital capacity and readiness. While there are rural hospitals serving many of the counties in the East, Spokane is the medical hub of the region, where patients requiring the most acute care are sent, a system in place well before the pandemic.

For the other metrics, however, Schanz and other district leaders asked the governor to look at county-level data.

“Leave the regional approach for hospitalizations, but if you meet that hospital readiness objective, look at each county’s readiness,” Schanz said.

Schanz acknowledges that a county approach might not immediately move all counties the Tri-County  district . Ferry County, which has recorded five new cases in the past two weeks, likely could move ahead, however.

In the Northeast Tri County Health District’s letter to the governor, officials suggest that the COVID-19 case trend be used on a county-by-county basis, not regional basis, and that percent positivity not be used at all.

“There must be a way to recognize that counties, not large geographical regions, will be at different stages of readiness to advance given COVID-19 disease prevalence,” the letter district leaders sent to Inslee and Shah says. “The counties that NETCHD represents (Ferry, Pend Oreille, Stevens) should not be held back from advancing based on what is occurring in more heavily populated counties.”

Inslee has not signaled he will change the Roadmap, but last week he acknowledged that there are “10,000 legitimate criticisms” of the plan.

He reiterated that the regional approach protects the hospital capacity across the state, since medical systems are not limited to counties, and said a county-by-county approach comes with challenges too.

A county-based system might lead to neighboring counties being in different phases, Inslee said, giving the example of restaurants open and closed on opposite sides of a street.

Déjà vu?

The calls for advancement from local officials echo those made in June. Leaders including Kerns and Woodward argue the health of the economy does not have to be sacrificed for the health of residents, and voice concerns about the impact of shutdowns on citizens’ mental health.

Inslee and state public health officials warn that moving too fast, too soon, will lead to another surge in cases and could force regions to move backward.

Last June, local leaders made efforts to advance as the county’s COVID-19 cases were on the rise, although still below levels seen in recent months. Their calls were rebuffed, and hospitalizations and deaths related to COVID-19 began to rise shortly afterward.

Woodward warned against comparing the reopening push last summer to criticism of the governor’s current plan. She noted there is far more community spread of the disease now and advocated for more testing to track it.

When asked whether increased community spread is a case for maintaining restrictions, Woodward said, “You could stay shut down forever, I guess, until you’re on the other side of the pandemic, but I don’t think that’s realistic. You have to look at safe ways to reopen.

“We have to allow people to get back to work in a safe way,” Woodward said.

City Spokesman Brian Coddington also argued a comparison to last summer is unfair, largely because Phase 2 of the current plan is still far more restrictive than what would have been in place if Spokane County had been allowed to move forward last year.

The push last June also took place before a statewide masking order and while access to personal protective equipment remained limited, Coddington said. (Inslee issued a statewide masking order on June 26, but Lutz had issued a masking directive on May 20.) Since then, “We’ve learned a whole lot about how to behave and protect ourselves – including on the business side,” Coddington said.

Kerns believes, based on an analysis by the Washington State Hospitality Association, that restaurants can now safely reopen for indoor dining at 50% capacity. The Hospitality Association draws a correlation between states that have allowed dining at that level and lower coronavirus transmission.

According to the Department of Health data, restaurants and food service remain the top  source of outbreaks, second only to long-term care facilities, since the start of the pandemic. As of Thursday, there have been 260 outbreaks in food services and restaurants statewide, including six in the most recent week.

Whether it’s a restaurant or a gym, and regardless of a building’s capacity under code, judgments should be made on the ability to wear a mask and remain 6 feet apart, Kerns argued.

But the reality is, indoor dining is a setting that increases virus risk, health officials say.

“It’s an indoor setting, and you tend to have customers seated next to each other and because people are eating and drinking, you have to bring your mask down and that increases risk,” Shah explained in mid-January.

State Epidemiologist Dr. Scott Lindquist told reporters in mid-January that when restaurants were closed, there were fewer outbreaks in those settings, but he noted at least 19 outbreaks among employees in restaurants still open for takeout only during that time.

Shah told reporters restrictions were put on restaurants and bars because health officials believe there is risk in those establishments.

“The data and science is very clear,” Lindquist told reporters last month.

While there are many people challenging the new Roadmap to Recovery, others question why any regions are reopening at all with new variants of the virus moving through the country, and at least five cases of the U.K. variant B.1.1.7 confirmed in Washington.

Shah said the pandemic has meant a constant balancing effort, and the Roadmap reflects that. He defended the decision to allow regions to go ahead when they meet three of four criteria, but he also said that the state health department can dial back a region as needed.

“If there is any concern in our minds that things aren’t going in the right direction, that’s why we have the means to dial back our regions,” Shah told reporters Thursday.

Shah also noted that while Phase 2 does open up some businesses, it is still very restrictive.

Washington’s restrictions have been much tighter than some neighboring states, like Idaho, which currently has restaurants open and now allows gatherings up to 50 people.

“One of the challenges I’ve seen throughout the country is that when you dial up or back very quickly, there are real challenges not just on the operations side but on the community psyche,” Shah said.

Health officials think the current roadmap combined with current public health response will be able to detect if the new variant is circulating, or there are outbreaks of concern going forward.

The East region’s next opportunity for advancement will be on Friday.

Woodward hopes for good news for those eager to reopen further.

“I am optimistic,” Woodward said. “My message continues to be to follow the guidance, to follow the health guidance of masking and social distancing and not having large groups in your home.”

Last week, she released a warning to limit unsafe gatherings during the Super Bowl.

“We don’t want to mess this up,” Woodward said. We have to continue to follow the guidance and make sure we don’t disrupt the numbers.”

Editor’s note: This story was changed on Feb. 8, 2021 to correct when Gov. Jay Inslee announced that he would loosen the state’s COVID-19 reopening standards, requiring a region to meet only three of the benchmarks instead of all four. Inslee made that announcement on Jan. 28.