COVID Q&A with Pierce County health director: testing, outbreaks, returning to school
Pierce County, you’ve forgotten lessons you learned before Phase 2, and now it may be time to go back to Phase 1.
That was just one of the topics covered in a News Tribune interview this week with Dr. Anthony Chen, director of the Tacoma-Pierce County Health Department.
When asked about a move back to Phase 1, he noted, “I think we need to have that conversation.”
He also spoke about his recommendation for schools to not return to the classroom this fall, saying that for now, it’s not going to be safe.
The health department is working with other state officials and education systems, public and private, to go over what it would take to reopen.
Chen also discussed his concerns about COVID-19 testing in the fall. He said he feels time was wasted while residents were sequestered in their homes, and the federal government could have been ramping up testing.
“We expect that COVID-19 will probably become more active at that time, but also the other people with COVID-like symptoms will need to get tested to make sure they do not have COVID, and so if we’re having challenges now, we’re going to have more challenges in the fall,” he said.
Chen touched on lessons learned so far, one aspect of safety operators the Emerald Queen Casino might consider and why the health department stands by its policy of not identifying locations of outbreaks.
Answers have been edited for length.
PHASE 1 AND NORMAL ROUTINES
Q: Given where we are now with the surge that’s been happening, have you considered recommending going back to Phase 1?
A: I think we need to have that conversation. I think people need to understand that we got to Phase 2 because everyone did their part. Everyone has a responsibility to do their piece, and everyone did, and we brought cases down. We were able to move from Phase 1 to Phase 2. What has happened is when we went to Phase 2 a lot of people forgot what they did, and they just went back to doing what they normally do. And so we’re trying to encourage people to please, do your part, take the responsibility and see if we can bring this down.
At some point if we can’t bring it down with that, we’re going to have to look at other measures. I’m going to hate to do that but, you know, we just can’t let this keep going up, and we need to have those conversations. And it’s hurting our community, it’s hurting the businesses, it’s really not accomplishing what we want to do. At some point, you know, the governor or someone else might tell us what we need to do. So we definitely need to have those conversations.
Q: While more people are wearing masks, many feel they can continue about their normal routine without social distancing or isolating as much as possible. Do you feel that wearing masks is enough? Is it OK for people to continue about their normal routine if they’re just wearing a mask?
A: The simple answer to your question is no. People should not be continuing their normal routine. Most people’s normal routine includes going to a lot of different places they shop, maybe driving all over the state to go hiking or camping, hanging out with friends, giving friends hugs. No, you should not be doing that.
I think what we saw in the spring was everyone really buckled down. Everyone stayed at home. It was clear there was no traffic. And then, two weekends ago, I was biking over the McKinley bridge and Sunday afternoon there’s a huge traffic jam on I-5. People have forgotten all these good habits that they learned during the stay-home order. People are forgetting that we’re in Phase 2. You’re only supposed to have gatherings of five people. You know someone on Facebook posted a picture from Monday where there were like 100 young people jumping off the pier on Ruston Way.
Yes, absolutely they should be wearing a face covering or a mask. Yes, they should not be going out if they don’t need to. Yes, they should be limiting the number of people they interact with — we recommend no more than five and for me two of those are my parents. I have elderly parents who live in Federal Way, those are the two people I will see every week, but I’m not hanging out with my friends. I’m not going out to dinner or whatever.
Yes, people need to maintain physical distance from other people. Yes they need to keep washing your hands, so it’s all these things that people need to do.
What we’re seeing now is when people don’t do that, we have lost our grip on this virus. We’re in uncontrolled rise in cases now.
Fortunately, a lot of those cases are in the younger people who tend not to get very sick and who tend not to die, not to say they don’t, because these are lagging indicators, but we are starting to see some uptick in hospitalizations, but the chance that 20-year-old is going to die is much less than an 80-year-old.
The problem is the 20-year-olds, give it to the older people, they have parents and their grandparents may still be living. And there are also a lot of people we know in our county who have illness chronic illnesses and underlying health conditions — obesity, heart disease, diabetes, asthma, and those people are going to have very rocky courses. And over 95% of our deaths have an underlying health condition.
ON KEEPING SCHOOLS CLOSED FOR IN-PERSON CLASSES
Q: Please explain your decision to recommend schools remain closed to in-person learning, while the Trump administration and CDC are urging schools to reopen in the fall.
A: We’ve been working with schools for a while, and all the schools have been doing work, and there are two issues that we’re working with them on. One is, how would you reopen if you could reopen? And this is where OSPI, CDC, there’s been a lot of guidance issued, and we still need to continue to work on them because there’s some areas where it’s not 100% clear …
On the other hand, the big issue, which led to my letter last week is, is it safe for kids to be back in school with in-person instruction? And right now the way that our cases are going and the widespread community transmission, it’s just not safe.
Everyone worked really hard together, and we were able to bring the cases down in April. It wasn’t always the smoothest because we hit these stubborn plateaus; we were hovering around 20 to 35 cases a day for about a month, then we came down to about 10 to 15 cases a day. Well, in the past week or two we’ve gone triple digits like four times and we are way higher than we were in April.
You know one of the metrics that the state has used, which is how many cases have you had in the last 14 days and what’s that rate per 100,000, as you know when we went from Phase 1 to Phase 2, the state was looking at 25 (cases per 100,000), and we were 16 at that time. But then within less than two weeks in June after we went to Phase 2, our cases started climbing. It’s pretty much been a straight line up from there. We are now at 141 for 100,000 in two weeks.
We’ll have to see because every few days, it looks like it might flatten but then we get surprised again. So, that’s the context and what that means is, there is widespread community spread of COVID-19. So at this time it’s not going to be safe to have groups of children together for in-person instruction.
Q: You have some legal authority to require that schools don’t reopen, but what power do you have to dictate to what extent that private schools open, because right now, a lot of private schools are saying that they are continuing plans to reopen.
A: We had conversations yesterday. I met with the Catholic schools and then in the afternoon met with the Association of Independent Schools. And I think what people need to be aware of is, what were people planning for and what is the reality now.
I think a lot of schools were hoping to be able to be open for in-person instruction in the fall. I don’t know how many now are still planning to after they’ve heard my recommendation on this. As I mentioned, we got it down in Pierce County to 10 to 15 cases a day. I mean there are other parts of the world where they’re down to zero cases a day, right, and nationwide they’re, like, in double digits of cases.
When you are able to bring cases down there and keep it down there, it’s fine for you to have kids in school. When you’ve got cases in the triple digits like we’re having now, it is not safe.
I can’t tell you what’s happening next week; I certainly cannot tell you what’s going to be happening on Sept. 1. But (schools) needed to plan, and they needed to have a clear indication of what my recommendation was and my recommendation as of last weekend — it’s not currently safe to do so.
REPORTING ON OUTBREAKS
Q: The News Tribune recently reported there were four restaurants that had COVID-19 cases and in a recent conference call you said there’s a lot more than that. In the way that it’s reported by the health department, the only time that is publicly known is if it’s a business with at least 30 employees and at least 10 cases. Have you considered reporting outbreaks in a different way or by even just type of business?
A: That’s a good question. We don’t report most of what we’re doing in terms of the businesses. If you remember when we started recording cases throughout the county, there were some parts of the county where the cases were low enough that you could guess who these people were, or at least people were trying to guess who they were and that is not what we want.
We don’t want people stigmatizing other people; we don’t want people avoiding businesses because they heard that the business had an outbreak. We have seen this. We had three restaurants that had norovirus outbreaks. They only had to close for 24 hours and sanitize. Well, in those three they either changed their names or they closed. And these were restaurants that had been in the community for a long time. We do not want to see that happening. Our job is to protect the public’s health — it’s not to put people at risk of being stigmatized or having rumors about their names, you know, so we want to be able to protect that and at the same time do what is needed to help these businesses control the outbreaks.
But I think the important point is COVID-19 right now is widespread in the community. I mean, yesterday we were working with 22 new businesses, and it’s not always that high but it’s not unusual for us to have like 20 businesses we’re working with. We had three new long-term care and congregate facilities. Hardware stores, they’ve been open the whole time, they were essential businesses. We did not use to see cases and outbreaks in hardware stores. Now, we’re seeing cases in hardware stores all the time. They’re not doing anything different. What it is is there’s so much disease in the community. People are coming in and getting their employees sick, or their employees are going home, or hanging out somewhere and they’re picking up the infection they’re coming to work and then the employer finds out they’re sick.
Businesses are required to have a response plan, and they consult with us. And so, we are helping them to control the infection. And, you know, we can think about whether we can do some lumping (together of cases), but I’m not sure what the public would do with that information. Would you not eat at restaurants? Would you not get your nails done? But we can think about that suggestion. Again, our focus is on identifying the cases, isolating people who are sick, quarantining those who have come in contact with them so they’re not spreading the disease.
EMERALD QUEEN CASINO AND OSHA COMPLAINT
Q: There were some serious allegations in an OSHA complaint that was recently filed against the Emerald Queen Casino, including overcrowding and masks not always being worn by people inside. Workers have complained that indoor smoking is not helping the matter. Has the department worked with Emerald Queen or have you been in contact with the operators to see what kind of guidance could be given? What, if anything, can the health department do?
A: This is very important for people to understand. The reservation and the tribe are not in my jurisdiction. They’re a sovereign nation. They have their own health authority. And you know I can’t tell them what to do. However, we do have good relationships with their health authority. And when they were having issues with getting testing supplies, we made sure we got it to them. It’s no different than during the H1N1 pandemic. We made sure they got the vaccine. Regarding the casino, I don’t want to speak for the casino. And I certainly don’t want to speak for the tribe. I can say that, you know, from how I understand it, you know the casino is a division or subsidiary of the tribe, they consulted with the Tribal Health Authority which is a different division of the tribe.
Regarding the smoking … not only is smoking dangerous to the people who smoke and the people around them, but we are very concerned that because we know the lungs are one of the key entry points and sites of infection for the coronavirus that we want to avoid situations where people are otherwise increasing their risk. We know smoking and vaping and things like that irritate the lungs. We know that those people are more likely to get colds and pneumonia.
Other tribes reopened their casinos banning smoking. I think the point that was made in the article was are people using smoking as an excuse not to wear the mask? That was an exception carved out, and you know you can’t eat or smoke if you’re wearing a mask. So, I think some people may be exploiting that and so, both for practical enforcement reasons, not giving people an excuse to not wear a mask and for just health reasons, I think it would be a great idea for the tribe and the Emerald Queen Casino to consider banning smoking.
Q: Would you feel safe going into a facility where smoking is allowed and these kinds of things are happening?
A: I can’t go in my official capacity, it’s not my jurisdiction, I have no power over what they do. As an individual, would I go into a smoking facility? No.
My son has asthma, my wife’s got mild asthma. We were traveling once overseas, and my wife went into an asthma attack on a bus because we were in a country where they didn’t allow smoking in the bus, but people would smoke outside the bus and come in and would have smoke all over their clothes. So I really don’t voluntarily go into any place that allows smoking.
TESTING
Q: What’s the state of testing in this area?
A: So let me be clear, we’re in a much better place now than we were in the spring.
The county has purchased mobile testing units that go around, and they’ve been doing sites throughout the county. You can go to our website and check on the testing sites, and it’s not just the county mobile units but others. We’re also working with health care systems to increase their capacity to be able to test.
That also has meant the number of tests we’re doing has increased significantly. The big frustration for us is, you know, our residents bought us time of several months by staying at home and really tightening everything up. And in between there still has not been any federal coordinated policy on testing. We’re still seeing some issues with reagents; this should have been fixed in a few months but hasn’t. One of the things we’re seeing now, as the demand for testing has increased, is that some of the big national labs are getting too backlogged.
Not so much our local labs. The state public health lab is kind of at capacity — the University of Washington is getting close to capacity — but we have other places locally we can send the test to where they still have capacity.
But when you have these big national chains that send their labs to regional centers, and then you also have places like Texas, Florida, Arizona where they’re melting down and they’re running gazillion tests trying to keep up with their cases, it has caused backlogs at some of these national labs, so that is frustrating.
And for the medical providers here, they should know that if they’re having problems with their lab they should get hold of us, we can direct them to some of the labs that department health has vetted and know that they have capacity and help them make arrangements to get their tests to those places, but no question we’re in a better place now.
I am just real concerned that as we head into the fall, we’re going to run into the cold and flu season. We expect that COVID-19 will probably become more active at that time, but also the other people with COVID-like symptoms will need to get tested to make sure they do not have COVID, and so if we’re having challenges now, we’re going to have more challenges in the fall.
What lessons have you learned?
Q: As we’ve progressed through this pandemic and learned more about the virus, what could you have done differently in the management of the county’s response?
A: This virus is teaching us a whole lot. And we’re learning new things about this, and we’re finding some really bad things around this virus. It’s kind of hard for me to point to any one thing I would have done differently at the beginning. I think we were fortunate that our health care systems and our partners were prepared. I think when you look at the numbers, we fared pretty well compared to King County and Snohomish County.
Some of the things that we started out doing shifted just because our understanding of the disease shifted.
We had such a shortage of PPE at the beginning. We were trying to tell people, please don’t rush down to buy the PPE or the surgical masks because the health care providers needed them. I think people got that a little mixed up with the message that we have now, which is you know we’re focused on face coverings. We still don’t want people using N95s, and they don’t even need to be buying up paper surgical masks.
I think that what we have learned since then is how important infection control is, and we learned that when we get outbreaks in nursing homes and long-term care facilities, that maybe we should have approached it a little differently because now we know that we go in and do mass testing and implement cohorting and, you know, things like that, and infection control, we can keep the death rate down and the infection rate down.
So, you know, one of the things that I wish we would have been able to do was, you know, be more targeted in how we did some the closures.
But, yeah, there’s just so many things we’re going to be learning from this pandemic and we’re going to have to do a lot of debriefing and after-action reports by the time this gets done. Whenever that will be.
This story was originally published July 30, 2020 at 11:58 AM.
