Pierce County’s top health official on COVID-19, reopening schools, Safe Start, vaccines
The Tacoma-Pierce County Health Department’s director of health wants early learners to return to schools and thinks Gov. Jay Inslee’s Safe Start plan needs to be revisited.
Dr. Anthony Chen spoke with The News Tribune the week of Oct. 26 about the COVID-19 situation in Pierce County.
Pierce County is in its third surge of the coronavirus pandemic. The 14-day case rate per 100,000 people was 141.5 as of Friday, Oct. 30.
“COVID-19 has shown time and again that it will find every single weakness, every single opportunity for it to get into our community,” Chen said.
Regarding schools, Chen said he feels that, while there are many factors to consider, children should be back in schools where possible.
“We have to try and get kids back to in-person learning,” he said. “On the other hand, you know, rightfully so, staff and teachers are also concerned about their health and their safety.
“We can’t say we’re going to do one thing and ignore the other because there’s harm. There are benefits in any of these decisions, and there are harms in any of these decisions.”
Chen said he also believes the state needs to revise its Safe Start plan. He said he feels strategies don’t “line up” with movie theaters and museums being able to reopen while schools cannot.
“It was a good, original game plan. But what has happened is now as various additional parts have been added to it, they don’t particularly line up,” Chen said.
Questions and answers follow below. Answers have been edited for length.
Schools
Q: We understand some school districts have announced that they won’t be returning to school until 2021. Is that something you recommend for all schools?
A: Our recommendations to schools are based on what the disease rates are and the Department of Health’s decision tree. It’s extremely hard for us to predict months out. I think in May or June, we had no idea we’re gonna get this big surge in starting from the middle of June into August. We thought we’ll get a little bump from Labor Day, and we had no idea we were going to go into this sustainable rise. We’ve now hit a bigger search than we had in August, which was pretty stunning ... So there’s really no way for us to predict what’s gonna be happening a few months from now.
I think the things that we are worried about is that we know that we’re getting to the cooler, wetter months. These are typically the months that we get flu, colds, upper respiratory illnesses. So two things may happen: Illnesses that give you the fever and coughing and trouble breathing, can look a whole like COVID-19. So there’ll be a lot of people who will not be able to go to work or not be able to go to school, because we’re screening people for symptoms. They’re going to be applying pressure on a health care system in our testing facilities. So if nothing else, we anticipate a big increase in the use of health care services.
The challenge we had in the summer where people were ... pent up and they wanted to go out and play and go out to the lakes and go hike and things like that. So we had issues with them congregating in some those areas. Well, now we’ve kind of got different problems. Last week, it was pretty nasty, and people are moving indoors, and when you’re indoors, you are more at risk for transmitting the virus. We were anticipating, as we’ve done to what we typically call the flu and cold and upper respiratory season, that COVID-19 activity is going to get worse. This is sooner than we had expected. So I think there’s other other things going on right now, but certainly no way for me to predict what’s going to happen in January.
Q: The health department recently issued a statement that clarified its role in school decisions for operations in the pandemic. Why did the department feel that needed to be issued?
A: There were people asking us for waivers and variances, and, technically, when you talk in a legal regulatory role, waiver, variances are needed if you have a law or requirement. OK, so what we have done is, when the rates came down over the summer, we were committed to working with our school partners, both public school districts as well as our private schools.
So they helped us make some decisions. I mean, part of the challenge we have is that the decision tree has quite a few gray areas in it. So we worked with them to clarify what some of those gray areas were.
So, for example, it talks about when you’re in a high-disease activity range, you can bring back small groups of students who have the highest needs. And one of those subcategories is early learners. So I think many people who are in education think of the highest risk might be grades in like K to 3. That’s when kids are learning to read, they’re learning, they’re socializing to be in a school environment and so on. But in conversations with our superintendent representatives and the representatives of the heads of the private schools, they concurred that they felt that it should be K to 5.
Of course, the school serves so many other functions, including feeding kids and being eyes and ears. So detecting child abuse, being there to detect and intervene on mental health or behavioral health issues there. So that’s one need. We have to try and get kids back to in-person learning.
On the other hand, rightfully so, staff and teachers are also concerned about their health and their safety. Because while children may not get sick, as much we know that adults do, and certainly from starting middle school to high school, people are going to be transmitting disease at the same rate as adults.
From the public health standpoint, we’re worried about what’s the disease activity in the community. COVID-19 has shown time and again that it will find every single weakness, every single opportunity for it to get into our community. So how do you balance all of these different needs?
That’s a huge challenge for us right now. We can’t say we’re going to do one thing and ignore the other because there’s harm. There are benefits in any of these decisions, and there are harms in any of these decisions. So that’s why we have been committed to working with the schools.
Safe start
Q: Have you heard if there’s going to be any updates to the decision tree and its the language from the state?
A: I understand that there’s conversation and not just about the decision tree. I think we need to revisit this whole Safe Start issue.
One of the things which our community points out some concerns they have when they email me or board members is that they are very focused on their children and students and wanting them to be in school, but there’s some kind of dissonance that at the same time we’re opening up movie theaters and other things.
Of course, that was done to help the economic side to help the businesses. But at the same time, people are saying what’s more important? Everyone can answer that question for themselves.
So Safe Start was instituted by the governor. It was a good, original game plan. But what has happened is now as various additional parts have been added to it, they don’t particularly line up.
We are in Phase 2 by name only. Our numbers are nowhere close to being in Phase 2. I mean, we hit 139 the other day. I mean, that’s ridiculous in terms of that’s much more than we saw in April.
It doesn’t make sense when you’re telling museums and movie theaters and whatever to say, “You can do all this in Phase 2,” but our numbers are nowhere close to Phase 2. Now, it might be more fair, if you were to say, the same way we defined for schools and a decision tree, you can do this under 25 per 100,000, you can do this when you’re between 25 and 75. If we continue to do well, we’ll move down to the low range. That would make sense.
Another area that, you know, has perplexed me is there is no upper limit to that high range. Heck, you could be 1,000 per 100,000, and all those same things apply to you. It was good to at least bring the same consistency for us to be able to provide guidance and recommendations to the schools. But it needs work. I think the whole system needs to be worked on.
Q: So are you saying that the way Safe Start plan works, you think that that had to do with the uptick in September that began us on the third surge?
A: No, I’m not saying it’s due to the Safe Start plan. I’m just saying the Safe Start plan constrains what we can do.
This is my opinion, you know, I can’t speak for the government and Department of Health. My opinion is that Safe Start was designed to provide us a one way road map to reopening society.
The challenge was ... there was not a mechanism to allow us to be readily responsive. In other countries, they have re-instituted stricter guidelines, but under the Safe Start right now, there’s not a real mechanism. No one in the state has ever asked to go backwards. The only thing that says in there is, “Hey, if things are going crazy, the Secretary of Health has authority to pull you back to a lower phase.” But it’s not like the thermostat in your house when it gets too cold. In winter, it kicks the heater on, and then when it gets a little too warm, it cuts the heater off, right? And that’s what we should be trying to do.
We need to be able to be nimble to respond when things are going well. We continue to, you know, do what we’re doing. When it’s doing really well, we can let people do more. And then when things aren’t doing well, we need to be able to pull that back a bit.
It’s not Safe Start that’s the issue. It’s people’s behavior right now. I mean, everyone’s got to take responsibility. This is the perfect time to remember, same thing you have heard for decades about your vote counts, right? I mean, I’ve voted. My wife has voted. You know, everyone I know has voted. But it comes back to it might seem like you’ve just got one tiny vote out of 900,000 people in Pierce County, but your vote makes a difference. It might be one person, you’re thinking, “I’m just one out of 900,000 Why should I wear the face mask?” Or, “what if I just go sneak out and, you know, go hang out with my friends?” Well your one action adds up, and it makes a difference.
Vaccines
Q: In the last board of health meeting, there was discussion of filling gaps for health care providers in preparing for the vaccine. You all talked about looking at refrigerated trucks and freezers. Are you fighting with other counties or entities to try to get those supplies that you need to gear up for the vaccine?
A: No, I don’t think we’re fighting with anyone else on this. I think it’s moving really well.
What has turned out to be kind of fortuitous for us is that we have done a lot of gearing up for the flu vaccination. I want to thank the community.
You’ve heard me say the recommendation now is everyone over six months of age get the flu vaccine. This year is gonna be so important for people. We’re running a series, I think, of about 12 drive-thru vaccination clinics. We did, like, 1,300 vaccinations on Saturday. Wow, just amazing throughput, huge demand.
In fact, so much demand, we weren’t prepared for it. We’ve got a little overwhelmed. We’ve improved that so the throughput is much better now. But those are going to be really important exercises for us and how to handle mass vaccination.
One of the leading vaccine candidates is going to require ultra cold storage. These are special freezers that most places do not have. I think the hospitals may have them because they have used them for other things. But doctors clinics normally don’t have these facilities. So there’ll be some challenges there.
Right now, I don’t think we’re seeing a mad rush on it. Although there’s a question about are there gonna be enough ultracold freezers countrywide to be able to get to this. I think we’ve been planning this for a while. I’m confident that we’re going to move forward on it.
This story was originally published October 31, 2020 at 7:05 AM.
