COVID-19 is raging in Pierce County. Is it time for vaccination rules of some kind?
The Aug. 25 COVID-19 vaccination clinic on the University of Washington Tacoma campus vibed like a late summer street fair: free food, a danceable soundtrack, giveaways.
It lacked only one thing: people.
Passersby who happened upon the clinic quickened their pace as they declined offers of chimichangas and home coronavirus testing kits being given away with a jab in the arm.
By the time the MultiCare nurses and organizing staff from the Pierce County AIDS Foundation packed up their needles and vials, they had given a total of four vaccinations over six hours.
The turnout was nothing new to MultiCare nurse Sheri Mitchell. Chairs are more often empty than occupied lately at the clinics she runs all over Pierce County.
“We’ve really seen the numbers just die,” Mitchell said.
That low vaccine uptake is coming at a high price in the county.
As the Delta variant sends cases skyrocketing throughout the state, Pierce County has been particularly overwhelmed. Tents sit outside MultiCare’s Tacoma General Hospital and Good Samaritan Hospital in Puyallup in an attempt to make more room for the influx of patients.
“Our hospital is full,” Dr. David Carlson, MultiCare’s chief physician officer, said of Good Sam at a statewide hospital news briefing Aug. 30.
“I never saw the mass quantities of people that we’re seeing now,” Emily Smith, a registered nurse and hospital supervisor at MultiCare Good Samaritan Hospital, told The News Tribune in a recent interview at the hospital.
Smith said the average number of patients the hospital is seeing are more sick than ever before.
“This time, they can’t go home. The oxygen need is too high,” she said. “They’re just too sick.”
After weeks of rising case numbers, COVID-related deaths now are rising, too. By Friday, The Tacoma-Pierce County Health Department noted that 25 deaths had been reported over five days, a marked increase from the usual one death every day or so, or multiple days with no deaths, in calmer times.
Outbreaks are on the rise, with 18 related to schools, day cares or summer camps, 57 business outbreaks (including the Puyallup Costco and South Hill Fred Meyer) and 31 at long-term care facilities, according to the health department’s presentation to the Board of Health on Wednesday and the outbreak listings on its website.
It feels like the worst of 2020 all over again, with the exception that there are vaccines.
The UWT vaccine clinic was a long way from the county’s first mass vaccination clinic on Jan. 26 at Clover Park Technical College in Lakewood. That event drew 1,700 eager people who waited hours in freezing temperatures after negotiating a complicated vaccine allocation system to get their first shot.
According to the health department’s most recent totals, 55.68 percent of Pierce County residents have initiated vaccination among the total county population.
Just 48.64 percent are fully vaccinated.
That compares with the state’s rate of 60.6 percent of the total population initiating vaccinations, and 55 percent fully vaccinated. In King County, the rate is 71.2 percent and 65.9 percent, respectively.
Areas with some of the lowest vaccine uptake rates include Hilltop, Spanaway, west Parkland, north Lakewood, Graham and Key Peninsula, along with rural areas in the south and east parts of the county.
At the Board of Health COVID-19 update presentation from the health department, Kejuan Woods, deputy incident commander for COVID-19 response, said, “The unfortunate truth here is there’s more than 400,000 Pierce County residents have not initiated vaccination. And since December. We’ve seen the highest rates of disease in our 18- to 29-year-old population.”
‘Things are not working’
The week started off with state hospital executives agreeing that having events like the Washington State Fair in Puyallup right now was “a very bad idea.” The fairgrounds are not too far from Good Sam and its tent for COVID overflow patients.
On Tuesday, the health department announced a mask order for the fair that required their usage among all fair attendees and staff both inside and outside.
By Wednesday, several members of the Tacoma-Pierce County Board of Health were offering blunt assessments on how the county’s mitigation efforts were going, but with little agreement on the path forward to change the county’s current trajectory.
Board member Dr. William Hirota noted that area health care workers are “demoralized” and suggested a change in strategy.
“Things are not working and there’s vaccine hesitancy in the community that’s not changing, at least in Pierce County,” he said.
“Other municipalities are doing things such as vaccine passports,” he said, offering New York City as an example. “If you want to go out and enjoy a meal or go to a theater opening, you have to show a vaccine passport, and that would perhaps mitigate some of the outbreaks that are happening in the community. And people who don’t want to vaccinate could just stay home until this maybe all blows over until we get some kind of herd immunity. But the current strategy is obviously not working.”
Clallam and Jefferson counties on Thursday introduced such a measure for indoor dining at bars and restaurants, to take effect Sept. 4.
County Executive Bruce Dammeier, who also serves on the Board of Health, pushed back against the passport idea for Pierce County.
“I would encourage us to be very cautious before we start discriminating based on vaccination status,” Dammeier said at Wednesday’s meeting. “And I am all-in on convincing people, explaining to people, doubling down, tripling down on why this is smart — trusted messengers, all that stuff — I just want us to be cautious before we start talking about limiting significantly people’s access to society based on vaccination status.
“That’s a big step. I would be very concerned about those discussions,” he added.
“It’s not discrimination,” Dr. Anthony Chen, director of the Tacoma-Pierce County Health Department, told the board. “If it is something you can change, that’s not discrimination. I mean, if it’s a habit or behavior, that’s not discrimination.
“There are so many other things we do ... I mean, you can’t drive without a driver’s license. And ... businesses are doing this already. They’re saying you’re not coming in my restaurant or bar if you’re not showing proof of vaccination because they don’t want their workers sick, they don’t want their business ruined, and they don’t want their customers infected. So, absolutely, we don’t want to discriminate, but asking for proof of vaccination is not discrimination,” Chen said.
Pierce County Council member and Board of Health member Marty Campbell said, “I’m going to push back a little bit on the trusted messengers. We’ve been doing trusted messengers for 18 months. It almost got us there this summer. In July, I thought we turned the corner — it was looking good. And then it wasn’t.
“And if they haven’t heard from a trusted messenger by now, we’ve got to change the message. I don’t know what it is yet.”
By Friday, Chen had issued an outdoor mask order for everyone 5 years and older in Pierce County at any outdoor event with 500 or more people in attendance regardless of vaccination status.
The order goes into effect the day after Labor Day.
Patients in hallways with no room
Jim Igoe is a registered nurse working as an assistant nurse manager in the emergency room at Good Samaritan who spoke with The News Tribune on Monday evening.
In one day, he said, he discharged 12 COVID-19 patients.
“In the nursing workforce and our techs and doctors, everyone is a lot more worn out because we’re stretched thin, and so everyone’s picking up overtime and everyone’s very tired,” Igoe said Monday. “I think it’s more of a strain.”
The hospital is so full, patients are being seen in hallways.
“We don’t have places to see patients because there are so many patients here. Because the hospital is full. Our ER patients can’t actually move upstairs yet, because there are no rooms for them to go to. So they spill out back into the waiting room,” Igoe said. “If you’re really sick and need to get back, we typically don’t have a place for you to go, so we put you into a hallway.”
MultiCare, which operates Good Samaritan, reports 98 percent of its hospital COVID-19 admittance across the regional hospitals are among unvaccinated patients. Holly Harvey, a MultiCare spokesperson, said some elective surgeries have been canceled to handle patient capacity and staffing.
Smith, the Good Sam RN and hospital supervisor, oversees the staff and equipment levels and prepares schedules for the next day.
She said the hospital’s supply of medical devices like BPAP machines and ventilators is on the threshold of danger. A “bi-pap” machine, or bilevel positive airway pressure machine, is a mask that pushes air via the nose and mouth to help a patient breathe, serving as an alternative to ventilator intubation.
Ventilators also help a patient breathe, but a tube is placed down into the windpipe.
Smith described the last year and a half as the hardest time in her career. She only recently moved from a bedside nurse to a supervisor, in part because of the burnout and danger. Seeing patients younger than she is and in relatively healthy condition die from the coronavirus frequently has taken its toll.
“We can’t sustain this level,” Smith said. “We are all holding on that it will end soon. It’s really hard, and everyone is frustrated that we are here again.”
Igoe recently recovered from COVID-19 himself. He is vaccinated and said he experienced mild symptoms.
“On a personal level, it does get us even though we’re vaccinated and trying to take all the precautions that we can,” he said. “People are getting stressed, our resources are stretched to the limit.”
The nurses have spent time trying to convince patients who have not been vaccinated to receive a COVID-19 vaccine, but many continue to refuse.
“It’s shocking how many people say COVID is a joke, that it’s a money-making scheme for hospitals,” Smith said.
In light of the current surge, Igoe said, “It feels like it’s something that we could have prevented.”
Trying to get more people vaccinated
At Wednesday’s Board of Health meeting, Dammeier defended the decision to move ahead with the weekend opening of the state fair under the health order.
“We recognize that there’s value in having the fair open, ... our goal was to achieve that,” Dammeier said. “But also, do everything we could reasonably do to drive down the potential for COVID cases. We wanted to drive the vaccinations, particularly when you think of some of the folks who might be going to the fair. So we’re getting vaccinations on site, testing on site. And the third thing that we wanted to do is reduce the load on our local hospital, particularly Good Sam.”
Dammeier said the fair will offer some medical services to avoid sending more people to Good Sam’s emergency department.
“So when you look at the precautions that were put in place that we announced for the Washington State Fair, and you compare them to anything anybody else in Washington state’s doing — go look up at the Evergreen State Fair, go to Husky Stadium on Saturday. Take a look. Look at what we’re doing. I think we are sending a strong message,” Dammeier said.
Back at UWT, by late August, most of the people nurse Mitchell said she was seeing at her mobile clinics were anything but eager.
“I get a lot of, ‘Wait and see,’” she said. They wanted to see if the vaccine negatively affected people.
Others believed conspiracy theories or don’t trust the government, Mitchell said.
“There’s also mistrust generally in the BIPOC (Black, Indigenous, People of Color) community, historically, with the medical industry,” Mitchell said.
Mitchell, who is Black, hopes she and her multiracial staff can alleviate that mistrust.
“I’m all for everybody having their own free choice and things, but this is a no-brainer for me,” she said. “I’m looking out for all of those in the community. I’m protecting myself to protect others, so that we can get ahead of this virus.”
There has been some glimmers of hope.
Woods, at Wednesday’s BOH meeting, noted that the “12-to 17-year old population is actually leading the way, at twice the county average right now,” in getting vaccinated.
“Great leaders, our young people,” he added.
This story was originally published September 4, 2021 at 5:05 AM.
