Here’s Pierce County’s Phase 2 plan for COVID testing, contact tracing, mitigation
Pierce County submitted a mitigation plan in its application to move to Phase 2 of the state’s Safe Start COVID-19 reopening plan.
The Tacoma-Pierce County Health Department’s Dr. Anthony Chen said in a Board of Health meeting Sunday the county can blunt a COVID-19 case surge with a controlled, gradual reopening and aggressive testing, case investigation, contact tracing and helping people get into isolation and quarantine.
Chen said those strategies would reduce the chance of a surge in positive cases that could overtake hospital capacity.
The application was signed and submitted to the state Tuesday morning. Washington Secretary of Health John Wiesman could accept, modify or deny these plans.
If the application is accepted, Phase 2 allows retailers to resume in-store purchases, restaurants to reopen with 50 percent capacity and table sizes no larger than five diners, and the re-start of new construction, real estate, hair and nail salons, and barbers.
Gov. Jay Inslee made it clear that if counties do not continue progress in slowing the spread of the virus, they will be demoted back to Phase 1.
Here is a breakdown of the application by category.
Testing
Pierce County’s positive rate of test results has dropped from 7.4 percent COVID-19 positive during the last week of April to 2.7 percent in the last week of May, according to the application.
The average number of tests performed per day in the last week of May was 37.3 COVID-19 tests.
There has been a decrease in residents seeking testing, Chen said in the Sunday meeting. He believes fewer people are getting tested because there are fewer people with symptoms of being infected with the coronavirus. As summer approaches, viruses like the cold and flu are disappearing.
In the Board of Health meeting, County Executive Bruce Dammeier said that there needs to be a “retraining” of the public’s mindset on testing.
When there was a more severe shortage of testing supplies and testing kits, Washington health departments limited testing to those who were symptomatic and in high-risk populations. Now the testing threshold is primarily being symptomatic, Dammeier said.
“Now we need to retrain them to seek tests and I agree that we want to have kind of a strategy that gets us out into the community as much as is possible,” he said in the board meeting.
State targets for the Phase 2 application include: 2 percent of tests are positive and 50 tests are administered per positive COVID-19 case in the past week.
Pierce County reports 2.7 percent of tests are positive and 37.3 tests administered per positive case from May 17 to 23.
Testing sites are available across Pierce County.
In the health department’s proposed budget plan to Pierce County, it asks for $13.2 million to increase testing and lab capacity to 300 tests per day, in accordance with Inslee’s guidance for Phase 3.
The funding has yet to be approved.
Contact Tracing
The Tacoma-Pierce County Health Department has planned for a surge scenario of up to 350 new cases a day.
The TPCHD currently has 44 people trained and assigned to the case investigations team, according to the application.
The health department wants to bolster the investigations team, up to 199 people trained and available for a possible surge of positive cases by September, according to the agency’s plan.
Contact tracing starts when there is a positive case identified by the state or a health care provider. The investigation team checks in with the sick person and asks that person to stay home. The investigators ask when symptoms started, where the person visited and who they had close contact with.
The state asks that 90 percent of people who have tested positive are reached by phone or in person within 24 hours of a positive test report as part of a county being granted permission to enter Phase 2.
The TPCHD said in the last two weeks, 81 percent of the time the investigations team conducted an interview within 24 hours of a positive case.
The state has another target that 80 percent of close contacts are identified and reached by phone or in person within 48 hours of a positive test report. Pierce County reports 89 percent of close contacts have been interviewed since May 18.
Some data collection for contact tracing has gone missing, the application said. The date of interview is missing from almost one-fourth (24%) of all COVID-19 cases.
“We had a high number of contacts with missing data (about half) in our internal database,” the application to the state said.
This expansion is estimated to cost $16.2 million, according to a proposal submitted to the county. Pierce County has approved $1.27 million for IT equipment and training and hiring up to 15 additional contact and case investigators for six months. The health department had asked for an additional 45 contact tracers in two months.
The health department’s plan will pull staffing from several areas to prepare for a swelling of cases. TPCHD staff who are at risk of being laid off will be reassigned to the team.
The Pierce County Medical Reserve Corps is providing about three contact tracing volunteers a day and could provide up to 20 daily volunteers, president Olga Kimbrel said in the application.
Furloughed or laid off county and city staff are included in the TPCHD’s list of potential investigators. Dammeier told the Board of Health on Sunday there are 79 Pierce County employees on stand-by and ready to be trained as contact investigators.
“We’re committed to making sure that we don’t fall back; that we have the resources and the systems committed to make sure that we don’t retrench,” he said.
Hard-hit communities
Some minority communities have seen a higher percentage of cases than what they represent in Pierce County.
In the Phase 2 application, the state asks for details on the COVID-19 response for those disporportionally affected. There isn’t a target data point, but counties are asked to address health disparities.
Native Hawaiian and other Pacific Islanders make up 1.6 percent of Pierce County’s population but have seen 6.3 percent of confirmed COVID-19 cases, according to TPCHD’s most recent data. With 11 percent of the population, Hispanics have had 23 percent of Pierce County’s positive cases.
The health department created an equity team in its response to the coronavirus pandemic. In order to reach communities most affected, the application includes plans to train 15 to 30 community health workers and community leaders to hold listening sessions. The Asia Pacific Cultural Center had the first listening session.
“Additional sessions with other impacted groups are scheduled, and we expect to complete the community needs assessment by the end of July,” the application stated.
Providing public health communication that’s accessible to all people is a part of the plan to protect communities of color, including outreach on Spanish-speaking community radio.
Case investigators and contact tracers from vulnerable communities will be recruited. The plan also emphasizes that the health department will create low-barrier, accessible and equitable access to testing.
Congregate outbreaks
One of the targets for Phase 2 calls for counties with a population of 300,000 or more, like Pierce County, to have two or fewer outbreaks at workplaces or living facilities. An outbreak is defined by the state as two or more “non-household cases where transmission occurred at work, in congregate living, or in an institutional setting.”
Since the week of May 3, there have been eight outbreaks at congregate living and health care facilities, the application said. Last week, there were no outbreaks at Pierce County facilities
Chen said the health department has been successful in its strategies for outbreaks. Hospital chains partnered with TPCHD to create a team of health care professionals. Doctors and nurses test people at nursing homes, businesses or congregate care facilities with a positive case, separate positive residents and employees, and implement infection control protocol.
The teams assess personal protective equipment needs, review policies for testing, isolation and quarantine, help develop plans for suspected or confirmed transmission, and educate staff on government mandates.
Hospitals
Two health care systems that own most of the hospitals in Pierce County, CHI Franciscan and MultiCare, submitted letters that were included in the Phase 2 application.
CHI Fanciscan and MultiCare Health System said their hospitals can accommodate a 20 percent increase in suspected or confirmed COVID-19 hospitalizations. CHI’s St. Anthony Hospital, St. Clare Hospital, St. Joseph Medical Center and MultiCare’s Tacoma-General, Good Samaritan, Allenmore and Mary Bridge Children’s have at least a 14-day supply of personal protective equipment, and no staff are wearing an N95 respirator for longer than one shift.
The state asks counties applying for Phase 2 to have less than 10 percent of hospital beds occupied by suspected or confirmed COVID-19 cases.
“Overall suspected and confirmed COVID 19 patients account for 6.4% of all licensed Pierce County beds in acute care hospitals,” the application said.
The state targets also ask that fewer than 80 percent of a county’s hospital licensed beds be occupied by patients of any type. In MultiCare, 62.9 percent of beds are occupied and 74 percent of CHI Franciscan’s bed are occupied, the application said.
Personal protective measures
Chen said on Sunday the public needs to continue to wear masks and practice public health safety measures, like social distancing and teleworking if possible.
Washington and Pierce County have not ordered a blanket mask requirement, but the state calls for all workers interacting with customers to wear face masks.
Pierce County handed out free personal protective equipment to businesses from June 1 to June 3. An estimate of one million disposable masks and 20,000 digital thermometers will be provided to local businesses and nonprofits.
Dammeier told the Board of Health the county is expecting another million masks to support the move into Phase 2. The masks are arriving from China and will be used in future PPE distribution, communications director Libby Catalinich said.
The county cannot let down its guard until there is a vaccine, and the county can ensure that the vast majority of the community is immunized, the health director said.
Chen wants residents to observe Phase 1 restrictions as much as possible if the county is approved for Phase 2.
“We just have to remember that 99% of the people in Pierce County have not been infected yet. They have no immunity to this,” Chen told the Board of Health on Sunday. “We could very easily tip back over into a large surge and so you will hear later how we are preparing for that.”
This story was originally published June 5, 2020 at 10:00 AM.
