County Public Health Report ~ 3/29

Today, March 29, Jefferson County Public Health Officer Dr. Tom Locke shared his assessment of the pandemic in Jefferson County and answered questions submitted by KPTZ listeners. Department of Emergency Management Director Willie Bence also gave an update on current Emergency Operations actions, in light of the most recent developments.

General Comments:

  • The national picture appears troubling at this point. Past weeks recorded a decline in new cases, then a plateau. A 15% increase was recorded for new cases nationally, with an average of 63,000 cases a day. Twenty two states, with more than a 10% increase of new cases are seeing the evidence of the fourth wave of this pandemic. The presence of this fourth wave will also further complicate keeping schools safer, even as many teachers become fully vaccinated.
  • To limit morbidity and mortality, suppression of the new variants imported from other countries, as well as our own homegrown variants of concern is critical. It is estimated that nearly one half of all new cases will be caused by the UK variant by mid-April nationwide. Washington State ranks third in sequencing efforts and this tracking shows the UK variant is spreading slower in this state currently, as compared to other states.
  • Although nationwide deaths and hospitalizations continue to decline, it is projected that deaths among our citizens will exceed 650,000 by the time this pandemic ends, making it as lethal or more lethal than the 1918 pandemic.
  • Washington recorded a 29% increase in new cases in the last two weeks, with cases primarily among the 20-39 year old group, possibly driven by variants of concern, especially the UK variant that has proven to be more contagious and can cause more severe disease progression in younger people. Washington’s new case rate stands at 125 per 100,000 population, while the new case positivity of those testing for COVID-19 is 3.3%. Plus there are a few counties with high new case rates, which are generally dense urban areas or areas with a concentration of college aged persons.
  • Hospitalizations also increased in our state, up 12% statewide, with King County experiencing a 40% rise in hospitalizations, primarily among people aged 40-50 years. Hospitalizations for those older than 75 are non-existent at this time and have been attributed to the effectiveness and high rates of vaccinations for COVID-19 among this age group
  • Jefferson County had no cases this last week, but recorded 7 new cases two weeks ago. Our case rate stands at 22 per 100,000 population, with 2% positivity of those testing for COVID-19. Neighboring counties are showing similar trends. Clallam recorded 43 new cases per 100,000 and 2.2% new case positivity. Kitsap recorded 80 new cases per 100,000 population. Jefferson, Clallam and San Juan County remain the lowest in the state for these metrics.
  • More than 3 million vaccine doses have been dispensed statewide, with 24% receiving at least one dose and 15% fully vaccinated. Jefferson County leads all counties in dispensing one dose to 43.19% of its residents and 28% of its population fully vaccinated. 20,000 doses were allocated to this county as of a week ago Friday, and that does not include those delivered this last week (about 1,000 doses). Clallam County ranks high as well, making the peninsula counties leading in doses provided.
  • This last Friday, Jefferson County did not receive all the doses requested, dropping to 800 doses. This is the temporary situation of reduced doses that Dr. Locke warned us about several weeks ago. Reallocation to other areas was expected, with a surge in allocations expected by mid April, and enough vaccine for all those who want the vaccine to be available by May. Vaccinations will remain by appointments for the near future.
  • Vaccination efforts still face many challenges. Federal funding was not allocated for distribution within states or to the local counties, infrastructure, paid dedicated staff or the development and outreach to specific underserved or hard-to-reach populations. In the absence of these necessary funds, public hospitals, pharmacies and public health organizations have borne the burden and expense of vaccine rollout in local counties, without additional funding, creating administrative challenges. Funding is now in the pipeline from the current administration and plans are being made to support pharmacies and other organizations to develop more vaccination clinics which serve a variety of specific populations. This will be especially critical as the county has more vaccine supplies and the effort will be directed at encouraging more individuals to be vaccinated to achieve herd immunity.
  • The next tier to become eligible for vaccine appointments begins Wednesday, March 31. These new tiers include all people 60 years and older, all people 16 years and older who have 2 or more co-morbidities or underlying health conditions, people, staff and volunteers in certain congregate settings, such as correctional settings, group homes for persons with disabilities, or settings in which people experiencing homelessness live or access services. It also includes high-risk critical workers in certain congregate settings such as restaurants, food service, construction, or manufacturing. The last tiers and the newly eligible tiers will add about 5 million more residents seeking the vaccine.
  • While this approach continues to address and prioritize population groups who have been disproportionately impacted by COVID-19 due to external social factors and systemic inequities, there is the recognition that these tiers are becoming more difficult to interpret for the general public as to whether or not they fit the profile of the eligibility tiers. Dr. Locke stated that many of his fellow health officers have proposed dropping the current tier system as vaccine supplies become more available. They propose this move to begin as early as mid-to-late April, if allocations to local counties are increase as projected. In the meantime, Dr. Locke asked everyone to use the state WAPhaseFinder with truthful responses to determine their eligibility and take advantage of available appointments. He stated we are beginning to have appointments available, with fewer takers, as the tiers have been difficult to figure out for the general public.
  • The second clinic sponsored by Jefferson County Public Health and the Department of Emergency Management at Chimacum Schools this past Saturday ran smoothly and vaccinated 309 residents. As vaccine supplies increase, this clinic is anticipating serving about 600 residents a week for either their first or second vaccine doses.
  • Jefferson Healthcare is delivering the bulk of vaccines (80%) at their clinic across from the hospital, while commercial pharmacies make up approximately 20% of doses given. The new public health clinic at Chimacum Schools vaccinated 639 residents of the nearly 21,000 doses given in this county to date.
  • Dr Locke also spoke about the “best practices” we all need to maintain as more variants of concernbegin to circulate and our community works toward herd immunity. He referenced the recently published CDC recommendations for those fully vaccinated.
  • Small gatherings with family members or others fully vaccinated people remains the safer course, although we are beginning to see the effectiveness of vaccines in suppressing new infections among hospitals and at-risk individuals. He cautioned those wanting to travel to areas with increasing or high prevalence of new cases or with more infectious strains. Traveling close to home may be safer for those fully vaccinated. The threat of an increase in cases close to home has not yet passed and it is unclear how and when we will reach herd immunity, especially if local or surrounding area resistance to getting the vaccine is high. Source from an infectious patient is still highly reduced if everyone continues to wear a well fitting mask, maintains social distance, and takes advantage of better ventilation by opening windows in closed, indoor spaces wherever possible.
  • It is clear at this point in time that there remains disparity in access to vaccinations in every county. The goal of vaccinations remains preventing progression to serious disease among those determined to be at risk. While initially the tiers have served to capture a large portion of these individuals, a very different strategy, other than complicated tiers is needed and has been communicated to Governor Inslee. Barriers to access need to be determined and plans made to circumvent these problems, such as pockets of elderly, homebound seniors, or flexible programs for special-needs populations such as the homeless shelters or jails, with the use of the one dose Johnson&Johnson vaccine. This vaccine has only 5 doses per vial and lends itself to inoculating small groups of people, homebound seniors, or group homes for the developmentally disabled. Plans for these types of vaccination outreach efforts are in the planning stages.
  • The issue of “extra or leftover doses” was raised and addressed. Organizations administering vaccines may have doses not used when a vial is opened and not everyone scheduled for an appointment shows up. As every vial has an expiration time limit, some clinics dispense unused doses to volunteers in the clinic and others may establish a wait list according to various criteria or networks of those needing the vaccine.
  • Those counties exceeding the metrics for staying in Phase III have not, to date, been moved back to the Phase II. The recent statewide advancement to Phase III is not seen as the cause of the increase in new case rates or hospitalization. Dr. Locke noted that the current increases are most likely attributable to behavior 4-6 weeks ago due to opening up activities and increasing capacity in closed, indoor spaces.

KPTZ listener’s questions

  • There is a difference between the state vaccination numbers cited and local entries giving vaccines, such as Jefferson Healthcare (JHC) because JHC only counts the vaccines they administer (80%), not all the vaccines given in the entire county. Pharmacies account for about 20% and are counted through the state database. There is also another stream of accountability as some residents have received their vaccines out of county. All entities are required to report the number of vaccines given within 24 hours, making the state numbers the most accurate.
  • Social distancing remains important as more residents get their vaccine. Six feet, established in the United States, was based on respiratory droplet studies and the likelihood of aerosolized particles emitted from an infectious patient. Although studies have documented aerosolized spread beyond six feet, this distance provides good, but not complete protection.
  • When you receive a vaccine at a pharmacy, the staff are permitted to charge an administration fee for providing the service, but there is no patient co-pay. The vaccine is at no charge to all residents and was relatively expensive to develop.
  • If you did not experience any side effects from a second vaccine dose, it does not indicate the vaccine did not work. Although between 60-80% of individuals experience some side effects from the second dose, don’t worry if you don’t.
  • Dr, Locke stated that for those seeking a vaccine appointment, if you answer the WAPhaseFinder questions honestly, and it states you are eligible, do make an appointment. As this may be the last two weeks of restrictions, Dr. Locke asks you abide by the hierarchy, because by mid-April, if supplies of vaccine comes through, there may be no need for tiers at that point. It is not possible for vaccine clinic staff or volunteers to verify the eligibility of every person scheduled for a vaccine. Those in Tier 3 and 4 can sign up starting March 31.
  • For spring break plans next week, avoid travel or stay close to home. If you do travel, pay attention to new case rates, especially if you are not fully vaccinated. When you return home, isolate for 4-5 days and then seek a COVID-19 test and be sure to tell the nursing staff you have returned from out of the area. If you do not get a test, CDC guidelines advise you to quarantine for 10 days.

Willie Bence, Director, Department of Emergency Management(DEM):

  • Although 309 people received vaccines this last weekend at Chimacum School, there is not enough vaccine allocated to Jefferson County to run a clinic this upcoming Saturday. Those receiving their first dose on March 21 at this clinic site can schedule for a second dose for April 17 on their own or through the DEM Vaccine Phone Line at 360-344-9791. If you do not schedule an appointment, you will be reminded by email or a call to make sure you receive the second dose.
  • Volunteers are continuing to be recruited as all the clinics are staffed by volunteers and it will take months to vaccinate all residents who want a vaccine. Volunteers are now also needed to assist the Bainbridge retired medical corps who currently staff the Chimacum Grange site through TriArea Pharmacy in Port Hadlock.
  • For those retired medical volunteers stepping up to assist, please be aware of the more extensive screening required for your category, as well as the few weeks of training needed before you are cleared for an assignment. Your participation is greatly needed and the DEM staff needs to clear some bureaucratic hurdles before you are put to work. All volunteers are directed to email to sign up with vaccination efforts.