The effort included a trip to the morgue in the search for supplies to do more COVID-19 testing
CLARK COUNTY — With the number of confirmed COVID-19 cases in Clark County now at 20 and climbing, and hospitals bracing for an influx of patients, emergency coordination in the county is ramping up.
Today, Clark Regional Emergency Services Agency (CRESA), along with Clark County Public Health, announced the opening of the COVID Supply Warehouse. The goal is to have a single place where businesses or individuals with medical equipment can donate them, and then have those distributed to healthcare providers in the area.
“The response we are receiving is a reflection of the generous community wide support that exists in Clark County,” said Robin Albrandt, emergency preparedness and response regional coordinator with Clark County Public Health in a statement sent out on Wednesday. “We have such an extensive need for basic supplies in our medical facilities and for our emergency responders, and we cannot rely solely on state and/or federal sources to meet them. Corporate donors have taken stock of their own needs and are working with us to help fill the gaps.”
The county is seeking new and unopened items, including:
- Latex free gloves
- Commercially made procedural masks and surgical masks
- N95 respirators and N95 filters
- Other respirators (P100’s, PAPR’s, and PAPR supplies/parts)
- Face shields
- Splash shields
- Hand sanitizer
- Disinfecting wipes
To keep warehouse workers and volunteers safe, the county is asking that anyone wishing to donate email them at COVIDsupplies@Cresa911.org to arrange a time to drop items off.
At Wednesday morning’s meeting of the county Board of Health, CRESA Director Dave Fuller said they were also reaching out to dentists across the county, many of whom have decided to close during the outbreak, and even veterinarians, to see if they might have equipment that could be used.
Laboratory capacity to run tests for COVID-19 is now greater than the number of tests being submitted each day in Washington state, but many providers say they lack the needed equipment to perform the tests, such as nasal pharyngeal swabs and viral transport media.
Dr. Alan Melnick, public health officer for Clark and Skamania counties, said they were able to find some of those supplies in an unusual place.
“We were able to find nasopharyngeal swabs in the morgue,” he said, “just to give an example of how we’re scrambling around.”
Melnick called the situation “really frustrating,” noting that the lag in getting tests completed is largely to blame for getting to this point.
“We’re flying blind, in terms of what’s happening in the community,” Melnick told the board.
Melnick blames that lack of testing for much of the seeming disregard by many in the community, who flocked to small communities across the region last weekend, prompting the governor to issue a stay home order.
There is some hope that supply lines might begin to improve somewhat, Melnick says. Clark County has now been moved to tier one status as part of the state’s disaster declaration, which Fuller said he hopes means the area’s healthcare providers will soon start seeing deliveries of much-needed equipment.
“We’ve got an inventory list of what’s being shipped to us from the state,” Fuller says, “and we’ve worked with Dr. Melnick and his office to come up with a PPE prioritization, as far as what are our needs in the community and who needs to get that first.”
Still, Fuller describes the amount of supplies arriving soon as “very, very small,” and said the best bet right now will be through donations from local businesses.
Healthcare capacity ready to ramp up
While statewide data shows visits to emergency rooms and hospital admissions for cases with symptoms similar to COVID-19 have increased sharply in recent weeks, overall traffic at emergency rooms across the state is down.
“So if you go to the emergency room, it’s actually pretty quiet right now,” says Melnick. “I suspect a lot of people are avoiding emergency rooms because they’re worried about coming in contact with this.”
In order to prepare for an increase in cases, most healthcare providers have postponed elective and non-urgent procedures. They’ve also set up tents outside of emergency rooms where people with symptoms similar to COVID-19 can be examined.
Fuller says there are conversations going on about securing additional space for beds, should surge capacity be needed for local hospitals. They’ve also identified other resources, such as cots or beds that could be repurposed.
“One of the challenges will be in finding the staff to go in there and help work in those particular areas,” says Fuller. That may be solved by bringing in doctors freed up by the postponement of other procedures.
The county also has to plan for the absolute worst case scenario, says Melnick. That could include life and death choices, such as the ones happening in Italy.
It’s known as a ventilator allocation, and involves deciding, in a situation where life supporting equipment availability falls short of the number who need it, which individual gets the ventilator, and which doesn’t.
“If we actually create this and work this out with the hospitals, there’ll be a triage team made up of a critical care doc, a critical care nurse and an ethicist that will be blinded to who the patient is,” Melnick told the board. “So the physician at the bedside would not be making the decision about removing somebody or putting somebody on.”
Right now, a triage agreement is not in place, and would need to be moved up. In the meantime, the hope is that things can be managed.
A bit of positive news
Statewide, out of nearly 32,000 tests, around seven percent have tested positive, according to numbers shown by Melnick. Rates are higher in some places, such as King County, which has a 13 percent positive test rate. Four percent of tests performed in Clark County have been positive for COVID-19.
The ray of potential good news comes when you look at the ages of the people being tested.
In children four years of age and younger, approximately 1,300 tests have been performed. Out of those, only five tested positive. In people under the age of 17, only one percent have proven to have the infection.
Melnick says the numbers may show evidence that, even when exposed to the virus, younger people could be less likely to develop enough of an infection to lead to a positive diagnosis.
But it remains bad news for people over the age of 80. Eighteen percent of those tests have been positive, and while they represent 14 percent of cases in the state, half of all deaths have been in people over the age of 80.
So far, no one under the age of 40 has died of COVID-19 in Washington state, and only 38 percent of confirmed cases have been in that age group.
Melnick says they’re also having to adjust how they respond to cases, as the number of positive tests rises.
“We don’t have the bandwidth and the resources to do active monitoring and call close contacts,” Melnick told the council members. “We still identify cases, we ask them who their close contacts are, and now we’re going to be giving them handouts to give to their close contacts to have their close contacts voluntarily quarantine, and we won’t be monitoring them.”
Melnick says that means the county has officially transitioned from the containment phase, to mitigation, making things like social distancing and temporary closures of businesses a key component of slowing the virus’ spread.
“And the other thing you need to realize, the incubation period is 14 days, right?” he added. “So depending on how we’re doing now (with social distancing) is going to translate to what we’re seeing 14 days from now.”