Public Health officer says self quarantines will be fully voluntary
CLARK COUNTY — When Washington Gov. Jay Inslee announced this week that Clark County was among 10 counties cleared to apply for a quicker move to the second phase of his Safe Start phased reopening plan, hope sprang eternal.
The Clark County Board of Public Health, which is composed of the Clark County councilors, met on Wednesday to hear an update on how soon that application to the governor could be submitted.
On Thursday afternoon, a notice was posted to the county’s website that the Board of Health would hold a special meeting on Friday at 12:30 p.m., followed immediately by a Clark County Council meeting.
The councilors are expected to approve having Dr. Alan Melnick, the county’s public health officer, send an application to the governor’s office to move ahead to Phase 2 of the four-phased Safe Start reopening plan sooner than the rest of the state.
At Wednesday’s board of health meeting, Melnick detailed the criteria they would have to meet in order to have the variance approved by the governor and State Secretary of Health John Wiesman.
The diciest metric may be a requirement that there be no more than 10 new cases per 100,000 residents in the past two weeks. For Clark County, with a population of 488,000, that would mean there had to be no more than 49 new cases since May 7.
Clark County now has 419 confirmed COVID-19 cases, including four more since yesterday. According to an analysis of the data by Clark County Today, the county has seen 47 new cases of COVID-19 since May 7, putting the county just under the threshold required by the state.
“We’re not out of the woods with this pandemic in Clark County yet,” said Melnick. “This can change but, right now, we need this metric.”
The second metric involves the availability of testing, and the percentage of those tests coming back positive for COVID-19. Melnick says that, as the availability of testing has increased, the county’s positive rate has dropped from around six percent in April to 1.64 percent as of May 9.
Including rapid care tests being performed by many healthcare providers, Melnick says nearly 1,600 tests were done the week ending May 9, which is above the threshold required by the state of at least 50 tests per case.
The county also must obtain letters from Legacy and PeaceHealth Southwest hospitals, certifying that they have capacity to manage a 20 percent surge in cases, along with at least 14 days worth of Personal Protective Equipment (PPE). Melnick said both hospitals were in the process of providing those letters, and feel confident they are prepared.
Contact tracing and case investigation
The final metric has been, perhaps, the most controversial. That includes ramping up personnel to interview confirmed cases within 24 hours, and then notify any close contacts within 48 hours.
Melnick says Clark County Public Health will handle case investigation in house, hiring up to 14 nurses on a temporary basis. They will be tasked with contacting confirmed cases to ask a detailed list of questions which include “whether they have symptoms, when their symptoms started, when and where they have been, when they might have been contagious and who they had contact with.”
That information, minus the name of the infected person, is then passed along to contact notifiers, who will reach out to those on the list and let them know they need to isolate for at least 14 days from the time they were in close contact with a known infected person.
“Obviously, if it’s a household member, you’ll know about that,” said Melnick. “But we certainly protect the privacy of folks who are cases.”
The county is working on a contract with the Public Health Institute, which Melnick said can make up to eight teams of contact tracers available, which would be 72 people.
But Melnick added that, right now, they expect only three teams would be needed to handle the current rate of new cases.
“If we had all these people, you know, like 80-90 people working on this, most of them would not have enough to do,” Melnick said, “because we don’t have enough cases and contacts for that large a staff.”
Clark County is also not making use of National Guard members who are being trained at the state level to assist with contact notification.
The county is also not considering any kind of forced quarantine or isolation, Melnick stressed.
“We’re not putting ankle bracelets on folks,” says Melnick. “We’re not. It’s basically voluntary compliance.”
The county has done case notification and voluntary isolation in the past, most notably with the measles outbreak in 2018. Melnick says they know that voluntary isolation worked in that case because within a month of the outbreak starting, 87 percent of new cases were from in-home exposure, such as one sibling infecting another.
“If you start mandating this and start enforcing it, my concern is that people will be less likely to get tested,” said Melnick. “And they’ll be less likely to notify us who their close contacts are, and they’ll be less likely to cooperate.”
Melnick also insisted that no one who has a place to stay will be asked to isolate away from their home.
“We will not, ever, require families to be separated if one member is a close contact or if one member tests positive,” Melnick told the board. “We never will remove a child from the home for this.”
During Wednesday’s meeting, board members pushed Melnick and his staff to do everything possible to get the application finished this week, to get ahead of the holiday weekend.
“I understand it is tough, but it’s really tough on other people,” said County Chair Eileen Quiring. “By the emails and calls I’ve received, people really are ready to do this. Small business owners, they’re ready.”
Melnick said it is uncertain how quickly the governor’s office and the secretary of health could review the application.
“Hopefully ours is so perfect that it’s quick,” he joked, before adding that nearby Skamania and Wahkiakum counties both received their approval within a couple of business days after applying.