HomeMy WebLinkAbout2020-44 - Res. Adopting Request for Variance from COVID-19 Phase 1 Recovery to Phase 2 Recovery MASON COUNTY BOARD OF COMMISSIONERS
RESOLUTION NO. (gyp-qq
A Resolution Adopting a Request for Variance from COVID-19 Phase 1 Recovery to
Phase 2 Recovery
WHEREAS, Mason County Community Services, Public Health opened Incident Command for support
of COVID-19 response on February 24, 2020; and
WHEREAS, Mason County initiated Area Command on March 4, 2020 to address COVID-19
response; and
WHEREAS, Governor Inslee adopted Proclamation 20-25 STAY HOME — STAY HEALTHY on
March 23, 2020 proclaiming a State of Emergency for all counties throughout the state of
Washington as a result of COVID-19; and
WHEREAS, Governor Inslee announced, on May 19, 2020, that Mason County is eligible to apply for a
county variance to move into Phase 2. This is based on the new metric of <10 cases/ 100,000
population over a 14 day span. County variance applications will be approved or denied by the
Secretary of Health; and
WHEREAS, the Mason County Board of Commissioners met in a special meeting, in compliance
with the Open Public Meetings Act, on May 22, 2020 to consider the Application for Variance,
COVID-19 Phase 1 to COVID-19 Phase 2; and
NOW,THEREFORE BE IT RESOLVED by the Mason County Board of Commissioners to approve
the Mason County Application for Variance from COVID-19 Phase 1 to Phase 2 (Attachment A) and
direct staff to send to the Secretary of Health.
Adopted this 22"d day of May 2020
BOARD OF COUNTY COMMISSIONERS
/2�z
Sharon Tr k, Ch it
Ra y Nea rlin, Commissioner
Kevin Shu , Commissioner
ATTES-TF:W'aQ_
Melissa Drewry, C of the Board
APPROVED AS TO FORM:
Tim Whitehead, Chief Civil Deputy Prosecutor
J:\RESOLUTIONS&ORDINANCES\RESOLUTIONS-ORDINANCES Word Files\2020\COVID request to Phase 2-Commissioners
May 22.docx
Mason County Application for
Variance
Phase s. to Phase z
Abstract
Mason County application to Washington Department of Health to move from Phase i recovery
to Phase 2
21 May 2020
dwindom@co.mason.wa.us
Contents
Statementof Purpose.............................................................................................................................2
Washington's Phased Approach..............................................................................................................2
PublicHealth Criteria..............................................................................................................................4
CaseData............................................................................................................................................4
EpiCurve.............................................................................................................................................5
Case ................................................................................................................................................5
Case Calculations for Release..............................................................................................................6
Hospitalizations ..................................................................................................................................6
Physical Distancing Adherence Trends................................................................................................6
Long Term Care Facilities....................................................................................................................6
Readinessand Capabilities Needed ........................................................................................................7
Instructions2.a....................................................................................................................................7
TestingCapacity and Availability:....................................................................................................7
Instructions2.b ...................................................................................................................................7
Instructions2.c ...................................................................................................................................8
Instructions2.d ...................................................................................................................................8
Caseand Contact Investigations......................................................................................................8
Outbreak Considerations ................................................................................................................9
CaseTiming ....................................................................................................................................9
Instructions2.e....................................................................................................................................9
Healthcare System Readiness.........................................................................................................9
BedAvailability...............................................................................................................................9
Ventilators.....................................................................................................................................10
PPE ...............................................................................................................................................3.0
Instructions2.f..................................................................................................................................10
CaseSupport.................................................................................................................................10
In-home Support...........................................................................................................................10
Instructions2.g .................................................................................................................................10
Ability to Protect High-risk Populations ........................................................................................3.0
Reliance on DOH Resources.............................................................................................................. 11
SocialConsiderations........................................................................................................................ 11
AUTHOR:MASON COUNTY PUBLIC HEALTH
i
21 May 2020
MasonCounty is Ready.........................................................................................................................12
Summary..............................................................................................................................................12
Statement of Purpose
Mason County seeks a collaborative and responsible approach to moving our community from Phase i
Recovery into Phase z.Mason County,operating with a comprehensive partnership including the
community,tribes, health care,first responders,city,and county leadership,continues to meet or
exceed the criteria needed to reopen our local economy and support medical systems. Mason County's
population estimate is 66,768(census.gov, 5/5/2020).As a responsible governing body, Mason County
is seeking this variance to prevent collapse or further unnecessary and preventable second and third
order of effects to the population and economy. It should be noted that our primary focus is always
keeping the community safe while moving into Phase II.
Washington's Phased Approach
Governor Inslee, in collaboration with local elected officials,the Department of Health,and local health
jurisdictions, has established a data-driven approach to reopening businesses and modifying physical
distancing measures while minimizing the health impacts of COVID-19.This approach reduces the risk
of COVID-i9 to Washington's most vulnerable populations and preserves capacity in our healthcare
system,while opening businesses safely.The plan involves assessing COVID-s9 activity in the state
along with healthcare system readiness and our state's ability to perform extensive testing, isolate and
manage cases,quarantine their contacts,and protect high risk populations.The state will implement a
phased approach to reopening businesses and modifying physical distancing measures when disease
activity is adequately suppressed,and readiness is achieved in four key areas.
AUTHOR:MASON COUNTY PUBLIC HEALTH
z
zi May 2020
WASHINGTON'S PHASED APPROACH
Modifying Physical Distancing Measures as we Reopen the State
INDIVIDUALS AND BUSINESSES SHOULD FOLLOW ALL REQUIREMENTS LISTED ABOVE DURING ALL PHASES
0 El 13
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Mason County seeks to use a locally based version of this approach to move from Phase s as outlined by
the Governor's office,to a Phase 2 as acknowledged in the following variance request. Mason County
continues to experience very low occurrence of new cases since the observed peak in late March. It is
conceivable that low numbers of cases may continue to come in over an extended period with potential
increased testing capacity statewide.As new cases trickle in,they fall well within the capability of the
current resources available in Mason County to maintain further testing,tracking, and tracing.
Mason County continues to move past the most highly infectious stage of COVID-ig. Businesses,
organizations,and the public have been incredibly responsible in complying with all recommendations.
This has brought the case levels down but is also having increasingly harsh effects on economies and
lives.With a comprehensive partnership with the community,tribes, health officials, emergency
responders,city and county leadership, Mason County is strongly prepared and ready to move forward
into Phase 2.
AUTHOR:MASON COUNTY PUBLIC HEALTH
3
2-May 2020
Public Health Criteria
Case Data
Totals Confirmed Cams M County Lepow
Confirmed Cases 33
Deaths 1 ,1,520+
Percent of Deaths ,1,141 to
3.%(deaths/confirmed cases) ,1,520
Total Tests I.S" 761 to 1,140
Percent Positive 2.1% ,381 to 760
1 to 380
0
54 of 18,611 confirmed cases do
not have an assigned county
i
Demographics
Age Range Cases Deaths
0-19 0 0
20-39 7 0
40-59 11 0
60-79 11 1
80+ 2 0
Sex Cases Deaths
Male 19 0
Female 12 0
Updated:5/11/2020 1600hrs
http www.doh.wa,gov/Em_e_rgencies/Coronaviru_s
AUTHOR:MASON COUNTY PUBLIC HEALTH
4
21 May 2020
Epi Curve
Confirmed Case Courts Data Incomplete
4
3
2
1
0
Feb 2020 Mar 2020 Apr 2020 May 2020
Deter of Illness Onset
54 of 18,611 confirmed cases do not have an assigned county.Illnesses from the last 4 to 7 days may not yet be reported.
z
Case
COVID-19 In WashbVWn State
Number of Individuals Tested by Specimen Collection Date
Testing for COVID-19 has been steadily increasing in Washington.Beginning in late March,drive-through testing became available in some
communities,which increased testing availability.Learn More
Number of Individuals Tested 11%of individuals tested positive Data may be incomplete
0 Positive Negative for the most recent dates
40
30
20
10
. . a ■ . 11 1 11 Jul..
Mar 2020 Apr 2020 May 2020
Specimen Collection Date
3
AUTHOR:MASON COUNTY PUBLIC HEALTH
5
21 May 2020
Case Calculations for Release
Using CDC recommendations of.71 new cases per 1oo,000 people and applying that to Mason County
we show the following calculation. From April 22nd to May izth Mason County has had.4 cases per
day(crude rate)which falls well within the ability of public health to track and trace as well as
within the health care system ability to treat.This calculation has been verified by DOH and
forwarded by email to Mason County.
Hospitalizations
As of May 1st, Mason County has had three patients hospitalized in hospitals outside of Mason County.
Mason General Hospital has had no in-patient cases of COVID-1g.Mason General Hospital currently has
capacity far more than what has been required for both COVID-19 and general patients.
Physical Distancing Adherence Trends
DOH does not maintain the same detailed set of adherence data for small counties as it does
for greater Puget Sound urban communities. An extrapolation could be made using Seattle
data for Mason County due to its proximity. "Based on the aggregated Facebook data, we can
say with confidence mobility behavior in the greater Seattle area has reduced dramatically since
early March, when it first became clear community transmission of COVID-19 was occurring in
the area. Significantly fewer people are commuting to work, and many more people are
spending their days at home. However, we see evidence of inconsistency, particularly during
weekends. Mobility is not a direct measure of social distancing; while these data indicate
people are spending much more time at home and away from shared spaces (which has been
shown to reduce disease transmission), we cannot use it to determine the percent reduction in
social contact. See the follow-up report to learn how these changes in mobility relate to
reductions in COVID-19 transmission."4
Long Term Care Facilities
To date we have not experienced a COVID-19 outbreak in any of the settings mentioned above.
A COVID-19 outbreak will be handled just as we would handle any infectious disease outbreak
in these settings. Mason County Public Health (MCPH) staff will quickly and efficiently respond.
Following all DOH and DSHS guidelines we will direct the outbreak response and investigation.
(See Instructions 2.d, pg 8 and 2.g, pg 11) With the help of our local Department of Emergency
Management we will ensure they have adequate PPE and testing supplies throughout the
outbreak. Mason General Hospital has the testing capacity to serve our testing needs in the
event of an outbreak in a local facility or workplace. MCPH currently has 4 public health nurses,
4 administration staff, two volunteers, and 9 public health staff(total 19) all trained in
2 Data as of ig May
3 Data as of ig May
4 https://covid.idmod.org/data/Understanding_impact_of_COVID_policy_change_Seattle.pdf
AUTHOR:MASON COUNTY PUBLIC HEALTH 6
21 May 2020
the Incident Command System, outbreak investigations and contact investigations. This meets
the guidelines of 15 investigators/100,000 population.
Should the incident exceed local resources, MCPH will contact DOH for an immediate strike
team and request additional resources from DOL trained investigators. Ten additional
investigators will be moved to Emergency Command where they have access to phones and
computers. A MCPH nurse will supervise these additional resources. Mason County also has a
partnership with the Squaxin Tribe to provide culturally appropriate case investigation.
Readiness and Capabilities Needed
Instructions 2.a
Testing Capacity and Availability:
As noted in the tables below, Mason County continues to maintain adequate capacity for
testing. Mason General Hospital conducts daily drive-through testing averaging 25-35 tests per
day. Other testing capacity exists with Harrison Hospital, Port Orchard, as well as Peninsula
Health Care Systems in Belfair and Kitsap County. Laboratory resources are adequate through
the public health lab and private labs.Total tests average 25-35 per day. Tests are
geographically and economically available to all populations.
Mason County has a Drive Thru testing site available at our Mason General Hospital as well as
testing through clinical outlets. We have supported Mason General Hospital in promoting these
testing sites in multiple ways.The test site triage line is on multiple websites throughout the
county to include Mason general Hospital and Mason County Public Health. The Joint
Information Center(JIC) has promoted the site in various ways to include public outreach in the
English and Spanish language.The JIC partnered with Mason General Hospital creating a video
of the step by step process that occurs at the testing site. It continues to be shared and
promoted on multiple social media pages throughout Mason County. Kitsap County has 2
locations for testing available to our North Mason residents for convenience and working with
our Hospital District 2 partners. All the above locations for testing are available to low-income,
no insurance, or underserved populations.Testing sites have a triage phone line available to call
and set up testing times and dates.
Instructions 2.b
Over the past 4 weeks Mason County has had 11 positive cases with a median of 7.5 from
symptom onset date to specimen collections date. We continue to promote and encourage
testing at the earliest signs and symptoms of COVID-19.Area Command continues to assess
cultural and geographic barriers and implement interventions that may get patients to testing
and treatment earlier.
AUTHOR:MASON COUNTY PUBLIC HEALTH
7
21 May 2020
Instructions z.c
Positive Tests Negative Tests Percent Positive Positive Tests Negative Tests Percent Positive
4/19/2020 0 9 0.00% 5/3/2020 0 4 0.00%
4/20/2020 0 23 0.00% 5/4/2020 2 41 4.88%
4/21/2020 0 22 0.00% 5/5/2020 0 36 0.00%
4/22/2020 1 31 3.23% 5/6/2020 0 27 0.00%
4/23/2020 1 24 4.17% 5/7/2020 0 34 0.00%
4/24/2020 0 28 0.00% 5/8/2020 0 26 0.00%
4/25/2020 0 16 0.00% 5/9/2020 1 9 11.11%
Totals Week 1 2 153 1.31% 1 Totals Week 3 3 177 1.69%
4/26/2020 0 6 0.00% 5/10/2020 0 9 0.00%
4/27/2020 0 47 0.00% 5/11/2020 0 35 0.00%
4/28/2020 1 34 2.94% 5/12/2020 0 43 0.00%
4/29/2020 0 44 0.00% 5/13/2020 2 36 5.56%
4/30/2020 1 25 4.00% 5/14/2020 1 38 2.63%
5/1/2020 1 23 4.35% 5/15/2020 0 37 0.00%
5/2/2020 0 7 0.00% 5/16/2020 0 10 0.00%
Totals Week 2 3 186 1.61% Totals Week 4 3 208 1.44%
Four week totals 11 724 1.52%
Based on DOH dashboard data,goal from guidance is below 2%for any week and in combination.
Instructions z.d
Calculation:66,768/zoo,000 x iS=io Case investigators required
Case and Contact Investigations
Mason County Department of Community Services, Public Health and Human Services Division
maintains a highly trained communicable disease staff with experience in contacts investigations.
With Mason County's population at 66,768 we have established so FTE's are required to conduct
efficient contact tracing investigations.MCPH currently has 17 public health staff and 2 citizen
volunteers,all trained in the Incident Command System,outbreak investigations and contact
investigations.This is a total of 1S.2 FTE's.This meets the guidelines of 1S investigators/3.00,000
population. No gaps identified for steady state operations.
At the peak in March, Mason County did not exceed the capacity of the first line series of investigators.
ioo percent of positive cases are investigated within 24 hours. Most case investigations are completed
within 3.2 hours.
Case Timing
Mason County Public Health has identified 11 cases over the last 4 weeks.Of those cases,z00%have
been contacted well within the 24-hour time frame.Staff is monitoring incoming positive case
notifications seven(7)days a week and initiating contact tracing same day.
Mason County experienced 13 cases over the past month/Total of 72 Close Contacts-all were
contacted and placed in 3-4-day quarantine
AUTHOR:MASON COUNTY PUBLIC HEALTH 8
21 May 2020
Outbreak Considerations
A COVID-i9 outbreak will be handled just as we would handle any infectious disease outbreak in these
settings. Mason County Public Health(MCPH)staff will quickly and efficiently respond. Following all
DOH and DSHS guidelines,we will direct the outbreak response and investigation.
To date Mason County has experienced one(1)COVID-1g outbreak in a workplace setting of four(4)
employee cases and one(1)contact case. Mason County Public health was able to contact cases and
conduct contact tracing investigation efficiently in less than 24 hours without diminishing or exceeding
our capabilities.
With the help of our local Department of Emergency Management,we will ensure they have adequate
PPE and testing supplies throughout the outbreak. Mason General Hospital has the testing capacity to
serve our testing needs in the event of an outbreak in a local facility or workplace.
Instructions z.e
Healthcare System Readiness
Bed Availability
Throughoutthe COVID response Mason County has never reached or exceeded bed capability either
for COVID patients or patients requiring hospital beds for other reasons.Currently Mason General
stands mostly empty.
Local Hospital Beds available:
Current Availability as of May 19, 2020 Mason General
0 32 Available
Within county:231 beds (5/19/2020)
0 20 can be put in place
Mason General Hospital 0 3 ventilators
0 4 Ventilators on order
• 32 beds available 0 2 Bypass machines
which can be
• 20 additional expansion beds converted.
In addition to hospital facilities, Mason County Community Services(MCCS)also has a too bed
Alternate Care Facility(ACF)ready to deploy to the middle school directly behind Mason General
Hospital to provide further capability.This location provides rapid access to the Mason General
emergency department. MOU's are in place to cover cleaning,food,and security. MCCS also provided
support to Community Lifeline to add a thirty-bed capacity to care for homeless who are ill but not with
COVID symptoms.County owned Building 10 converted to an isolation/quarantine facility with 75 beds,
showers,and porta-potties to handle an outbreak within the homeless population should one occur.
MOU's are in place to cover cleaning,food,and security. For instances when additional small numbers
of beds are needed for quarantine or isolation, Mason County retains funds to rent a limited number of
motel rooms.Should more than ten rooms be needed,the ACF or Building 10 will be activated.
All the above-mentioned facilities are continually available with no expiration date unless school
begins.
AUTHOR:MASON COUNTY PUBLIC HEALTH
9
21 May 2020
Outside of county bed availability generally:
• Thurston Capitol average 25 available
• Thurston St. Pete average 37 Available
• Kitsap Harrison 14-20
Ventilators
Mason General currently has 3 ventilators with 4 on order and two bipap(non-invasive)machines which
can be converted
PPE
• Mason General currently has adequate PPE for both COVID-ig response and clinical operations
• Area Command has PPE for EMS, law enforcement and emergency management.The pipeline
continues to fill all Tier I orders and is slowly expanding to Tier II
• Mason General has the ability to surge within its own facility as well as having access to too
beds in a public health provided Alternate Care Facility
Instructions 21
Case Support
Investigators maintain communication with positive cases throughout their case progression to ensure
that positive cases have the resources needed through recovery.
All cases with the exception of the two cases hospitalized outside of Mason County, have isolated and
recovered at home.The county has the capability to isolate/quarantine an additional 170 cases utilizing
the alternate care facility and the Building 10 isolation and quarantine facility.
Should the need arise, DOH maintains strike teams that would support Mason County Staff in
contact tracing and tracking.
In-home Support
The health department case investigator is asking each positive patient who is isolating at home if they
have family or friends that can bring groceries or supplies. If the patient has no help,we access United
Way, Meals on Wheels,Agency on Aging, and the local Senior Center to provide emergency boxes of
food and supplies.
The health department case investigator/staff makes referrals to outside agencies.The agency will let us
know when boxes of food/supplies is available and delivered. Health department case investigator
checks in with patient every day—so we know when supplies are low, more food is needed,or
medications need delivery.
Instructions 2. g
Ability to Protect High-risk Populations
Mason County maintains the ability to immediately respond to outbreaks in congregate settings such
as long-term care facilities, homeless shelters,jails,and works with Department of Corrections for
prison facilities.
AUTHOR:MASON COUNTY PUBLIC HEALTH
io
21 May 2020
• To date,there have been no cases within the long-term care facilities in Mason County.
Outreach to LTC's was the very first priority.
• Mason County maintains internal capacity to respond to outbreaks within 24 hours and has the
ability to reach out to DOH strike teams if needed.
• Through local positive case reports and monitoring of the DOH website5, Mason County
maintains situational awareness of cases and works with partners such as the Squaxin Tribe and
Skokomish Tribe to ensure that vulnerable populations receive protection.
Reliance on DOH Resources
• Per guidance from Secretary of Health John Wiesman, should any incident exceed the
capacity of local resources, MCPH will contact DOH for an immediate strike team and
request additional resources from DOL trained investigators.Ten additional investigators
will be moved to Emergency Command where they have access to phones and computers.
A MCPH nurse will supervise these additional resources. Mason County also has a
partnership with the Squaxin Tribe to provide culturally appropriate case investigation.
• Relying on DOH to provide relief for local investigators avoids exhaustion and multiplies
effectiveness.
Social Considerations
The stress put upon the population from the"Stay Home,Stay Healthy"is beginning to take its toll.
Concerns among mental health professionals are increasing.Though it cannot be definitively listed as
causation,there is a very high and suggestive correlation that mitigations for COVID19 are creating
greater stress especially for those with underlying mental health conditions.
The population is beginning to see the allowed activities as arbitrary and capricious.Anger continues to
grow amongst those that were initially supportive of policies to reduce the effects of the virus.Lives
and livelihoods are severely impacted. Businesses are beginning to close permanently due to the
lengthy closures.The estimated unemployment rate is as high as 17%. Every number is a real person
with families and obligations that suffer more intensely the longer restrictions are in place. If
restrictions cannot be relaxed in a controlled way immediately, public support may well vanish by the
end of May.
5
AUTHOR:MASON COUNTY PUBLIC HEALTH
21 May 2020
Mason County is Ready
Phase 1 Phase 2
high Fisk Populations Continue to Stay Home,Stay Healthy Continue to Stay Home,Stay Healthy
(Golf,fishing,hunting,boating, All outdoor recreation involving fewer
kaeation hiking) t han 5 people outside you r household
None-
Drive-in spiritual services with one Gather with no more than S people from
Gatherings household per vehicle outside your household perweek
Limit nonessential travel within proximity
TnvFl Only essential trave I of your home
New construction
Remaining Manufacturing
Esstential businesses open In-home domestic services
Existing construction that meets RetaiIin-store
criteria Real Estate
Landscaping Professional Services/office based
AutomobileSales businesses
Curb-side retail Salons and barbers
Car Washes Housecleaning
Business/Employers Pet walkers Restaurants<50%capacity
Mason County has all the policies and support systems in place to move forward into Phase 2.Our case
peak happened over a month ago.Cases per day are at.38 which is well below CDC recommendations
Of.7s cases per day/ioo,000. Our businesses and communities are prepared with great,common sense
interventions that fully support the effort to prevent a second wave.The Emergency Operations Center
stands ready to implement the move to Phase 2 as soon as possible.
Timeline(Tentative):
• Wednesday May loth, request letter of support from Mason General Hospital
• Wednesday May loth, request special meetings of the BOH and BOCC
• Thursday May 21st, present to Area Command and key partners
• Thursday May 2ist,send to Board of Health and County Commissioners
• Friday May 22nd,submit completed packet to John Wiesman,Secretary of Health.
Summary
Mason County strongly believes to have addressed each item in Governor Inslee's Plan to Re-open
Washington at the state level based on county capabilities and data.We are safeguarding the health of
the population from COVID-19 while looking towards the long-term foundational needs of our society.
We kindly request to be considered and approved to allow Mason County move forward into re-opening
the economy and reducing the long term factors that will adversely affect the physical, mental,and
economic well-being of the people of Mason County.
AUTHOR:MASON COUNTY PUBLIC HEALTH
12
21 May 2020
David Windom, Mason County Director of Community Services and Area Command Planning Chief is
available for any questions you may have.Contact information is on file.
AUTHOR:MASON COUNTY PUBLIC HEALTH
13
21 May 2020
STArg oA
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STATE OF WASHINGTON
DEPARTMENT OF HEALTH
APPLICATION FOR COUNTY COVID-19 VARIANCE
Date: 22 May 2020
County: Mason
Local Health Jurisdiction: Mason County Community Services
Submitter's Name,Organization,E-mail Address,Phone Number:
David Windom MSHS
Mason County
dwindom@co.mason.wa.us
360-427-9670
The brackets below should be checked to confirm the applicant has included the materials in
their variance application or agrees to the statement.
[X] Included with this application are documents demonstrating approvals and
endorsements for all of the following:
1. The local public health officer's recommendation to the Board of Health.
2. Documentation of the vote of the Board of Health, including the motion and the vote
totals.
3. Letters from all hospitals used by the county certifying their bed capacity for COVID-19
patients and PPE supplies.
4. Documentation of the vote of the county commission, including the vote totals.
[X] Attached to this application is a document describing all of the following,in
accordance with the instructions:
1. COVID-19 testing site information.
2. Data on median number of days from onset of illness to COVID-19 specimen collection
date.
3. Testing data for each of the previous four weeks.
4. LHJ's resources to perform case and contact investigations.
5. Information on isolation and quarantine facilities.
6. Resources for supporting persons in home isolation/quarantine.
7. LHJ's capacity to perform outbreak investigations in congregate living situations and
workplaces.
8. Any additional information the applicant feels is important for consideration.
[ ] By submitting this application,the local health jurisdiction agrees to notify the DOH
on-call communicable disease duty officer at 206-418-5500 of any COVID-19 outbreak
investigation within their jurisdiction within 6 hours of beginning.the investigation.
As the Director of the applicant LHJ,I am authorized pursuant to the adoption of the COVID-19
Variance Plan by the local board of health and county commission to submit to the Washington
State Department of Health this application for consideration.
Signature Date
,. .� r
Mason Health
Mason General Hospital • Mason Clinic
6 May 2020
Mason Health has admitted no Covid-19 patients to date. In preparation however, we have set
up 7 negative air flow rooms, created isolation procedures and trained staff in managing Covid-
19 patients should we receive any. We have eliminated hospital visitation except for the Birth
Center and exceptions for end of life circumstances. We are not performing elective procedures
or seeing routine healthy patients in our clinics. We are performing diagnostic test collection
through a drive through tent in our parking lot and have established procedures to separate
suspected Covid-19 patients from other patients in our clinics.
We have adequate PPE on hand and report our burn rate and PPE on hand on a daily basis as
required. Our staff are trained in the use of PPE and have sufficient PPE available to them at all
times.
Our bed utilization has not exceeded 80%with the lifting of capacity limitations associated with
Critical Access Hospital status.
In summary, I certify that we have adequate PPE supplies for our workforce with current or
increased demand. And,we have adequate bed capacity for current or foreseeable surge
demand.
('Xi
Dean E. Gushee, MD, MS, FACEP I
Chief Medical Officer
Mason Health
i
PO Box 1668
Shelton, WA 98584 I
360-432-7728
dgushee@masongeneral.com
Mason Health
Mason General Hospital • Mason Clinic
I
20 May 2020
i
Mason Health certifies the following:
1. We maintain a minimum of 20 percent surge capacity which would allow us to
accommodate a 20 percent increase in suspected or confirmed COVID-19
hospitalizations.
2. We report daily including on weekends all data required by DOH in WA HEALTH.
3. We maintain a minimum of a 14-day supply on-hand of PPE including N-95 masks,
surgical masks, face shields, gloves and gowns. !
4. We are not using PPE conservation strategies that involve the reuse of PPE supplies.
Dean E. Gushee, MD, MS, FACEP
Chief Medical Officer
Mason Health
PO Box 1668
Shelton,WA 98584
360-432-7728
dgushee@masongeneral.com
i
U%pMASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
From the Office of The Mason County Health Officer
Daniel Stein, M.D.
415 N.61h Street,Shelton,WA 9SS84♦ Phone:360-427-9670,Ext.582 ♦ Fax:360-427-7787®Email: DStein@co.mason.wa.us
To whom it may concern:
I first would like to thank the Governor and the state officials for providing an excellent preliminary
response to this pandemic. I think we, in Washington State, have been very successful in flattening the
curve and are now seeing a reduction in COVID-19 diagnoses and deaths throughout the state. Mason
County as well has created a strong, coordinated approach to combating the novel coronavirus. I am
proud that we have demonstrated few cases since our peak and that our established healthcare system
has not become overwhelmed.
Because of these successes as listed above, I, as the health officer for Mason County,would request a
full Phase 2 variance.Currently, Mason County has continued to see sporadic cases of COVID-19,
indicating that there are still low levels of transmission in our community.As outlined in the variance
request,we have been able to prepare our community and we feel that our healthcare system,case and
contact investigations and isolation and quarantine availability are well prepared for additional cases
that may arise. I recognize that relaxing social distancing rules and expanding businesses could pose a
threat to increase the spread of this virus in our area, and that we may be potentially susceptible to
additional spikes in cases. I believe that continuing to encourage social distancing is required to maintain
our low incidence rate. Allowing outdoor recreation including fewer than 5 people outside the
household, opening remaining manufacturing, additional construction, in-home/domestic services, retail
with restrictions, real estate, professional services/office-based businesses, salons and barbers,
restaurants and pet grooming will likely involve only a small increase in risk based on our suspected
prevalence of disease. County business partners and officials have assured me that all businesses will be
evaluated prior to opening to assess that they meet the required State recommended criteria for
opening. We would use our local authority to regulate the safety of these businesses.
Mason County recognizes our responsibility as an early adopter of the phased reopening. As we
cautiously restart our economy,we will evaluate and act quickly to contain additional outbreaks. I am
especially concerned about reopening rapidly and exposing high-risk individuals. Even with allowing
additional access to business resources,we will continue to stress the importance of restricting
exposure to those who are at a very high risk of death if exposed to the SARS-CoV-2.
a) MASON COUNTY
COMMUNITY SERVICES
Building,Planning,Environmental Health,Community Health
From the Office of The Mason County Health Officer
Daniel Stein, M.D.
415 N.6th Street,Shelton,WA 98584♦ Phone:360-427-9670,Ext.582 ® Fax:360-427-7787♦Email: DStein(cDco.mason.wa.us
If we are allowed to move forward with a Phase 2 variance, we will continue to monitor the situation.
Mason County is prepared to reevaluate, potentially further restrict services and to step back to Phase 1
if needed. I appreciate the excellent work of our Board of County Commissioners,the Mason County
Board of Health,the Public Health Department, and our health system for allowing us to have this
discussion.
Sincerely,
Daniel Stein, M.D., Mason County Health Officer
lSVd;uSW S!s!r Giafwd r{
10Heal th
May 16, 2020
Key Metrics to Guide Public Health Decision-Making during the
COVID-19 Pandemic
The following set of metrics will be use to guide public health decision-making throughout the
COVID-19 pandemic.The targets represent the ideal state.The state and/or counties will not
necessarily need to meet all targets in order to move to the next phase in the "Safe Start
Washington" plan. Likewise, the state and/or counties will not necessarily need to drop to a
previous phase if targets are not maintained. While these metrics are important, other factors
will be considered in public health decision-making.
Incidence of new cases reported during prior
Target:<10 cases/100,000/14 days
COVID-19 two weeks
Activity
Reproductive rate by region Target: Re< 1
% licensed beds occupied by patients Targets:Green: <80%
Healthcare (i.e., hospital census relative to licensed beds) (Yellow:81-90%; Red: >90%)
system
readiness % licensed beds occupied by suspected and Target: Green:<10% -
confirmed COVID-19 cases (Yellow: 11-20%; Red: >20%)
Average number of tests performed per day Target: 50 times the number of cases
during the past week(or average%tests (or 2%)
positive for COVID-19 during the past week)
Testing --..-- ----- -- -------------
Median time from symptom onset to
specimen collection among cases during the Target: median <2 days
past week
Percent of cases reached by phone or in
person within 24 hours of receipt of positive Target: 90%
Case and contact lab test report
investigations Percent of contacts reached by phone or in
person within 48 hours of receipt of positive Target: 80%
lab test report on a case
Number of outbreaks reported by week
(defined as 2 or more non-household Target:0 for small counties
Protecting high- cases epidemiologically linked within 14 (<75,000), 1 for medium counties
risk populations (75,000-300,000), 2 for large
days in a workplace, congregate living or
institutional setting) counties (>300,000)
Mason County Application for Variance Appendix A
Case Calculations for April 22 to May 15 -Crude Rate .4 cases/100,000/day
Release
Instructions Per Guidance
2.a Testing Capacity and Mason General, Shelton : Drive Thru testing
Availability Harrison Hospital, Belfair
Port Orchard, Kitsap
Penninsula Health Care Systems, Belfair and Kitsap County
All sites low/no income, no insurance, and underserved
2.b 11 positive cases w/median date symptom to testing of 7.5 days
Public outreach continuing
2.c See narrative page 8
2.d Case and Contact Pop 66,768= 10 FTE investigator(15/100,000 pop)
investigations(i.to vii.) 4- Public Health Nurses
9-trained community health and EH Specialists
4-trained administration staff
2-trained volunteers
Total 19= 15.2 FTE
No further training scheduled at this time
Mason County: 1 workplace outbreak(4 employees and 1 contact
case) case investigation complete<24 hours
2.d Case and Contact Use of DOH Resources :
investigations(viil) Use • Per guidance from Secretary of Health John Wiesman,should any
of non-local health incident exceed the capacity of local resources, MCPH will contact
DOH for an immediate strike team and request additional resources
from DOL trained investigators.Ten additional investigators will be
moved to Emergency Command where they have access to phones
and computers.A MCPH nurse will supervise these additional
resources. Mason County also has a partnership with the Squaxin
Tribe to provide culturally appropriate case investigation.
• Relying on DOH to provide relief for local investigators avoids
exhaustion and multiplies effectiveness.
2.d (ix.) Cases identified 11 cases over the past four weeks
and percentage reached 100%contacted within 24 hours
<=24 hours Staff monitors 7 days per week and initiates contact tracing same day
2.d Close contacts Mason County experienced 13 cases over the past month/Total of 72
identified (x.) Close Contacts—all were contacted and placed in 14-day quarantine
2.e Facilities used for Super 8 Motel
isolation and quarantine
<10 persons isolation/quarantine
Time period indefinite
Food, laundry, provided by Mason County(Jail kitchen and laundry)
Paid w/Corona funds
BUounty Owned
U _ 75 beds for either isolation or quarantine
County owned—indefinite time period
Housing, laundry,food, recreation county provided
Security services—private contract additio ounty co; t
Showi&2 interior bathrooms
ortable toilets and handwash facilities
Mountain View Middle School (directly behind Mason General
Hospital)
100 Bed Alternative Care Facility (portable)
MOU with Shelton Schools—available until school starts
Showers, bathrooms in school gym
Food, laundry, reMation county pro
2.f In-home isolation The health department case investigator is asking each positive
patient who is isolating at home if they have family or friends that
can bring groceries or supplies. If the patient has no help, we access
United Way, Meals on Wheels, Agency on Aging, and the local Senior
Center to provide emergency boxes of food and supplies.
The health department case investigator/staff makes referrals to
outside agencies.The agency will let us know when boxes of
food/supplies is available and delivered. Health department case
investigator checks in with patient every day—so we know when
supplies are low, more food is needed, or medications need delivery.
2.g Outbreak Mason County maintains the ability to immediately respond to
Investigations outbreaks in congregate settings such as long-term care facilities,
homeless shelters,jails, and works with Department of Corrections
for prison facilities.
• To date,there have been no cases within the long-term care
facilities in Mason County. Outreach to LTC's was the very first
priority.
• Mason County maintains internal capacity to respond to outbreaks
within 24 hours and has the ability to reach out to DOH strike teams
if needed.
• Through local positive case reports and monitoring of the DOH
website, Mason County maintains situational awareness of cases and
works with partners such as the Squaxin Tribe and Skokomish Tribe
to ensure that vulnerable populations receive protection.