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2020/05/22 - Board of Health
MASON COUNTY BOARD OF HEALTH PROCEEDINGS SPECIAL MEETING 411 North 511 Street,Shelton,WA May 22,2020 Attendance: Randy Neatherlin,County Commissioner;Kevin Shutty, County Commissioner; Sharon Trask. County Commissioner;via telephone;Peggy VanBuskirk,Hospital District#2;Keri Davidson, Shelton School Board;Gary Plews,Fire Commissioner. Kathy McDowell,City of Shelton Council Member; and Dr.Daniel Stein,Health Officer Absent: Scott Hilburn,Hospital District#1; 1. Call to Order Chair Peggy VanBuskirk called the special meeting to order at 10:32 a.m.via teleconference and roll call was taken. 2. Actions to Consider-Adoption of Resolution approving Application for COVID-19 Phase I to Phase II Dave Windom noted the required items in the application.He said he would like to have the application out this afternoon with a turnaround expected within two to three days. Cmmr.Neatherlin/Shutty moved for full approval of the application for COVID-19 Phase I to Phase II.Motion carried unanimously.All in favor. Dr. Stein noted that the County will allowed to evaluate businesses before opening.He clarified that just because we may move to Phase II,the business may not open if they are not compliant or ready to do so.Discussion was had about how evaluations and/or enforcement may be handled.Dr. Stein said if spikes occur the County does have the power to close once again. Kathy McDowell questioned how large business can be open,yet small businesses cannot.Dave said he has been working at the state level to rectify that,but at this time that is the guidance from the Governor. Adjourn-The meeting adjourned at 10:45 a.m. BOARD OF HEALTH PROCEEDINGS May 22,2020-PAGE 2 ATTEST MASON COUNTY,WASHINGTON BOARD OF HEALTH hdtu� MASON COUNTY,WASHINGTON Clerk of the Boaru 4brl�A. Scott ilburn,Hospital District#1 Kathy McDowell, Co issioner Kevin Shutty,Immissioner "I&V and eat •lin,Commissioner �on Trask,Commissioner Peggy Van Busl' c,Hospit District#2 Gary Plews,Fire Ldmmissidu& Keri Davidson, S e on Scho Board Resolution No. ZO—CZ 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 Health 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 BEITRESOLVED bythe Mason County Board of Health to approve the Mason County Application for Variance from COVID-19 Phase 1 to Phase 2 (Attachment A) and direct staff to send the application to the Washington State Department of Health. Adopted this 22"d day of May 2020 MASON COUNTY,WASHINGTON BOARD OF HEALTH A 6 oeL Scott Hilburn, spital District#1 Kat y M owell, Ci Commissioner Kevin Shutty, Commissioner Randy Neatherlin, Commissioner Sharon Tras , Commissioner L;4LL)Q, .- -gr" ATTEST Peggy an Buskirk, Hospital District#2 Board of Health Resolution No.20-o3 Request to COVID-19 Phase 2 Gary Ple Fire Com issioner Vri - k the Board Keri son, Shelt n School Board APPROVED AS TO FORM: Tim Whitehead, Chief Civil Deputy Prosecutor Page 2 of 2 J:\Board of Health\Resolutions\2020 BOH Resolutions-Proclamations\Resolution for COVID Phase 2 request-May 22.docx Mason County Application for Variance Phase 1 to Phase z Abstract Mason County application to Washington Department of Health to move from Phase 1 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 CaseCalculations for Release..............................................................................................................6 Hospitalizations..................................................................................................................................6 Physical Distancing Adherence Trends................................................................................................6 LongTerm Care Facilities....................................................................................................................6 Readiness and Capabilities Needed ........................................................................................................7 Instructions2.a....................................................................................................................................7 Testing Capacity and Availability:....................................................................................................7 Instructions2.b...................................................................................................................................7 Instructions2.c ...................................................................................................................................8 Instructions2.d...................................................................................................................................8 Case and Contact Investigations......................................................................................................8 OutbreakConsiderations................................................................................................................9 CaseTiming....................................................................................................................................g Instructions2.e....................................................................................................................................g Healthcare System Readiness.........................................................................................................9 BedAvailability...............................................................................................................................9 Ventilators.....................................................................................................................................zo PPE ...............................................................................................................................................zo Instructions2.f..................................................................................................................................10 CaseSupport.............................................................................................:...................................10 In-home Support...................................................................................................... Instructions2.g .................................................................................................................................10 Ability to Protect High-risk Populations........................................................................................10 Relianceon DOH Resources..............................................................................................................11 SocialConsiderations........................................................................................................................11 AUTHOR:MASON COUNTY PUBLIC HEALTH 1 21 May 2020 MasonCounty is Ready.........................................................................................................................12 Summary..............................................................................................................................................22 Statement of Purpose Mason County seeks a collaborative and responsible approach to moving our communityfrom Phase 1 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-1g.This approach reduces the risk of COVID-1g to Washington's mostvulnerable populations and preserves capacity in our healthcare system,while opening businesses safely.The plan involves assessing COVID-1g activity in the state along with healthcare system readiness and our state's abilityto 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 21 May 2o2o WASHINGTON'S PHASED APPROACH Modifying Physical Distancing Measures as we Reopen the State INDIVIDUALS AND BUSINESSES SHOULD FOLLOW ALL REQUIREMENTSLISTED'ABOVE DURING ALL PHASES El 13 Phase 1 Phase 2 Phase 3 Phase 4 iPop. 1sk aumnphTk.p•bk,kkn.•Idl tlonf,PapulUons• c.>nttnfr.msuyx<m.,suyu.athy cawmf.Insuyu.m.,s.rytelury tbwaw asuytwn.,suyx..ldw MNrt+Mng -W Woor pup lKK..f pfrx utl.ttlu -I iOuf�lemrp.spt I1 dondlu.00ltlu•ItSDT:,*.dty OuldovrKmtlanMwklnpSarlaw.r ll g, gl•arapa a•,,..J jg�. Recreation 10.pwnowl4o.lIiUn g.balfb.11.01 Ft"mas ro—tkf.l.dhlty Gatherings : ta,pHtu.lurvl,ffukh G.IAu wlthfwfmn lhan sp.aN< All— th,fing,w(th—.th.n IstxW,fpldluaU ..»ho.•eh.Mpu.•Nd. .tuhld.y^urhow.hoW p<r.wa SOprop6 Allowi.thuktgf with>50p"O* rW nt410+w1 enJ IYnited r.urosfmx,l 6unikl trevA.nd Iknitasl of iruf m141 Travel towll"FN9*1 p.rfnbftals"Wllk$ tr.r.11.,Ph. Hp.mdnmk Wimps. Rnwof nsavn.tNal anal ContlmwtwMxentl.ltravd •MoWNmtrunul.<twiq -AddlO.uu,ontttunbn .n •Initom./domulkurW" -sula.franu/n.flnSc7S.c.psdgd WnN.f,hoafede.Ntw.f1U t.bkdnrfol.wu lh.n10 •ik h,tb•fm..pnd.0 1low.d -0u,rw klmwnaN.ntn,.t udlh rmd,tluul .]SK„putty -6a^WlbwGufwf•ppnan .Wdf.l.h •NM.du.l.n•taSONncc my •i.blt^pmnnrwtlan/hatm..h •1-in nd u.<I.u/ot&•W •Mtam<r luln govnmfinU,mn. •yip°pm ult,d• bwlnmu aat.wwkrmuW.wnab ffuhwwkrema�utlondren,oungedl -h7pMdub. •�p fo(WoOM •SOnd<f •WMulymuef -AutMs Wa-0d@ Y,eIn -x.trmdn,llatonfhub,n •61u..fwf •IargsfpwWq..mb BUSIAess/ •fUkO(cutrtlaspkkup ordtn only) •fYtCy anlnVp •A0^Ihu Wfltwa.ullvltlnnolr.l 1tam,utu%kI.d.t.f7uw d—,Wft; •[ar.nfhes •x.,btwnlN.wnulf6i:up.dl luhM 0f1.d....pit...J hkluh...dwmt. •bulmNlnu.bpr.uk.hydul Employers v.tva6wn .k.o4ryvtluns(n•h.r. awl w"t;..Wlh.n�0pwk dkl.ndag..dpaalhr�.n 'wr�^Mw••..N..s+�.,rfn..r+,,.o. w,f.f..•..m... .+.��rfa,.M�a ,43�foM nW=bfn,wn:Mu .o.r•>.rrva.n,,.,..f.,..F:+:oe,«,i wL.e�..,..ww�.l:.weLt �e.f"°..a..nr-a..r,.L:i:.':wf�.f"1L�.•�e+ fn r•.r..r..,..«w.f.w..au,w Mason County seeks to use a locally based version of this approach to move from Phase 1 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-19.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 21 May 2020 1 Public Health Criteria Case Data Totals Connnned cases by county Legend Confirmed'Cases 33 Deaths ,1,520+ Percentlof Deaths ,1,141 to 3:40`(deaths/confirmed cases]) .1,520 Total Tests 1.584 ®761 to 1,140 381 to 760. Percent positive 2.1% 1 to 380 I, 0 C 54 of 18,611 confirmed cases do not have an assigned county i .Demo ra 'hits- - A e-Ran e ' -Cases::. Deaths 0-19 0 0 20-39 R 0 40-59 11 0 60-79 11 1 80+ 2 0 Sex Cases Deaths...: Male 9 0 Female 0 Updated:5117J2ozo 1600hr lhttps:/(www.dohwa.gav Emergencies/Coronavirus AUTHOR:MASON COUNTY PUBLIC HEALTH 4 21 May 2020 Epi Curve Confirmed Case Counts Data Incomplete 4 3 2 1 i r 0 Feb 2020 Mir 2020 Apr 2020 M.ay 2020 Date of Illness Onset 54 of 111,611 confirmed cases do not have an assigned county.,lllnesses fra.0 I.he.last 4 to 7 days may not yet be reported. 2 Case ----- ---- -- ---- --- -- ...... --- COVID-191n Washington State Number of Individuals Tested by Specimen Collection Date Testing for.001/6-19 has been steadily increasing in Washington.Beginning in late March,drive-through testing become available in some communities,which increased testing avdifability.Learn More Number of Individuals Tested mir.,of ind vi aais tested positive Data maybe incomplete •Positive Negative for the mostrecentdates. . 40 30' I 20 . I I Phar 2020 Apr 2020 Mpy 202a Specimen Collection Date 3 AUTHOR:MASON COUNTY PUBLIC HEALTH S 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 12th 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 abilityto treat.This calculation has been verified by DOH and forwarded by email to Mason County. Hospitalizations As of May1't,Mason County has had three patients hospitalized in hospitals outside of Mason County. Mason General Hospital has had no in-patient cases of COVID-19.Mason General Hospital currently has capacity far more than what has been required for both COVID-mg 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.114 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 2A, 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 Data as of 19 May 3 Data as of 15 May 4 https://covid.ldmod.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 2.c Positive Tests Negative Tests Percent Positive _ Positive Tests Negative Tests Percent Positive 4/20/2020 0 9_ 0.00% _ 5/3/2020 0 4 4.88% 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% TotalsWeeki 1 2 153 1.31% TotalsWeekB 1 3 1 177 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 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 30 TotalsWeek2 3 1 186 1 1.61% __ TotalsWeek4 3 208 Fourweektotals 1 11 1 724 1 EBased on DOH dashboard data,goal from guidance is below 2%for any week and In combination. Instructions 2.d Calculation:66,768/1oo,000 x 15=10 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 10 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 15.2 FTE's.This meets the guidelines of 15 investigators/1oo,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. too percent of positive cases are investigated within 24 hours.Most case investigations are completed within 12 hours. Case Timing Mason County Public Health has identified 11 cases overthe last 4 weeks.Of those cases,t00%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. ason Count ex erienced 1_ cases over the &ast month/Total of -2 Close Contacts—all wer •o Nacted ran.d rolaced I in 14;day quarantine AUTHOR:MASON COUNTY PUBLIC HEALTH 8 21 May 2020 Outbreak Considerations A COVID-19 outbreak will be handledjust 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-19 outbreak in a workplace setting of four(4) employee cases and one(2)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 2.e Healthcare System Readiness Bed Availability Throughout the 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 May19,2020 Mason General 0 32 Available Within county:231 beds 571�9/2©2 o 20 can be put in place Mason General Hospital o 3 ventilators o 4 Ventilators on order • 32 beds available o 2 Bypass machines which can be • 20 additional expansion beds converted. In addition to hospital facilities,Mason County Community Services(MCCS)also has a soo bed Alternate Care Facility(ACF)readyto deployto 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 so 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 so 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 I 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-19 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 zoo 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 additionall7o 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 30 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 websites,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 DOLtrained 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 COVID1g 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. s http IL-vvw.cloh.wa.gov Emerciencies9Coronavirus AUTHOR:MASON COUNTY PUBLIC HEALTH u 21 May 2020 Mason County is Ready phase 7 Phase 2 High Risk Populations Continue to Stay 1-13me,Slay Healthy Continue to Stay Hume,Stay Healthy IGolf,fishing,huntlag,boating, Alloutdcor recreation ltwolvingfeever Recreation hiking) than5p°ople outside your,household -------- Hone- _ -- — Drive-1nspirltual services with one Ga liter with no more than 5 people from Gatherings householdpervthicle outside you r hu use hold pet week Limit non-essential travel within proximity Travel Only essential travel of your home fiewconsuuction Remaining Vanufacturing Esstential businesses open In-home domestic services Existing construction that mile Ls Retail lit-store criteria Real Estate Landscaping Professional Services/office based Automobile Sales businesys + Curb-side retall Salonsand Barbers CarWashes Housecleaning Business/Em to eR Petwalkers Restaurants<5"Icapacity Mason County has all the policies and support systems in place to move forward into Phase z.Our case peak happened over a month ago.Cases per day are at.38 which is well below CDC recommendations Of.71 cases per day/1oo,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 z as soon as possible. Timeline(Tentative): • Wednesday May zoth,request letter of support from Mason General Hospital • Wednesday May zoth,request special meetings of the BOH and BOCC • Thursday May 21st,present to Area Command and key partners • Thursday May 21st,send to Board of Health and County Commissioners • Friday May zznd,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-1g 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 22 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 ��y,srer¢oA o � less d� STATE OF WA,SHMGTON DEPARTMENT OF HEALTH APPLICATION FOR COUNTY COULD-19 VARIANCE Date: 22 Mav 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 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 wiih 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 weeps. 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 .. .� t �, ♦' Mason Health ealth Mason General Hospital o 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. I Dean E.Gushee, MD, MS, FACEP ` Chief Medical Officer Mason Health PO Box 1668 Shelton,WA 98584 360-432-7728 dgushee@masongenerai.com Mason Health Mason General Hospital • Mason Clinic 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, I! 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. { I 1 cr' - Dean E. Gushee, MD, MS, FACEP Chief Medical Officer Mason Health y PO Box 1668 Shelton,WA 98584 360-432-1728 dgushee@masongeneral.com ' i i 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 9 Phone:360-427-9670,Ext.582 ©Fax:360-427-7787 0 Email:;DSteinC�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. 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.61h Street,Shelton,WA 98584 0 Phone:360-427-9670,Ext.582 0 Fax:360-427-7787 0Email: DStein0c6;mason.w6.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 001 D;a 9 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 COVID-19 two weeks Target:<10 cases/100,000/14 days 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 during the past week(or average%tests Target:50 times the number of cases positive for COVID-19 during the past week) (or 2/0) 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- (<75,000), 1 for medium counties cases epidemiologically linked within 14 risk populations days in a workplace,congregate living or (75,000-300,000),2 for large counties(>300,000) institutional setting) J i 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 WSuper 8 Mote( isolation and quarantine 10 ersons isolation/qua-,ntina .Time period indefinitd ood, laundry,provided by Mason County(Jail kitchen and laundry)'. aid w/Corona fundl 0 d , e i i o n t ' WmaliT ieuv i°ddiIr,S ool(+tl►rea;J 0®B:ed Aite,rnatiue Czar ciJ�,y( o_r,�ta�•lei OU wi' h;eh=our Sch©ois av ila•le a -hool M a ow r a hroa ai oo� la,und ree OPM n co n PMo.aid e 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 LTCs 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.