County Public Health Report ~ 1/19 (contd.)

Nationally, new COVID-19 cases have risen to an all-time peak, with nearly 200,000 new COVID-19 cases reported daily, signaling a 38% increase in the last two weeks. Additionally, nearly 3,000 deaths were reported each day and approaching nearly half a million deaths since the start of this pandemic. This pattern has been repeated in many states.

Washington, as of January 18, reported a 7-day average of more than 1,800 new cases, up 27% from the previous 2 weeks, and deaths nearing 4,000 since January 2020. Cases per 100,000 population was 272 statewide in the first 2 weeks of January. Hospital admissions in the state have increased slightly, but currently remains below capacity.

As of this day, Jefferson County now has 269 cases, with 125 cases per 100,000 population, a 3.18% case positivity. Neighboring Clallam County has 154 cases per 100,000 population with 8.5% new case positivity. Both counties remain among the lowest in both metrics in Washington. Mason County has recorded 360 cases per 100,000 population and 19.8% positivity for new cases, with Kitsap County at 233.cases per 100,000 and 12.5% positivity. The metrics for Mason, Kitsap, Jefferson, and Clallam Counties are tied together in determining progression to the next phase of loosening restriction for re-opening under the RoadMap to Recovery statewide plan.

Changes are expected with the inauguration of a new administration regarding federal prevention strategies, vaccine production and availability, and policies. In the next six months, Public Health infrastructure will be appropriately funded, staff increased and science will provide the basis for these efforts.

Vaccines:

Currently, vaccine availability remains limited and Jefferson County has been vaccinating those individuals in the 1A tier, which include front-line medical workers who face heightened exposure to infectious patients and settings, as well as residents and staff in long-term living settings. Jefferson County has stepped up and used some of its vaccine supplies for the staff of these facilities when it was evident that organizations contracted to vaccinate this population were behind schedule. The residents still need vaccinations. Jefferson County has now included the 1B, Tier 1 population, which focuses on the eldest at risk of severe complications and death. Although state guidelines include a larger age band in their eligibility (over 65 years of age), Jefferson County has a disproportionate number of seniors here as compared to other counties. Only individuals 80 years and older are currently eligible for the limited supply of vaccines. About 37% of this county’s population is over 65 years of age and will take a longer time to vaccinate as compared to other counties.

Our biggest challenge in this moment is managing our expectation about when we will individually get the vaccine and what that means going forward.

Jefferson HealthCare is the main site and has scheduled 1,000 persons this week for vaccinations, about 250 a day. We have received 2,198 doses for the first doses to date, and now will use the reserved supply held for the second dose for more seniors at-risk to receive their first dose. Supplies for those needing the second dose will be used as new shipments arrive. Although supplies are limited, the state has been informed this is a temporary situation. New types of vaccines are expected to get FDA approval sometime in March and will increase availability.

Local county staff have been observing the vaccination clinic events in Sequim and Port Angeles in anticipation of events like this for Jefferson County in the near future. Currently in Jefferson County, all individuals eligible can register at one of three facilities taking appointments: Jefferson HealthCare, Safeway, and Tri-Area Pharmacy. These sites have requested residents not to call the site, but go to their websites as all these sites have critical responsibilities to fulfill and are burdened when they are diverted to calls related to vaccinations.

Another category in 1B, Tier 1 includes 50 year olds in multigenerational households and is aimed at those caretakers of elderly individuals in the same household. This has been difficult to operationalize as this information tends not to be in medical records. It is up to individuals to truthfully represent their situation if they fall into this category. The state has recently provided more clarification describing those considered in this category.

Response to Listener Questions

Organizations and businesses providing vaccinations must apply to the state and undergo a rigorous vetting due to the specific needs of these new vaccines, including storage, technical knowledge, and equity requirements, such as no out-of-pockets costs to residents.

The pandemic will not be over for the community when an individual resident gets a vaccination. We must continue to use mitigation measures to keep cases from continually rising and deaths are greatly reduced. If a vaccinated person goes to the store and does not wear a mask, they will be asked to leave as they still pose a risk. The vaccine protects a person, when infected, from progression to serious disease. This must continue until death and disease go down. As vaccinations continue, guidelines may provide some exceptions for vaccinated persons in limited circumstances. Public health leaders and scientists are trying to gather more information about infectiousness on some of these questions. As long as new case prevalence remains high, it is too risky to drop our prevention measures.

There is no need to get a COVID-19 test prior to getting vaccinated. If you are currently experiencing symptoms, are in quarantine or isolation, you should not get the vaccination, mainly to protect the medical workers and volunteers.

There is no out-of-pocket expense for the vaccination in Jefferson County, although some organizations may bill your insurance company for the cost of administration.

If you do not have insurance, you can still get the vaccine at no cost to you.

It appears these first two vaccines have slightly higher allergic reactions than other vaccinations. Non-COVID-19 vaccines typically produce 1 in 1,000,000 allergic reactions in the vaccinated population as compared to 11 in 1,000,000 for the new COVID-19 vaccines. All vaccination sites are prepared to treat individuals if reactions occur, as trained personnel watch all vaccinated individuals for 15 minutes after the shot is received. For those vaccinated with a history of reactions, they are observed between 30 and 60 minutes, depending on the facility and reported history of reactions of the patient. It is critical to report any history of reactions to past medical procedures or vaccinations to the provider giving the vaccinations. Currently, very few exceptions are listed as contraindications for these first two vaccines.

Common side effects reported from vaccine trials and those currently receiving the vaccinations are soreness at the site of injection (50%) and headaches and fatigue (50%). Side effects with the second dose may include more symptoms, including a mild fever and affect your stamina for going to work, but just for a day or so. These symptoms are recorded as side effects, but are actually a sign that your immune system is reacting to the presence of a protein it has not seen before and developing a response. If you have no side effects, Dr. Locke says you are lucky and still building a response.

Because we are grouped with Mason, Kitsap and Clallam Counties under the states RoadMap to Recovery, our progression to Phase II is dependent on our collective ability to meet the state’s health metrics over time and is influenced by each county’s local epidemic numbers. Data listed on the state’s DOH website is different and at odds with the data each county has tabulated for a variety of reasons. The local county and the state collect data from different sources, some of which have crashed recently. Our status of being in Phase I actually acts to support case suppression and currently is safer for all of us. Traditional public health interventions like case investigations and contact tracing continue to work if we collectively suppress transmission.

The professional organization for local health officers has provided input on the state’s proposed plans, but it appears this has not been taken into consideration at this point, including an effort to revamp the entire public health jurisdiction during this pandemic. Dr. Locke will testify soon at the state capitol to emphasize the importance of heeding the advice of local public health professionals, as well as the proposal to revamp a well working model of local health jurisdictions.

Continue to check the Jefferson HealthCare website as the main clearing house for updates and opportunities for vaccinations.

Willie Bence of the Department of Emergency Management (DEM) stated many people volunteered to staff the line that helps seniors get a vaccination appointment, when they have trouble getting into the JHC website or don’t have access to a computer. Their office line (360-344-9791) remains open weekdays from 9-4pm.

If you leave a message, it may be 48 hours before your call is returned due to the volume of calls. Mr. Bence encouraged all residents to use the JHC website as it will answer typical questions and is updated regularly. Also, volunteers are still needed for medical and non-medical roles as temporary emergency status.

Submit your Public Health questions to Dr. Tom Locke by emailing [email protected]. Note: The weekly deadline for these to be submitted is on Fridays at noon, to be answered at the following Monday’s BOCC meeting.