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A 'holding pattern' in Pierce, other counties, as COVID-19 cases grow

Dr. Anthony Chen, director of health for Tacoma-Pierce County Health Department, addresses reporters in mid-March about the county's first COVID-19 death.
Dr. Anthony Chen, director of health for Tacoma-Pierce County Health Department, addresses reporters in mid-March about the county's first COVID-19 death.

Pierce County is losing ground against COVID-19. That’s the word from Dr. Anthony Chen, director of health for the Tacoma-Pierce County Health Department.

In a blog post, Chen said the county will pause its plans to advance in the state’s four-phase reopening plan. He said the move to Phase 2 also brought an increase in cases.

“People were tired. They were tired of being home,” Chen told KNKX. “They're tired of not being able to see their friends and family. And when we did move to Phase 2, I think they got a little too exuberant.”

He says the increase in cases is being seen everywhere — and can’t be connected to particular place or event, like group living or public protests. Chen said Pierce County had a promising start to dealing with the pandemic, which proved people can practice social distancing, and wearing face masks in public. He says it’s crucial that people remember to keep up those efforts.

Chen talked with KNKX All Things Considered host Ed Ronco. Listen to their conversation above, or read a transcript of it below. Both have been edited for length. 

Ed Ronco, KNKX: Early in the pandemic, the approach from health officials in the state was to ramp up testing, to establish networks of contact tracing, there were widespread closures — these kinds of government led responses. The emphasis seems to have shifted now toward mass squaring, toward maintaining distance, more heavily weighted toward personal responsibility. Is that a fair assessment of the transition?

Chen: The term personal responsibility tends to have taken on a political flavor, unfortunately. But you have to understand that government can set policy and guidance. You know, the governor said stay at home, but it wasn't the governor staying at home alone. Every one of us stayed at home. I don't care whether you call that personal responsibility, civic duty or whatever. This is a false dichotomy to say we're shifting to personal responsibility. There always has been personal responsibility, but I don't want to call it that. It is being smart and it's also being caring. And that's no different than when, you know, we drive down the road. We drive carefully because we hope the other guy's driving carefully, too, so that we don't get in an accident. That's not a personal responsibility thing. It's us doing the right thing and it's us doing every little bit. And I think that's the strength of democracy, is that every little bit that you and I do adds up.

KNKX: It's a challenging position you and other public health officials find yourselves in. When governmental officials try to warn the public about threats, oftentimes, those threats are visible, are perceptible. There's a hurricane coming. I see the sky turning gray. The wind is picking up. (A virus) is invisible.

Chen: Well, you know, I think that's not the only thing that's invisible. Right? When there's a measles outbreak, it's news. When I grew up, I had measles. It was so common before. Now it's news because we have done such a good job. And, you know, while the virus isn't invisible, the impacts are not. When we're having businesses that worked really hard to reopen and they're having to close again because they're getting little outbreaks, that's totally visible. When you have people dying, that's totally visible. It's just that people don't see it that way. To them, that the threat feels invisible. But it's not invisible.

KNKX: Over the past two or three months: Are there lessons learned? Both missteps and things that you really got right?

Chen: Pierce County has been very fortunate. If you look at our numbers, we have always lagged King County and Snohomish County. People forget Yakima (County) is our neighbor, and they're just being so challenged, and we fortunately have not been. Our hospital capacity has done OK. When we have had outbreaks in long-term care facilities, we've been able to control them.

Were there missteps? Of course there were. It revealed the weakness of the supply chain. It is still the case, and it is very frustrating to me, that there is a lack of a national strategy to control the pandemic. We had time to fix the supply chain. It has not been fixed. It just gets me very frustrated when I'm hearing that we're going to be running into testing supply shortages again. You know, we're home to (Joint Base Lewis-McChord) and I know they can get a screw for a piece of military equipment to the other side of the world to repair a tank, an airplane, whatever, and we can't even get swabs. This is inexcusable. There are lessons learned from that.

There are some positive things, too. Everyone has become an amateur epidemiologist. They're talking about the numbers, the reproductive ratio – the R factor. People are paying attention to it. Public health has always labored in the shadows. And we've seen significant cuts to public health funding. I'm hopeful that people will recognize that this is an important investment in our health, and in fact for our country's security, to have good public health.

KNKX: We've been in major pandemic response mode in this country for about three to four months now. What do you see in the next three months? Which communities are you most concerned about? Potential hot spots? What is the near future look like to you right now?

Chen: I think the thing COVID-19 is telling us is that it is throwing us curve balls everywhere. It's very difficult to predict. However, we are in a better place now than we were a few months ago. In the past few days, we've been doing case investigation contact tracing, contacting 450 people a day. A year ago, if you’d have told our infectious disease folks, who normally do STDs and HIV, that we would be doing 450 patient contacts a day, they would have laughed. And that's part of the calculation that goes into whether we can move forward or not.

We're obviously in a holding pattern. We're not going to recommend any progression in phases until we, number one, see stabilization. This curve has to flatten out. Number two, we would like to see it going down. It doesn't help us if we flatten out at 80 cases a day. We are preparing for the fall. COVID-19 will probably start to demonstrate some seasonality. It probably will increase in infection as we get into what we normally call the flu season. The flu season and upper respiratory infection seasonal will arrive. What does that mean? Chaos will break out again.

My mother was in the hospital a few times earlier this year. I remember walking into St. Francis emergency room to see her. There were people lining the hallways. You couldn't sit in the waiting room. That's what happens in flu season. What we're going to need people to do this fall is — everything that we're talking about now, they need to double up on it, not just for COVID-19. They need to prevent flu and other respiratory infections. And everyone needs to get a flu shot. The recommendation is everyone over six months of age should get a flu shot. We need to keep people out of emergency rooms. We need people to be healthy so they don't think they have COVID and be rushing to go to the emergency room. And then we will find out whether some of our guesses are correct.

School is scheduled to reopen. Colleges are going to be coming back to full session. We already have seen University of Washington now has an outbreak among its fraternities. I mean, it's the summer. If we're having a fraternity outbreak at a college, what's it going to be like when more kids are back in the fall? And it's very concerning for us about the economy as well. If businesses are struggling now with infections and outbreaks, what's it going to be like later?

So that's what we plan for. We plan for the big Nisqually earthquake and hope that it’s just a little tremor. I don't want to get people scared, but I need to know that we are planning and we need people to be doing their part because we're all in this together.

Dr. Anthony Chen is director of health for the Tacoma-Pierce County Health Department.