“The fact that we moved into this modified Phase 1 a couple of weeks ago made me think that we're going to move to Phase 2 in a reasonable time frame,” says Lynch, who has been guiding much of King County’s coronavirus response since January as the director of the University of Washington Harborview Medical Center’s infection control team.
But it remains unclear whether King County residents and the medical system are truly prepared for broadened freedoms and the risks they bring — especially as cases rise and contact tracing efforts lag behind.
“For the foreseeable future, there will always be risk and uncertainty when moving forward with additional social, recreational, work and business-related activities in the community,” Dr. Jeff Duchin, King County’s health officer, said via email Thursday. “For this reason it is critical that the public, business owners and other organizations that sponsor activities understand the seriousness of the ongoing risk and take all possible precautions to prevent COVID-19 transmission in workplaces and other settings as we move forward. As we apply to carefully increase the activities that we all want to do, this is a time to double down on, not relax, COVID-19 prevention measures.”
A man wearing a face mask to help prevent the spread of COVID-19 joins a crowd of demonstrators during protests across downtown Seattle, May 30, 2020. A wave of protests have swept across the U.S. following the death of Floyd. Minneapolis Police Department officer Derek Chauvin has been charged with his murder. (Matt M. McKnight/Crosscut)
With King County making progress toward minimizing coronavirus infections, and county residents increasingly concerned about financial and economic disaster, the Washington State Department of Health approved the 2.2 million-person county’s application to move to Phase 2 on Friday, June 19. The approval, effective immediately, came exactly two weeks after the county entered Phase 1.5, an intermediary step in the four-stage program meant to guide counties toward safe economic and social activity while mitigating infection and death under the coronavirus pandemic.
In the week leading up to Phase 2, the number of coronavirus cases increased by 47% in King County, Duchin said, with 113 more new cases in the week of June 12 to 18, compared with the previous weeklong period. Hospitalizations and deaths remained flat.
“We’re not talking about thousands of cases,” he said on a media call Friday, but he did call the increase “concerning.” “There’s a balance we need to strike between how much we can do and how safely we can do it,” he said, “so I don’t want to be at a point where I regret that we’ve opened up the community too much.”
As of June 21, at least 9,234 King County residents have tested positive for COVID-19 since January, with 1,541 hospitalizations and 584 deaths, the most of any Washington county.
The county logged two COVID-19 deaths and four hospitalizations between June 18 and 21. It may take a week or two for death and hospitalization data to reflect the impact of reopening under Phase 2, as the death rate lags weeks behind the infection rate, and case count increases are an imperfect indicator of infectiousness.
In going from Phase 1.5 to 2, restaurants moved from 25% to 50% indoor capacity; retail stores from 15% to 30%; and personal service businesses like hair and nail salons moved from 25% to 50%. Gyms and small-group fitness programs are allowed to reopen with safety precautions. Significantly, people are allowed to recreate outside (for permitted activities) with up to five people outside their households. They’re also allowed to gather with up to five people outside their household per week. People are allowed to gather indoors for religious purposes, either in houses of worship (limited to 25% capacity or 200 people, whichever is fewer) or for in-home services of five or fewer people.
“It's not a huge jump, but we think it's important to move forward for many reasons,” Duchin said.
In making the decision to apply to the next phase, Duchin said, the county considered three main factors: disease activity (numbers of new infections, hospitalizations and deaths), the impact on the health care system and on vulnerable populations, and the long-term sustainability of current restrictions on activity. The parameters of the governor’s Safe Start that govern whether counties can move forward in the phased system highlight disease activity and high-risk population protection, as well as the need for case and contact tracing investigations, expanded and faster testing, and health care system preparedness to treat additional cases.
“King County is currently meeting all of the metric goals outlined on the risk assessment dashboard, which suggests they have the necessary public health systems in place to respond to the situation in their community,” state Secretary of Health John Wiesman said via email Sunday. “We are not able to speculate if or how this will impact their ability to advance to a different phase in the near future.”
A chart from King County's application for Phase 2 of reopening, showing the county's progress toward reopening benchmarks. The chart uses a stoplight color-coding system to show which benchmarks are being met (in green), which are in progress (yellow) and which are far from being met (red). (King County.)
Under the county’s application to enter Phase 2, it is fully meeting two of its three disease activity targets, and all health care system readiness and testing targets have been met. However, there are still slightly more outbreaks reported per week than would ideally protect high-risk populations, though outbreaks are trending downward. Of 12 total target areas, it gets strong marks for seven of them; middling marks for four; and is doing poorly with one aspect of contact tracing.
That weak contact tracing metric is critical for King County. The county has so far failed to meet its goal of contacting at least 80% of people who test positive daily. A pilot test was launched June 9 to test three different methods.
“The contact tracing program is not working,” says Harborview’s Lynch. “We need to find ways for the health department to be able to do contact tracing effectively… and if that’s not working, I am quite concerned about our ability to progress.”
Contact tracing, Lynch says, is still based on a system that requires people to answer calls from unfamiliar numbers.
“I don’t answer phones unless I know who’s calling,” he says. “I don’t know what the technical issues are around the delay, but we’ve got to get the community on board with this.”
Even counties that don't meet the benchmarks of the Safe Start program can still move forward to future phases.
“These are not hardline measures, but we have an ideal target for each metric to help counties and the public understand how they’re doing,” said Wiesman.
According to the governor’s coronavirus website, the Department of Health considers these disease-reducing metrics collectively: “Where one target is not fully achieved, actions taken with a different target may offset the overall risk," the website states.
That decision-making process was important after recent news showed Department of Health testing data had been erroneous for the past eight weeks.
“These negative test numbers, while inflated, have not impacted decision-making as it pertains to counties advancing through phases,” Wiesman said. “We consider many factors in our holistic reviews of county applications for new phases, so a change to one factor doesn’t necessarily affect the final decision.”
After assessing the daily data and being in constant contact with other infectious disease doctors, Lynch remains “cautiously optimistic” about the county doing OK during Phase 2 . He thinks more and better hand hygiene, mask wearing, cleaning, social and work interactions and other protocols will aid that progression.
Lynch says everyday citizens seem to have handled phase guidance well so far.
“In general my feeling is it’s pretty good here in King County,” he says. “When I go to the hardware store or grocery store or walk in my neighborhood, people are pretty decent about wearing masks and doing physical distancing.”
Like many in the medical and health community, he views current protest activity as essential.
“Systemic racism is probably one of the most dangerous and unhealthy things impacting communities, and that needs to change as much as our actions need to change around COVID-19,” says Lynch, who attended the recent Doctors for Justice rally in Seattle. “As of right now, from the hospital perspective, we have not seen the impact of the protests on the need to hospitalize patients,” he says.
However, Lynch doesn’t think we’ll leave Phase 2 anytime soon.
“I suspect we’re going to be in Phase 2, or some sort of modified Phase 2, for a while because there’s limits on what we can do with physical distancing and masking,” Lynch says. “I think one really important thing to recognize is that our status right now in King County in terms of the number of infections is far more [numerous] than it was in February, before we had our surge. So we will have another surge unless we behave differently.”
“I think COVID-19 is going to be with us for a very long time, for years, but I think that its impact will be lessened with time, certainly if the vaccine becomes available,” Duchin said on the media call. “We will be needing to grapple with it, and I think it will fundamentally require us to reconfigure our lives in many ways.”