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Nov. 23, 2020

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Virus on vexing trajectory in Clark County

Data shows COVID-19 cases increasing well ahead of anticipated winter surge locally, nationally

By , Columbian staff writer
2 Photos
Clark County Public Health Officer Dr. Alan Melnick, left, and Dr. Lawrence Neville, chief medical officer at PeaceHealth Southwest, speak March 13 during a COVID-19 press conference at the Clark County Public Service Center. Seven months later, the pandemic is no closer to being over.
Clark County Public Health Officer Dr. Alan Melnick, left, and Dr. Lawrence Neville, chief medical officer at PeaceHealth Southwest, speak March 13 during a COVID-19 press conference at the Clark County Public Service Center. Seven months later, the pandemic is no closer to being over. (The Columbian files) Photo Gallery

For weeks, Clark County Public Health Officer Dr. Alan Melnick has been warning of another COVID-19 surge that could arrive in the late fall and winter.

He’s relayed the message to Clark County councilors at Board of Health meetings, and cautioned the public during press interviews.

As cold weather and rain become the norm, and the sun recedes earlier in the day, it seems likely that people will congregate inside more often, where coronavirus spreads more easily.

But even before those chilly temps and dark, rainy days have fully arrived, Clark County, and the rest of the U.S., are already encountering deeply discouraging data around coronavirus cases.

State and national health officials are worried about case counts heading into winter, when the outlook could worsen even more. Officials attribute the recent coronavirus increase to a combination of factors that include pandemic fatigue and politicized science.

“Things are going to get worse, and they are getting worse,” Melnick said.

Cases on the rise

In Clark County, community transmission continues to increase. By Oct. 21, the county had already set a new monthly record for COVID-19 cases.

COVID-19 officially arrived in Clark County in early March. For the first five months, cases were confirmed slowly. But since July, every month has had more confirmed cases than the combined total of the first five months.

Part of that is explained by increased testing and better investigation and tracing of the virus, which leads to more discovered cases, but Clark County’s total testing numbers have been fairly stable for the last few months. It’s the positivity rate that is climbing.

Since June 27, Clark County has registered a positive test rate above 2 percent each week, the target goal for Phase 3 in Washington’s COVID-19 recovery plan.

With a couple of exceptions, the positive test rate has generally remained above 3 percent each week, sometimes closer to 4 percent. The week ending Sept. 5 saw a 5.12 percent positive test rate.

“We’ve got more disease in the community,” Melnick said. “When when we had those increased blips earlier, we saw that testing did go up, but the percent positives of tests went up out of proportion” with the total testing increase.

A local and statewide problem

Statewide numbers are also reason for concern.

Last week, state health officials warned of increased virus transmission in Western Washington.

A Tuesday news release from the Department of Health said that case counts in Western Washington counties are “climbing at an alarming rate,” so much so that it might constitute a fall surge.

The news release also said case counts are not due to localized outbreaks, such as at a specific workplace or gathering, but rather widespread disease in the community.

A little more than a week before July 4, Clark County’s COVID-19 activity rate rested under 20 new cases per 100,000 population over 14 days. That number rose to 115.05 cases per 100 population Tuesday, which is about 40 cases more than Washington’s threshold for “high” COVID-19 activity (75 new cases per 100,000 population).

State Secretary of Health John Wiesman said it’s important for people to get their flu shots now so flu season doesn’t add further stress to the state’s hospitals.

“When this happens, we place everyone, but particularly our elders, parents, grandparents and those with diabetes, heart disease, cancer and other chronic disease, at great risk. A surge in COVID-19 along with flu season puts us at enormous risk of overwhelming our hospital systems and undoing other important statewide progress toward containment,” Wiesman said in the news release.

Health officials still urge people to wear a mask in public, even with friends or family they see regularly and when in small circles. They also advise to keep gatherings small and hold them outdoors if possible and frequently wash your hands.

“It’s time to flatten the curve again,” state health officer Dr. Kathy Lofy said in a statement. “I’m optimistic we can get our kids in school, keep our businesses open, and control the spread of COVID-19 if everyone does their part.”

Tracing transmission

At the Clark County Board of Health meeting on July 8, Melnick had to reiterate that the data was correct.

Due to a significant increase of cases in early July, and the training of new staff, Clark County Public Health was drastically failing to reach a state goal of contacting 90 percent of confirmed coronavirus cases within a 24 hours of receipt of a positive lab test.

Instead, Melnick said, Clark County was only reaching 8 percent of cases in that time frame, 82 percentage points below the goal — which Melnick says is a difficult-to-reach target and a number the state’s own contact notifiers have struggled to attain.

“That is not a typo,” Melnick told the board of health. “That is the number — and it is a dismal number.”

For the entire month of July, Public Health only reached 24 percent of cases within 24 hours, but in August and September, Public Health reached 57 and 59 percent of cases, respectively.

Melnick said Public Health has reached closer to 70 percent of cases more recently.

He’s seeing the improvement as Public Health has brought on more staff to help track the virus. They want the information to track outbreaks of disease, investigate their causes and inform close contacts of patients, who were potentially exposed.

In June, Clark County only attempted contact or reached 36 percent of patients daily during their isolation period. In July and August, Public Health attempted contact or reached 78 and 86 percent of patients daily during their isolation period, respectively. In September, Public Health reached 73 percent daily.

COVID-19 in Clark County By the Numbers

4,410: Positive cases in Clark County as of Friday afternoon

66: Deaths in Clark County as of Friday

24.3%: Total percent of cases reached within 24 hours for contact tracing in July

59.2%: Total percent of cases reached within 24 hours for contact tracing in September

115.05: Rate of new cases per 100,000 population in Clark County as Friday afternoon

“We’re still relatively early in this pandemic. I’m concerned about these small private gatherings that are more intimate and people are not masking and physically distancing.”

Dr. Alan Melnick, Clark County Public Health officer

Public Health also reached 70 percent of close contacts of cases daily during their quarantine period in September, a number that is up from 17 percent in June, which included attempted and successful contacts.

The county has still struggled to reach close contacts of cases within 48 hours of a positive lab test result. That’s in part because one person could have dozen of close contacts to reach, and also because contact notification is difficult work. Some people don’t return calls or texts and some people don’t want to cooperate with health authorities.

“Some folks are not that easy to reach,” Melnick said.

Pandemic fatigue

The majority of coronavirus transmission in Clark County is happening outside the household, as The Columbian reported earlier this month.

Public Health data from July through September illustrated how the virus has spread locally. While half of the cases in those months did not have a likely source of exposure, the data did show that small private gatherings were a frequent spreader.

Melnick said the gatherings might be a sign of pandemic fatigue, where people begin to shirk health guidance as they’ve grown tired of living restricted lives.

“We’re still relatively early in this pandemic,” Melnick said. “I’m concerned about these small private gatherings that are more intimate and people are not masking and physically distancing.”

Earlier this month, The New York Times reported on the international fatigue, which has been labeled as one reason behind the recent increase in worldwide cases.

Melnick, who has been a health officer for around 30 years, said he thinks politicized science and denial of science also are to blame for the national and local struggles with COVID-19.

The U.S. has amassed more than 8 million cases.

The national coronavirus picture is more bleak than local and statewide trends. The U.S. recorded a 36 percent increase in cases over the past two weeks from Tuesday, according to The New York Times.

As the Times reported, 18 states added more new coronavirus infections during the seven day period that ended on Oct. 16, more than any other week since the pandemic began. France, Spain, the United Kingdom and much of Europe are also experiencing increasing case counts.

Burden of misinformation

Melnick said science has always received some denial during his career, but the spread of misinformation has been strong during this pandemic and last year’s measles outbreak in Clark County.

“COVID-19 brings out the best of us and the worst of us,” Melnick said.

Marissa Armstrong, who monitors Clark County Public Health’s social media accounts as its public information officer, said people now have a platform in social media, where they can reach “more people with their skepticism,” or their science denial.

As a result, misinformation is frequently floating around the community and hindering Public Health’s work. Some people claim masks don’t work, despite studies to the contrary. Others don’t want to limit gatherings or abide by restrictions despite the advice of experts. People don’t believe the virus is deadly, despite the fact that COVID-19 is the third-leading annual cause of death in the U.S. this year.

Melnick admitted his work is more challenging, when he’s not only fighting a virus, but also misinformation. He said people need to at least believe in basic facts, or else it’s like a return to the Middle Ages.

“That’s a recipe for disaster,” he said.