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Posted on: July 9, 2020

Update for Clinicians: COVID-19 Cases Increasing in Snohomish County

Update for Clinicians
COVID-19 Cases Increasing in Snohomish County
July 7, 2020

Contents

  • Requested Actions
  • COVID-19 Data Summary
  • Updated COVID-19 Testing Guidance for Healthcare Providers
  • Employer Roles and Responsibilities

Requested Actions

  • Be aware that COVID-19 cases have been increasing over the past four weeks since moving into Phase 2 and our situation seems precarious in terms of capacity to suppress transmission and preserve hospital capacity.
  • Advise patients to follow face covering orders when out of the home, to obey limits on gathering size (i.e., ≤5 non-household members per week), to heed physical distancing recommendations (>6’) with non-household members, to maintain good hand hygiene, and to spare the elderly and chronically ill from exposure. 
  • Emphasize with COVID-19 cases and contacts the importance of answering calls from the Health District and being responsive to daily monitoring texts or calls. 
  • Have a low threshold for conducting COVID-19/SARS-CoV2 testing.
  • Ensure your location fills out the online form at www.snohd.org/employernotifications  

COVID-19 Data Summary

  • After reaching a nadir of 10-15 case reports per day during the latter part of May and early June, case reports have increased substantially. This has been associated with a concurrent increase in the proportion of positive SARS-CoV2 PCR test results and an increased in the estimated reproductive rate of the infection to 1.7 for western Washington.

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  • The age distribution of recent cases is substantially younger than early in the local epidemic.  The peak age group has shifted down to 20-29 years from the earlier peak in the 50-59 year age group and the recent median has fallen to 30-39 years from the cumulative median of 40-49 years. This is attributable to (1) increased testing of younger populations over time, (2) increased social and occupational activity among younger adults in recent weeks.   

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  • The slope of this increase has been slower than we experienced in March during the initial wave of infections. Likewise, COVID hospitalizations (22 confirmed cases as of July 6) have not yet increased in the wake of four weeks of increased transmission. This may be due to the relative sparing of older age groups to-date during this second wave. However, the durability of this relative protection of elders and hospital capacity is uncertain, if not questionable, and merits close ongoing monitoring. 
  • Cases in recent weeks appear geographically distributed roughly according to the population distribution, primarily but not exclusively along the Interstate 5 and State Route 99 corridors.
  • The Health District is encountering substantial challenges reaching cases within 24 hours of report (actual 32%, target 90%) and contacts within 48 hours (actual 40%, goal 80%).  Valuable time for intervention and containment of transmission is lost in these delays that have been mostly associated with failure to answer the telephone and promptly return messages. The Health District’s Health Officer Order 20-71 has been drafted to establish expectations of these individuals with respect to responsiveness and cooperation with investigation, isolation, and quarantine efforts. 
  • Given increased case reports, testing positivity rates, and sub-target performance in case and contact follow-up, the Health District and Snohomish County have deferred on applying for a transition to Phase 3 of the Safe Start plan. Subsequently, the Secretary of Health and Governor have placed a freeze on applications for advancement that extends at least through July 16. 

Consider becoming familiar with and bookmarking these web pages to track the local epidemic:

Updated Guidance on COVID-19 Testing for Healthcare Providers
c/o Kathy Lofy, MD (State Health Officer, Washington State Department of Health [DOH])

This week, DOH updated our COVID-19 testing guidance for healthcare providers. Here is a summary of the changes made to the document:

  • Revised language to stress the importance of testing people who are mildly symptomatic along with asymptomatic close contacts
  • Added recommendation to test all newborns born to parents who are suspected of having or who have tested positive for COVID-19
  • Removed preference of specimen type
  • Described a new process for ordering through the Public Health Laboratory
  • Clarified language around consenting minors

Test all patients with symptoms consistent with COVID-19, and their close contacts even if they are asymptomatic.

Healthcare providers should test all patients with new onset of symptom(s) consistent with COVID-19, regardless of their age or health status. Patients should be tested as soon as

possible after seeking care, ideally within 24 hours. If healthcare providers are unable to provide testing within this timeframe, patients should be referred to another testing site. Broad testing is strongly encouraged at this time.

Other DOH Healthcare Provider Resources and Recommendations
https://www.doh.wa.gov/Emergencies/NovelCoronavirusOutbreak2020COVID19/HealthcareProviders

Employer Roles and Responsibilities

As new COVID-19 cases continue to increase in Snohomish County, the Snohomish Health District encourages all employers to review local and state requirements for re-opening. This includes the need to create a Safe Start plan according to sector guidelines, identify a COVID site supervisor for each location, and understand what is expected if one or more employees test positive for COVID-19.

The Health District issued a press release earlier today further explaining some of those roles and responsibilities. Please read that information at www.snohd.org/CivicAlerts.aspx?AID=379.

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