April 1, 2020 - From the April, 2020 issue

Stay Home, Stay Healthy: Enforcing Social Distancing in Washington State

With evidence suggesting a decline in new COVID-19 infection rates in Washington, TPR continues its coverage of states and cities leading the public health emergency response, with Governor Jay Inslee's March 23 address in which he announced the state’s Stay Home, Stay Healthy shelter-in-place order. As the first state in the nation to confirm cases of COVID-19, the course of action taken in Washington by Gov. Inslee served a model and barometer nationwide. TPR  includes excerpts from the Institute for Disease Modeling report from March 10, which first stressed the epidemiological impacts of COVID-19 in Snohomish and King Counties in Washington.


“To be socially irresponsible in these times is to risk the lives of our loved ones"—Jay Inslee

Good evening, my fellow Washingtonians.

I’d like to speak to you directly tonight about the COVID-19 pandemic; a pandemic that threatens to overwhelm our society without decisive action.

We have now confirmed that more than 2,000 Washingtonians have contracted the virus [4,896 on 3/30]. There are likely thousands more that have not yet been diagnosed.

COVID-19 has taken more than 100 lives in our state, a number that will also continue to rise.

Our hearts ache for all of the Washingtonians and their families affected by this virus. As we move forward, we cannot forget the losses they have suffered. This is a human tragedy, on a scale we cannot project.

It’s time to hunker down in order to win this fight.

So, tonight, I am issuing a “Stay Home” order to fight this virus. This is Washington’s “Stay Home, Stay Healthy” order. This includes a ban on all gatherings, and closures of many businesses, unless those businesses are essential to the healthy functioning of our community, or are able to let employees work remotely from home.

It is still safe to go outside using social distancing of six feet, but only for essential purposes. The grocery stores, doctor’s offices and other essential businesses will remain open. This also does not prohibit people from merely going outside to enjoy a walk on a sunny spring day.

So life will go on, but for all of us in every part of Washington, with this in mind: Stay Home, Stay Healthy. The less time you spend out in public, the more lives we can save; the more time we can buy to fight the waves coming down on us now and in the immediate future.

Now I would like to talk to you about this order and what it means for you, your loved ones and our communities.

This order builds on other unprecedented steps we have taken to protect Washingtonians, including the closure of schools, restaurants, entertainment venues and other businesses where people congregate. We have been thoughtful and deliberate in making these tough choices.

I have been very clear on the need for Washingtonians to stay home, but I have heard from health professionals, local officials and others, that people still — still — aren’t practicing these precautions. That is one reason why I am taking these steps.

These measures are more stringent, our goal is the same: To reduce social interactions where this highly contagious virus can spread. This weapon, distancing ourselves, is the only weapon against this virus. And we have proven that it can work, but only if we actually use it.

Here is what the order will do, effective for a minimum of two weeks:

It essentially requires every Washingtonian to minimize physical contact with others, unless they are pursuing essential activities, like grocery shopping, going to a doctor’s appointment or the pharmacy, or if they work at a business deemed essential to continue functioning during an emergency.

This does not mean you can’t go outside. If you feel like going for a walk, gardening or going for a bike ride, we consider that essential activity too for everyone’s physical and mental health. We all just need to practice social distancing of six feet to protect ourselves and others — everywhere, all the time.

This order will immediately ban all gatherings of people for social, spiritual and recreational purposes.

This includes events that affect the old and the young in our state. If you want to have parties on the beach, play pickup basketball, or have sleepovers, these are no longer allowed.

This also applies to some of the most important gatherings in people’s lives, like weddings and funerals. For the sake of all, even those occasions must be postponed.

Forty-eight hours from now, this order will close many businesses in our state excluding those deemed essential in these times or businesses where employees can work remotely without coming into contact with others. If a non-essential workplace can close now, it should.

Some businesses are essential, and are not being closed by this order. We’ve chosen these essential businesses based on federal guidelines. Essential businesses and personnel not limited by this order include those that help us fight this outbreak, including emergency services; health care industries; critical manufacturing; child care providers; food and agriculture; transportation; financial services; defense industries; and critical local government operations, including courts.

The media will continue to operate as well. They are critical to keep the public informed.

Of course we care about all employees. So any essential business or entity allowed to operate under this order must implement rules that help facilitate social distancing of at least six feet.

 I should also say to our many struggling restaurants, this order does not stop you from providing to-go and delivery service, as many of you are doing already.

Many of Washington’s sovereign tribal governments around our state have already implemented similar measures and other important steps. They have been exceptional partners in this effort.

We expect everyone out there to comply with this order voluntarily. Because everyone knows all of our loved ones are at risk here.

But make no mistake, this order is enforceable by law.

To be socially irresponsible in these times is to risk the lives of our loved ones.

The rapid growth in the number of cases has put our state in a race against time. We need to grow hospital capacity or else face an even greater public health emergency.

The more of us who stay home, the fewer of us who will be infected by COVID-19, and more lives will be saved.

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I make this difficult choice knowing it will add to the economic and family hardship many in our state are already feeling as we try to slow and turn back this pandemic.

We want to get back to normal as soon as possible. We don’t want this to be a lingering intrusion in our lives. The fastest way to get back to normal is to hit this hard.

Why? Because Washingtonians want to get back to business.

To address this, last week I told you about steps we’re taking to relieve economic impacts on affected Washingtonians. We continue the search for ways to mitigate the economic impacts of this pandemic on the lives of our 7 million residents. You can learn more about what state assistance is available by visiting coronavirus.wa.gov.

And I cannot emphasize the following point strongly enough: For the sake of our neighbors, our health workers, our seniors and others: No one should make a run on the grocery stores to overstock. If each of us maintains our normal shopping habits, there will be no empty shelves.

In these uncertain times, I would encourage everyone to turn to that which brings them hope, whatever it is.

What gives me hope, are the stories of resilience and of action by individual Washingtonians to aid and comfort each other as we weather this crisis.

Stories like the school districts in Tacoma and Puyallup, that are launching child care services for our first responders and medical workers, professionals working under enormous pressure on the front lines of our war against this virus.

Our child care workers are a crucial support system in this struggle. So are our health care providers and emergency responders, because they go to work, at great risk to their own health, so we can stay home.

I’m also inspired by the story of a furniture factory in Mukilteo, that is now using its facilities to produce surgical masks and face shields for Providence health care workers, to address the threat of protective equipment shortages.

And in Yakima, where a small restaurant owner, in business only three months before this crisis hit, is now serving free brown bag lunches that seniors can pick up daily outside her restaurant.

While we minimize our physical connections, it is essential that we maximize our emotional connections.

This is temporary. Schools will reopen; weddings will happen; factories will start again; and you can toast the end of this at your favorite hangout. But every single Washingtonian must enlist themselves in this tumultuous struggle, to be thoughtful, calm and compassionate, knowing for certain we can get through this together.

I am reminded of the work of the great American poet Walt Whitman. In “Song Of Myself”, he wrote of “the courage of present times and all times,” of fighting through the storm with knuckles tight and not giving back an inch to save others consumed by the tides.

We need this now in Washington. We need this now in America.

Life will be different in Washington, but we will keep working until this pandemic is defeated.

Until then, I make this promise to you, my fellow Washingtonians, borrowed from the same great poet:

“Be of good cheer, we will not desert you.”

Stay home. Stay healthy. Thank you, and be well.

Institute for Disease Modeling King & Snohomish County Washington Outlook

Find the original report here 

Summary We describe projections for the burden of infections and deaths in King and Snohomish Counties through April 7, as projections further out are strongly sensitive to assumptions about the scale of the local outbreak and importation dynamics from other regions that are not yet known. For the projections, we considered four scenarios for the increasingly effective impact of social distancing on COVID-19 incidence: 

  • A baseline scenario assuming no change since January 15
  • Scenarios with 25, 50, and 75 percent reductions in the rate of transmission assumed to take place starting March 10.

The scenarios describe the generalized impacts of social distancing policies but do not currently speak to specific policy recommendations on issues like school closures, event cancellation, and work policies. We estimate that in the baseline scenario, on average across multiple simulations, there will have been roughly 25,000 people infected by April 7. Assuming mortality statistics will be like those seen in China, we expect that roughly 80 deaths will have occurred by April 7 and that roughly 400 total deaths will have been destined but not yet occurred. Effective social distancing slows the growth rate of the epidemic, and very effective interventions may stop the continued exponential growth. The table below illustrates the reductions in infections and deaths we expect with social distancing interventions.

Introduction The novel coronavirus SARS-CoV-2 virus emerged in Wuhan, China, in late Nov or early Dec 2019. As of 9 March 2020, it is responsible for 109,577 confirmed cases and 3,809 deaths of the disease COVID-19 (WHO). After initial emergence in China, travel associated cases started to appear in other parts of the world with strong travel connections to Wuhan (http://rocs.hu-berlin.de/corona/). The first confirmed case in the US was a travel-associated case in Snohomish County, WA, screened on 19 January 2020. In the 6 weeks following to late February, a second presumptive case was identified roughly 10 miles away from where the first case was treated. As of the afternoon of March 10, Washington State reports 267 confirmed cases and 24 confirmed deaths associated with COVID-19 with the majority from King and Snohomish counties

In this working paper, we describe projections for the burden of infections and deaths through April 7 based on modeling results informed by early incidence data and genomic epidemiology as described publicly by Trevor Bedford.

Key inputs and assumptions Additional details about the model itself are provided at the end of this document. Here, we describe the key inputs and assumptions that affect our results. This is science in rapid development and represents our best current understanding which may change within days.

Transmission modeling The figures below show the results of our model, run forward from the putative initial importation event into Snohomish County on January 15, through May 5. The baseline scenario assumes no change in social distancing behavior for the entire time period, and thus is a worst-case scenario that will likely over-estimate the severity of the epidemic. The 25%, 50%, 75% reduction in transmission scenarios show possible impacts on disease burden of sustained social distancing, where the distancing in the simulation starts on March 10 (a few days after the King County recommendations began). The model shows that any social distancing that results in reduced transmission rates will slow the rate of growth of the epidemic, but only large changes in contact rate can interrupt ongoing transmission. We estimate that in the baseline scenario, on average across multiple simulations, there will have been roughly 25,000 people infected by April 7, but that this declines to roughly 9,700 total infections for a 25% reduction in contact, to 4,800 for a 50% reduction, and only 1,700 for a 75% reduction. Furthermore, by looking at the estimated active infections, only the 75% scenario shows the number of infections getting smaller over time.

....

Conclusions to date Social distancing measures are critical to slowing the progression of the COVID-19 epidemic (Reference). There remains a great deal of uncertainty about the scale of the epidemic and the effect of current social distancing policies. But, given past experience with weather-related social distancing in the Seattle metro region, we do not expect current policies will be sufficient to prevent severe overburden on the health care system. For COVID around the world, societies that have reduced established community transmission to what appear to be manageable levels, like South Korea, Hong Kong, Singapore, and now China, have implemented more restrictive social distancing policies and extensive testing for case confirmation, isolation, and containment than have occurred anywhere in the US. Health system impacts come from both the demands of the sick and the needs of the caregivers, and so we appreciate the need to mitigate the societal impacts of widespread social distancing. But we think the most acute need is to prevent the overwhelming accumulation of disease, and so we hope to see more comprehensive non-pharmaceutical intervention policies implemented as soon as possible. 

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© 2020 The Planning Report | David Abel, Publisher, ABL, Inc.