COVID-19 updates from San Juan County around subjects on the minds of islanders
— from Mark Tompkins, SJC Health and Community Services Director, and
Dr. Frank James, SJC Health Officer —
As San Juan County begins to see positive COVID-19 test results in our community, we want to explain how San Juan County Health and Community Services staff respond to all positive tests and our efforts to keep the islands safe.
We want to highlight that COVID-19 is here in our community and is likely already being spread. The lack of testing supplies and the number of asymptomatic patients means that testing is not as reliable an indicator as we would like. No matter the test results, we all need to be focused on keeping our communities safe. The best way to do this is to stay at home, and minimize contact with others.
When our health department is notified of a positive case of coronavirus , our Health Officer (Dr. James) and public health nursing staff immediately reach out to the patient and the patient’s medical provider to gauge the risk and identify any and all people who may have had close contact with the patient. For COVID-19, close contact is more than 10 minutes of time less than 6 feet apart. That definition is based on our current understanding of the disease and how it is transmitted.
This process of investigation is known as case investigation and contact tracing, and is the foundation of an effective public health response. It is labor intensive and challenging, but in most cases achieves a level of containment. The symptomatic patient is told to isolate at home while sick. The patient remains in home isolation for either seven days after onset of symptoms, or three days after their fever ends and their symptoms improve, whichever is longer. Close contacts are told to quarantine for 14 days and monitor themselves for symptoms.
Keep in mind that unlike many mainland jurisdictions, our health department is small. We have three public health nurses on staff, and have brought in some extra personnel to help out, including some retired medical professionals from the community. That handful of trained experts are the critical backbone of our surveillance response.
Another critical piece of the public health response involves patient privacy. There are strict legal requirements around revealing information which could expose the identity of a patient. That means in a small community, we need to be very careful about releasing details that could lead to identification.
Sometimes public health staff need to make difficult decisions between protecting privacy or protecting the public, but rest assured that we’re making thoughtful and careful choices.
We recognize that some in the community would prefer full details of all patients so that people can understand their risk of exposure. Not only is that illegal, but it doesn’t actually help with reducing spread, and it can have a negative impact on community mental health. For this particular disease, casual contact does not equal high risk. Detailed contact tracing is the best tool we have to contain community spread. For any positive case, our public health staff work quickly and aggressively to minimize spread.
We need to all be working off the assumption that there are carriers in our community already.
We are working on getting the supplies and resources to do more active disease surveillance testing in the general population. That will be key to understanding our risks, and for carefully monitoring and mitigating risks in the future. For now, tools like social distancing and contact tracing are our frontline defenses.
Please continue to take this seriously, seek out moments of calm and connection, and do everything you can to minimize your direct social contact. We truly appreciate your efforts. We are in this together.
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Thank you for this, Mark and Dr. James.
The additional detail with the 3 identified cases that l I feel would be helpful for our own monitoring, would be:
-What symptoms did they have that led them to be tested?
-Could they trace where they were infected? Or was it “out of the blue?”
-What age bracket are they in?
-How has their recovery progressed?
Another subject: Should all food workers…on Orcas: the Co-op, Island market, Senior Center…be tested, possibly more than once in these weeks? As you say, someone could be a carrier and be asymptomatic.
Keep up the updates….thank you
If Covid-19 testing were a lot easier and quicker, and presented no dangers to the testers, there is no doubt in my mind we should be doing more of it, particularly of those identified as close contacts.
As WHO Director Tedros Ghebreysius implored recently, “Test, test, test! You cannot fight a fire blindfolded.”
What efforts have our public advocates made to secure the 500 test kits to fully trace the *KNOWN*routes*of*infection* over the course of this local epidemic.
??
A declared “Medically Underserved Area,”
with twice the normal number of *most* susceptible,
a declared “Public Health Emergency,”
ability to raise $$$hundreds of thousands instantly,
access to a global community of testing expertise,
direct links to “world renowned” UW healthcare goliath testing apparatus..
**A SMALL POPULATION.
And we cannot test the fifty known contacts of THREE KNOWN CASES.
“Social isolation” is MITIGATION:
~CDC~ “a set of actions… to help slow the spread of… infections.”
~LET US BE CLEAR~
“Slowing the spread,” mitigation, lessens peak demand, saves healthcare resources, protects critical workers, but it does not save Abuela Rosa. It just POSTPONES her encounter with the virus.
We know this. Just you sticking to the script makes us fearful for ourselves & Abuela Rosa.
This. Is. A.. “Test.”
It is now April 2 and the county is reporting 159 people tested with 48 results pending and 6 diagnosed cases. Unfortunately, this gives us no information about how thoroughly contact tracing is being done. How many people in the 159 were tested as a result of contact tracing? How many of the 159 were on each island? Were some of the contacts on the mainland? How many of the contacts were possible causal contacts which were tested to see if they might be sources to those who tested positive? It would be comforting to know that you are tracing contacts in both directions, causal and consequential. It is complicated, I know, but it seems to me that a great deal more information could be revealed without violating personal privacy.
No offense, but this is the update that should have been written in early February. At this late date, this is not reassuring. Please enlighten us about the methodology in contact tracing, and why asymptomatic people are not being advised to cover their noses and mouths if we have to go out among others, so that we don’t spread the virus unknowingly before symptoms arise or if we’re carriers. The other comments all contain valid points and reasonable questions and concerns. We seek answers.
You can protect privacy and still answer questions and address people’s concerns. As Leif pointed out, we are a small, under-served isolated population.
We’ve heard the reasons for withholding information: to not cause widespread panic. Knowledge is power; it’s not knowing enough that causes fear, anxiety, and lack of faith in the systems in place.