Dr. Dimyana Abdelmalek answers questions in latest letter to county residents

Hello Thurston County!

In last week’s letter, I asked the community to submit questions for me to answer. I have selected three questions to answer this week.

Question 1: The governor set requirements for each phase of his Safe Start Plan. Why are we still in Phase 3 when our case count is higher than allowed by the Phase 3 requirements? Why haven't we gone back to Phase 2?

Good question! First, I just want to give a little background on the phased reopening plan in Washington State. Governor Inslee announced the Safe Start Phased Reopening plan in May which consists of four phases. Several factors determine whether a county can move to the next phase:

• Healthcare system readiness or the ability of health care facilities to care for people who become severely ill from COVID-19

• Availability and capacity to test for COVID-19

• Capacity of local public health jurisdictions to conduct contact and case investigations

• Ability to protect high risk populations

• Transmission rates or the number of new cases per 100K over 14 days

The first phase requires staying home, essential businesses and very limited nonessential businesses are open, no non-religious gatherings are permitted, and nonessential travel should be limited. In Phase 2, staying home is strongly encouraged, gatherings of no more than 5 people are permitted, and limited nonessential businesses can reopen. In Phase 3, gatherings of up to 10 people are allowed, nonessential travel can resume, most businesses can resume, and customer facing government services can resume, although teleworking is recommended. In phase 4, all public interactions can resume with physical distancing.

When Thurston County applied for Phase 3, all requirements to advance to Phase 3 were met. Our rate of transmission was less than 25 per 100K over 14 days, the percent of individuals testing positive for COVID-19 was less than 2%, hospitals had less than 80% of their beds occupied, and fewer than 10% of their beds occupied by people suffering from COVID-19. As transmission rates within the county increased, the positive testing rates increased and depending on patient flux, our hospital capacity has varied. We have not exceeded 10% of hospital beds occupied by COVID-19 positive patients.

The governor paused all phase movements forward on July 28, 2020 when state transmission rates increased. Additionally, the Governor added increased restrictions including mandatory wearing of face coverings and additional restrictions on restaurants, entertainment, fitness centers, and other high-risk settings.

We are in contact with the Department of Health and, at this time, we are building on the approach taken by the Governor to work on Thurston County specific guidance to limit the spread of COVID-19 in our community, rather than moving the entire county back to Phase 2. Our goal is to keep our county safe and healthy while allowing people to have the most freedom and flexibility to safely live their lives.

Question 2: Can you address the safety of dental visits?

In response to Governor Inslee’s proclamation on March 19, 2020, all non-urgent health care services were suspended with few exceptions, including non-urgent dental care. This was done to preserve health care capacity and health care resources, like personal protective equipment. Non-urgent dental work was resumed in Washington State on May 18, 2020.

In the United States, the Centers for Disease Control (CDC) and the American Dental Association (ADA) have guidelines to be used by dental offices to prevent the spread of COVID-19 as a result of dental procedures. This guidance includes recommendations for personal protective equipment for dental health care providers which include a mask, eye protection, gown, and gloves. Many dental practices are avoiding aerosol generating procedures including the use of an air/water syringe, air polishing, ultrasonic scaler, and other modalities if not strictly necessary. Dental offices follow guidelines for cleaning and sanitizing the procedure space and equipment after each visit. The CDC and ADA have put guidance in place to make dental care as safe as possible under the current circumstances. If you still have concerns, please contact your individual dental care provider for their patient safety procedures.

Question 3: Your letters consistently say travel is a factor in transmission of COVID-19 and that we should limit travel. Can you please define what you mean by travel?

Thank you for bringing up this topic! What we are finding out about travel is traveling to an area with higher transmission and close contact with non-household members are significant causes of spread. Our cases have used both automobile and plane as modes of travel. Travel where contact with nonhousehold members is limited, like going camping or going to a cabin with household members, have not contributed significantly to COVID-19 transmission in our county. Thurston County’s Phase 3 Status means that non-essential travel can resume, however those in other phases should follow guidance specific to their phase. Thurston County residents should be aware of local restrictions and risks before traveling where there is higher disease activity and of course, be sure to always wear your mask, maintain 6 foot distancing, wash hands frequently, and bring along sanitizing products.

We appreciate working with community members during case investigation and contact tracing to get specific information about potential exposures. When our case investigators call people who test positive, we do ask for exposure history so we can determine patterns of transmission in our county. There patterns are derived from what people who have tested positive share with us and the patterns we see as we talk to individuals over time who may have had the same exposure. This is why it is so important for people to share what they did before they had symptoms or tested positive.

We know meeting outdoors is safer than meeting indoors. Limiting the number of people outside your household you meet in a given week is another good way to limit exposure, wearing a face covering plays a significant role in preventing spread, and maintaining a physical distance of 6 feet or more from non-household members is the best way to prevent the spread of COVID-19.

Thank you all for submitting your questions! Please remember to submit your questions to tcphss.pio@co.thurston.wa.us. I look forward to answering more questions next week!

Wishing you the best of health,

Dimyana Abdelmalek, MD, MPH

Health Officer, Thurston County

This letter was provided by the Thurston County Health Department.