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US Where coronavirus outbreak started in Washington state, officials see hope as cases appear to be leveling off

04:36  27 march  2020
04:36  27 march  2020 Source:   washingtonpost.com

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KIRKLAND, Wash. —The suburban hospital that handled the first onslaught of coronavirus patients weeks ago — a crush of seriously ill and dying nursing home residents that signaled the beginning of the national health crisis — is now offering cautious optimism to people across the United States who are searching for an end to the springtime nightmare: They believe they might have flattened the curve here.

a car parked on the side of a building: EvergreenHealth Medical Center in Kirkland, Wash., where the coronavirus outbreak surged early but is showing signs of leveling off. © Mason Trinca/for The Washington Post EvergreenHealth Medical Center in Kirkland, Wash., where the coronavirus outbreak surged early but is showing signs of leveling off.

At EvergreenHealth Medical Center, two miles from the shuttered Lifecare nursing home where 35 patient deaths were linked to the virus, officials say their rate of new covid-19 cases has remained steady for two weeks, leveling off at a trickle. On some days, doctors here see just one new case and haven’t seen more than four in a single day since mid-March. Few need admission to the intensive care unit, which is now half full, two weeks after overflow necessitated transfers to nearby hospitals.

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“We don’t know if this last two weeks has been a calm before the storm or if the social distancing and all those things that are being practiced are working,” said EvergreenHealth CEO Jeff Tomlin, whose hospital has handled 40 of Washington state’s more than 130 virus-related deaths. He said the hospital is no longer overwhelmed, though it still lacks needed supplies.

“You will never hear me declaring victory at any point of this,” he said. “But I can tell you we’re making sure we have enough supplies, beds and ventilators as we can. I’d say we’re gearing up just in case a surge does happen like in New York or in Italy.”

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In the state that saw the nation’s first confirmed covid-19 case on Jan. 31, and the first recorded coronavirus-related death on Feb. 29, initial dire predictions of massive spikes have waned even as testing has increased rapidly. While the number of cases in Washington state grew by as much as 28 percent in one day on March 15 — it has since slowed significantly statewide, as have hospitalizations and deaths.

State authorities said there have been 2,580 positive cases and 132 deaths, and as testing in Washington has ramped up, the percentage of positive cases has remained low — holding at about 7 percent.

“We know this is still a dire challenge, we know we have not turned the corner and we are not even close to the end of this battle, but we do think there is some evidence that our community mitigation strategy — to close schools, restaurants and theaters, to prohibit gatherings — we think these things have slowed the rate of increase in King, Snohomish and Pierce counties,” Inslee said during a news conference Thursday, pointing to a graph showing Washington’s rate of new cases beginning to flatten while most other states trend upward.

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a man sitting in front of a house: Judy Layton and her son pray for the coronavirus victims at the Lifecare Center of Kirkland earlier this month. © Mason Trinca/for The Washington Post Judy Layton and her son pray for the coronavirus victims at the Lifecare Center of Kirkland earlier this month.

While cases continue to surge in metropolitan areas in New York, Michigan and Louisiana, Inslee’s take on what is happening in the Pacific Northwest could signal that there is a way out, if people continue efforts to keep from spreading the disease by limiting contact. Cases also are flattening in China and South Korea — where authorities ramped up testing and used strict social distancing — and research indicates that social distancing can delay a surge in cases so severe they require intensive treatment and overwhelm hospitals.

“It is a glimmer of hope,” Inslee said. “This is suggestive that some of the things we’re doing together is having some very modest improvement. The things we did two weeks ago are now appearing in our hospitals.”

At Overlake Hospital in Bellevue, about seven miles south of Kirkland, doctors have seen a recent uptick in cases, with about 20 to 30 positive tests a day, what they believe to be due to viral spread throughout the region before strict social-distancing policies took effect two weeks ago. David Knoepfler, Overlake’s chief medical officer, said his hospital has about 70 covid-positive cases — or people they are working to rule out — and that patient traffic has been “much higher and accelerating quickly.”

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But Knoepler also said he believes strong social-distancing policies could lead to an imminent decline.

“What we are seeing now is a result of delaying the social distancing until 1-2 weeks ago,” he said. “I am hopeful that in another week we will see some leveling off.”

'A military operation'

In the beginning of March, when the coronavirus had touched only this state, Chief Joseph Sanford stood in the middle of Central Way and Lake Street, Kirkland’s busiest intersection, and took a picture in each of four directions. No cars. The city was in panic. Sanford was attending multiple covid-19 task force meetings per day and was managing a swelling list of firefighters under quarantine after potential exposure to virus-carrying patients.

People were dying, and the spread of the virus was both inevitable and terrifying.

Today, while traffic has resumed at a tempered pace, the chief and his counterparts in local government have begun to take stock of what worked, and what they might pass on to other communities. New York, with its population density, is an outlier, but fire and EMS leaders from communities like Aspen, Colo.; Rochester, Minn.; and Taos, N.M.; call several times per day seeking advice on how to respond to a virus just beginning to make an impact on those communities.

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Sanford is an especially good person to ask: Out of 95 EMS personnel, just one has tested positive for covid-19, despite Kirkland officials having no expectation of encountering the especially contagious virus in this suburban enclave east of Seattle.

Rather than enter a potentially infected nursing home, Kirkland first responders asked staff to bring patients out into the fresh air to reduce risk.

They stripped the back of the ambulance of unnecessary equipment and separated the front and back compartments with thick transparent plastic shields, to speed up the decontamination process. They used electrostatic foggers to lay down disinfectant in big coats. The tweaks took the cleaning process from 40 minutes to five.

“There was no example to follow,” Sanford said. “We were first.”

EvergreenHealth officials this week have been drafting a release on best practices, to be released late this week, in an effort to educate hospitals around the country on what worked in Kirkland. A spokesperson for EvergreenHealth said the hospital was uniquely positioned to deal with an infectious disease outbreak, owing to its status as one of Washington’s highest-rated hospitals and the presence of Francis Riedo, the hospital’s Johns Hopkins-schooled and CDC-trained medical director of infection control.

Their cheatsheet for hospitals will include a host of procedural items and a few examples of social engineering. For example, EvergreenHealth advises the strongest feasible limits on visitors at the outset — banning them — until the situation allows for family members to safely enter the hospital. That way, the hospital never has to walk back less-stringent policies.

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“The other thing we learned right away was how much you have to communicate and how much you have to be present,” Tomlin said, noting that people need to hear a consistent voice of leadership. “It does begin to feel very much like a military operation in terms of logistics and operations and communications.”

a group of people standing around a bag of luggage: Scott Holm, founder of Chainline Brewing, speaks with taproom manager Jake Hoveland in Kirkland, Wash., on Thursday. Holm, 42, says he has had to lay off most of his staff during the coronavirus outbreak. © Jovelle Tamayo/for The Washington Post Scott Holm, founder of Chainline Brewing, speaks with taproom manager Jake Hoveland in Kirkland, Wash., on Thursday. Holm, 42, says he has had to lay off most of his staff during the coronavirus outbreak.

'Unseen enemy'

While the medical community continues to urge caution, many Kirkland residents have begun to look beyond the virus to the looming economic threat to the 6,000 small businesses that call the city home. Those concerns multiplied this week as a recommended shutdown of “nonessential” businesses became a mandated one, Inslee threatening potential police action should businesses defy it.

The clash playing out here — between economic forces and medical concerns — lies ahead for thousands of American communities that lag weeks behind Kirkland in their coronavirus timelines. It also mirrors the debate happening inside the White House, as President Trump has set Easter as a target for the United States to — in his words — “have the country opened up and raring to go.” This is a projection that defies expert medical projections on his own coronavirus task force, but echoes sentiments swirling from coast to coast that the nation might not be able weather societal shutdown for an extended period.

While new covid-19 cases have plateaued locally in the Kirkland area, Mayor Penny Sweet said she is getting an influx of requests for life to return to normal, as people have begun to head outside into unseasonably nice weather and believe the situation is stabilizing.

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“What has not slowed down for me is the deluge of calls and emails I’m getting from community members who are panicked about the economics of it all,” Sweet said. “I’m glad the governor made the call to shut the state down, but I got a lot of calls today saying they’re picking winners and losers, and small businesses will be the losers unless we take action.

“The really scary consequences are yet to happen.”

a person standing in front of a building: Scott Holm and his wife, Michelle Holm, with son, Cade, 6, at the family’s brewery taproom in Kirkland. © Jovelle Tamayo/for The Washington Post Scott Holm and his wife, Michelle Holm, with son, Cade, 6, at the family’s brewery taproom in Kirkland.

Seeing no clear path to solvency, Scott Holm, owner of Chainline Brewing in Kirkland, is one of many who have written to Sweet for help. Like others who have contacted the mayor this month, he asked for an order similar to the one just issued in Seattle mandating a moratorium on commercial evictions. All the city could offer came Wednesday afternoon in the form of a link on the Chamber of Commerce website to apply for seed money from Google, a $250,000 relief fund.

“The fund is pretty much small potatoes compared to what people really need,” Sweet said. “But it’s a start. It’s not going to pay anybody’s rent.”

The best-selling beer at Chainline is Tune Up IPA. It, along with the six-year-old company’s name and several of its beers, is a nod to Holm’s previous career in bicycle sales. His “pride and joy,” though, is the “Polaris Pilsner,” which won a silver medal at the 2016 Great American Beer Festival.

He’s not bottling any more for the time being, and he’s moving what stock he has out the door as soon as possible, because while the state allows him to sell the beer during the shutdown, he can’t serve it in the taproom. Holm, 42, said he has had to lay off most of his staff during the outbreak as he prepares to pay two rents: One for the current brewery, soon to be demolished to make room for Google’s expanding campus, and the other for the new location, still being fitted.

“We could last a few weeks into the shutdown,” Holm said. “We could sell through the inventory we have, assuming the landlord doesn’t evict us. Then we’re done. Like many small businesses, we’re leveraging quite a bit, and our house is our collateral. So if this business fails, we lose the house. That’s the reality.”

Making matters worse, Scott’s wife, Michelle, is an Emergency Department nurse at EvergreenHealth. Scott is now watching their 6-year-old son, Cade, because schools are closed and none of their friends and family in the neighborhood will pitch in, fearing Michelle could be exposed to the virus at work.

“They try to be nice about it, but ultimately nobody wants to be around her or me or our son, because of this unseen enemy,” he said.

a sign in front of a building: Beer pickup tents outside Chainline Brewing. The taproom is closed, but the brewery is selling its products in a “no contact” pickup area. © Jovelle Tamayo/for The Washington Post Beer pickup tents outside Chainline Brewing. The taproom is closed, but the brewery is selling its products in a “no contact” pickup area.

A resistance among some small business owners was evident in the city’s busy shopping district the day Inslee put out the mandate as some stores remained open, including a massage spa.

Daniel O’Malley defended his decision to keep open Epicurean Edge, a specialty knife store, as a necessity to avoid layoffs.

“I think that this is such a big thing for everyone that emotionally it’s important to keep things moving as much as we can while being safe,” O’Malley said.

Kellie Stickney, the city’s communications manager, said the desire to get back to normal is misguided. “It’s becoming very difficult to convince people that we are not out of this thing yet,” she said. “We don’t see disasters here. We don’t see tornadoes, hurricanes, earthquakes. The most people get here is a lot of snow, so it’s hard for people to understand what it is to be in disaster mode.”

Holm understands the medical necessity for Inslee’s order, but it doesn’t make it any less devastating. To add insult to injury, friends on social media with paying jobs during the shutdown appear to be treating the days off as “one big vacation.”

“Their main concern right now is boredom from being forced to stay home, which I just can’t quite square,” Holm says.

The virus chews up his business by day, and in the evenings, it chews up his wife. Most nights she comes home in street clothes, having left her scrubs at the hospital, part of her new routine. Cade, who is learning to write, leaves illustrated notes for her arrival: “I love you mommy.” She clings to order and cleanliness in the home, Scott says, as a means of coping with shifting hours and a deadly disease at work.

Though hopeful that this will pass, that Kirkland will return to normalcy before too long, he is trying to stave off bankruptcy while dealing with stress, anxiety and uncertainty.

“Some of us are fighting for our lives,” Holm said. “I don’t see a clear path forward.”

robert.klemko@washpost.com

Coronavirus in the US: How all 50 states are responding – and why there is no federal stay-at-home order .
At least 38 states have stay-at-home orders in effect, covering millions of Americans. Pressure is growing for the holdouts to follow suit.An aerial view of Bronte Beach with the words "Stay Home" written into the sand by local lifeguards on April 2 in Sydney, Australia.

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