Administration May 29, 2020 TO: Snohomish Health District Board of Health SUBJECT: Recommendation to request a variance to implement all Phase 2 modifications of community mitigation strategies identified in the Phased Approach to Reopening Washington Plan. Dear Board Members, Attached are an application and relevant appendices addressing the Snohomish Health District’s request for a variance from the Washington State Department of Health (DOH) to proceed to Phase 2 of the state’s Reopening Washington Plan. Such a transition would permit resumption of the following in Snohomish County, provided that individuals and enterprises involved in such activity adhere to Washington State guidelines for COVID-19 prevention and control applicable to their setting:  Participation in outdoor recreation involving 1-4 people who are not household members (e.g., camping, beaches, etc.)  Gathering with 1-5 people per week who are not household members  Limited non-essential travel within proximity of an individual’s home  Manufacturing enterprises not already approved for activity  New construction  In-home/domestic services (e.g., nannies, housecleaning, etc.)  Retail (in-store purchases allowed with restrictions)  Real estate  Professional services and office-based businesses (telework remains strongly encouraged)  Hair salons, stylists, barbers, and nail salons  Restaurants (seating at <50% maximum capacity and no table size >5 customers) Beyond these and previously approved (Phase 1 and essential) activities, remaining elements of the Governor’s March 23, 2020, Stay Home-Stay Healthy order would remain in effect. If our application is approved, Health Officer’s Orders 20-059, -060, and/or 061 may be modified or rescinded as appropriate to remain coherent with this phase. Decisions on when and how DOH will allow a county with a Phase 2 variance to move to Phase 3 have not yet been made, but staff will track that process, work toward making Snohomish County ready for that transition as soon as feasible and permitted, and keep you informed of our progress. Based on the information in the application demonstrating Snohomish County’s recent case reports and our capacity for testing, case investigation, contact tracing, hospital surge, and protection of vulnerable populations, I think it is reasonable to proceed forward. Therefore, I recommend that Snohomish County request a variance to implement all Phase 2 modifications at this time. Sincerely, Christopher Spitters, MD, MPH Health Officer 3020 Rucker Avenue, Suite 200  Everett, WA 98201-3900  tel: 425.339.5225  fax: 425.339.5217 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 1 of 44 BOARD OF HEALTH STAFF REPORT SR 20-0XX Staff member’s name: Shawn Frederick Topic of staff report: Resolution 20-16, Application for variance to Phase 2 of Washington’s Safe Start Plan Proposed Board action Approve Resolution 20-16 authorizing the submission and application for a request for a variance from the Washington State Department of Health to proceed to Phase 2 of the Safe Start Plan. Background On May 1, 2020, Governor Inslee announced a phased approach to reopening all aspects of public life in Washington State. This Safe Start Plan calls for four distinct phases lasting a minimum of three weeks each. Not all counties will be in the same phase at the same time. Snohomish County is currently in Phase 1. At this time, a move to Phase 2 is not automatic. In order to move to Phase 2, an application for a variance must be submitted to the Washington State Secretary of Health. In Snohomish County, the variance request begins with submission to the Board of a signed recommendation by Dr. Spitters that the County move into Phase 2. Dr. Spitters has issued a recommendation to that effect. The next step in the process is for the Board to take official action and by a majority vote, recommend moving forward with an application to move to Phase 2. Resolution 20-16 formally authorizes submission of a variance application for Snohomish County. If Resolution 20-16 is approved, the County Council will vote on the District’s plan to apply for Phase 2. The approvals by the legislative bodies will be packaged up and sent to the State, along with documentation regarding testing processes, data on reported positive tests, investigation protocols, isolation and quarantine facilities, and hospital preparedness. The State will then approve or deny the application for a variance. Board Authority On May 19,2020, the Department of Health issued instructions on how counties can apply for a variance to move from Phase 1 to Phase 2 of the Safe Start Plan. This action is consistent with that guidance. Recommended Motion MOVE TO APPROVE RESOLUTION 20-16 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 2 of 44 Administration Division SNOHOMISH HEALTH DISTRICT RESOLUTION OF THE BOARD OF HEALTH RESOLUTION NUMBER: 20-16 RESOLUTION SUBJECT: A RESOLUTION OF THE BOARD OF HEALTH OF SNOHOMISH COUNTY AUTHORIZING SUBMISSION OF AN APPLICATION AND REQUEST FOR A VARIANCE FROM THE WASHINGTON STATE DEPARTMENT OF HEALTH TO PROCEED TO PHASE 2 OF THE STATE’S REOPENING WASHINGTON PLAN WHEREAS, on January 31, 2020, the United States Department of Public Health and Human Services Secretary Alex Azar declared a public emergency for the novel coronavirus (COVID-19) beginning on January 27, 2020; and WHEREAS, on February 29, 2020, Governor Jay Inslee declared a state of emergency exists in all counties in the State of Washington due to the number of confirmed cases of COVID-19 in the State; and WHEREAS, on March 23, 2020, Governor Inslee issued Proclamation 20-25, Stay Home, Stay Healthy, which requires citizens to remain in their homes, except to conduct essential business; and WHEREAS, the Governor’s Stay Home, Stay Healthy order required closure of all non-essential businesses; and WHEREAS, on May 1, 2020, Governor Inslee announced his Safe Start Plan, which implements a phased approach to re-opening all aspects of public life; and WHEREAS, Snohomish County is currently in Phase 1 of the Safe Start Plan; and WHEREAS, on May 19, 2020, Governor Inslee announced eligibility requirements for counties over 75,000 to move to Phase 2; and WHEREAS, counties that meet certain prescribed criteria may apply for a variance from said eligibility requirement; and WHEREAS, while Snohomish County has not yet met every requirement that would automatically trigger moving to Phase 2, it has demonstrated robust public health readiness, which demonstrates that it should qualify for a variance; and WHEREAS, Snohomish Health District has demonstrated testing capacity, established contact tracing and case investigation protocols, and has protections in place for vulnerable populations; and WHEREAS, local hospitals have capacity and the PPE necessary to combat the virus; and WHEREAS, it is necessary to the continued economic and social viability of the county to move to Phase 2 of the Safe Start Plan. 3020 Rucker Avenue, SuiteFOR 306VARIANCE  Everett, WA 98201-3900 SNOHOMISH COUNTY REQUEST FOR PHASE 2  ph: 425.339.5210  fax: 425.339.5263 Page 3 of 44 Page 2 Snohomish Health District Res. 20-16 Phase 2 Variance Application NOW, THEREFORE, BE IT RESOLVED, the Snohomish County Board of Health hereby authorizes the application and submission of a request for a variance from the Washington State Board of Health to move to Phase 2 of the Safe Start Plan. Staff is further authorized to take any and all steps necessary to effectuate this authorization, including but not limited to supplying all data and documentation supporting the application and request. ADOPTED this 29th day of May. ATTEST: Stephanie Wright, Chair Board of Health Shawn Frederick, MBA Administrative Officer 3020 Rucker Avenue, Suite 306 Everett, WA 98201-3900  tty: 425.339.5252  fax: 425.339.5263 SNOHOMISH COUNTY REQUEST FOR  VARIANCE FOR PHASE 2 Page 4 of 44 1321 Colby Avenue Everett, WA 98201 t: 425.261.2000 J- Hospital Attestation Template DENCE SHD Variance Application Regional Medical Center Everett Shawn Frederick, MBA Administrative Officer Snohomish Health District 3020 Rucker Ave, Ste 306 Everett, WA 98201 Dear Mr. Frederick: I am writing to attest to the following with respect to Providence Regional Medical Center Everett and the Health District?s request for a variance to move to Phase 2 of the Reopening Washington Plan: 0 We currently have 20 percent surge capacity to accommodate a 20 percent increase in suspected or confirmed hospitalizations. We are reporting, and will continue to report daily, including on weekends, all data requested by the Washington State Department of Health (DOH) into WA HEALTH. . We have at least a 14?day supply on-hand of PPE, including N-95 respirators, surgical masks, face shields, gloves, and gowns. . No staff person is wearing any one N95 respirator or surgical mask for longer than one shift. 0 We are following PPE guidance on reuse or extended use as set forth in If you or DOH have any questions regarding this attestation or Providence Regional Medical Center Everett's capacity to respond to a surge of demand for acute care due to please feel free to contact us. Wawm Kim Williams Chief Executiv fficer Wem/ rthwest wook, MD Chief Medical Officer Providence Regional Medical Center Everett SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 5 of 44 From: To: Cc: Subject: Date: Rivera, Stacia N Sachdeva, Sandeep; Chris Spitters Shawn Frederick; Welling, Lynn E; Rivera, Stacia N RE: Response from Swedish Edmonds Thursday, May 28, 2020 4:44:55 PM Good Afternoon  Both Dr. Lynn Welling, Chief Clinical Officer and Jeffrey Robert, Chief Operating Officer have virtually signed off on the Snohomish County Attestation. I am waiting for the actual signatures on the attestation and will send once I have received. Please consider this email as a start that Swedish is a “yes” across the board for the following:   · We currently have 20 percent surge capacity to accommodate a 20 percent increase in suspected or confirmed COVID-19 hospitalizations. · We are reporting, and will continue to report daily, including on weekends, all data requested by the Washington State Department of Health (DOH) into WA HEALTH. · We have at least a 14-day supply on-hand of PPE, including N-95 respirators, surgical masks, face shields, gloves, and gowns. · No staff person is wearing any one N95 respirator or surgical mask for longer than one shift. · We are following PPE guidance on reuse or extended use as set forth in https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PPE-Reuse.pdf.   Please let me know if you have any questions, I can be reached by cell at any time.     Stacia Rivera MBA, CHOP Swedish Medical Center Director Environment of Care, Emergency Management, and Security 747 Broadway MS-NT1450 Seattle, Washington 98122 Office Phone 206.386.2915 Mobile 206.930.0173 Pager 206.998.4563 Fax 206.215.3071 Email stacia.hayes@swedish.org www.swedish.org     From: Sachdeva, Sandeep Sent: Thursday, May 28, 2020 11:26 AM To: Rivera, Stacia N ; Chris Spitters Cc: sfrederick@snohd.org; Welling, Lynn E Subject: Response from Swedish Edmonds   Hi Chris – it was nice catching up  with you just a few minutes ago. Shawn – so sorry you and I couldn’t connect earlier in the morning.  Stacia Rivera is our awesome System’s Director for Emergency Response. She will be submitting the attestation on behalf of Swedish Edmonds by the EOTD today. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 6 of 44   Sincerely, Sandeep.   Sandeep Sachdeva, MD, CHCQM, FACP Chief Medical Officer – Swedish Edmonds & Swedish Mill Creek Chief Medical Officer – Medical Staff Services, Swedish Health System Mobile: 206 437 8193 Administrative Assistant: Terri.Fisher@Swedish.org; 425 640 4002   Caregiver Wellness Caring for Caregivers https://providence4.sharepoint.com/sites/SwedishCaregiverWellness       This message is intended for the sole use of the addressee, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the addressee you are hereby notified that you may not use, copy, disclose, or distribute to anyone the message or any information contained in the message. If you have received this message in error, please immediately advise the sender by reply email and delete this message. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 7 of 44 Shawn Frederick, MBA Administrative Officer Snohomish Health District 3020 Rucker Ave, Ste 306 Everett, WA 98201 Dear Mr. Frederick: I am writing to attest to the following with respect to EvergreenHealth Monroe and the Health District’s request for a variance to move to Phase 2 of the Reopening Washington Plan: • • • • • We currently have 20 percent surge capacity to accommodate a 20 percent increase in suspected or confirmed COVID-19 hospitalizations. We are reporting, and will continue to report daily, including on weekends, all data requested by the Washington State Department of Health (DOH) into WA HEALTH. We have at least a 14-day supply on-hand of PPE, including N-95 respirators, surgical masks, face shields, gloves, and gowns. No staff person is wearing any one N95 respirator or surgical mask for longer than one shift. We are following PPE guidance on reuse or extended use as set forth in https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/PPE-Reuse.pdf. If you or DOH have any questions regarding this attestation or EvergreenHealth Monroe’s capacity to respond to a surge of demand for acute care due to COVID-19, please feel free to contact us. Sincerely, Lisa M. LaPlante, MHA Chief Administrative Officer Midori Larrabee, MD, FACP Chief Medical and Quality Officer SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 8 of 44 _S__kagit m) Regional Health May 27, 2020 Shawn Frederick, MBA Administrative Officer Snohomish Health District 3020 Rucker Ave, Ste 306 Everett, WA 98201 Dear Mr. Frederick: I am writing to attest to the following with respect to Cascade Valley Hospital and the Health District?s request for a variance to move to Phase 2 of the Reopening Washington Plan: We currently have 20 percent surge capacity to accommodate a 20 percent increase in suspected or confirmed hospitalizations. We are reporting, and will continue to report daily, including on weekends, all data requested by the Washington State Department of Health (DOH) into WA HEALTH. We have at least a 14-day supply on-hand of PPE, including N-95 respirators, surgical masks, face shields, gloves, and gowns. No staff person is wearing any one N95 respirator or surgical mask for longer than one shift. We are following PPE guidance on reuse or extended use as set forth in If you or DOH have any questions regarding this attestation or Cascade Valley Hospital?s capacity to respond to a surge of demand for acute care due to please feel free to contact us. Casc? Valley Hospital Skagit Regional Health CEO Cascade Valley Hospital, Skagit Regional Health CMO ill P-O- fax (360) 423'2475 web Skaglt?egiqgg??l?h?rg Administration Division May 29, 2020 Dr. John Wiesman, DrPH, MPH Washington State Secretary of Health secretary@doh.wa.gov Re: Request for Variance from the Stay Home, Stay Healthy Proclamation for Snohomish County to Move from Phase 1 to Phase 2 Dear Secretary Wiesman: Please find enclosed Snohomish County's formal variance request and application package to move from Phase 1 to Phase 2 All Modifications. Through a community-wide effort, Snohomish County meets several criteria established by Governor lnslee and the Department of Health to move from Phase 1 to Phase 2 as outlined in the Department's Variance Plan instructions (May 19, 2020). As of May 23rd, Snohomish County had less than 29.4 COVID-19 cases per 100,000 population for the previous two weeks. With the help of many local partners, including, but not limited to, local county and city governments, healthcare providers and first responders, civic groups, businesses, and Snohomish County residents, we believe that our county is ready to move to Phase 2 of the state plan. Our enclosed application details our county's capabilities to meet or exceed the criteria outlined in the May 19 variance criteria for case investigations and contact tracing, hospital surge capacity, testing capacity, isolation and quarantine capacity, case management assistance, and response to an outbreak in a congregate living setting. Thank you for leadership and support during this challenging time. We look forward to your prompt response to our application. Sincerely, Chris Spitters, MD, MPH Health Officer Shawn Frederick, MBA Administrative Officer 3020 Rucker Avenue  Everett, WA 98201-3900  tel: 425.339.5210  fax: 425.339-5263 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 10 of 44 Figure i.1 TOTAL CASES OF COVID-19 IN SNOHOMISH COUNTY BY DATE SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 11 of 44 Figure i.2 NUMBER OF NEW CASES REPORT IN SNOHOMISH COUNTY BY DATE SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 12 of 44 A. COVID-19 TESTING SITES IN SNOHOMISH COUNTY Testing is widely available throughout Snohomish County. A testing survey of health care facilities conducted by Snohomish Health District and Emergency Support Function (ESF) 8 was conducted on May 27, 2020 and identified current testing capacity for Snohomish County to be 5790-6560 tests per week, see figure A1. Actual testing for Snohomish County is included in Figure A2. This includes testing at clinics/healthcare facilities, and testing conducted through Snohomish Health District (SHD) and Medical Reserve Corps at Long term care centers (LTC) and mobile community-based (drive up) testing sites. SHD also coordinated a FEMA/HHS-supported drive up site in Everett, WA from March 23-April 16 that tested 2347 people which could be stood up again in response to a surge in cases. Community based test sites operated by SHD are accessible to any resident with symptoms and offered throughout the County in partnership with Sno-Isle Library System. There is no charge for this service and proof of insurance is not required. Language and registration assistance are available. SHD is also working with partners such as Snohomish County Human Services to identify and coordinate testing sites serving the unsheltered population and the Pacific Islander Health Board to improve testing access and opportunities for underserved populations. In addition, based on current staffing, SHD offers testing at one LTC facility per day with the goal of providing testing to all skilled nursing facilities by June 10th and all assisted living facilities by June 30th. Testing at LTC facilities is also open to all local first responders and law enforcement. Testing is processed through the Public Health Lab and PNW Laboratories. Testing services available for residents who are low-income, have no insurance or are underserved in Snohomish County include: • • • • • • • Community Health Centers of Snohomish County (Everett, Lynwood) Everett Clinic (Everett, Smokey Point). Weekly testing metrics available in Figure A1. Evergreen Health Care (Monroe and In-Home Services) Providence Medical Group (Everett, Mill Creek Monroe) SeaMar Health Clinics (Everett, Marysville, Monroe) Snohomish Health District CBT and LTC Sites (Locations rotate throughout the county) Swedish Edmonds (Edmonds) Hours for testing sites are illustrated in Table A1. CBT availability, times, locations, criteria, and registration are available at www.snohd.org/drive-thru-testing. The registration process is online. A “button” that people can click to go straight to the drive-thru testing page is prominent on our main COVID-19 webpage (www.snohd.org/ncov2019). The SHD Equity Committee is creating an advisory council with natural community leaders in order to improve access to the registration process for non-English speakers. When new community testing dates are announced, the drive-thru testing page is updated and the new dates, times. Registration information is provided in a press release and in social media SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 13 of 44 posts to Facebook, Twitter and Instagram, as well as in daily email briefings that are sent to public information professionals throughout Snohomish County. The most recent of the social media posts had a reach of 7,175 people who viewed it, according to metrics from the social media platforms. There have been 40,312 visits to the drive-thru testing webpage as of May 28. In our Frequently-Asked-Questions document, multiple blog posts and social media posts, and on the drive-thru testing page, we also emphasize that people can contact their medical provider for COVID-19 testing and clinic and healthcare sites. Links to information from local medical centers for COVID-19 information and testing are provided under a “Who to Call” heading on our COVID-19 page, as well. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 14 of 44 Table A1 COVID Testing Sites in Snohomish County Proprietor Site Hours Test capacity (#/week) SHD -Long term care facilities (varies throughout Snohomish County) -Community Based Testing (currently at various Sno-Isle Library locations) -LTC: 2-3x per week 0900-1400 - CBT: 2-3x per week 0900 1600 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 -LTC: 50-150 per facility. About 100300 per week Low income; Uninsured; Underserved Advertising Yes YES, website and press releases -CBT: 30-80 per day. About 100-250 per week Page 15 of 44 Proprietor Site Hours Test capacity (#/week) The Everett Clinic -Smokey Point Everett Clinic -7600 Everett Way Clinic Providence Medical -Mill Creek Walk in Group Clinic -Mill Creek Drive Thru Tent -Monroe walk in clinic Low income; Uninsured; Underserved Advertising Monday – Friday 0900-1700 and Saturday and Sunday 09001600 About 1500 per week Yes Yes, using their website -Mill Creek Walk In: 0800-1930 (7 days a week) Drive Thru: variable (up to 50 a day and as low as 7 a day). Average about 20 a day (between 140350 a week) Yes No external advertising. They only test PMG caregivers and select partner institution patients at the drive thru -Mill Creek Drive Thru: 1000-1700 -Monroe Walk In: 0800-1930 (7 days a week) SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 -Walk in clinics combined (Mill Creek and Monroe): roughly 210 a week Page 16 of 44 Proprietor Site Hours Test capacity (#/week) Providence Medical -PRMCE is Center conducting rapid/high throughput PCR testing for PUI and inpatients -We have partner with ExpressCare to do a drive thru for Pre-Op swabbing and testing onsite. ExpressCare is running the test on their own analyzers, not the ones we used at PRMCE. Swedish Medical Center -Swedish Edmonds Drive thru -PRMCE inhouse testing is 24/7 -Drive Thru for Pre-Op testing by ExpressCare is Sun-Fri 9am6pm. Monday – Friday 0900-1500 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Low income; Uninsured; Underserved Advertising -PRMCE inhouse We test for all capacity is 1000 per patients that have week a clinical need and in preparation for -Drive Thru by surgery/procedure. ExpressCare is 300 per week We do not, these are only for clinical need and Pre-Op patients About 300 per week No. By appointment only but if someone comes without an appointment but has symptoms, they will still get tested Yes Page 17 of 44 Proprietor Site Hours Test capacity (#/week) Low income; Uninsured; Underserved Advertising Evergreen Hospital Monroe -Evergreen Health Monroe (in house testing) 24/7 depending on who needs testing About 1000 per week Yes No, by appointment only. Community Health Centers SC -Lynnwood CHC -7 days a week from 0800-1700 About 20-50 per day (average 140350 per week) Yes Yes, using Facebook and website SeaMar -Monday – Saturday from 0800 - 1700 About 1000 per week Yes Marysville -SeaMar Marysville/ Everett/ and Monroe (in house testing) No, by appointment after evaluation with physician Total 13 sites N/A 5790-6560/week N/A N/A -Everett CHC SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 18 of 44 Figure A1 The Everett Clinic COVID-19 Weekly Testing Data Summary The results are from TEC lab testing using a combination of RT-PCR (Abbott m-2000) and Abbott ID NOW Point of Care Assays. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 19 of 44 Figure A2 SNOHOMISH COUNTY COVID-19 TESTING BY DATE SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 20 of 44 B. MEDIAN NUMBER OF DAYS FROM ONSET OF ILLNESS TO COVID-19 SPECIMEN COLLECTION DATE FOR POSITIVE CASES OVER THE PAST 4 WEEKS The median number of days from reported onset of illness to COVID-19 specimen collection over the past 4 weeks for Snohomish County residents is 2 days. Week 1 (4/26-5/2/2020) 2 (5/3-5/9/2020) 3 (5/10-5/16/2020) 4 (5/17-5/23/2020) Total Median (d) 2 3 2 1 2 Table B1 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Mean (d) 3 4 3 1 3 Interquartile Range (d) 0-21 0-18 0-11 0-4 0-21 Page 21 of 44 C. TOTAL NUMBER OF COVID-19 TESTS REPORTED, NEGATIVE AND POSITIVE COUNTS AND PERCENT POSITIVE OVER EACH OF THE PREVIOUS 4 WEEKS; 50 TIMES THE NUMBER OF POSITIVE TESTS; AND THE PERCENT POSITIVE OF ALL TESTS FOR THE 4WEEK PERIOD See Table C1 for a summary of COVID-19 testing results for each of the previous 4 weeks, and the total for the previous 4-week period. Please note these results are based on SHD verified data from WDRS for lab confirmation date; data available 4/26-5/19/2020. Week Tests Reported 1 (4/26-5/2/2020) 2992 2 (5/3-5/9/2020) 3047 3 (5/10-5/16/2020) 3054 4* (5/17-5/23/2020) 1557 Total 10650 *Incomplete data available Table C1 Negative 2793 2902 3948 1495 10138 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Positive % Positive 199 145 106 62 512 6.7 4.8 3.5 4.0 4.8 50 Times weekly positive number cases 9950 7250 5300 3100 25600 Page 22 of 44 D. SHD’S RESOURCES TO PERFORM CASE INVESTIGATIONS AND CONTACT TRACING USING THE STATEWIDE STANDARDIZED COVID-19 CASE AND CONTACT INVESTIGATION PROTOCOLS i. CALCULATION SHOWING THE NUMBER OF CASE AND CONTACT TRACERS NECESSARY FOR SNOHOMISH COUNTY: 818,700 residents / 100,000 x 15 = 123 case & contact tracers needed ii. NUMBER OF SHD STAFF TRAINED AND READY TO PERFORM CASE INVESTIGATIONS AND CONTRACT TRACING, THEIR JOB CLASSIFICATIONS, AND FULL-TIME EQUIVALENTS: See Table D1 for a summary of the number of SHD staff trained and ready to perform case investigations and contact tracing. SHD has developed and implemented a surge capacity system of case and contact staff so that we can utilize staff as needed based on the number of cases and contacts at any given time. SHD has submitted a request to the Department of Health (DOH) and received approval for 60 additional case and contact tracers to exceed the minimum 123 FTE. Table D1 SHD Staff Available for Case Investigations and Contact Tracing Investigation Job Classification Number FTE capacity/4 per day Epidemiologist 3 3.0 12 Public Health Nurse 7 7.0 28 Disease Intervention 6 6.0 24 Specialist Healthy Community 4 4.0 16 Specialist Total 20 20.0 80 iii. NUMBER OF COUNTY/CITY GOVERNMENT STAFF TRAINED AND READY/IN THE PIPELINE TO PERFORM CASE INVESTIGATIONS AND CONTACT TRACING SHD does not have any County/City government staff trained and ready to perform case investigations and contact tracing. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 23 of 44 iv. NUMBER OF VOLUNTEERS OR NON-GOVERNMENTAL EMPLOYEES TRAINED AND READY TO PERFORM CASE INVESTIGATIONS AND CONTACT TRACING Table D2 Job Classification Number Medical Reserve Corp (Volunteers) Total 16 8.0 Investigation capacity/ 4 per day 32 16 8.0 32 v. FTE SUBTOTAL OF THOSE TRAINED AND READY TO PERFORM CASE INVESTIGATIONS AND CONTACT TRACING BY FTE SHD has 32 FTE trained and ready to perform case investigations and contact tracing. vi. NUMBER OF PERSONS/FTE IN THE PIPELINE TO BE TRAINED BY JUNE 15, 2020 Job Classification Disease Intervention Specialist Healthy Community Specialist Medical Reserve Corp (Volunteers) Total Table D3 Number scheduled for hire/training 50 50.0 Investigation capacity/4 per day 200 1 1.0 4 32 16.0 64 83 67.0 268 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 FTE Page 24 of 44 vii. GAP BETWEEN THE MINIMUM OF 15/100,000 (123 FTE) AND THE TRAINED AND TO-BE- TRAINED PERSONNEL Snohomish Health District has 95 FTE available or in the pipeline to recruit and train to conduct case investigators and contact tracers; 28 less than the required 123 necessary to meet the minimum 15 case and contact investigators per 100,000 residents. However, SHD staff and volunteers (ready and trained and those in the pipeline) can conduct 380 case investigations per day. Table D4 Job Classification Trained and Number Total FTE Investigation ready scheduled Available capacity/4 per for by June day hire/training 15, 2020 Epidemiologist 3 0 3 3.0 12 PHN 7 0 7 7.0 28 Disease 6 50 56 56.0 224 Intervention Specialist Healthy 4 1 5 5.0 20 Community Specialist Medical Reserve 16 32 48 24.0 96 Corp (Volunteers) Total 36 83 119 95.0 380 SHD submitted and received approval for 60 DOH FTE staff, if necessary, to support case investigations and contact tracing. These 60 FTE, in addition to the 95 FTE available, ensures that SHD has 155 FTE available case investigators and contact tracers, exceeding the necessary 123. Note: Snohomish County is part of centralized investigations by DOH. Should additional case investigators and contact tracers be needed (or forecasted to be needed) exceeding the available 155 FTE, SHD and the Snohomish County Emergency Coordination Center (ECC) will request resources from the State EOC for trained staff; request support through mutual aid; or hire additional staff. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 25 of 44 Job Classification Trained and ready Epidemiologist PHN Disease Intervention Specialist Healthy Community Specialist Medical Reserve Corp (Volunteers) DOH Staff Total 3 7 6 Table D5 Number Total scheduled Available for by June hire/training 15, 2020 0 3 0 7 50 56 FTE Investigation capacity/4 per day 3.0 7.0 56.0 12 28 224 4 1 5 5.0 20 16 32 48 24.0 96 60 96 0 83 60 179 60.0 155.0 240 620 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 26 of 44 viii. CERTIFICATION LETTERS FOR SHD PERSONNEL FOR CASE AND CONTACT INVESTIGATIONS SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 27 of 44 SNOHOMISH HEALTH DISTRICT Administration May 28, 2020 Matthew Zimmerman Washington State Department of Health Dear Mr. Zimmerman, The Snohomish Health District would like to request the support of surge staffing available by the Washington State Department of Health to assist in our response to Internally we have pulled staff from all areas of the Health District and have integrated the Medical Reserve Corps into our response efforts to maximize our ability to meet the needs of our county. The Health District would like to request the support of 60 staff from your pool of available staffing resources. This would allow the Health District to not only meet the needs of the community in responding to but also ensure that other immediate public health concerns are able to be addressed in a timely manner. We look forward to collaborating with the Department of Health as we continue to respond to COVID- 19. Sincerely, 1 Wm Shawn Frederick Christopher Spitters, MD, MPH Administrative Officer Health Of?cer Snohomish Health District Snohomish Health District 3020 Rocker Avenue Suite 104 Everett WA 982201?3900 I tel: 425. 339 5250 I fox: 339. 5254 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE Page 28 of 44 From: To: Cc: Subject: Date: Attachments: Zimmerman, Matthew S (DOH) Chris Spitters Katie Curtis; Shawn Frederick; Linda Carl; Courogen, Maria (DOH); DOH-HR (DOH) RE: Snohomish Health District Request for Assistance Thursday, May 28, 2020 3:56:00 PM SHD ASSISTANCE REQUEST 20200528.pdf Dr. Spitters,   Thank you for submitting this request, it has been a pleasure working with your team to plan for supporting these efforts. We acknowledge the request for support of 60 staff from our pool of available staffing resources. We will ensure that we have the capacity to fulfill this request as you identify the need for activating them to support COVID-19 response efforts within your community.   I am including Maria Courogen and Stephanie Price on the Cc line for their visibility and to ensure that the appropriate next steps are taken on our end.   We look forward to continuing to work with you all and to collaborate closely with Katie to ensure that we are able to support you to the fullest and to be able to fulfill this request in a rapid manner.   Best,   Matthew Zimmerman Strategic Planning Officer Shoreline IMT, WA DOH 360-870-1434     From: Chris Spitters [mailto:cspitters@snohd.org] Sent: Thursday, May 28, 2020 3:26 PM To: Zimmerman, Matthew S (DOH) Cc: Curtis, Katie (DOHi) ; Frederick, Shawn (DOHi) ; Linda Carl Subject: Snohomish Health District Request for Assistance   Hi, Matthew.   Attached is a formal written request for assistance with COVID-19 transmission suppression efforts (i.e., case investigation and contact tracing) that is part of our response planning, as well as a required element of our forthcoming application for a variance to proceed to phase 2.  My understanding is that Katie Curtis has had productive conversations with your team regarding this request.  In addition to accepting this written request, it would be helpful to us if you could please respond to this email with an acknowledgement so that we may include it in our variance application.  Please feel free to contact me on my cell phone if you would like to discuss it directly with me.    SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 29 of 44 Thank you for considering this request and for supporting Snohomish County in our shared response to this emergency.   Chris Spitters Cell 425 422 2049     Christopher Spitters, MD, MPH Health Officer Snohomish Health District 3020 Rucker Avenue, Suite #306 Everett, WA 98201 p: 425.339.5210           Public Health: Always working for a safer & healthier Snohomish County NOTICE: All emails and attachments sent to and from the Snohomish Health District are public records and may be subject to disclosure pursuant to the Public Records Act (RCW 42.56).   SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 30 of 44 i. TOTAL NUMBER OF CASES IDENTIFIED OVER THE PAST FOUR (4) WEEKS AND THE PERCENTAGE OF CASES REACHED BY PHONE OR IN PERSON WITHIN 24 HOURS OF RECEIPT OF POSITIVE LAB TEST REPORT Table D6 Week 1 (4/26-5/2/2020) 2 (5/3-5/9/2020) 3 (5/10-5/16/2020) 4 (5/17-5/23/2020) Number contacted within 24 hours Cases Reported 212 200 110 134 104 97 69 85 Percent contacted within 24 hours 49.1% 48.5% 62.7% 63.4% Number contacted within 48 hours Percent contacted within 48 hours 62.3% 66.0% 73.6% 73.1% 132 132 81 98 Data source WDRS, Snohomish Health District COVID-19 line list. Data excluded serology cases as they indicate older infections and are low priority for investigation. ii. TOTAL NUMBER OF CLOSE CONTACTS IDENTIFIED OVER THE PAST FOUR (4) WEEKS AND THE PERCENTAGE OF CONTACTS REACHED BY PHONE OR IN PERSON WITHIN 48 HOURS OF RECEIPT OF POSITIVE LAB TEST REPORT ON A CASE Week Table D7 Contacts identified Number contacted within 48 hours Percent contacted within 48 hours 1 (4/26-5/2/2020) 221 167 76% 2 (5/3-5/9/2020) 313 215 69% 3 (5/10-5/16/2020) 160 120 75% 4 (5/17-5/23/2020) 140 120 86% Total 834 622 75% Data source: Snohomish Health District contact list. Data excludes DOH centralized investigation cases, as contact data is unavailable. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 31 of 44 E. NUMBER AND TYPE OF ISOLATION / QUARANTINE FACILITIES SECURED TO HOUSE PERSONS WITH COVID-19 WHO NEED OR DESIRE THIS ASSISTANCE • Facility 1: o Angel of the Winds Arena o Conference Center/Sporting Facility o Isolation capacity = 48 o Quarantine capacity = 48 o Secured until June 30th (see below for extension plans) o Services: housing, laundry, meals, snacks, internet access, telemedicine, onsite medical care (Providence Regional, SeaMar, Pioneer Human Services), facility coordinators, 24-hour security, housekeeping, MAT, behavioral health, social workers, phones/tablets, clothing, pet sheltering and veterinary care o Services coordinated by Snohomish County Human Services and ESF 6 • Facility 2: o Snohomish County Fairgrounds, Gary Weikel Building o Event Pavilion o Isolation capacity = 24 o Quarantine capacity = 24 o Secured July 1-Indefinate o Services: housing, laundry, meals, snacks, internet access, telemedicine, onsite medical care (Providence Regional, SeaMar, Pioneer Human Services), facility coordinators, 24-hour security, housekeeping, MAT, behavioral health, social workers, phones/tablets, clothing, pet sheltering and veterinary care o Services coordinated by Snohomish County Human Services and ESF 6 • Surge Capacity: Current plans and facilities (The Gary Weikel Building) have the ability to surge to: o Isolation capacity = 150 o Quarantine = 150 Medical providers who have identified a positive COVID-19 case or who have a patient with a pending COVID-19 test that does not have the ability to isolate or quarantine, contact the Isolation and Quarantine site coordinator to request admittance. The I and Q site coordinator will request and obtain the approval letter from Snohomish County Health Officers, Dr. Chris Spitters. Transportation is coordinated by the I and Q site and provided through local cabulance service. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 32 of 44 F. DESCRIBE HOW THE LOCAL HEALTH JURISDICTION PROVIDES OR LINKS PERSONS WITH IN- HOME ISOLATION OR QUARANTINE WITH NEEDED SERVICES WHEN REQUESTED Snohomish Health District supports individuals in home isolation in accordance with our previously established protocol for supporting in-home TB isolation. SHD contact investigators assess the individual to determine need for additional services to support in-home isolation or quarantine, in coordination with Health Officer if necessary. Basic needs, including the purchase and delivery of food and medications are coordinated through the contact investigator and the MRC coordinator. Referrals from outside healthcare and social service agencies can be submitted through the SHD Communicable Disease 24-hour call line. To support Snohomish County residents experiencing homelessness, in April of 2020, Snohomish County created the Snohomish Agencies for Engagement (SAFE) Team in partnership with the City of Everett, City of Lynnwood, City of Mill Creek, City of Monroe, South County Fire, Fire District 7, Snohomish County Sheriff’s Office, Snohomish County Law Enforcement Embedded Social Workers, and Sea Mar Family Medicine. SAFE utilizes physicians, EMTs, social workers, and law enforcement to perform outreach to vulnerable populations, especially Snohomish County residents experiencing homelessness. Their objective is to provide COVID-19 screenings (questions, temperature, blood pressure, and oxygen stats), provide information about how to protect themselves from COVID-19 and what to do if they contract the virus, education on best hygiene practices with available resources, and connect those that are willing to services such as housing, substance use disorder treatment, benefits, and more. SAFE has contacted approximately 400 people since April. SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 33 of 44 G. DESCRIBE THE LOCAL HEALTH JURISDICTION’S CAPACITY TO CONDUCT OUTBREAK INVESTIGATIONS IN CONGREGATE LIVING SETTINGS AND WORKPLACES Snohomish Health District currently supports two outbreak response task forces within its ICS activation to response to outbreaks or investigations within congregate living settings and workplaces: • • Long term Care Task Force Employer Notification Task Force The purpose of the task force is to rapidly provide assistance and appropriate testing in a congregate living facility or work environment experiencing cases of COVID-19. Task force staffing includes: • • • • • • • 1 Infection preventionist 2 RNS 1 MA 2 PHNs 1 EH 1 DIS 1 Outreach specialist (Equity Committee representative) These teams are supported by Snohomish County MRC as requested. In addition, SHD has division-specific expertise available to address cases in food service establishments (Environmental Health Food Safety Program) and in childcare settings (Child Care Health Program). Snohomish Health District maintains a two-week supply of testing kits and PPE at SHD and ECC calculated burn rates and also has point of care testing capabilities with Abbott NOW testing currently stationed at SHD and Community Health Centers of Snohomish County. We have a mobile testing team that includes: • 1-2 SHD Staff • 1 MRC - Medical consult • 1 MRC - Documentation • 1 MRC – Lab courier SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 34 of 44 H. ADDITIONAL CONSIDERATIONS a. STATUS OF COVID-19 CASES IN SNOHOMISH COUNTY BY DATE SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 35 of 44 b. METRICS AND CONTINGENCY PARAMETERS FOR CONSIDERING RETURN TO MORE STRICT NON-PHARMACEUTICAL INTERVENTIONS Category COVID-19 Activity Measure Incidence of new cases reported during prior two weeks Reproductive rate by region Healthcare system readiness Testing DOH Target Target: <10 cases/100K per 14 days Target: Re < 1 % licensed beds occupied by patients (i.e., hospital census relative to licensed beds) Targets: Green: <80% % licensed beds occupied by suspected and confirmed COVID-19 cases Target: Green: <10% Average number of tests performed per day during the past week (or average % tests positive for COVID-19 during the past week) Median time from symptom onset to specimen collection among cases during the past week Current SHD Contingency Thresholds 29.4 >50 cases/100K per 14 days Not Calculated R>1.0 74% >80% 6% >10% 4% >5% over a 7day period 1 Median >4 days (Yellow: 8190%; Red: >90%) (Yellow: 1120%; Red: >20%) Target: 50 times the number of cases (or 2%) Target: median <2 days SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 36 of 44 Category Case and contact investigations Protecting highrisk populations Measure Percent of cases reached by phone or in person within 24 hours of receipt of positive lab test report (for last 14 days) DOH Target Current SHD Contingency Thresholds 63% <60% 80% <60% 5/10-5/16/2020 –2 ≥4 outbreaks per week for two consecutive weeks Target: 90% Percent of contacts reached by phone or in person within 48 hours of receipt of positive lab test report on a case (for last 14 days) Target: 80% Number of outbreaks reported by week (defined as 2 or more non-household cases epidemiologically linked within 14 days in a workplace, congregate living or institutional setting) Target: 0 for small counties (<75,000), 1 for medium counties (75,000300,000), 2 for large counties (>300,000) SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 5/17-5/23/2020 -1 Page 37 of 44 c. EMERGENCY SUPPORT FUNCTION 4 (FIRE AND EMS), EMERGENCY SUPPORT FUNCTION 6 (MASS CARE AND SHELTERING), EMERGENCY SUPPORT FUNCTION 8 (PUBLIC HEALTH) AND EMERGENCY SUPPORT FUNCTION 13 (LAW ENFORCEMENT) DATA CONSIDERATIONS The Snohomish County ECC (specifically ESF 4, 6, 8, and 13) currently tracks the following data elements. The fire and EMS data elements are looking the dispatch data in real time on a rolling 24 hours. ESF 4 can set up alerts for each of these and they are current set at 2 time standard deviation of the previous 52 weeks. When that threshold is reached the member of the data team are then alerted via email or text message. A subgroup of the team will, after receiving an alert, review all the data elements and determine the next course of action. On March 7, 2020, Sno911, the county dispatch agency, implemented Protocol 36 in the emergency medical dispatch (EMD) system, which is a pandemic protocol determinant code. The current data points for Fire and EMS are: • • • • • • County Incidents EMS County Incidents Protocol 36 Triage – the EMS incidents that went to Protocol 36 Protocol 36 (remained) – the EMS dispatches that remained in Protocol 36 Shortness of Breath CAD EMD Falls/Weakness CAD EMD o These two EMD determinates have been identified in as the primary or secondary impressions of the COVID-19 positive patients that have been transported by the fire service in the county SNO911 FD – County Incidents (CAD Type) SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 38 of 44 SNO911 – Protocol 36 (remained) SNO911 – Shortness of Breath CAD EMD SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 39 of 44 d. SNOHOMISH COUNTY FIRE CHIEFS’ ASSOCIATION ATTESTATION SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 40 of 44 Snohomish County Fire Chiefs’ Association Established 1970 “Progressive Fire Protection Through Cooperation” 12425 Meridian Ave S Everett 98208 Phone – 425.551-1270 Fax – 425-551-1273 Officers President Chief Chris Alexander Vice-President AC Rich Llewellyn Treasurer Chief Jim Haverfield Immediate Past President Chief Travis Hots Zone Representatives Zone 9 Chief Thad Hovis Zone 11 Chief Eric Andrews Zone 12 Chief Keith Strotz Liaisons Legislative Chief Brian McMahan Fire Commissioners Chief Martin McFalls Shawn Frederick, MBA Administrative Officer Snohomish Health District 3020 Rucker Ave, Ste 306 Everett, WA 98201 Dear Mr. Frederick: On behalf of the Snohomish County Fire Chiefs’ Association, I am writing to attest to the following with respect to Fire/EMS preparedness and the Health District’s request for a variance to move to Phase 2 of the Reopening Washington Plan: • • • • • Training/Safety Officers DC Craig Clinton Special Operations DC Larry Huff EMS Council Chief Dennis Fenstermaker Fire Prevention DC Mike Fitzgerald Washington Fire Chiefs Chief Kevin O’Brien Policy/Procedure Committee Chair Chief Eric Andrews SNO911 Fire Tac AC Steve Guptill • We currently have two months’ Personal Protective Equipment (PPE) for every fire fighter in the county on-hand. We are continuing to use our county task force to bulk purchase PPE to maintain that level of supply for the rest of the year. To extend the useful life of our N-95 masks, we purchased UV-C units to decontaminate the masks up to 10 times before disposal. We have instituted the scout process countywide for all our medical responses to insure those that have direct patient contact are properly protected. To properly decontaminate our vehicles, equipment, and facilities, we have purchased applicators and solution and made them a part of our standard decontamination procedures. We are tracking prehospital and hospital key metrics to provide early warning of an increase in cases both county-wide and by region of the county. This capability is shared with our law enforcement, public health, emergency management, and hospital partners. If you or DOH have any questions regarding this attestation or Fire/EMS preparedness to respond to COVID-19, please feel free to contact me. Sincerely, Christopher W. Alexander Fire Chief, Mukilteo Fire Department President, Snohomish County Fire Chiefs’ Association SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 41 of 44 e. SNOHOMISH COUNTY SHERIFF’S OFFICE ATTESTATION SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 42 of 44  SNOHOMISH COUNTY ADAM FORTNEY SHERIFF SHERIFF’S OFFICE  JEFF BRAND UNDERSHERIFF M E M O R A N D U M DATE: May 28, 2020 TO: Snohomish County Board of Health FROM: Sheriff Adam Fortney RE: Snohomish County Request for Phase 2 I strongly support the Snohomish County Board of Health and the Snohomish County Council’s decision to request a variance and move to Phase 2 of Governor Inslee’s phased reopening plan. I would encourage the State to quickly approve the request and move Snohomish County into Phase 2. The residents of Snohomish County have shown and continue to show they are following the safety precautions from the Governor and for the most part, our communities are doing all they can to keep themselves, their families and their neighbors safe and healthy. As the curve continues to flatten, I believe it is time to trust local government with the knowledge of what is best for their respective communities. It is a unique time when all of Snohomish County government is in agreement, and it is time for Snohomish County to move to Phase 2 and help our residents get back to work safely. I am proud to join our county leaders and I look forward to helping in any way I can to assist with getting Snohomish County back on a safe path to economic recovery. NORTH PRECINCT 15100 40TH Ave. N.E. Marysville, WA 98271 Phone (425) 388-5200 FAX (360) 653-7609 SOUTH PRECINCT 15928 Mill Creek Blvd Mill Creek, WA 98012 Phone (425) 388-5250 FAX (425) 337-5809 EAST PRECINCT 515 Main Street Sultan, WA 98294 Phone (425) 388-6260 FAX (360) 793-7774 SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 CORRECTIONS 3000 Rockefeller Ave. M/S 509 Everett, WA 98201 Phone (425) 388-3474 FAX (425) 339-2244 ADMINISTRATION 3000 Rockefeller Ave. M/S 606 Everett, WA 98201 Phone (425) 388-3393 FAX (425) 388-3805 Page 43 of 44 f. SNOHOMISH COUNTY SHERIFF AND POLICE CHIEFS’ ASSOCIATION LETTER OF ATTESTATION SNOHOMISH COUNTY REQUEST FOR VARIANCE FOR PHASE 2 Page 44 of 44