The shelter-in-place directive that was instituted across the state to blunt the impact of the COVID-19 pandemic in Montana expired on Sunday, April 26 for individuals and Monday, April 27 for businesses. Under that directive, Montana aggressively managed the virus with a series of actions including suspending nursing home visitation, closing schools, closing higher risk businesses such as bars, restaurants, gyms and movie theaters, and enacting a stay at home order. Last week Governor Bullock announced the implementation of a new planned reopening to be implemented in phases as certain benchmarks criteria are achieved and maintained. The plan calls for a gradual lifting of emergency measures and re-opening of businesses as certain benchmarks in countering the epidemic are reached. But officials emphasize that it will not mean going back to normal. It will be more like going forward to a “new normal.”
“It was only because we as Montanans decided to enter into this thing and act responsibly that we are now ready to enter this first phase,” Governor Bullock stated at a press conference last week announcing the new Re-Opening Plan.
“There are very few states in the country that can say they have seen the number of positive cases decline over these past weeks. Montana can say that because, together, we have made that decline in cases possible,” Governor Bullock said. “I am going to ask Montanans to continue to go to great lengths to protect one another, to continue looking out for our neighbors who need it the most, and to continue being vigilant in every step we take.”
The plan to reopen gradually, he said, is based on the latest scientific evidence and data, and in consultation with public health experts, health care providers, business leaders, and emergency management professionals. The plan is detailed in a Directive and accompanying Appendix with guidelines for certain industries.
Bullock presented a thumbnail sketch of the progression of the pandemic in Montana. It took five weeks, he said, for the epidemic to grow from its first reported case in the state to 426 (as of April 17). It took 13 days to reach a hundred reported cases. After that first 100 cases the rate of increase remained fairly steady, increasing by another 100 every five days up to 300 case reports. Since then the growth rate has slowed, taking nine days to reach 400 cases. Two weeks ago there were 49 new positive cases reported. Last week there were only 11.
Reports show that the demographics involved are remaining consistent as well, with people from 20-29 years of age accounting for 20% of all COVID-19 cases in Montana. The next largest age group of people with COVID-19 in the state are 50-59 years of age at 19%; followed by 30-39 at 16% and 60-69 at 16%.
The ratio of men to women in Montana’s reported cases is roughly even with 48% male and 52% female.
Of the 381 cases of known races at the time of the report, 93% identified as white and 5% as Native American. “Native Americans are not disproportionately impacted by COVID-19 in Montana at this time,” he said.
He said transmission information and community acquired cases have stayed steady, meaning that there has not been an increase in community transmitted cases (as opposed to travel originated) over the last few weeks.
Bullock said that the state was doing a very good job at contact tracing and cluster control. The investigations increasingly added to the case counts indicating that the disease control efforts through local public health staff are identifying those who are infected and isolating them appropriately.
“Local public health officials have done a great job with contact tracing providing information to the state for making decisions,” said Bullock. “They are quarantining and isolating people as necessary. They also investigate all positive cases to determine how people got infected, identify known contacts and require them to quarantine for 14 days.”
The report compared the impacts per 100,000 people in Montana to neighboring states. As of April 17, Montana had 39.5 cases per 100,000 people. Wyoming had 71.2; North Dakota had 57.5; South Dakota 159.5; and Idaho had 92.6.
Although it is important to recognize the number of infection cases, he said, it is also important to look at the number of cases recovering. For example, out of Gallatin County’s 140 reported cases, only five are still active and the rest have recovered. In Lewis and Clark County, out of 16 cases only 3 are still active. Ravalli County has had only five cases and three have recovered. Montana reached 445 cumulative cases of COVID-19 on Saturday, April 25 with 339 people recovered and 11 actively hospitalized.
Bullock said that Montana has had the resources to do contact tracing on COVID-19 since the first case and will continue. This work will continue through Phase I of the Re-Opening. He said the state was ready to provide additional help to local governments if needed.
“There are challenges that remain, and we will all do our part to mitigate those challenges,” he said.
The impacts in most communities have been relatively the same, but statistics coming out of Toole County are surprisingly different in a number of ways. Approximately 86% of cases in Toole County are female and 22% of the cases were hospitalized. This differs significantly from the statewide statistics where 13% have been hospitalized and half are female.
The mortality rate of 11.4% of cases in Toole County is also far greater than state’s 2.3% of cases.
Bullock said the situation in Toole County was likely related to the higher average age of people in Toole County compared to the state as a whole.
Bullock said the state was ready to fulfill its responsibility and test those who are symptomatic and trace contacts of positive results. He said they are asking all symptomatic people in the state to be tested. In addition to over 12,000 tests done at the state lab, 18 private labs reported 2,700 additional tests with 76 testing positive. All positive tests are reported on the state’s totals. He said this information is crucial to understanding where and how the virus is spreading.
Phase I of the plan involves developing ‘sentinel sites’ to screen patients in at-risk communities. “You have my assurance that we will continue this work through Phase I to bolster that testing capacity. This work won’t end in Phase I. It won’t end at any time while I’m serving as governor,” said Bullock.
Dr. Marc Mentel, president of the Montana Medical Association, said, “Because of Montana’s aggressive approach of shutting everything down early in the pandemic, we are in the fortuitous position of having a very low viral burden in the state. With that being said, I feel assured that a cautious, vigilant, and step wise approach to opening up our healthcare, commerce, and education sectors could be attempted. Keep in mind that for every two steps forward we might need to take a step back, but it is in everyone’s best interest that we try.”
Bullock said, “Our new normal is going to look different. This virus isn’t gone from Montana. So as we turn to support our main street businesses and get more families back to work during this time – as we should – we must also be sure to continue looking out for those around us and protecting everyone around us. Once we begin to reopen, we want to be able to stay open. Our personal responsibility to protect those around us – particularly those most vulnerable – remains just as important as any time during this pandemic.”
“This is not the time for celebratory barbecues or going out to dinner or bars or breweries each and every night. This is a time when we all need to be creating another new normal. In order to determine when we move into the next phase we need to see what happens with the virus in Montana. We won’t be moving out of Phase I unless the curve remains flat,” said Governor Bullock.
“For a lot of Montanans,” he said, “especially our most vulnerable, this phase should be substantially the same as the staying at home period. The more protective actions that Montanans take now and in the coming weeks the more likely that we will keep that curve flat. In this new normal I will continue to emphasize all along the way that our personal responsibility is to adhere to strict social distancing and businesses have a responsibility as we begin to navigate to some form of normalcy in serving customers.”
In the Phase I plan, visitation at nursing homes will continue to be suspended and older Montanans and those who are immunocompromised should continue to follow the stay-at-home directive. The reopening also relies on Montanans to adhere to social distancing guidelines whenever possible and to continue to limit gatherings. Guidance remains in place for members of vulnerable groups to continue to shelter at home, though it is no longer mandatory.
Main street and retail businesses could become operational on or after April 27 if they adhere to requirements to limit capacity and maintain strict physical distancing. Employers are directed to develop policies to keep employees and customers safe including teleworking when possible, enforcing social distancing protocols, and other measures as provided in an appendix of reopening guidelines.
Places of worship could become operational on April 26 in a manner consistent with social distancing between people who are not members of the same household. Restaurants, bars, breweries, and distilleries can begin providing some in-establishment services beginning May 4 if they can maintain social distancing requirements.
Businesses where groups gather without the ability to social distance including movie theaters, gyms, and other places of assembly remain closed.
On May 7, all schools will have the option to return to in-classroom teaching delivery at the discretion of local school boards. The Directive does not preclude school boards from declaring local emergencies to continue to receive all appropriate state funding to continue to provide remote learning.
Montana’s travel quarantine will remain in effect and out of state travelers and residents arriving from another state or country back to Montana for non-work related purposes are required to quarantine for 14 days.
The Directive does not prohibit more restrictive local ordinances and encourages local officials to work regionally and make local adjustments as local needs demand.
The plan includes several phases and details the factors that will determine when it is appropriate to move to the second phase of reopening. This decision will be driven by conditions on the ground and the latest data. Governor Bullock and his task force will continue to monitor cases closely and carefully to analyze Montana’s work to contain the virus.
The Directive and its Appendix with reopening guidelines are posted online at covid19.mt.gov.