Health board won’t enforce mandates despite covid surge

At its last meeting on November 10, the Ravalli County Health Board made it clear in its discussion with officials from the City of Hamilton that it supports the CDC and Public Health recommendations and guidelines concerning masking and social distancing, but the Board is not going to enforce any mandates. It was also made clear that the Board had no plans for addressing the current surge in COVID-19 cases.

Public Health Officer Dr. Carol Calderwood told the Board that the county was seeing a higher percentage of positive test results for COVID-19. She said she was not privy to the numbers of available Intensive Care Unit beds at the hospital but that she knew they were transferring people from other departments who had experience in the ICU over there to help. She said there was also less availability for transferring patients to other facilities as well and that everyone was under a lot of stress. One positive note was that the new PCR tests for the health care workers that had been taking up to a 48-hour turnaround for results were down to 24 hours.

County Public Health Nurse Tiffany Webber gave the Board an update on her office and how it was steadily falling behind in its work despite hiring more help. Two new people were hired fresh out of nursing school. Webber said nurses were hard to find and that, as far as nurses go, Ravalli County was “at the bottom of that barrel.” A third employee was hired to work on tracing and tracking contacts. 

Webber said the number of COVID-19 cases coming in were “more than we can get to.”

She said they have generally been infected for three to four days and then it will take another couple of days to get lab results. She said they needed to get a swabbing program going but haven’t had the time. She said Ravalli County was one of a handful of counties getting complaints about violations of the governor’s mandates submitted on the state site. 

Webber said that when the lab notices come in the people have to be contacted. She said they may not be showing symptoms and need to be informed. But right now, they are having trouble making all the calls. Under the current overload it can be four or five days before they contact the person that tested positive, leaving it pretty much impossible to do effective tracking. At the time (Nov. 10) they had one full time nurse out sick and two nurses fresh out of graduate school and three retired nurses working a couple days a week on the tracing program. They are asking the people who test positive to contact people who may have been exposed. She said there was a 4% positivity increase at Marcus Daly Hospital the first week of November.

Hamilton City Council President Claire Kemp said that city residents were reaching out a lot about the COVID-19 situation and a majority were wanting more enforcement of the Governor’s mask mandate. She said that their attorney informed them that authority to enforce a mask mandate locally was in the hands of the Ravalli County Health Board. She said that they were hoping to discuss with the Board at what point there would be more enforcement. “Do we need more numbers? We wanted to hear from you,” she said.

County commissioner Jeff Burrows, who chairs the Health Board, asked if she was requesting a citation for not wearing a mask or citing the businesses for not requiring a mask.

Kemp said they were just looking to the Board for what its next steps might be, “because, as your public health officer just stated, it’s getting worse.”

Councilor Jenny West said they were thinking about limiting group sizes and “seeing what we can do together to make this easier, but as a city we have our hands tied.”

Burrows called the request vague and suggested they put together a list of what they would like to see done.  “We have asked the public to follow the guidelines. There is no penalty or citations. Is that what you are requesting?”

West replied, “What is your plan? We are looking to you for guidance.” 

Burrows said, “For me it’s just sort of status quo and trying to meet the needs of our public health office as far as contact tracing. I don’t know what else we can do. Or we pull the trigger on a mandate with citations. I’m not in favor of that.”

Board member Dr. Michael Turner said that it was the citizens of Ravalli County who had to take responsibility here. “There are things that you can do. I don’t think this board wants to be a police organization going out and arresting people who don’t have masks on or are meeting in too big of groups. So that means citizens have to take responsibility.”

Board member Dr. Chilcote said, “We are not going to stomp out the disease. We are not going to stop it. Maybe a vaccine will help. What are we aiming for here? Our concern is overwhelming our medical community. It would be nice to have some beds.” He said the question was, “How do we keep our medical facilities functioning without clamping down on society?”

Board member Roger DeHaan said, “My answer would be, we don’t have a plan. We are just letting this thing run its course. Unfortunately, the ones who are susceptible and at most risk are the ones being deprived. They are not able to go to meetings or gatherings because other people are not willing to wear masks or social distance. It’s a tough line to follow but we will know it’s working when businesses can get back to work. When our schools can function normally. To me that’s the goal.” 

“Some people in Ravalli County feel they don’t want to give up a little freedom now for more freedom later on. And we don’t know if this will be months or years,” he said.

Dr. Turner said, “We are not going to be doing the community a favor by locking everything down I don‘t think, because there’s a side effect of that,” with kids out of school and parents out of work. He noted that the disease was most serious for elderly people and those with co-morbidity symptoms.

Burrows said, “Maybe that answers your question about our plan. We don’t have much of one, but maybe it’s an answer you don’t like.”

Kemp responded, saying that “by and large our constituents want some action. They want some mandate, but it is not in our authority. But without it, if hospitalizations rise and we run out of beds, what do we do?”

Dr. Calderwood said, “I don’t think it would be successful in this community to try the heavy hand. I think it might be time for the board to make a strong statement with a louder voice that we take some action because the holidays are going to be very bad if people don’t limit their contact groups and if they don’t stay home when they are sick. Even if you can’t mask, then it would be good if you could have a strong voice that we need to do something different. “

Turner said that with 400 people sick it amounts to  1% of the county. “That’s what we know. I would assume there are several more of those that we don’t know they have it,” he said.

Calderwood said they were seeing clusters in the county and cases with no known contact and no travel, meaning that there was community spread and no way to really track it. She said they were also seeing big clusters in certain businesses and schools, hospitals and dental clinics and nursing homes.

“But we have not shut anybody down,” said Calderwood. “All these businesses are running out of staff due to quarantines whether through being sick or being in contact with someone who is sick. It’s heartbreaking not just for the people who get sick and die, also the economic impact and the personal impact on people who can’t do their daily activities because they are trying to reduce the spread.”

She said they are seeing from 5 or 10 people daily who test positive and say they have been within six feet of people in their office because they work in a business that is not masking and not keeping social distance, resulting in all the workers needing to be quarantined. 

She said in the hospital where she works they do not eat together, do not get within 6 feet of each other, and mask 100%, “so that if I get sick I haven’t given it to you. And you do not have to be quarantined because of me.”

She said her only contacts are at home. “I’m not going to any parties, I’m not going to any bars, I’m not going to sit in a group that’s touching, because that’s what I can do. Even if I don’t believe in masking I could still stay apart. But people don’t think about it until they get sick and they are shedding the virus for 48 hours before they have any symptoms. They have already spread it for a couple of days. If they keep going to work because they think it’s a cold but then lose their sense of smell and come in, there has already been five days since they were sick plus the two days before that, so it’s been a week that they have been spreading it.”

“If you don’t want to enforce things and I don’t think it’s going to be successful in this county, then the main thing is to just push the education and maybe a strong voice from the board would be impactful at this point. It isn’t a normal year to go to work if you don’t feel well. Employers need to realize that it is a different day,” said Calderwood.

“I think the main people who are spreading it just aren’t listening to the warnings and doing the basic guidelines. In a way, it is a loss of freedom but in a way it is a willing sacrifice to make, and if everyone did make a sacrifice we could keep the hospital from being overwhelmed. I fear for this holiday season,” she said.

Over 30 people attended the meeting, almost all of them sitting shoulder to shoulder and without masks. The public comment went on for hours with most everyone speaking against the enforcement of any directives which were generally considered a violation of constitutional rights. Other comments included allegations of data being misused and even fraudulent, that enforcement of mandates would ruin the economy and were basically useless and unenforceable, and some still claiming that the pandemic is a hoax.

Following this meeting on November 10, there was a hiatus in the steady reports that had been coming from the Public Health Office of the number of daily active cases of COVID-19 and the number of daily new cases in the county. When the reports were resumed they came from the Sheriff’s Office and only the number of new cases for November 13 were reported. The number of active cases was not included in the report. The next report of active cases was released on November 16 when the county reported 137 new COVID-19 cases over the weekend (November 14th and 15th) and an additional 59 cases on Monday, November 16th. 

The report also noted, “Ravalli County has updated the number of recovered cases, and currently has 326 confirmed active cases of COVID-19 in Ravalli County.” This update is reflected in the associated graph as the drastic drop in the graph line from 405 active cases on November 10 to the updated number of 326 on November 16. From there the number of active cases begins another climb upwards, more than doubling over the next four days to 669 on November 20.

The county also announced that it will no longer be reporting the numbers of hospitalized patients “because of the inability to report on local cases that might be hospitalized out of the County.”