The following is a summary of the presentation made by Dr. Tom Locke, our local Health Officer, during the Public Health briefings at this week’s Board of County Commissioner’s meeting:

Submit your Public Health questions to Dr. Tom Locke by emailing [email protected]. Note: The weekly deadline for these to be submitted is on Fridays at noon, to be answered at the following Monday’s BOCC meeting.

General Remarks:

• Nationally, new COVID-19 are declining, noting a 40% drop from the peak in January, with hospitalizations decreasing 24% after rising to an all-time peak.
• Washington, having seen a surge in December and January, has seen a 52% drop in new cases, with a concurrent 19% drop in hospitalizations. The state rate of new COVID-19 cases is 392 per 100,000 population, down from the previous week of 462 cases per 100,000, with a high 9.6% case positivity.
• As of this day, Jefferson County reported triple its new cases (28), as compared to the previous week of 8 cases reported. Our case rate now stands at 106 per 100,000 population, up from 72 the previous reporting period, with 3.23% positivity.
• Neighboring Clallam County has 84 cases per 100,000 population with 3.25% new case positivity. Mason County has recorded 174 cases per 100,000 population and 14% positivity, with Kitsap County at 155 cases per 100,000 and 7.3 % new case positivity. Local public health websites in our regional area continue to be the more reliable source for DOH metrics, as the state has lags in reporting and recording data.
• Dr. Locke first addressed the concerning worldwide news of new virus variants being reported, stating the regional mutations to the spike protein impacts the state of the pandemic, making the virus easier to transmit to another person. While vaccination efforts are ramping up, the public health tools of masking, distancing, and sanitizing our environment become critically important to stop the spread and subsequent replication of the virus when it finds a new host. Evidence continues to demonstrate the mutations are more transmissible and emerging evidence shows it is more likely some mutations are more deadly, making vaccination campaigns more urgent. Politicizing the pandemic imperils our recovery, as evidenced by some states repealing mask mandates previously implemented.
• Locally, 5,019 doses of vaccines have been given out, with 90% of all vaccines given by Jefferson HealthCare and 10% given by three local pharmacies. The next allotment (about 1,000) heading to Jefferson County will be used to support those needing their second dose. A small proportion will be used for older, very high risk seniors for a first dose, especially those identified as receiving cancer treatment or with other immunosuppressive conditions.
• Washington’s allotments have increased slightly to about 155,000 doses a week, with the majority going to first dose needs and a small portion being used for second doses. The state is now managing second-dose logistics, releasing the local counties of this burden. All vaccine allotments are required to be given within 7 days and are being used as fast as they arrive in the local counties, with no holding second doses in reserve. The number of doses given statewide reflects a delay in recording and reporting local data. Currently, 62% of vaccine allotments have been given to Washington residents.
• Our allotments locally have been reduced temporarily to give previously under-allotted counties their fair share. Vaccine allotments and shipments are expected to stabilize towards the end of February, and the state has predicted that counties will know the allotment quantity weeks ahead of planning appointments. Jefferson County continues to focus on getting those at highest risk of severe disease and death vaccinated. Dr. Locke is asking those healthy residents, aged 65-75 years to wait to get the vaccine so the available supplies go to the most vulnerable at this time.
• Pharmacies are following state guidelines as to the targeted populations for vaccines, currently those aged 65 years and older in Washington.
• Mass vaccinations events are being planned for Jefferson County when supplies of vaccines outpace the current method used for the drive thru setup near the hospital. A plan has been submitted to the state to indicate our readiness to receive larger allotments. Efforts are underway for increasing availability of volunteers and equipment for this eventuality in the months ahead, as it is estimated that 70-80% of our residents intend to get the vaccine.
• The Jefferson HealthCare website still remains the central source of information related to vaccination availability. National production is steady, but not enough for the current need of those wanting the vaccine.
• The the RoadMap to Recovery statewide plan from the Governor has received criticism due to the faulty methodology employed in determining progression to re-opening. It is a case of flawed methods leading to flawed policy, as evidenced by those areas with the highest prevalence being able to progress to re-opening before lower prevalence areas, especially when a percent reduction is employed in the calculations. There is some logic in recognizing our connectedness, especially as many people travel to high prevalence areas for work. However, increasing opportunities to gather more indoors, especially dining, could accelerate new cases, prompting closures again.
• For our Northwest Regional area, Kitsap and Mason counties continue to influence our collective epidemiology picture, with Kitsap having the largest population and Mason County being the site of the prison medical facility for COVID-19 inmate cases for the state.
• To reduce the prevalence of cases now and with the emerging evidence of normal, but concerning mutations, Dr. Locke is advising all residents to double mask for several months. The inner mask should be a surgical mask, then covered with a cloth mask to seal any gaps, especially when in closed, crowded public spaces.
• Public health officers are limited in the facts they can share with the public regarding cluster outbreaks, so the remarks are general here regarding a cluster outbreak in our community. In large population areas, these cluster outbreaks are common and relatively easy to prevent ongoing spread to the wider community. As a rule, containment is the goal in cluster outbreaks.
• Focus on the specific cycle thresholds being used for PCR tests conducted mainly at the University of Washington is being used, in Dr. Locke’s opinion, as an argument, to undermine the reliability of these tests. This is an issue of timing in the disease process, whether at the beginning or the end of the infectious stage, as well the amount of virus present in the nasal swabs. The PCR is a highly reliable indicator of current infection, as well as other epidemiological information collected when conducting case investigations. There is no reason for the public to doubt its reliability and sensitivity at this point in time.
• Long-term care residents and staff are now getting the vaccine, after a slow initial roll-out by the contracted, national pharmacy chains. Locally, Jefferson County used some of their allocations to vaccinate staff, as this is the potential introduction of the virus into these facilities. Protection of the most frail was the biggest consideration in taking this action.
• A vaccine manufacturer, Johnson and Johnson, just released their efficacy data in a press announcement. They reported a 70% plus efficacy in preventing severe disease and no hospitalizations, which in Dr. Locke’s opinion is excellent for a one-shot, easy-to-store coronavirus vaccine. After application and approval of an Emergency Use Authorization (EUA), supplies are expected by early April.
• The placement of teachers in the hierarchy of the statewide plan considers this group to be an essential worker, which is the next group to be included, but focuses on those 50 years of age or older. Schools are seen as low-risk environments according to the epidemiology. As supplies increase, teachers of all ages will be included. Many of the details in the state’s plans are difficult to operationalize for local health officers.
• Serious reactions are very rare with this vaccine, so if this occurs for an individual on the first inoculation, they are advised not to get the second shot. It is critical to know why a person reacted, to determine if another vaccine is more appropriate, especially if they reacted to a component of the vaccine.
• The timing of the second dose can be either a few days early or up to 6 weeks after the first dose, according to a newly published CDC document.

Willie Bence’s response to our current situation:

• He thanked the many residents registering to help with future vaccine clinics. About 200 non-clinical residents applied as well as 40-50 clinical volunteers. The goal is to register a lot of volunteers, as work shifts require a volunteer to be on their feet all day, which is about walking 7 miles for those directing traffic. He stated this needs to be a whole community effort with lots of residents taking turns for several months.
• Jefferson HealthCare continues to be the most up-to-date site for vaccine appointments. He encouraged all persons 65-75 years of age to sign up on this website to be notified when appointments become available. In the future, the county may become the central site for information, especially if more entities apply and get approved for vaccine allocations in our county.
• Residents can refer to the state website for metrics pertaining to the progression to the next phase for re-opening our economy. The next date for calculations is Feb 12, with implementation to begin on Feb 15.

• Nationally, new COVID-19 cases have begun to decrease, after rising to an all time peak. Daily case counts have decreased about 33%, a reduction of about 17,000 new cases per day, currently.
• Washington, having seen a surge in December and January, has seen a 37% decrease in new cases, documenting nearly 1,600 new cases a day. Hospitalizations continue to be our highest numbers yet, but do not exceed our current capacity. Washington is currently reporting 462 new cases per 100,000, with 10.7% cases positivity.
• As of this day, Jefferson County now has 283 cases, with 69 cases per 100,000 population, and a 3.23% case positivity. Neighboring Clallam County has 143 cases per 100,000 population with 6.4% new case positivity. Both counties remain among the lowest in both metrics in Washington. Mason County has recorded 246 cases per 100,000 population and 19.8% positivity for new cases, with Kitsap County at 195 cases per 100,000 and 9.6% new case positivity.
• Concerning news is that the variants discovered in Britain have been recently documented in Washington as expected: this strain appears to be about 50% more transmissible than our current circulating strain.
• The metrics for Mason, Kitsap, Jefferson, and Clallam Counties are tied together in determining progression to the next phase of loosening restriction for re-opening under the RoadMap to Recovery statewide plan. The Northwestern regional data on the four crucial metrics indicating progress to recovery is coming closer in alignment to the data each county is reporting.

Dr. Locke’s responses to questions and topics submitted by KPTZ listeners:

• Currently, two vaccines are available, Pfizer and Moderna. Both vaccines require two doses and will be given according to the schedule dictated by the clinical trials, with no deviation. Pfizer’s second dose will be given 21 days after the first dose and Moderna’s will be given 28 days after the first dose.
• All state Governors control allocation of available vaccine supplies according to each individual state’s priorities. Deliveries go directly to each county. Each local county health officer has been encouraged to create a subset of at-risk individuals within state guidelines, to begin with those most at risk of severe disease and death. Currently, Jefferson County is focusing on those in 1B and up for the limited supply of doses available.
• The vaccines are considered to have an excellent safety record, with over 20 million nationwide having received the vaccine. There is intense demand and it will take a while to get the vaccine to all who are willing to be vaccinated. Initially the state was providing doses to those counties who had the immediate capacity to use doses as soon as they were received. Allocation now is temporarily going to larger urban areas until they receive their equitable share to date. The state will then resume equitable allocation to smaller counties, so we may see a decrease for a few weeks. Our county has nearly one third of residents over 65 years of age and it may take several weeks to make a dent in vaccinating this age group. Expected doses are about 1,000 doses a week for the present time. Washington needs 3.4 million residents statewide to be vaccinated to reach 70% herd immunity.
• Once you are vaccinated with both doses, nothing will change from our present day recommendations to mask, distance and wash your hands. If you are vaccinated and become a close contact to a confirmed COVID-19 case, the health department will still expect you to quarantine for 14 days…all mitigation strategies remain the same until mid-summer.
• At some point, traditional community festivals are likely to be able to restart with modifications to spacing and ventilation requirements to reduce outbreaks. It will also depend on the percent vaccinated as this still remains an experimental vaccine granted under the Emergency Use Authorization (EUA) from the FDA and all vaccinations remain voluntary.
• There is no truth to the rumor that the state is with-holding any vaccines doses.
• Currently, three (3) pharmacies and a hospital are scheduling vaccinations. We can expect modest increases mid February. The state has directed all received allocations be immediately used, as second doses are accounted for separately.
• Nearly 4,000 vaccines have been used so far in Jefferson County. Frail elders are being served best in the drive thru clinic at about 250 people a day, some days with up to 400 seniors. Nearly all the 1A priority who want the vaccine have received them. About 75% of hospital personnel have received the vaccine. Dr. Locke will meet with first line responders to answer their questions and encourage higher levels of vaccinations.
• Currently, new COVID-19 cases result from unsafe behaviors when non-household friends and family congregate. Another risk is just being in the wrong place at the wrong time when a highly infectious person is circulating in the community. As many as 59% of persons infected are either pre-symptomatic or never get symptoms.
• Locally, the best source of vaccination information is the Jefferson HealthCare website.
• For information and questions about the vaccines, the Centers for Disease Control CDC) has a phone line operating 7/24: 1-800-CDCINFO. You are also encouraged to bring questions to your health care when you have an appointment.
• Small social circles of vaccinated persons is not considered safe or wise at this point. Public health officials do not have the data to provide science-based recommendations until the current studies are completed. This is especially dangerous after just having the first dose. High viral prevalence in our community makes this unwise and unsafe.
• Multigenerational households with the following scenarios will be part of those in the 1B category prioritized for vaccinations, according to further clarification from the state. If you are a grandparent caring for a grandchild, a caregiver of an elderly person or relative, or a family member taking care of an elderly person, you are eligible to receive the vaccine if you are over 65 years old, as supplies become available.
• Dr. Locke expressed his concern regarding the angst and anger directed at those health professionals managing the vaccination rollout as unfair, given the shortage of vaccine supplies and massive undertaking for all government agencies. It is their role to identify and prioritize those at the greatest risk of disease and death at this point in time. He stated this vaccine is for every resident in this county, not just Jefferson Healthcare patients. Several sites are trying to identify these individuals and reach out to them.
• It is a matter of being patient, and waiting your turn, and recognizing the inherent limitations of all government and medical facilities when facing and adjusting to this unprecedented pandemic. We currently have the means to protect ourselves, doing what we have done for the last 10 months, until supplies of the vaccine improve. This last stretch will require intense patience, grace, and gratitude from all residents.

Department of Emergency Management Director Willie Bence’s response to our current situation:

• Jefferson HealthCare has paused making appointments due to lack of vaccines for new appointments; will resume later in the week.
• Volunteers with medical backgrounds who can give vaccinations and hold a current license are still needed – such as MD’s, RN’s and EMT’s with specialized training to give inoculations. The larger clinics and larger vaccination sites will function mainly on these types of volunteers.
• As changes happen rapidly regarding vaccine information, the best site is still Jefferson HealthCare. Our efforts have paid off as Jefferson County ranks 4th in the state for giving the vaccine doses per 100,000 population delivered to our county, even in this year-long crisis.
• If anyone is having trouble navigating the appointment system of websites, they are encouraged to call the phone lines at the Department of Emergency Management at 360-344-9791. Priority still is based on age at this time.

Nationally, new COVID-19 cases have risen to an all-time peak, with nearly 200,000 new COVID-19 cases reported daily, signaling a 38% increase in the last two weeks. Additionally, nearly 3,000 deaths were reported each day and approaching nearly half a million deaths since the start of this pandemic. This pattern has been repeated in many states.

Washington, as of January 18, reported a 7-day average of more than 1,800 new cases, up 27% from the previous 2 weeks, and deaths nearing 4,000 since January 2020. Cases per 100,000 population was 272 statewide in the first 2 weeks of January. Hospital admissions in the state have increased slightly, but currently remains below capacity.

As of this day, Jefferson County now has 269 cases, with 125 cases per 100,000 population, a 3.18% case positivity. Neighboring Clallam County has 154 cases per 100,000 population with 8.5% new case positivity. Both counties remain among the lowest in both metrics in Washington. Mason County has recorded 360 cases per 100,000 population and 19.8% positivity for new cases, with Kitsap County at 233.cases per 100,000 and 12.5% positivity. The metrics for Mason, Kitsap, Jefferson, and Clallam Counties are tied together in determining progression to the next phase of loosening restriction for re-opening under the RoadMap to Recovery statewide plan.

Changes are expected with the inauguration of a new administration regarding federal prevention strategies, vaccine production and availability, and policies. In the next six months, Public Health infrastructure will be appropriately funded, staff increased and science will provide the basis for these efforts.

Vaccines:

Currently, vaccine availability remains limited and Jefferson County has been vaccinating those individuals in the 1A tier, which include front-line medical workers who face heightened exposure to infectious patients and settings, as well as residents and staff in long-term living settings. Jefferson County has stepped up and used some of its vaccine supplies for the staff of these facilities when it was evident that organizations contracted to vaccinate this population were behind schedule. The residents still need vaccinations. Jefferson County has now included the 1B, Tier 1 population, which focuses on the eldest at risk of severe complications and death. Although state guidelines include a larger age band in their eligibility (over 65 years of age), Jefferson County has a disproportionate number of seniors here as compared to other counties. Only individuals 80 years and older are currently eligible for the limited supply of vaccines. About 37% of this county’s population is over 65 years of age and will take a longer time to vaccinate as compared to other counties.

Our biggest challenge in this moment is managing our expectation about when we will individually get the vaccine and what that means going forward.

Jefferson HealthCare is the main site and has scheduled 1,000 persons this week for vaccinations, about 250 a day. We have received 2,198 doses for the first doses to date, and now will use the reserved supply held for the second dose for more seniors at-risk to receive their first dose. Supplies for those needing the second dose will be used as new shipments arrive. Although supplies are limited, the state has been informed this is a temporary situation. New types of vaccines are expected to get FDA approval sometime in March and will increase availability.

Local county staff have been observing the vaccination clinic events in Sequim and Port Angeles in anticipation of events like this for Jefferson County in the near future. Currently in Jefferson County, all individuals eligible can register at one of three facilities taking appointments: Jefferson HealthCare, Safeway, and Tri-Area Pharmacy. These sites have requested residents not to call the site, but go to their websites as all these sites have critical responsibilities to fulfill and are burdened when they are diverted to calls related to vaccinations.

Another category in 1B, Tier 1 includes 50 year olds in multigenerational households and is aimed at those caretakers of elderly individuals in the same household. This has been difficult to operationalize as this information tends not to be in medical records. It is up to individuals to truthfully represent their situation if they fall into this category. The state has recently provided more clarification describing those considered in this category.

Response to Listener Questions

Organizations and businesses providing vaccinations must apply to the state and undergo a rigorous vetting due to the specific needs of these new vaccines, including storage, technical knowledge, and equity requirements, such as no out-of-pockets costs to residents.

The pandemic will not be over for the community when an individual resident gets a vaccination. We must continue to use mitigation measures to keep cases from continually rising and deaths are greatly reduced. If a vaccinated person goes to the store and does not wear a mask, they will be asked to leave as they still pose a risk. The vaccine protects a person, when infected, from progression to serious disease. This must continue until death and disease go down. As vaccinations continue, guidelines may provide some exceptions for vaccinated persons in limited circumstances. Public health leaders and scientists are trying to gather more information about infectiousness on some of these questions. As long as new case prevalence remains high, it is too risky to drop our prevention measures.

There is no need to get a COVID-19 test prior to getting vaccinated. If you are currently experiencing symptoms, are in quarantine or isolation, you should not get the vaccination, mainly to protect the medical workers and volunteers.

There is no out-of-pocket expense for the vaccination in Jefferson County, although some organizations may bill your insurance company for the cost of administration.

If you do not have insurance, you can still get the vaccine at no cost to you.

It appears these first two vaccines have slightly higher allergic reactions than other vaccinations. Non-COVID-19 vaccines typically produce 1 in 1,000,000 allergic reactions in the vaccinated population as compared to 11 in 1,000,000 for the new COVID-19 vaccines. All vaccination sites are prepared to treat individuals if reactions occur, as trained personnel watch all vaccinated individuals for 15 minutes after the shot is received. For those vaccinated with a history of reactions, they are observed between 30 and 60 minutes, depending on the facility and reported history of reactions of the patient. It is critical to report any history of reactions to past medical procedures or vaccinations to the provider giving the vaccinations. Currently, very few exceptions are listed as contraindications for these first two vaccines.

Common side effects reported from vaccine trials and those currently receiving the vaccinations are soreness at the site of injection (50%) and headaches and fatigue (50%). Side effects with the second dose may include more symptoms, including a mild fever and affect your stamina for going to work, but just for a day or so. These symptoms are recorded as side effects, but are actually a sign that your immune system is reacting to the presence of a protein it has not seen before and developing a response. If you have no side effects, Dr. Locke says you are lucky and still building a response.

Because we are grouped with Mason, Kitsap and Clallam Counties under the states RoadMap to Recovery, our progression to Phase II is dependent on our collective ability to meet the state’s health metrics over time and is influenced by each county’s local epidemic numbers. Data listed on the state’s DOH website is different and at odds with the data each county has tabulated for a variety of reasons. The local county and the state collect data from different sources, some of which have crashed recently. Our status of being in Phase I actually acts to support case suppression and currently is safer for all of us. Traditional public health interventions like case investigations and contact tracing continue to work if we collectively suppress transmission.

The professional organization for local health officers has provided input on the state’s proposed plans, but it appears this has not been taken into consideration at this point, including an effort to revamp the entire public health jurisdiction during this pandemic. Dr. Locke will testify soon at the state capitol to emphasize the importance of heeding the advice of local public health professionals, as well as the proposal to revamp a well working model of local health jurisdictions.

Continue to check the Jefferson HealthCare website as the main clearing house for updates and opportunities for vaccinations.

Willie Bence of the Department of Emergency Management (DEM) stated many people volunteered to staff the line that helps seniors get a vaccination appointment, when they have trouble getting into the JHC website or don’t have access to a computer. Their office line (360-344-9791) remains open weekdays from 9-4pm.

If you leave a message, it may be 48 hours before your call is returned due to the volume of calls. Mr. Bence encouraged all residents to use the JHC website as it will answer typical questions and is updated regularly. Also, volunteers are still needed for medical and non-medical roles as temporary emergency status.

Submit your Public Health questions to Dr. Tom Locke by emailing [email protected]. Note: The weekly deadline for these to be submitted is on Fridays at noon, to be answered at the following Monday’s BOCC meeting. 

The following are links recommended by hosts Robert Ambrose and Dahr Jamail to timely, relevant articles related to the discussion on Critical Conversations #3.

This Must Be Your First – Acting as if Trump is trying to stage a coup is the best way to ensure he won’t – December 7, 2020

America Has Entered the Weimar Era – The violent storming of the Capitol by pro-Trump extremists underlines the face of crises to come – January 7, 2021

You’ve Been Coup’d – America has been in the middle of a coup for months and it’s been obvious for years. Now there’s guns in Congress – January 6, 2021

• Nationally, new COVID-19 cases have increased by 38% in the last two weeks, a pattern driven by recent holiday travel, repeated in many states. On January 7, Washington recorded more than 4,000 new cases, up 27% from the previous two weeks. Hospital admissions due to COVID-19 have increased slightly, but have not reached capacity.  
• As of today, Jefferson County now has 255 cases, with 122.26 cases per 100,000 population, an increase from the previous week. Case positivity has increased from 4% to 4.335% this week. Neighboring Clallam County has 113 cases per 100,000 population with 5.7% new case positivity. Both counties are among the lowest in both metrics in Washington. However, travel to and from this county remains increasingly more risky as the rise in statewide cases continues. 
• New regional cohorts created by the state tie our individual county data to improvements in four (4) key metrics among four (4) neighboring counties before progression to the next re-opening phase occurs. The state calculates progress based on the data individual counties report in a plan entitled Road to Recovery Plan.
• Kitsap County, with the largest population,will have the biggest impact in our cohort with respect to progressing to Phase 2 of re-opening. Progress can be followed on the state DOH website. 
• Jefferson County has received 3 shipments of COVID-19 vaccine from the federal government and has administered 76% of the doses, compared to only 30% of delivered doses administered nationwide. Remaining vials are being held for the 2nd dose for persons in the 1A priority category. 
• Jefferson County will now begin vaccinations for the 1B priority category, starting with the eldest (85 and up) among us.  A drive-through clinic, by appointment, will begin January18, with approximately 550 doses to be given that day. TriCare Pharmacy has received the Moderna vaccine, but has limited supplies, with more pharmacies applying to receive vaccines.  About 7,000 county residents are in the 70 years of age and older category in 1B and Jefferson Healthcare will administer these vaccines as they become available from the state. While supplies now are limited, Dr. Locke expects this situation to be temporary until the new administration takes office. Availability for appointments and clinics will be announced on the Jefferson Healthcare and Public Health websites.

Answers to questions submitted by KPTZ listeners:

• Citizens are encouraged to listen to their recorded messages left by unknown callers in case it is a message left by public health contact tracers with important medical information. Citizens can also register with “Notify WA” which is a cellphone app developed for contact tracing to see if you have been near a person who now tests positive for COVID-19. About 25% of the Washington residents are enrolled. 
• COVID-19 restrictions are not a reason to restrict use of the community warming center for the homeless.  It requires vigilant infection control practices, as the homeless population is on the lowest tier of Phase 1B for vaccinations.
• Increased COVID-19 cases here are NOT likely due to the new coronavirus strain. But it is inevitable that we may have this strain spread here because it is more conducive to spreading easily. 
• Safer travel beginning in the summer is dependent on the supply of vaccine, and the numbers of persons vaccinated for the greatest protection. Travel with the United States may be safer than internationally.
• Advice on gathering with friends after completed vaccinations is premature at this time. Five percent (5%) of persons vaccinated will not develop immunity and we must follow the public health recommendations until risk of infection is mediated by mass vaccination. 
• Forty cases in our youth is a lower percentage than in other counties, telling us that our 0-19 population has been acting responsibly. Ages are spread across the range, with our first incidence of infection in a 2 months old. 
• No case of influenza A or B have been reported in Jefferson County, with 2 cases of Influenza B reported by the state to date.  Public health guidelines for COVID-19 are having an impact on this seasons influenza case numbers.
• Confirmed COVID-19 cases are defined by a positive test result with the molecular PCR test and probable cases are defined by a positive result with less-sensitive, quick antigen tests.
• The Institute for Health Metrics and Evaluation (IHME) projection for the peak in deaths late January reflects an increased rise of the population at risk of complication when the general prevalence of COVID-19 cases increases. 
• Gyms may now open on appointment basis only as specified in the “Road Map to Recovery” cited above with some restrictions specified depending on the square footage of the gym to accommodate distancing guidelines. 
• All COVID-19 strains are captured by the currently available coronavirus tests. Epidemiologists are tracking the spread of new strains with sophisticated, but limited genomic testing. 
• Essential workers listed in 1B, over 50 years of age may be dependent on verification of their status from their employers. Verification is not the purview of the health department and needs another mechanism, which has not been established as yet. 
• Licensed massage workers are considered 1A priority category, which is defined as those who work physically close to clients, and tey can be vaccinated now. 
• Currently, limited supplies of vaccines are expected to increase once the Biden/Harris administration is sworn in, with an aggressive rollout of supplies to the states.
• Because the rollout to vaccinate residents and staff in congregate living settings has been slow to start, Jefferson County has used some of it’s vaccine supply to vaccinate staff at our local facilities. Current supplies of vaccines are now being used for residents. 
• Clallam County is starting 1B vaccinations this week courtesy of the Jamestown Family Health Clinic run by the S’Kallam Tribe, who are responsible for vaccinating 1A priority residents in eastern Clallam County. 
• Jefferson County residents should use Phase Finder and information from the local hospital to monitor availability and time for vaccination eligibility.  Dr. Locke wants everyone who makes an appointment to keep it as the supply we have right now has fragile handling limitations. 
• The category 1B (50+ years of age in a multigenerational household) definition is being sent back to the state to be reworked.  The intent is to specify a population of elders that are more at risk in these settings.
• Healthcare providers should not mix and match different vaccines to get to two doses. With increased funding in the recent relief bill, we will stick to the instructions of the vaccine producer according to the FDA licensing agreements. 

Department of Emergency Management Director Willie Bence reported: 

• He is gratified by the response from retired medical professionals stepping up to assist with the vaccine rollout plans. 
• A possible emergency waiver for current non-licensed retirees from the state is beginning to be considered. Some retired practitioners who have not renewed their license could assist in the observation area in mass vaccination clinics. 
• Registration is the only activity at this time in preparation for mass vaccination clinics down the road.  Email any inquiries to [email protected]. 
• Thanks to the Bainbridge Island retired medical core for assisting with vaccinations in Hadlock. 

Remember, the next Public Health update will occur on Tuesday, January 19th due to the Martin Luther King Holiday on Monday.

Submit your Public Health questions to Dr. Tom Locke by emailing [email protected].

Here is one person’s experience: “All of the sudden, I felt like I was drowning in exhaustion and sadness. I could only do two things: BE and BREATHE. Sometimes, the worst thing that we can do when we’re tired is to keep doing more things.”
– BE…I gave myself the gift of just accepting who I was in that moment, even if I wasn’t in a good place. It was okay for me to not be okay.
– BREATHE…I allowed myself to concentrate on breathing. It took about an hour for me to rise back up. But as I practice “be and breathe” I knew that the feeling will pass. It will for you, too.

Then, BALANCE…Life must go on. I’ve had to re-evaluate how much I do, how fast I’ll move and how far I’ll go.

In CONCLUSION…Be gentle with yourself, friends.

The relentlessness of this pandemic has been exhausting and stressful for all of our citizens. Over the summer there was some indication that as a nation we were making some headway on the virus due to our diligence with the behavioral recommendations. Hot spots seemed to be related to increased public circulation, especially large gatherings of non-member households and an increase in virus circulation.

It would not be unusual for people to want to quit following the guidelines in the face of their exhaustion and the confusing messages played out on the media. Some of the thoughts we have all had to contend with include: I am tired of being protective; I don’t care anymore; I want my freedom/independence; the president says it is not a big deal; no one I know has died; when state governments okay the opening of bars, restaurants, gyms, and movie theaters, that means these are safe places to attend.

Likewise, when you see people socializing without wearing masks or social distancing, it looks normal and the temptation is to join in. It is increasingly hard to stick to long-term behaviors that look like all downside and no upside. That’s because the immediate gratification of socializing freely is more appealing than the constant protective measures we do day-in and day-out with the unspectacular reward of not getting the virus.

Think about these symptoms and whether they are present lately in yourself or your family:
• eat or sleep more or less than usual
• trouble focusing (brain fog)
• feel edgy or nervous
• snap at or argue with others
• lack motivation
• unable to stop racing thoughts
• withdrawing from others

The process of changing our behavior has many ups and downs. It is expected that individuals will back slide at times. These are normal reactions to the rigor and determination required to change our behavior. Rather than thinking of pandemic restrictions as something we are forced to do, we can remind ourselves that we are freely choosing these actions to help our loved ones, ourselves, and everyone in our community.

To help with stressors, here are some Healthy ways to cope and recharge your batteries:

1. Take care of your body – exercise, sleep, meditate
2. Limit news intake – read, play games, sort photos
3. Lower your stress – go out in nature, take a bath
4. Connect with others – reach out to others for your mental health and for theirs
5. Accept your feelings – they are normal; stop and listen to yourself
6. Try positive self-talk – I can do this
7. Create new traditions – movie/game nights; cooking, have a child teach you something

If symptoms persist despite using various coping skills, please consider reaching out for help. A good first step is talking with your doctor about current symptoms and asking for recommendations for counseling if they don’t offer it. Remember, most of your contacts are going to be over the internet, so you will interact with a counselor from the comfort of your own home.

I hope this presentation has given you some perspective on the impact of the coronavirus on our mental health and has added some ideas to your skill set of coping mechanisms during these trying times. This is Dick “the Rooster” Keenan and my wife, Kate Keenan on KPTZ FM 91.9, saying, “Stay well and stay informed.”