A tactic of the times: Social media campaigns featured call-outs to medical professionals among public health messages developed to reach young adults — an at-risk group— during the COVID-19 shutdown. (Image courtesy Whatcom County Health Department)
Erika Lautenbach’s first day as director of Whatcom County’s health department was March 18, 2020 — the day after Gov. Jay Inslee announced a statewide ban on large gatherings and closure of in-person dining.
“It was really bad timing,” she said, of assuming the department’s leadership as a global pandemic took hold.
Now in her third year of leading the recently renamed Whatcom County Health and Community Services (WCHCS), Lautenbach can say in retrospect that her department wasn’t particularly prepared for the enormity of what they’d face in the following two years.
“We have never actually had to work on a public health emergency with our emergency partners (before COVID),” she said. “We’ve worked with them on floods and other natural disasters, but there was a lot of confusion about what role the health department would take in a public health emergency versus fire, EMS (or) emergency management.”
Three years after COVID-19 upended society, are state and local organizations ready for the possibility — however unlikely — that another pandemic could strike?
Starting behind
Several things, Lautenbach said, initially hampered WCHCS response to COVID-19.
The organization had been chronically underfunded in the years leading up to 2020, leaving it without appropriate staffing for activities like case and contact investigations, data collection or logistical work like setting up quarantine facilities or testing centers.
The pandemic also revealed that some roles and responsibilities weren’t well-defined. And unlike in more localized emergencies, the county could not obtain assistance from corresponding jurisdictions in other counties, because COVID was affecting all of them at the same time.
As the pandemic continued, things improved.
COVID-related state and federal funds allowed WCHCS to beef up staffing in key areas, Lautenbach said. She was also able to define responsibilities with partners such as emergency management, and to develop solid working relationships with elected officials and the local business community, including nonprofits that relied on guidance and services from the health department.
The trust issue
One unmet priority that continues to produce conversations within her department, however, is the need to have adequate trust from the community. Messaging during the pandemic changed quickly, and was badly affected by internet misinformation.
“We could have had three people working nonstop, just trying to address all of the misinformation,” Lautenbach said. “But that misinformation was so broadly distributed beyond Whatcom County borders that it was really challenging.”
As the pandemic dragged on, pushback on public health measures became increasingly antagonistic.
“I think the line ‘we’re in this together’ applied for about three months,” she said. “Then it was just a downhill slide to outright contempt and mistrust of the health department.”
Lautenbach recounted in an August 2021 interview having received a number of harassing emails; one compared her to Hitler. At the peak of the harassment, a county council member’s Facebook message leaked Lautenbach’s personal cellphone number, leading to a threatening voicemail that compelled her to contact police.
Lives were saved
Still, state and local public health measures saved lives: Whatcom County had the seventh-lowest mortality rate from COVID-19 among Washington’s 39 counties. (San Juan County had the lowest death rate, despite a third of its population being aged 65 or older. As a whole, Washington had the seventh lowest mortality rate nationwide.)
Vaccine uptake was also quite high in Whatcom County, where nearly 80% of its residents were fully vaccinated, and in San Juan County, where nearly 90% were fully vaccinated by early 2022.
Whatcom County Executive Satpal Sidhu said that while Whatcom County could have done better in its initial response, he was satisfied with the overall way county agencies responded and collaborated to get through the pandemic.
Side was particularly pleased with how federal pandemic relief funds were pooled and spent, with decisions made by the county council and an emergency operations council consisting of eight city mayors, Sheriff Bill Elfo and himself.
“Some counties in Washington state, when they got CARES Act dollars at the peak of COVID, were not even able to spend money because they couldn’t agree what to do,” he said. “They had to return the money.”
Restricting restrictions
Lautenbach is also a board member for the National Association of County and City Health Officials (NACCHO).
Several weeks ago, while visiting Washington, D.C., members received a briefing on the changes state legislatures were making to governmental and public health authority as a result of COVID-19. For example, some legislatures have restricted the power to mandate masking or require quarantine for people with dangerous infectious diseases.
Lautenbach said she believes many politicians are responding to pressure from constituents as part of the politicized debate those measures took on during COVID. In the event another deadly virus begins to spread, she said, she’d anticipate those new rules to change quickly.
“We are damn lucky that COVID didn’t kill a whole lot more people than it did,” she said; “because we weren’t prepared, and the only way to be prepared is to have some of these measures in place. I have to believe that, if something else does come forward, that we can all sort of react in a way that helps protect people.”
During Washington’s 2021-22 legislative session, dozens of bills were introduced that would have limited public health mandates associated with COVID-19.
Though most weren’t voted on and many more never left committee rooms, some had the potential to alter containment measures both for COVID-19 and future public health emergencies.
Among bills introduced in the House, one would have banned all state and local government entities from requiring the COVID-19 vaccine in public places. Another would have expanded that rule to all schools and transportation providers; even private businesses would not have been able to legally require the vaccination of employees.
Other bills would have limited the state’s labor and industries department from adapting health-related rules stricter than federal ones; limited emergency health orders to 30 days unless approved by the legislature; and allowed anyone ordered to isolate or quarantine, by government or even private business owners, to decline doing so unless confirmed to be sick and symptomatic.
Yet another House proposal would have prohibited governing health and educational bodies from requiring masks and COVID-19 testing of student athletes unless the virus’s mortality rate hit 5% or higher.
Among those who strongly opposed vaccine requirements was Sen. Doug Ericksen, R-Ferndale, who helped introduce a Senate bill combining several provisions of those House bills in January 2021. Ericksen, whose vaccination status was unknown, died of COVID-19 that December.
Strengthened response
Two bills meant to strengthen public health responses during emergencies did make their way to the governor’s desk.
Senate Bill 5178, enacted in July 2021, codifies something Inslee did during the last pandemic: waive specific state healthcare laws during a state of emergency.
The bill ensures that the governor can suspend healthcare-related regulations — within five days of issuing a state of emergency — if that emergency demands immediate action by hospitals to prevent system failure and ensure their ability to work with emergency management.
This includes waiving required certification of needs for building and opening a new health facility or reopening a closed one; increasing bed capacity in acute care, nursing home and assisted living facilities; and increasing the number of dialysis stations at a kidney disease center.
Also included are waivers for facility licensing, pharmacy licensing and health care provider requirements for medical assistant supervision.
House Bill 1152, also signed in July 2021, was implemented to create public health districts to centralize resources and expedite funding for emergencies. The bill requires counties to make structural changes to county boards of health, adding additional members from several broad categories. These include consumers of public health, community stakeholders such as nonprofits involved in health inequalities and public health practitioners and employees.
Tense talks
Discussion is underway locally on how to comply with HB 1152, but those sessions have at times been contentious.
The Whatcom County Council serves as the county’s health board, and an 18-member Public Health Advisory Board (PHAB) serves as an advising body to both the health board and Lautenbach.
At a Jan. 10 council meeting, applications to fill seven PHAB vacancies were considered. Four were chosen, while five others, including one from antivaccine activist Misty Flowers, were rejected.
During the Jan. 31 advisory board meeting, council members Kathy Kershner and Tyler Byrd criticized PHAB chair Steve Bennett and other committee members for rejecting applications from Flowers and others who disagreed with how health authorities had dealt with the pandemic. Kershner and Byrd maintained that the advisory board’s expansion should allow room to represent community members who disagreed with officials’ decisions.
In the ensuing fraught discussion, council member Todd Donovan abruptly left the meeting; Lautenbach told Byrd his chastising the volunteer members of the advisory board in an open hearing was inappropriate.
What’s ahead?
Seeking to further contextualize the county’s COVID-19 response, the Whatcom County Council hired Seattle’s BERK Consulting to create a report to help improve the county’s response to future disasters.
The 63-page document was completed last September. It highlights the roles, coordination and planning of local agencies before and during the pandemic response, and offers 30 recommendations divided into five categories.
One of the categories — planning, training and exercises — is an area already being attended to.
Sidhu said the county’s department of emergency management is revising its processes and procedures at his request. He also wants to see annual tabletop exercises for the county council, local mayors and county administrators, where proper procedure and chain of command would be discussed.
“It’s very fresh in our minds, what we went through,” he said of COVID. “The situation may not be health-related. It may be something else.”
Eleven of BERK’s recommendations involve health department connection, and Lautenbach said a greater focus is being placed on essential training for staff, including those who are to interact with emergency management.
Overall, Lautenbach said she feels her department is now more prepared than it was before March 2020. State funding has allowed additional nurses, data and communication staff.
“We’ve been able to grow in the areas that are going to be most impactful,” she said. “They’re going to be able to react much more quickly to the needs of the community.”
Still, the uncertainty of what a future public health emergency looks like keeps her vigilant.
“The interventions we used for a respiratory virus are going to be different than for other types of pandemics,” Lautenbach said. “I feel like we’re relatively well-prepared for something that’s similar to COVID. But I think we’d have to rewrite the playbook for something else that was spread in a different way.”
— Reported by Matt Benoit