INTERPRETIVE STATEMENT RELATED TO PROCLAMATION BY THE GOVERNOR 20-24, RESTRICTIONS ON NON-URGENT MEDICAL PROCEDURES

INTERPRETIVE STATEMENT RELATED TO PROCLAMATION BY THE GOVERNOR 20-24, RESTRICTIONS ON NON-URGENT MEDICAL PROCEDURES

TO: Interested Stakeholders

FROM: Governor Jay Inslee

DATE: April 29, 2020

SUBJECT:     Interpretive Statement Related to Proclamation by the Governor 20-24, Restrictions on Non-Urgent Medical Procedures

Background. On March 19, 2020 Governor Inslee issued Proclamation 20-24 with the goal of ensuring hospitals and the health system would have enough surge capacity and personal protective equipment to manage an influx of patients with COVID-19. The Proclamation applies to services delivered in hospitals, ambulatory surgical facilities, dental, orthodontic, and endodontic offices in Washington State. The Proclamation will remain in effect through May 18, 2020.

As providers across the state have significantly adjusted operations in response to the Proclamation, the need for additional guidance has been identified. The purpose of this statement is to provide that guidance.

It is the position of the State that the Proclamation allows performance of all services considered to be “emergent” or “urgent” for which delay would result in worsening a life-threatening or debilitating prognosis. Clinicians should use clinical judgment to determine performance of procedures considered to be non-urgent or “elective.”

In addition, given the evolving and fluid nature of pandemics in general, and COVID-19 in particular, clinical judgments regarding non-urgent or “elective” procedures need to be viewed through the lens of relative harm to patients of treatment versus deferment, in terms of potential patient and provider contraction of COVID-19.

The remainder of this document pertains to health care services, procedures, and surgeries falling into the non-urgent or “elective” category.

 Considerations in determining “harm” to the patient. The Proclamation limits, “healthcare services, procedures, and surgeries that, if delayed, are not anticipated to cause harm to the patient within the next three months…” The Proclamation goes on to provide examples of procedures to delay, which include, “most joint replacements, most cataract and lens surgeries, non-urgent cardiac procedures, cosmetic procedures, some endoscopy and some interventional radiology services.”

The Proclamation does not provide a definition of “harm.” To clarify, the Governor leaves assessment of harm up to the individual clinician. In order to assess harm, clinicians should consider if a patient’s illness or injury is: causing significant pain, significant dysfunction in their daily life or work, or is either progressing, or at risk to progress. Additionally, clinicians should assess the risk of harm that could be experienced by a patient as a result of undertaking the surgery or procedure during the COVID-19 pandemic.

The decision to perform any surgery or procedure in hospitals, ambulatory surgical facilities, dental, orthodontic, and endodontic offices, including examples of those that could be delayed in the Proclamation, should be weighed against the following criteria when considering potential harm to a patient’s health and well-being as described above:

  • Expected advancement of disease process
  • Possibility that delay results in more complex future surgery or treatment
  • Increased loss of function
  • Continuing or worsening of significant or severe pain
  • Deterioration of the patient’s condition or overall health
  • Delay would be expected to result in a less-positive ultimate medical or surgical outcome
  • Leaving a condition untreated could render the patient more vulnerable to COVID-19 contraction, or resultant disease morbidity and/or mortality
  • Non-surgical alternatives are not available or appropriate per current standards of care
  • Patient’s co-morbidities or risk factors for morbidity or mortality, if inflicted with COVID-19 after procedure is performed

Furthermore, diagnostic imaging, diagnostic procedures or testing should continue in all settings if disease is suspected, based on clinical judgement that uses the same definition of harm and criteria as listed above.

Prerequisites to performance of healthcare services, procedures and surgeries. Foundational to the performance of any healthcare service, procedure, or surgery permitted under Emergency Proclamation 20-24 is the ability to meet infection prevention and control standards, maintain

appropriate personal protective equipment supplies, as well as following Department of Health (DOH)- issued guidance on use of personal protective equipment (PPE). For permitted procedures requiring an overnight stay, hospitals will not exceed 80% of available bed (licensed and staffed beds) capacity.

Specifically, the following PPE prerequisites are required before facilities can perform procedures, surgeries, or services permitted under Emergency Proclamation 20-24:

  • Facilities must provide health care workers (direct patient care and affected ancillary staff) with appropriately sized and sufficient quantities of PPE to perform essential job
  • Facilities must be aligned with Washington State Department of Health’s PPE Usage Guidelines – PPE Conservation Strategies (Yellow), which says personal protective equipment is discarded and replaced when it is soiled, damaged, or hard to breathe
  • Facilities must follow the Washington State Department of Health’s Guidance on Extended and Re-use of PPE by Healthcare Personnel (HCP).
  • Facilities must have on-hand and in the facility 7 days of appropriate
  • Facilities must report accurate counts of PPE available and in the facility daily, as well as PPE on order, to the WA Health
  • Facilities must report following required DOH guidelines for PPE use and conversation to the WA Health
  • Health care workers have access to COVID-19 testing and to timely notification (within eight

(8) hours of awareness) of exposure to COVID-19.

  • Facilities must report on COVID-19 positive health care workers by facility and profession/position to the WA Health

Outpatient clinic visits. The Proclamation permits outpatient clinic visits, both in hospital-based clinics and other outpatient clinic settings. While not addressed in the Proclamation, the Governor encourages clinicians to weigh the benefits and risks of such visits to patients given the active presence of COVID-19 in our communities. He also encourages clinicians to use telehealth visits where possible. If a clinician determines an outpatient clinic visit is necessary, all steps possible should be taken to promote social distancing measures and reduction of infection risk by appropriate use of hand hygiene and PPE-use protocols.

Penalties and enforcement. The Proclamation states, “Violators of this order may be subject to criminal penalties pursuant to RCW 43.06.220(5),” making anyone found to be in willful violation of the order guilty of a gross misdemeanor. The department finds that documented clinical decision- making reflecting application of the Proclamation and this statement to the clinical matter(s) or case(s) under consideration will serve as evidence that performance of the health care services, procedures or surgeries was not a willful violation of the Proclamation.

WASHINGTON STATE COVID-19 RISK ASSESSMENT DASHBOARD LINK (04/29/2020)

WASHINGTON STATE COVID-19 RISK ASSESSMENT DASHBOARD LINK

We’ve had to take unprecedented actions to slow the spread of COVID-19 in Washington. Luckily, we’ve had some success, but until we have a vaccine, protecting the health of all Washingtonians will require ongoing effort. Gov. Jay Inslee and the state’s public health leaders use many factors to determine how to protect the health of all Washingtonians and begin our economic recovery.

TO READ THE MOST UP TO DATE DASHBOARD DETAILS PLEASE CLICK HERE

About this dial dashboard
This dashboard provides a high-level overview of the main data points discussed among state leaders and the level of risk experts perceive around the current numbers. It is not intended to represent the totality of all COVID-19 related data. The state is currently developing several new systems for collecting, compiling and reporting much of the data outlined below and this dashboard will link to those new systems as they are completed. In the meantime, where possible, we’ve linked to the data that is currently available or created a snapshot that summarizes the most recent information available.

This dashboard is updated weekly on Wednesdays.

 

JEFFERSON COUNTY COMMISSIONER WEEKLY MEETING COVID-19 SUMMARY 4/20/2020

Department of Health (Dr. Locke):

  • No new positive cases for Jefferson County reported from Sunday, April 19th.

Case / Test Data:

  • Jefferson County has peaked during this first phase of the virus transmission. We can expect to see additional phases developing until we can develop a robust testing and tracing protocol.
  • Jefferson County is ahead of the curve by 3 to 4 weeks. This is a good thing, but it also makes it harder to see if we are losing ground.
  • 775,000 COVID-19 cases nationally
  • 12,000 COVID-19 cases Washington State
  • 41,000 deaths nationally
  • 634 deaths in Washington State
  • In WA State, of all testing, 9.0% are positive
  • In Jefferson County, of all testing, 4.0% are positive
  • The Washington State COVID-19 website with county data is currently not accurate for Jefferson County. The site is showing that we have 11.0% of all tests are coming back positive, when in fact it is running a little lower that 4.0%. The disconnect is potentially from the national reporting lab network

Advisories:

  • Social distancing not only appears to be working – it is working.
    • Models assume social distancing at least through May 5th.
    • If we stop this mitigation too early additional virus phases will be upon us quickly
    • Doing so could cause positive rates to increase at 3×5 times (worse) rate than we are currently experiencing statewide.

Roadmap to Reopening:

  • How fast we move to re-opening will be based on how fast we can detect.
  • Robust and sustainable testing for only those who are symptomatic and who have been exposed to the symptomatic population, medical/hospital workers, long care facility teams, and first responders.
  • Testing program and protocol is critical, but testing is not enough.
  • Ability to analyze tests and investigate contacts through active and passive surveillance.
  • Outbreak investigations – positive cluster areas defined and mitigated.
    • There was one cluster event in Jefferson County at a residential care facility. That cluster was mitigated very quickly with no additional transmission.
  • Jefferson County is requesting clarification from the governor’s office to relook at some industries as being essential if social distancing protocols can be adhered to. Those would include, but not limited to:
    • Construction
    • Recreational
  • Caution should be heeded on portable immunity testing for anti-bodies. The companies producing the tests are unregulated and tests are typically unreliable.
  • The unknown about re-opening strategies is FEAR. The higher risk population will show a great deal of caution regard moving around safely.
  • We know the reopening is starting to happen because hospitals are starting to perform some elective surgeries.
  • DEM states the COVID-19 is like a 26-mile marathon race, it is important to know that we are in the beginning stages of this race and we are far from the finish line.
  • DEM is modifying and developing virus continency plan timelines for 30-day, 3-month, 6 month and 1-year scenarios.
  • Protests about stay at home. 70 to 80% of the population supports and agrees with the stay at home program. Even though it is inconvenient and annoying, they see the need.

Personal Protection Updates:

  • Jefferson County DEM continues to receive N-95 masks and gloves from WA. State Emergency Operations Center (EOC). There seems to be a shortage of gowns and eye protection. They expect more in the near term.
  • DEM states that 1,000 homemade masks have been produced and distributed. A large demand still exists

JEFFERSON COUNTY HEALTH DEPARTMENT AND DEPARTMENT OF EMERGENCY MANAGEMENT – WEEKLY UPDATE 4/6/2020

Department of Health

  • An announcement will be made later today, and the website updated to show an additional (6) positive COVID-19 cases in Jefferson County. This brings the county total up to 25.

Case / Test Data

  • Jeff Co. has a higher level of testing than do most rural counties.
  • Expectations are that we will experience a factor of 10X (250 in total during the whole outbreak) or more in positive cases.
  • Percent of positive cases per total tested is running at about 50% of statewide levels.
  • Washington is doing 10K tests a day… will be 2x that by next week.
  • Tests are being processed at UofW and local specialized testing locations for quick turn-around
  • National testing labs are no longer being used due to response time of test results which have run as high as 14 days.

Advisories:

  • 20% of people that are infected are a-symptomatic (no symptoms) or pre-symptomatic the 2 days prior to feeling any symptoms when your body is shedding the virus.
  • It is crucial to adhere to organized precaution efforts for the next 7 weeks.
  • King County cases expected to peak mid-April
  • Jefferson County cases expected to peak end of April
  • Highest risk of exposure will be during the next 4 weeks.
  • Case rates are climbing
  • Try to avoid:
    • In person grocery shopping during the next 4 weeks
    • Crowded areas even while social distancing
    • Vacation homes or short-term rentals.
  • If you are sick, do not leave your home.
  • Malaria drugs:
    • Testing should have results in two weeks.
    • These drugs could have some very serious, negative, unintended effects
  • Deaths from COVID-19 continue to be greater in the over 65 age group, with the 80+ being significant.

Updated protocol on grocery store visits.

  • If you do need to go to a grocery store:
    • Wash or sanitize your hands prior to going in the store
    • If wearing gloves, wash or sanitize those prior to going into the store
    • Adhere to the 6-foot social distancing protocol
    • Be aware that stores may be implementing one-way isles to help with distancing.
    • Do not touch anything unless you are taking it. especially perishables.
    • Wear a mask if you are comfortable in doing so.

Personal Protection Updates:

  • Washington State has a stronger supply of PPE – and has developed a more robust vendor supply chain.
  • Gloves – Non-medical personal that wear gloves often do not wash their hands enough due to a false sense of security that glove wearing gives.
  • Masks are good for source control but offer a false sense of security because of improper human use.
    • Masks can increase the risk of infectious spread if people touch the insides where droplets have been deposited.
    • Homemade masks with some filtering media between inner and outer layers are more relevant and act more like surgical masks.
    • Homemade masks should be thoroughly disinfected, washed and dried after each use.
    • People tend not to practice social distancing when wearing masks due to a false sense of security.

Jefferson Healthcare:

  • Has been planning for the surge that is likely to take place this month.
  • Only a limited number of infected patients have been admitted.
  • Although they normally only have 25 beds, there are ways in an emergency, to increase that number substantially
  • There are limited ventilators, however the number is enough for immediate requirements.
  • Jefferson Health is part of an area hospital collective which share resources or take overflow patients if needed.

HOW TO HELP 4/5/2020

Volunteer with Jefferson County Department of Emergency Management

The Department of Emergency Management is interested in volunteers with medical backgrounds (doctor, nurse, EMT, etc.), backgrounds in security (military, law enforcement), other emergency response (firefighters, Incident Command System) or other specialized skills.

More information can be found at: www.co.jefferson.wa.us/1450/VolunteerHow-to-Help

Volunteer or Donate through OlyCAP

OlyCAP offers a wide array of community service programs and can provide help to those in need or can use your help if you’d like to give back to the community.

More information can be found at: www.co.jefferson.wa.us/1450/VolunteerHow-to-Help

Help with Making Face Masks

While many people have stepped up to make face masks for community use, the demand has outpaced our supply! Jefferson County face mask volunteers have set up a Facebook page to help with locating resources. These masks are distributed to disadvantaged citizens, homeless and incarcerated persons; they are not available to the general public at this time.

If you are interested in helping with this project and need help with resources, you can find it here: www.facebook.com/groups/207602053835025/?ref=share

The face mask pattern and instructions can be found at: www.co.jefferson.wa.us/1450/VolunteerHow-to-Help

Donate Blood

Jefferson County Department of Health has coordinated appointment-only blood donations in our area at the following locations:

Monday, April 6 – Port Townsend Elks Lodge, Room 555 Otto, 12 pm to 6 pm

Wednesday, April 8 – Port Hadlock Community Methodist Church, 130 Church Lane, 11 am to 5 pm

To make an appointment or for more information call 1-800-398-7888 or visit: www.bloodworksNW.org

MENTAL HEALTH RESOURCES 3/30/2020

From Jefferson County Mental Health

Benji Project Online Teen Drop-In

  • The Benji Project’s trained teachers will host a FREE one-hour session two times a week to share stress relief, connection and coping practices. Drop in to our Zoom online meetings every Tuesday at 7pm starting March 24, and every Thursday at 4pm starting March 26.

Centers for Disease Control and Prevention: Coronavirus Disease

Discovery Behavioral Healthcare

  • DBH continues to provide a variety of mental health, crisis and medication management services. Please call our office at (360) 385–0321.

Jumping Mouse Children’s Center

National Alliance on Mental Illness 

National Suicide Prevention Lifeline

  • Or call 1-800-273-TALK (8255)

Port Townsend Police Department 

  • Community members seeking resources, please contact Judson Haynes LMHC, SUDP at 360-531-3445 or jhaynes@cityofpt.us

Volunteers of America

Volunteers of America is a national, nonprofit, faith-based organization dedicated to helping those in need live healthy, safe and productive lives. Since 1896, our ministry of service has supported and empowered America’s most vulnerable groups, including veterans, seniors, people with disabilities, at-risk youth, men and women returning from prison, homeless individuals and families, those recovering from addictions and many others.

  • Or call 1-888-910-0416

 

COVID-19 TASK FORCE FORMED

Members of two Village Council Committees, Health & Wellness and Emergency Management, have been combined to form a COVID-19 Task Force to provide two-way communications between Port Ludlow residents and the experts for this pandemic. As the chairs of the two Committees, Jim and Kim Moffitt are heading up this effort and our two Block Captain Coordinators, Pat Lohrey and Mike Towner will help lead the effort. In addition, Paul Hinton and Phyllis Waldenberg from Health & Wellness and PLVC President Bill Dean are actively involved.
The first assignment of the Task Force has been to declare a Limited Activation of the Port Ludlow EM Block Captain program. This is in concert with the limited activation of the Jefferson County Emergency Operations Center. In both cases, individuals will not be meeting, but will be using electronic means to perform their duties. If you have a question or need, contact your Block Captain. If you don’t know who your Block Captain is, contact us through the PLVC website (www.plvc.org/contact) and we will respond to you as soon as possible.
Click HERE to see more details on how the Port Ludlow activation will commence.
We are anticipating the need to communicate what is going on in the area and share information with the County about our situation here in Port Ludlow. COVID-19 Communication with residents will be updated on a regular basis. This has started with take-out food options, along with grocery purchase availability. Opportunities for blood donation and consolidated contact information for Utilities and other subjects is being worked on.
Bill Dean
PLVC President

EMERGENCY MANAGEMENT LIMITED ACTIVATION (March 23, 2020)

On Monday, March 16, Jefferson County declared a county-wide state of emergency, and the Department of Emergency Management (DEM) announced a “Limited Activation” of Emergency Services. In a normal activation, the Jefferson County Emergency Operations Center (EOC) becomes the central coordination point to serve the County.

A Limited Activation means the EOC has been activated, with only limited personnel working at the EOC, and most activities will be performed by telephonic or electronic means.

In Port Ludlow a COVID-19 Task Force has been established which combines the resources of two PLVC Committees, Emergency Management and Health & Wellness.  The Village Council Emergency Management Committee is initiating a Limited Activation of the Block Captain network.  Block Captains will be reaching out to their respective neighborhoods via phone, email or in person, considering social distancing as a priority, to assess the community. Block Captains will answer questions as well as gather needs information.

The COVID-19 Task Force is working with the DEM and Jefferson County Department of Health to provide relevant information on the pandemic and develop methods to respond to our community. We will be sending out additional information about this shortly.

COVID-19 RESPONSE PLAN

OBJECTIVE:  To provide the entire Port Ludlow community with information relative to the coronavirus outbreak and be a resource to assist residents in obtaining supplies and services as required.

PARTICIPANTS:  

  • Health & Wellness Committee
  • Emergency Management Committee
  • Jefferson County Department of Emergency Management (DEM)

ELEMENTS:

  • Use PLVC eblast system to communicate information and status
  • Post information on PLVC website
  • Use NextDoor social media system to further communicate info and status
  • Share all information with SBCA & LMC
  • Develop and maintain resource lists for food, prescriptions and supplies (open?)
  • Monitor Weekly Jefferson County Commissioners’ Meeting COVID-19 Update
  • Monitor Jefferson Healthcare website and information
  • Monitor Jefferson County Emergency Management website
  • Monitor Jefferson County Department of Public Health website
  • Limited activation of Block Captain Program to assist residents
  • Encourage residents to contact Block Captain with questions or problems
  • Encourage residents to use PLVC website to obtain information or assistance

COVID-19 What you need to know

COVID-19 is spreading in Washington state. Everyone should take
steps to protect their health and the health of people around them.

What is COVID-19?

  • COVID-19 is an illness caused by a new type of coronavirus.
  • Most people who get COVID-19 experience mild symptoms
    similar to a cold.
  • Some people, including older adults and people with other
    health conditions, are at higher risk for severe illness.
  • Currently there is no vaccine available.

TO READ MORE PLEASE CLICK HERE