COVID-19 cases are as high as ever. Hospitals are overcrowded with patients and understaffed. Emergency vehicles are waiting hours to drop off patients, delaying their return to help others. Eight schools are having outbreaks of 10 or more cases.

And the Kitsap Public Health Board wondered Tuesday what to do.

Bainbridge Island City Councilmember Kirsten Hytopoulos was open to having customers of businesses show proof of vaccination. “We’re sandwiched between three counties that do it,” she said of King, Jefferson and Clallam.

Kitsap Public Health Officer Dr. Gib Morrow said King County predicts it will have up to 76,000 fewer cases because of its mandate.

While some board members said mandates should be decided by each jurisdiction, Hytopoulos favored a more all-encompassing approach. “Take the politics out of it,” she said. “This is a dire public health emergency.”

County Commissioner Rob Gelder and others were against putting any more demands on small businesses, who have struggled to survive during the pandemic. He said when businesses try to enforce mandates with customers it creates a divide.

“Let it be their choice,” he said of businesses, adding they can market themselves as being vaccinated only. “It makes them stand out. It gives their patrons a level of comfort.”

He said for those who won’t get vaccinated, have them show proof of a recent test instead.

Morrow said while numbers have dropped some the past week they are still higher than they ever were before the past month or so. He said they are still “high” in the transmission range for everywhere but Bainbridge Island. He said more people age 40 and younger are getting it now. In some instances, unvaccinated healthcare staff is giving COVID to older residents, who are not getting as sick as before because they are vaccinated. But he did say deaths are way up with 52 in the last two months, compared with nine the two months before that.

“What gets lost in the numbers is each is a member of our community,” said Dr. David Weiss, associate chief medical officer at St. Michael’s Medical Center. He said conditions of patients worsen quickly, and they become “sick enough to be in the hospital.”

“The vaccine really makes a difference in keeping people out of the hospital,” he said, adding 83% of patients are unvaccinated.

Answering a question by Poulsbo Mayor Becky Erickson about “Crisis Standards of Care,” Weiss said patients are always triaged for care. “That’s a typical part of any emergency department,” he said, adding it depends on how long a patient can wait and what their condition is.

Surge plan

Weiss said they have been so busy they have been delaying surgeries and transferring patients to other hospitals.

Central Kitsap fire chief John Oliver said he’s had to take patients as far away as Tacoma General and Harborview Medical Center in Seattle. He asked the board to develop a medical surge plan.

Morrow said there is a surge plan, and it’s ongoing. It involves using the Medical Reserve Corps, which is basically retirees doing triage. “There just aren’t enough people to staff the facility and its completely demoralized workforce,” he said of St. Michael’s.

Erickson told the health board that to get people to get life-saving COVID-19 vaccinations they just need to get the facts. She and others on the health board said there is too much misinformation out there, and they need to do a better job of sharing factual information. “We have to refute the claims we’ve been hearing,” she said.

She also said mandates should be done by jurisdiction, rather than the entire county. She said only four of her city workers are unvaccinated. She said they won’t be fired immediately, but, “If you get sick, it’s on you.”

“Mandates are important in order to get our whole population safe,” Erickson said. However, she doesn’t think mandates should include private businesses. “That would just make them more angry,” she said.

Poulsbo fire chief Jim Gilliard also spoke. He said when patients are taken to St. Michael’s often they “have really long waits.” He said in the past few months 35 times they have had to wait over an hour. He said he heard about a Bainbridge Island case where the wait was 3 1/2 hours. “It doesn’t just affect COVID cases,” he said. “It affects our entire community.”

Gilliard suggested putting triage centers in front of the emergency room, so “we can get our crews back into service.”

COVID updates

Prior to the meeting, the Kitsap Public Health District put out updated information about COVID.

COVID remains at its highest level of the pandemic in Kitsap County, with over 700 new cases diagnosed each week since mid-August. Last week, there were 21 cases on Bainbridge Island and 90 in North Kitsap.

The cases countywide have resulted in over 219 hospitalizations in the past 30 days, and at least 28 deaths in the first three weeks of September, alone, the district says. There have been 184 deaths countywide since the pandemic began in March 2020.

Last week, the district was investigating 34 active outbreaks. The outbreaks are in a variety of settings, including long-term care facilities, healthcare facilities, workplaces, correctional facilities, schools and community events, the district says.

The surge is driven by the highly transmissible Delta variant and most severely impacting the unvaccinated. The district says it is critically straining a depleted and fragile healthcare system, which is now operating at levels approaching “crisis standards of care.”

Hospitals packed

Hospitals are at or beyond capacity due to staffing shortages and increased COVID hospitalizations. If the county reaches “Crisis Standards of Care,” health systems and providers are required to deviate from usual standard or care or use criteria to ration or selectively administer limited resources. The district says that means that medical staff may have to choose between who gets care and who doesn’t. That has happened already in northern Idaho, Montana, Alaska and parts of the Southwest.

The district says outbreaks and infected staff, primarily unvaccinated staff, in nursing homes have delayed patient discharges from the hospital, contributing to the already high COVID inpatient levels, which in turn has resulted in the need to “board” new admissions in the Emergency Department. That means there are not sufficient beds available to handle emergency patients. Additional impacts include ongoing delays of non-urgent surgical procedures for issues such as joint replacements, cancer resections, cardiothoracic interventions and other surgeries.

The district says vaccinations are the only tool to keep the economy and schools open, and to prevent the pandemic from further damaging individual and community health, the healthcare system, and the collateral damage to the economy, businesses, schools and government.

As of Sept. 21, 71% of Kitsap residents 12 and older had received at least one dose of COVID vaccine, and 65.5% were fully vaccinated. That is slightly below the state average of 75.8% with one dose and 68.9% fully vaccinated. Over 166,000 Kitsap residents have received at least one dose.

The district says to turn the tide the state needs to increase vaccination rates, and people need to wear face coverings in public indoor and crowded outdoor spaces, stay home when sick and get tested for COVID when appropriate. Also, the health district strongly recommends that local businesses in the hospitality and entertainment sectors voluntarily enact vaccination requirements for employees and patrons.

State employees and contractors, healthcare workers and education professionals who still need to be fully vaccinated in order to meet Gov. Jay Inslee’s Oct. 18 mandate have until Oct. 4 to receive the single-dose Johnson & Johnson vaccine to be in compliance.