Emergency Orders, School Cancellations, and Planning for Those Who Can’t “Quarantine At Home”

 

Don’t panic, but also, sort of panic.

That was the message during a press conference on new state and local orders to contain the COVID-19 epidemic this morning, when Governor Jay Inslee and King County Executive Dow Constantine announced that all large group events are effectively canceled. Inslee’s order bans all gatherings of more than 250 people, including family gatherings, in King, Pierce, and Snohomish Counties; the county’s order, which was signed by King County Public Health officer Dr. Jeff Duchin, bans gatherings smaller than 250 people unless the organizer can guarantee that they are following every CDC recommendation to contain the spread of the virus. Later in the day, Seattle Public Schools announced it was closing schools starting tomorrow, and the Seattle Public Library board was meeting to discuss potential closures.

Meanwhile, King County Department of Community and Human Services Director Leo Flor told me that a motel in Kent purchased by the county to house patients who can’t be quarantined at home (including both people without homes to go to as well as those who share their homes with vulnerable people) just accepted its first patient, a King County residents. The county, he said, is still working out plans to redistribute people currently living in close quarters in shelters, both by locating large indoor spaces like the Seattle Center Exhibition Hall, where the Downtown Emergency Service Center shelter moved some residents on Monday, and by distributing motel vouchers to people who are not infected but are especially vulnerable to the virus.

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So what do you need to know? Here are the basics, along with a few more specific details about planning for people experiencing homelessness, who are highly vulnerable to the novel coronavirus because of preexisting health conditions, substandard living environments, and lack of access to quality health care.

• Gatherings of 250 or more people will be prohibited until at least the end of March in King, Pierce and Snohomish Counties, an order that Gov. Inslee said would likely be extended and expanded to include more parts of the state.

The goal here is to slow, not prevent, the spread of the illness so that hospitals aren’t slammed with thousands of new cases all at once. “We do not want to see an avalanche of people coming into our hospitals with limited capacity,” Inslee said.

“We recognize that isolation and quarantine are going to be difficult settings for the people in them to be in, and the ability to provide behavioral health on site or by telephone to anybody who’s in one of those facilities is one of our top priorities.” — Leo Flor, King County

Inslee emphasized that the law is “legally binding on all Washingtonians,” but said he did not anticipate having to use state police or the National Guard to enforce it. “The penalties are, you might be killing your granddad if you don’t do it,” Inslee said.

• Gatherings of fewer than 250 people are also prohibited in King County, unless the organizers abide by guidelines established by the Centers for Disease Control to prevent spread of the virus, including social distancing (the CDC recommends six feet), employee health checks, access to soap and water, and other sanitation measures. “Temporarily banning social and recreational gatherings that bring people together will help to ensure that a health crisis does not become a humanitarian disaster,” Constantine said. “Below 250, we thought people, business owners, could take measures to keep people apart,” Inslee says. However, “We do not want to see people shoulder to shoulder in bars from now on. That is just totally unacceptable.”

Duchin said the new rules would allow some flexibility for groups where maintaining six feet of distance is impossible, and Constantine added that the county will be issuing additional guidelines for “restaurants,  grocery stores, and other institutions,” and that enforcement would be complaint-based.

The state and county are working to identify more places where people currently staying in homeless shelters can be moved to create the recommended six feet of distance between cots, mats, or beds, but did not have any additional details this morning. DCHS director Flor told me after this morning’s press conference that the county has been identifying shelters with the highest-risk populations, such as St. Martin de Porres, which serves mostly elderly men, and working to “deintensify” those shelters by moving people out to other shelters or into motel rooms. Flor declined to name specific sites the county is looking at, but said the “critical constraint” was not space but staff. “It’s one thing to have space inside the same building [as an existing shelter]; it’s another thing when we have to actually start moving residents to new buildings with new food requirements and new staffing,” Flor said. “Those are the problems that we’re really focused on.”

As for people without homes who do contract the virus, Flor said the county expects “a significant need to isolate and quarantine the folks who cannot go back to their homes” in new facilities, but did not say where additional funds would come from. The King County Council just allocated $19.5 million, out of a $28.2 million COVID response package, to buy and operate the Kent motel, which has room for about 84 people.

• People who are isolated or quarantined will inevitably include some people with mental health conditions and addiction. Detoxing from alcohol and benzodiazepines without proper medication can be deadly, and detoxing from opiates (or going off prescribed medication-assisted treatment with replacement opiates) is dangerous. Flor told me the county is standing up “integrated health teams” who will support isolation and quarantine facilities with behavioral health care, including continuation of methadone for opiate users on methadone maintenance. “We recognize that isolation and quarantine are going to be difficult settings for the people in them to be in, and the ability to provide behavioral health on site or by telephone to anybody who’s in one of those facilities is one of our top priorities,” Flor said.

 

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