Governor Jay Inslee, right, talks with Incident Commander for the Washington State Department of Health, Nathan Weed, left, while visiting a potential COVID-19 quarantine and isolation site at Maple Lane earlier this month.
One-by-one over the past several weeks, Washington has gone through the steps at its disposal, each one more stringent and disruptive than the last, to limit the spread of the novel coronavirus.
Encouraging hand-washing and cough etiquette. Telling people to disinfect surfaces and stay home if they're sick. Isolate people who are infected and people they've been in contact with. Check, check, check. Close schools, restaurants and bars. Check, check, check.
But there remain a couple tools still unused, tools that would be the most intrusive yet, but that could have the largest effect on stymieing the spread of the virus.
Gov. Jay Inslee said Wednesday it is not yet time to order Washingtonians to shelter in place, ban all nonessential travel, or institute travel cordons, essentially closing off the most infected areas of the state.
Trying to predict if and when that may happen is "a futile thing to think about," Inslee said.
"COVID is expanding in our state, we're concerned about that and we're making decisions as best we can on a daily basis," Inslee said at a teleconference Wednesday, at which reporters asked questions over a conference line to enforce social distancing. "We can't just try to speculate what may happen 30, 40, 60 days from now."
Not everyone agrees.
Judith Malmgren, an affiliate assistant professor of epidemiology at the University of Washington, said she would immediately implement a shelter-in-place order for King County.
In King County, nearly 10% of confirmed cases have resulted in death. Even if you remove the deaths attributed to the Life Care Center in Kirkland, the death rate among confirmed cases is still 3.7% -- alarmingly high -- although that number would certainly be lower if not for the lack of widespread testing, which means officials have confirmed far fewer cases than there actually are. As of Wednesday, there were 1,187 cases and 66 deaths in the state.
"The case fatality rate is going up, not going down. That could be temporary, but it's still so much higher than it should be," Malmgren said. "Not taking measures now and waiting for more information is just foolish."
"It's better to cut off your foot than to lose your leg," she added.
With the number of tests for the virus still constrained, both locally and nationwide, Inslee said they're constantly using a variety of measures to try to gauge both the spread of the virus and the success of the measures they've taken.
He said the closure of restaurants and bars, which he announced Monday, was influenced by looking at emergency department admissions. A spike in ER admissions, even without official confirmation of coronavirus, acted as a proxy, leading officials to believe further steps were required, Inslee said.
Officials look at highway traffic, Inslee said, as a way to gauge whether the "social distancing" measures in effect are having an impact.
"If we've had 30% reduction in traffic, that might be somewhat indicative of a reduction in the social interactions we're having," he said.
The Washington State Department of Transportation said this week they've seen "a sharp decrease on all Seattle area highways" but said it was too soon for specific numbers. The agency did note that on Monday travel times between Seattle and Everett were roughly half what they normally are.
So far, only one place in the nation seems to have taken stricter action than Washington state.
Seven counties in the San Francisco Bay Area, with a population of nearly 7 million, have been ordered to "shelter in place" to try to slow the spread of the virus. The order requires people to stay at home except for "essential needs."
But exemptions to the order are liberal. People can still leave the house for grocery shopping, to care for relatives, to take kids to child care and even to go for walks, but cannot gather in groups of any size. And the shelter-in-place order only says businesses must take all steps to allow employees to work from home "to the extent possible."
"Sheltering in place is a more rigorous form of social distancing," Santa Clara County, one of the affected counties, wrote. "Sheltering at home means stay home, only go out for 'essential activities,' to work for an 'essential business,' or for 'essential travel.'"
In New Rochelle, a suburb of New York City, more than 100 cases of coronavirus have been tied to a single gathering at a synagogue and the state placed a 1-mile "containment area" around the community, closing schools and limiting gatherings sooner than anywhere else in the state. The National Guard was deployed to clean schools and deliver food to people under quarantine. But the name is a bit of a misnomer -- streets aren't closed and people remain free to travel in and out of the zone.
Sheldon Jacobson, a professor of computer science at the University of Illinois who studies public health, said that outside of the Life Care Center in Kirkland, the Puget Sound region hasn't seen a cluster of cases in an area that would necessitate a cordon.
"You haven't seen the spikes, the transmission in any one particular area that would precipitate a containment zone being created," Jacobson said. "If you're going to take a measure as dramatic as a containment zone you better realize that there has to be a payback and benefit to it, because there are great costs to pay."
