Dr. Riechers speaks

Dr. Riechers addresses the Washington City Council Monday, Sept. 21.

A new policy in response to the ongoing COVID-19 pandemic was approved by the Washington City Council in a 7-1 vote Monday night. It restricts the rental of city facilities, including city park pavilions, streets and other city property, for mass gathering. It goes into effect Oct. 1.  

Joe Holtmeier, Ward 4, cast the no vote, telling The Missourian he felt “we need to mask up,” and the restrictions on mass gatherings do not go far enough.

“We started a dialogue with the council of what metric we should use to go ahead and consider not allowing our facilities to be used for mass gatherings (50-plus people),” said Washington City Administrator Darren Lamb. “Last month, we discussed the positivity rate, and we shared that with sources to get guidance and Mercy, who provided us with additional information.”

Last week, Mercy Hospital Washington Chief of Staff Dr. Tom Riechers sent a letter to Washington Mayor Sandy Lucy and other city officials urging swift action to mitigate the spread of COVID-19 in the city.

Riechers asked the council in his letter to consider three actions, one of which was limiting or modifying planned public gatherings like Sunset on the Riverfront and the Fall Arts & Crafts Festival.

“As I look through these numbers, and I have been receiving the daily reports from the Franklin County Health Department, I am very concerned about the rising cases,” said Riechers, who added the metric system the city is looking at has the Franklin County area in the red zone.

According to Emergency Management Director Mark Skornia, the metric system is based on the Harvard Global Health Institute and a Washington State-based model known as the King County Model, and it focuses on three things: daily cases per 100,000 population on a fourteen daily rolling average; whether the risk of being hospitalized with COVID-19 is changing; and whether the risk of death from COVID-19 is changing.

If approved, Lamb said. city staff would review the metrics each Monday and if two or more of the metrics are met mass gatherings on city property would be canceled for the week. 

Each metric is coded as green, yellow, orange or red zone to determine the assessed threat COVID-19 poses.

The daily cases per population is based on average of the total number of cases for the last 14 days per 100,000 residents. The target is for the fourteen day rolling average to be less than 25. Per Riechers, anything greater than 25 puts the city in the red zone; between 10 and 25 case-average would be in the orange; 1 to 10 average would be yellow; and anything less than 1 would be green.

The red (zone) is the tipping point where a large enough group in the population is spreading the virus in more of a “geometric explosion” rather than in a linear fashion, Riechers said.

According to the model, Franklin County was in the red zone for two of the three metrics measured on Sept. 18 and 21.

On Sept. 18, the total number of cases in Franklin County on a rolling fourteen day average was 26.07  per 100,000 people. Three days later, on Sept. 21, the average had increased to 28.78. Both dates were also in the red zone for increases in hospitalizations, which includes both intensive care and non-intensive care patients at all hospitals in the county.

Moving forward, Skornia says the city will be using hospitalization data from Mercy Hospital in Washington to evaluate that portion of the metric.  

Council members Jeff Patke, Ward 3, and Mark Wessels, Ward 2, agreed the metrics could be helpful.

“The reason why I feel these metrics (are) more helpful than the percent positive test is that this puts it into numbers of what we are seeing on an everyday basis,” Riechers said. “A certain percent of those cases will translate into a certain number of hospitalizations. The other metric that I think is important is our hospitalizations increasing and what is the capacity of our hospital to take those admissions.”

Riechers reiterated his other two requests for the council to consider, which were requiring mandatory face coverings and hand sanitizer stations at the entrance to all public facilities and public businesses and requiring mandatory employee face coverings, gloves and appropriate hand sanitizing policies at restaurants and food take-out sites.

Eric Eoloff, president of Mercy Hospital Washington, spoke to the hospital’s capacity.

The hospital is currently able to treat 100 patients. Currently there are 14 patients in the hospital with COVID-19, three of whom are on ventilators, who range in age from mid-40s to 80s, according to Eoloff.

While 14 patients may seem like a lot, Eoloff said, the hospital is “built for many patients,” including patients with cardiac issues, strokes and emergency medical treatment. The hospital also has maternity services.

According to the data Eoloff presented at the meeting, the facility has seen an increase in COVID-19 patients since July.

“Most days I have maybe a bed available in my critical care unit ready to accept my next critical care patients. ... I am not going to have an ICU bed for them soon,” Eoloff said, adding he plans to meet with EMS leaders across the county to develop a plan in case the hospital runs out of beds and must transport patients to other health care facilities.

This poses its own threats, he said, as it would take an ambulance out of service for an extended period of time, affecting the response rate for those in need of emergency care from first responders.

The hospital’s heightened concerns come as flu season approaches, said Dr. David Chalk, a Mercy physician, who shared with the council a report detailing the flu season trends for regional Mercy facilities since 2016.

In 2018, there were more than 3,500 cases of Influenza A and more than 700 cases of Influenza B during the peak of the flu season. In 2019, there were more than 3,500 cases of Influenza A and around 100 cases of Influenza B during the peak.

In 2020, the flu season peaked in February with more than 3,000 cases of Influenza A. Officials did not report on the number of hospitalizations related to Influenza A or B.

Chalk said as the hospital approaches flu season, a spike with 10 flu admissions per day could be problematic with the current concern of bed space. “There are a limited number of things we can do to help lower the number of cases of COVID in the community and the flu,” Chalk said.

One precaution would be a flu vaccination. Chalk reported that Mercy held a flu vaccine clinic where 150 people were vaccinated.

“We are going to do everything possible to dampen these spikes, but left unmitigated, the issues and scenarios that Eric alluded to are going to be unlike anything we have ever seen,” he said.

Council member Steve Sullentrup, Ward 1, encouraged the council to begin using the Harvard Global Health Institute and King County Model metric Oct. 1, so Downtown Washington, Inc. could host its Sunset on the Riverfront and Fall Festival of Arts & Crafts this week.

Tyler King, executive director of Downtown Washington, Inc., told The Missourian that masks will be required at both events.