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How DOH selected the health care capacity metrics in Gov. Inslee’s reopening plan

In a Tuesday work session, members of the Senate Business, Financial Services & Trade Committee questioned the Department of Health’s (DOH) Lacy Fehrenbach, Deputy Secretary of Health for COVID-19 response, on how DOH developed the metrics used in Gov. Inslee’s Healthy Washington Roadmap to Recovery plan.

The plan includes a few overarching principles, Fehrenbach said. It is a regional approach recognizing interdependency and a reliance on shared resources.

There are only two phases so far. Phase one – referred to as “the circuit breaker phase” – contains the most stringent metrics. Once in phase two, counties can miss one metric and still remain in phase two.

Regions must meet four metrics in order to move into Phase two:

  • Decreasing trend of 10% or more in two-week rate of COVID-19 cases per 100k population.
  • Decreasing trend of 10% or more in two-week rate of new COVID-19 hospitalizations.
  • Less than 90% Intensive Care Unit (ICU) occupancy.
  • COVID-19 test positivity of less than 10%.

How did DOH determine the metrics used in the plan?

Sen. Mark Mullet (D – Issaquah) asked why the state decided on the specific ten percent reduction in case rates, hospitalizations and positive tests as the metrics to determine whether counties are ready to enter phase two.

Fehrenbach said the metrics are based on national frameworks employed in other states. The methodology is also used by the World Health Organization (WHO) and and the Centers for Disease Control (CDC) to assess whether disease is increasing.

A ten percent decline is not a huge one. We wanted to see a meaningful decline to show that disease really is receding. I do want to mention that we have to have some threshold in order to make a determination from a public health perspective.”

How were the test positivity and ICU metrics developed?

For the seven-day test positivity metric, DOH will be looking at the positivity rate of electronically submitted lab results. This gives DOH the ability to compare positivity and negativity over seven days, said Fehrenbach.

The seven-day ICU metric is based on a national framework which, according to Fehrenbach, actually suggest a rate of 85% or lower rather than the 90% rate used in DOH’s plan.

Several committee members were perplexed by this metric, as ICUs usually operate near full capacity and prefer to do so for financial reasons.

Sen. Perry Dozier (R -Walla Walla) asked why the ICU metric would be useful given that 90% capacity was typical for hospitals even before the pandemic.

Dozier said that a hospital is in his district has an ICU at 90% capacity despite having minimal covid cases.

Fehrenbach said that the threshold is necessary for mitigating against a surge in cases. When a surge takes place, hospitals are typically forced to resort to “crisis standards of care.”

The goal of phase one is to prevent hospitals system from getting overwhelmed and limiting beds and staff attention, as is the case under crisis standards of care.

Looking ahead to later phases of the state’s reopening plan beyond phase two, Fehrenbach said DOH has not yet decided whether businesses will have to meet health care capacity metrics.

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