A flood of patients seeking testing and medical attention for COVID-19 has prompted physicians in the Treasure Valley to restructure their hospitals and clinics, even as much of the state continues returning to normalcy under Stage 4 guidelines.
Nearly 40 family doctors say the area’s reopening is no longer sustainable — and they’re calling on health districts and elected leaders to do more.
In a letter sent to Gov. Brad Little and Treasure Valley officials, 39 Boise-area doctors urged officials to codify prevention efforts into tangible policy, including a return to Stage 1 in Ada and Canyon counties and a mask mandate in Canyon County.
Idaho was averaging 25.4 new coronavirus cases per day — confirmed and probable — when reopening began May 1. That average reached as high as 568.9 on July 19.
“Our current rise in numbers is a direct response to an unsafe (reopening) in Idaho,” the letter reads. “Managing an outbreak of this scale requires a multi-scale and interdisciplinary system overhaul.”
A return to Stage 1 would involve closing restaurant dining rooms, gyms, bars and nightclubs and ending all public and private gatherings. Visits to senior living facilities would be stopped. Ada County is in Stage 3 at the direction of Central District Health; Canyon County is in Stage 4 with the rest of the state.
“People with exposures are overwhelming our outpatient COVID-19 testing sites. Our local laboratories are struggling to deal with the influx of tests,” the letter reads. “As medical providers in Ada and Canyon counties, we are doing all that we can in the spaces we occupy. … But we depend on you to interface within your spheres of influence and to be thoughtful leaders to the people you serve.”
Dr. Ryann Milne-Price, who wrote the letter, regularly tests patients for COVID-19 and cares for patients with the virus at the Family Medicine Residency of Idaho clinic where she works. For Milne-Price, the “juxtaposition” between the devastating effects of the virus she sees every day at work and the way the virus was being handled outside the clinic’s doors prompted her to write the letter.
After drafting the letter, Milne-Price sent it to family doctors she knows in the Boise area. It took only “two or three days” to gather the signatures, she said.
“The part of society pretending this isn’t real, when you’re seeing so much destruction and death from it in the hospital, became increasingly difficult to swallow,” Milne-Price said.
Milne-Price often sees patients who are unable to stay home from work because they don’t have paid sick leave. Many of these patients, she said, could have avoided contracting the virus if policy had been in place to mandate masks in the workplace and guarantee paid sick leave for employees — both of which are measures the letter urges officials to take.
EDUCATION VS. MANDATES
Dr. Julie Duncan, a family physician in Boise who signed onto the letter, specifically wants to see a mask mandate implemented in Canyon County — Ada County already has one. Canyon leads the state with 26.6 confirmed coronavirus cases per 1,000 residents.
Duncan, like Milne-Price, said tangible policy implementation is critical to preventing the pandemic from escalating further. To her, the rise in newly infected patients entering her workplace every day is caused by a lack of strong public health mandates in the Treasure Valley.
“I do not see this being sustainable long term,” she said. “If we don’t do something dramatic to help stop the spread, we will see a real strain on our system. … It’s clear that public health measures need to be implemented.”
Amy Bowman, a spokesperson for Nampa Mayor Debbie Kling, said the city of Nampa encourages the use of face coverings and adherence to safety precautions, but is not considering implementing a mask order.
Little has taken a similar approach to his coronavirus response, encouraging Idahoans to follow public health guidelines but refraining from issuing a statewide mask directive or a return to an earlier reopening stage. In an email to the Statesman, Marissa Morrison, Little’s press secretary, wrote that the governor would keep the state in Stage 4 but support health districts and mayors in implementing further measures as they see fit.
“Ada, Canyon, Twin Falls, Bonneville and Kootenai counties continue to be hot spots for virus activity,” Morrison wrote, “but half of Idaho’s counties are reporting minimal virus activity. The shift from a statewide approach to a more localized approach in our COVID-19 response is appropriate.”
But Milne-Price and Duncan said measures that fall short of tangible orders won’t cut it.
“It’s almost like they’re taking like this free-market-economy approach to a public health crisis,” Milne-Price said. “We need a different approach.”
The letter will be provided to the Nampa City Council, Bowman said, but there has been no dialogue between the city and the physician signatories since the letter was received. Spokespeople from the Caldwell and Boise mayors’ offices did not comment.
Milne-Price said that she had only received a response from one of the 12 entities the letter was sent to — Central District Health thanked her for her comments.
Russell Duke, director of Central District Health, said the agency was not likely to implement a sweeping Stage 1 order. Instead, he said the district would focus on smaller, more targeted mandates. After seeing cases arising from “birthday parties and backyard barbecues,” Duke said, the CDH Board of Health approved an order Aug. 11 restricting social gatherings in Ada County to 10 people or less.
ADA, CANYON UNDER DIFFERENT APPROACHES
Duke said several Board of Health members have voiced concern that the lack of a mask mandate and limited gathering orders in Canyon County could increase the case count in Ada County.
Ada has the state’s seventh-most cases per capita.
“No matter what we do over here, it’s going to make our job more challenging to control the virus when you have the influence of a neighboring county that’s not necessarily taking the same level of action,” Duke said. “It’s not like they’re not doing anything, they’re just taking an educational approach versus a public health order approach.”
Southwest District Health did not respond to the Statesman’s questions.
The letter also calls for “clear and consistent messaging about physical distancing, mask wearing and hand hygiene” and “strict regulations and standardized protocols around masks, sanitation and distancing” for businesses. It says further infrastructure for free testing sites needs to be built, hospitals need more “space, equipment and personnel,” and “schools need to have clear and robust plans for operation and alternative learning structures.”
“Only when these measures are in place,” the doctors write, “can we reopen, to a new and safer society.”
PROMINENT PROVIDERS RAISE CONCERNS, TOO
The 39 signatories are not alone in calling upon policymakers to take the advice of medical experts into consideration. In an Aug. 17 letter to school boards and districts in the Treasure Valley, Southwest and South Central Idaho, nine leaders of prominent medical providers — St. Luke’s, Saint Alphonsus, Primary Health Medical group and Saltzer Health — outlined steps school districts should take when deciding whether to pursue in-person schooling.
“Look, I have enough gray hair. I’ve earned it, “ said Dr. David Peterman, the CEO of Primary Health Medical Group who serves as chairperson for the committee of care providers and spearheaded the letter. “I’ve been through H1NI … I’ve been through recessions. I’ve been through earthquakes. Nothing in health care in this valley, in this state and, frankly, in this country, has been like this.”
Peterman and the other medical leaders stressed that schools must assess the transmission levels of COVID-19 in their communities before they decide to open in person and should not open in areas where community transmission is substantial. Peterman identified positivity rates in Ada and Canyon County as “too high.”
“As health care leaders, over the last five months we have spent countless hours redesigning our organizational processes to assure the safety of patients, staff and health care providers. As new information became available, innumerable adjustments were required,” the letter from the medical leaders says. “Similarly, your institutions will need to monitor the prevalence of COVID-19, adapt your processes to mitigate risk, respond to outbreaks in the schools and adjust your plans as needed.”
Like these leaders, Milne-Price and Duncan said they’ve had no choice but to confront the devastation of COVID-19 head-on. For them, the virus is anything but an abstraction, and the road ahead is long.
“This isn’t going to just go away on its own, it’s not gonna just burn out,” Milne-Price said. Doctors and nurses at her Boise clinic have begun reusing their N-95 masks, which are increasingly in short supply.
“Until we have a vaccine and until that vaccine is distributed, it could be upwards of a year. So we need to figure out how to exist so that people and their loved ones aren’t dying,” she said.