An interview with Dr. John McCarthy, MD: Okanogan County Health Officer
Dr. McCarthy reminds us to make choices that support the community, rather than the individual, to move our schools and economy forward.
OCPH Question: What is the role of the Health Officer in Okanogan County?
Dr. McCarthy Answer: The role of the health officer is a little different than a traditional doctor or nurse. The role of the health officer is to protect the public at large. It is not so much about a single individual, but rather about the community. The goal is to keep the community safe and healthy. Some examples range from making sure septic tanks or sewers don’t dump out onto someone’s drinking water supply, to tracking down outbreaks of gonorrhea or tuberculosis so we can keep those diseases in check. Most recently, health officers have been focused on COVID-19 and working to keep it under control in communities.
Q: What role does the Health Officer play in making decisions to reopen schools?
The health officer’s role is one of collaboration. I have the honor of working with the superintendents from the Okanogan County school districts, and they have been excellent. They are absolutely committed to the kids in their schools and to getting them back into school. They see the need and they are asking ‘how can we do this safely?’
As a team, we’ve talked about ideas like small group sizes, classes outside if you can, wearing masks, those kinds of things. We’ve talked about testing, who should be excluded from getting into the classroom, and how do we maintain safety. We met a few times in preparation for ‘early entry’, and created some exemptions for very high needs students. Now, we have met a threshold and so we are talking about initiating hybrid schooling.
Q: What other factors are you considering?
We are also working with school nurses. None of us were trained in pandemics, and school nurses could use some support around this. Also, how to interpret different tests. With our overall goal being how to protect those who are most vulnerable amongst us.
Q: What can our community do now to help with reopening, and prevent a re-closing?
It comes down to the entire community. It is not just the students, not just the teachers, not just the parents, it’s the entire community. If the community can say, ‘I have to make some sacrifices for other people, or ‘I don’t want to wear a mask, but I can keep my community moving forward by doing this’, that’s going to be the most helpful.
There are some communities who have said ‘We’re going to take this on as a community’ and they have done better. And that means ‘I’m not going to have a big wedding, I’m not going to go to a church that has a lot of people close together without masks’.
It’s the basic things that we’ve been told for a long time, and the same things that helped get rid of the 1918 flu! Which was ‘wear your mask, social distance, wash your hands’. This stuff really hasn’t changed, and it’s kind of boring but it’s actually really effective.
We all want the economy and the schools to be open, and moving forward. And so, we have some responsibilities as a community if we’re going to be successful with that.
Q: Is there a certain incidence rate (# of cases within the population) the county needs to reach to be considered safe enough to open?
The number for schools is 75 cases per 100,000 people over the previous 14 days (to open modified/hybrid schooling). But, the minute you dip to 74 cases is not the time to say ‘open all the schools up!’ Nor will it be the time, when it goes to 76 cases, to say ‘close all the schools down!’. There’s a little more finesse than that. But 75 is when we say ‘let’s try some things, let’s go slow and do a hybrid model’.
If the rate continues to go down to 25 cases per 100,000 people for 14 days. Then we can say ‘hey we’ve been really successful, we can open up and then we can contact trace every new case that we get’. And that is the goal: to be able to identify how many people have the disease, and prevent them from passing it on.
Q: How does testing influence our ability to measure the incidence rate accurately?
It’s important to know the incidence (number of cases) and percent of tests that are positive. With schools, the goal is to have 50 negative tests for every one positive test, and so you’d want to test the community significantly. For example, if somebody has a scratchy throat, test them. We would rather be able to name that disease than let people walk around with scratchy throats that are really mildly symptomatic COVID-19 carriers.
So, the way you do this is test anybody who has any symptoms of COVID-19 and test people who have had contact with people who were sick. If you have symptoms, definitely get tested. And if you test negative but your symptoms are serious, get tested again because no test is 100% effective.
If you have contact with someone who is sick with COVID-19, get tested. And if you have to keep in contact with someone who is sick because you live in the same house, either decide that you’re going to quarantine with them, or get tested again.
Q: What sort of safety precautions should we expect at school in order to protect kids/teachers/staff once we reopen?
In school, we’re not in a bubble, so we still need to do everything we said before and we have to double down. We have to adapt to a new normal. We all want to go back to the old normal, we’re comfortable with it, we like doing things the way we used to. But the reality is that we just simply can’t do that or the disease will come back with vigor. So that means new protocols, new distancing, new reminders, and listening to best medical advice, like the Washington State Department of Health website–this is a place for good information that we can trust.
Q: What role does testing play in the reopening and monitoring of schools for COVID-19 cases?
If we could all take a $1 nose swab or saliva test and figure out if we have the disease, that would be super. I think we’ll get there, but we’re not there yet. It could be done daily. So the best thing to do right now is to test very liberally: test anybody with any symptoms.
Public Health and people working on the tests are still figuring out the best way to do the testing: there are mail-in tests and home tests now but they’re not the best for detecting the virus in people who do not have symptoms. We need to be able to tell the difference between people who have the virus and have symptoms, and people who have the virus but who do not have symptoms. The tests for these different groups are different, and new tests are being developed regularly on this disease that is now 248 days old in the state of Washington.
Q: What ongoing program for testing students will be needed to ensure students are safe and that schools can remain open?
Public Health and the schools are working together to come up with a testing plan that makes sense. There will be nothing that is 100% accurate, and there will be COVID-19 in the community, and we need to accept that reality. But at the same time, we need to work to absolutely minimize how many people get it.
To be successful with reopening, we need to keep the disease out of the schools. If the disease gets into the schools and is being transmitted, then we will not be successful. Some of us may not like the test, but if we want our schools to be open then we need to compromise a little bit and say ‘ok, I’ll let my child get tested’.
Q: Setting Covid-19 aside, how important is reopening schools to the general health and welfare of the County?
Very important. Incredibly important. Some people have said ‘you’re just trying to shut us down’ and that is the last thing we want to do. The economy needs to be strong for our health, children need to be in school for our health, and that is absolutely a high priority.
Q: Any final parting thoughts?
The economy and schools will be able to move forward if people make community supportive choices, as opposed to individual supportive choices.
If we work together as a community we will defeat this. If we are divisive as a community then we will lose to it. And I think we’ve proven that–we have come together and significantly reduced community spread.