As COVID cases rise and healthcare professionals call for precautions, Montana is left with few viable options

By: - July 29, 2021 5:49 pm

Photo illustration by Fernando Zhiminaicela via Pixabay (Creative Commons)

With the number of COVID-19 cases reported hitting a five-month high and vaccination rates stalling, there are few things that are likely to be done to reverse the trend in Montana.

On Thursday, a weekly COVID variant report released by the Montana Department of Public Health and Human Services demonstrates what health officials had been predicting: That the delta variant of the disease would become the dominant strain, and without taking more precautions, hospitalizations would follow, reversing the downward trend of COVID cases that Montana – and other states – had seen with masking, social distancing and vaccinations.

However, unlike some other states, Montana not only faces an increasing COVID case load, but – compared to a year ago – is left with far fewer options to slow the spread of the disease. For example, the Legislature curtailed the ability of both the governor and local health boards to put into place mandatory public health measures aimed at slowing the spread of the disease, including shelter-in-place orders and masking mandates. Furthermore, House Bill 702, passed by the Legislature, made it illegal to require healthcare workers to get vaccinated, and in some cases, even limited the ability of employers to ask employees about the vaccination status. Finally, on Wednesday, the Associated Press reported that despite recommendations from the Centers from Disease Control and Prevention to use masks indoors, Montana Gov. Greg Gianforte said that he doesn’t believe that’s warranted, and instead ordered the state government to redouble its efforts at vaccination, which has stalled in the state to just below 50 percent of the population.

Delta variant

The number of delta variant COVID cases nearly doubled in the past eight days, rising from 65 detected cases on July 20 to 112 on July 28. The delta variant is considered a “variant of concern” and also includes the U.K. or alpha variant. Last week, variants of concern rose a total of more than 13 percent.

This follows a trend of increasing cases, more hospitalizations and concern for public health officials who fear that more cases translate to a growing likelihood the virus will mutate and that, in turn, could either lessen or destroy the effectiveness of vaccines.

Dr. Neil Ku, an epidemiologist with the Billings Clinic, explained that slowing or stopping the spread of the virus via vaccine or even other measures like masks and social distancing is critical.

Ku said the virus can only mutate – and create new variants – when it’s replicating. For example, it doesn’t mutate in the air or on a surface, but only when it starts multiplying in a host. It’s there that the rapidly-spreading virus can make copying errors, which can lead to a variant. Some variants make the virus less effective and those die out. But some can make the virus more contagious or more resistant to therapy, raising the specter that a pandemic could once again go unchecked.

For example, the delta variant is more dangerous. Its incubation time is four days instead of six, and it appears to spread more quickly. Kaiser Health News reported that the average number of people infected by a COVID carrier at the beginning of the COVID pandemic was two or three, but the delta variant, because of how rapidly it spreads, has raised that number to six on average. It also seems to attach to human cells more easily, making it more likely that a person becomes infected if exposed.

The delta variant is also causing concern for healthcare leaders who were inundated and taxed during the first COVID surge. Hospitalization rates ranged from 3 to 5 percent, but the new variants are proving statistically more troubling. For example, nearly nine percent of the alpha or U.K. variants wind up needing hospitalization, while more than 18% of those with the delta variant end up in the hospital.

Jon Ebelt, spokesman for the Department of Public Health and Human Services, said that 93 percent of all the hospitalizations in the state were by those who are unvaccinated. The delta variant is now the most common variant in Montana, surpassing the U.K. variant, which had been predominant in March through June.

This has led some health officials to call the most recent surge “a pandemic of the unvaccinated.”

COVID

The number of overall COVID cases has ballooned quietly in the state during the past month. On June 28, the state reported 54 new cases that day. On July 28, there were 263 new cases reported, or an increase of just less than 400 percent.

The number of patients being hospitalized is also starting to nudge back up. On Thursday, there were 97 active hospitalizations, 16 more than during the beginning of the week, but far fewer than numbers which topped 400 in the middle of the November 2020.

Currently, Flathead County leads the state in number of active cases with 290 – significantly more than the 163 active cases in the state’s largest county, Yellowstone, or even 149 active cases in Missoula County. As of Thursday, 1,704 Montanans had died due to COVID-19.

Also, 20- to 29-year-olds lead the state in number of diagnoses.

The state has stalled at just less than 50 percent of the state being fully vaccinated at 442,170 people, or 48 percent. Most of the counties with the lowest percentage rate of residents vaccinated are in less populated rural counties. But even counties with the highest rates, Missoula and Silver Bow, don’t approach herd immunity, estimated at some 94 percent by the Mayo Clinic.

Montana counties with the highest and lowest vaccination rates

Missoula County 61%
Silver Bow County 58%
Gallatin County 55%
Lewis and Clark County 55%

Wibaux County 27%
Carter County 27%
McCone County 25%
Powder River County 24%
Garfield County 23%

Montana vs. the federal government

On Monday, nearly five dozen groups came out with a joint statement urging federal leaders to require that all healthcare workers receive mandatory vaccinations as cases of COVID continue to surge beyond the borders of Montana.

While healthcare professionals in Montana largely applauded the national effort, Montana lawmakers stood by the legislation that prohibits employers from requiring – or in some cases – even asking about a vaccine status.

Rep. Jennifer Carlson, R-Manhattan, said nothing recently has dissuaded her that HB702 was the right decision for Montana.

“This is where Montana should lead,” Carlson said. “That is not the job of the federal government. In Montana and a lot of other Western states – (Republican-led) states – it’s a 10th Amendment issue. They don’t have the power to do that, and we will let them know if we’re going to follow the law,” Carlson said, referring to rights reserved to the state and people.

Anthony Johnstone, a professor at the Alexander Blewett III School of Law at the University of Montana, said a possible fight between the state and the federal government over vaccine mandates is a common case of pre-emption, or the concept that federal law prevails when state and federal law are in conflict.

However, he also told the Daily Montanan that Montana wouldn’t necessarily be required to enforce the federal mandate, but the state law may fail in court. Court, he said, is where the fight would likely play out.

Carlson said the media’s constant focus on COVID-19 has distorted the facts of the disease, and continues to stir up controversy.

“COVID cases are dropping and approaching zero,” Carlson told the Daily Montanan on Tuesday. “All the data out there from the World Health Organization and the CDC show an asymptomatic person transmitting the disease is infinitesimally small. I can’t give you an illness I don’t have.

“There’s a lot of pushing of fear that is unwarranted, especially in Montana. People need to remember that we come into contact with thousands of viruses every day. When you get a shopping cart, you can pick up a cold or a flu, but that shouldn’t be a reason to shut down everything.

“If you have a good immune system and eating well and are healthy, your chances of getting the illness is low and fighting it off are high.”

Ku, the epidemiologist, disputed that, saying that while an asymptomatic COVID carrier may have a smaller viral load – the sheer quantity of virus in the body – it’s still possible to transmit it if a person is asymptomatic, and that while breakthrough cases of COVID are small, the outbreak of cases for those unvaccinated appears to be rising quickly. Ku also said the medical record is replete with example of people getting sick and dying who had no other underlying health conditions.

Carlson suggested that rather than quarantining and taking these precautions, Montana should have remained open, and the disease would have run a more natural course with residents developing a herd immunity after exposure.

“If we had done that, the cases would be going down,” Carlson said. “We’re not in a pandemic, we’re in the end stages of the natural progression of a virus.”

She pointed to her undergraduate degree in biomedical sciences from Montana State University as an example of how those with backgrounds in the field can disagree.

“For everyone, if we did this every time we had a virus, we’d never go back to normal,” Carlson said. “The media needs to do its part and stop. It makes people fearful by constantly talking about it.”

She said that media is ignoring any evidence that doesn’t lead to fear.

“There is the state baseball tournament going on right now. And it went on last year, but no one ever talks about the normal things,” Carlson said.

She said even the state’s death rate in 2020 can be explained more by demographics than by COVID. For example, she said the death rate has continued to rise yearly because the “baby boomer” generation has approached the late 70s, meaning more deaths.

“There is no explosion of COVID deaths from 2020,” Carlson said. “There are other important things and all this attention is absolutely ridiculous.”

Instead, she said the media and the country should focus more on the billions the government handed out to develop the vaccine and should look more closely at the number of deaths correlated with the vaccine.

“Convincing people to get a vaccine that will kill them? That’s criminal in my opinion,” Carlson said.

According to the CDC, approximately 342 million doses of the vaccine have been given with a severe adverse effect happening in 6,320 cases. That is an incidence rate of less than 0.0019%, the CDC reports. However, the VAERS report, which gives that information, also said those are reports of people dying within the same timeframe as receiving a vaccination, and the causes of those deaths isn’t necessarily tied to the vaccine itself. For example, people in that count may have also been involved in a car accident or had a heart attack.

When the Daily Montanan asked if she’d recommend getting the vaccine, she said that people need to think seriously about the risks and benefits.

“You first need to consider are you even at risk? Could this product harm you?” she said.

Vaccinating healthcare workers

Vicky Byrd, the chief executive of the Montana Nurses Association and a registered nurse, said her group approved a vaccine stance in May. The two-page statement by the association said that nurses (and members of the public) should be exempted for legitimate medical purposes, like an allergic reaction or a “sincerely held” religious belief. However, Byrd said those cases are a tiny percentage and very rare. In all other cases, she said the group supports vaccination and doesn’t have a problem with the mandate, so long as those two limited exemptions are carved out.

Byrd said it’s not just a matter of protecting patients, but it’s also a matter of protecting the nurses and keeping the workforce safe and healthy enough to care for those who are sick with COVID.

“The MNA recognizes that nurses have a professional responsibility and an ethical duty to protect patients at all levels – as individuals, families, groups, communities, and populations,” the statement said. “We recognize the immense power of vaccines in the history and protection of public health and encourage all nurses, healthcare providers and community members to consider vaccination as an important step each one of us can take to protect ourselves, each other and the patients we work so hard to care for.”

She said the conversation isn’t just about COVID vaccination, but the power and importance of all vaccinations.

“We’re also concerned about measles, mumps, rubella, diptheria. I mean: Who wants those?” Byrd said.

While written largely in response to COVID vaccines, House Bill 702 covers all vaccinations, meaning that healthcare workers could not be forced to have any vaccinations, including the common, longtime vaccines for diseases like polio, measles and pertussis.

“All of us who can get it, should,” Byrd said. “It doesn’t just keep us safe, it keeps everyone safe. We have to all be in this together. We embrace science, and we embrace data.”

Ku said one of the challenges with HB702 is one of public perception. For example, many lawmakers and members of the public probably knew someone who got a mild case and recovered.

“They don’t know the severity of the situation,” Ku said. “If I didn’t work in a healthcare setting, I may not fully understand it.”

He said 80 percent of the COVID cases seem similar to a cold or the flu. But for those other 20 percent of the cases, the severity is serious, possibly requiring hospitalization or leading to death.

Ku said all protections are likely needed to overcome COVID. Until herd immunity is reached to stop the spread of the disease, the virus could continue to mutate. Adopting multiple measures, like masking, social distancing and vaccines, can arrest the spread. Each one of the measures is not a perfect, failsafe method, but using them together makes the spread much less likely.

For example, he said healthcare centers have required masks since they can’t require vaccines. While it’s helped reduce the spread of COVID, pulling a mask down to talk to a patient, eating inside a healthcare facility or even pulling a mask down to talk on a cell phone greatly reduces the effectiveness of the masks.

“The masks aren’t defective, it’s the human factor,” Ku said. “Is it 100 percent? No, it doesn’t work if people don’t use it.”

And when some larger healthcare centers around the state employ thousands, Ku said all it takes is one or two not to follow the protocol strictly for it to be ineffective.

He said asking healthcare workers to be vaccinated isn’t just a matter of personal choice, but also responsibility. He said that often doctors, nurses and other staff work with a number of infectious diseases ranging from the flu to more serious resistant bacteria. He said they have a duty to protect other patients from exposure.

“We always try to leave the patient better than they were,” Ku said. “Vaccinations absolutely play a role. It doesn’t just protect the patients, it protects the workers so that we can continue to be ready to do our jobs. It’s cheap and there’s a return on the investment because vaccination works.”

Jean Branscum, chief executive officer for the Montana Medical Association, the largest organization representing doctors and healthcare providers, said her organization is supportive of ensuring all healthcare workers are vaccinated, with a few very narrow exemptions.

“Physicians have a right to protect patients,” she said. “We need more Montanans vaccinated.”

She said missing in part of the conversation is that if more Montanans would get vaccinated, it would be a literal shot-in-the-arm for the workforce, which could be confident that the economy will remain open and robust.

“We can turn this around quite easily because vaccines are safe and effective,” Branscum said.

Because Montana healthcare workers and employers – with the exception of nursing homes – cannot require or ask about vaccinations, the only line of defense against COVID will be masking indefinitely for both healthcare workers, patients and families.

“Most people thought that masks should be the first things to go away, but in reality, they should be the last thing,” Ku said. “Until significant proportions of people are vaccinated, the masks shouldn’t go away because they not only protect people wearing them, they protect those wearing from spreading. It’s about stopping the spread.”

Already, President Joe Biden said his administration is considering making vaccines mandatory for all healthcare workers in the federal government, including the Veterans Administration.

Public safety

In a controversial, but not unexpected move, the CDC also changed direction and recommended that even vaccinated people begin to wear masks again indoors in places where cases are rising. Thirty-nine states, including Montana, are in that category.

Previously, the CDC had said that those who were fully vaccinated could cease wearing masks. Ku said the move was an effort to incentivize getting a vaccine. However, public health officials admit the move has largely backfired as Americans have been lax – as a whole – in getting the COVID vaccine, and those who were not vaccinated took it as a signal to stop wearing masks, thereby setting cases back on the rise.

“The problem is: It didn’t work. People didn’t go and get vaccinated,” Ku said.

No vaccines, taking off masks and not observing social distancing was a recipe for an increased caseload, Ku said. He noted that the demographics and even the epidemiology of the disease has changed. For example, when the disease first hit, extreme measures were enacted to protect the elderly, including quarantine and social distancing. When vaccines were developed and proven effective, they first went to elderly people, who have among the highest vaccination rate. This has led to a higher percentage of COVID cases and even deaths from younger residents because they tend to be more likely not to get a vaccine, believing perhaps that they are stronger or more immune. He said there’s a good reason the 20- to-29-year-olds are getting sick: They are also the mostly likely group to be together in crowded, indoor spaces.

He said employing all the tools against COVID from masking to vaccination is essential.

“My focus is keeping as many people alive as possible and we’re shooting for maximal protection,” Ku said.

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Darrell Ehrlick
Darrell Ehrlick

Darrell Ehrlick is the editor-in-chief of the Daily Montanan, after leading his native state’s largest paper, The Billings Gazette. He is an award-winning journalist, author, historian and teacher, whose career has taken him to North Dakota, Minnesota, Wisconsin, Utah, and Wyoming. With Darrell at the helm, the Gazette staff took Montana’s top newspaper award six times in seven years. Darrell's books include writing the historical chapters of “Billings Memories” Volumes I-III, and “It Happened in Minnesota.” He has taught journalism at Winona State University and Montana State University-Billings, and has served on the student publications board of the University of Wyoming.

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