Community, COVID-19

Letter to the Community - October 15, 2020


Hello Thurston County! Thank you for the very thoughtful questions you have been submitting, keep them coming!

Yesterday in response to rising transmission rates in our community, I made the recommendation for at least a 14-day pause for expansion of hybrid in-person learning. Students who are currently engaged in hybrid in-person learning can continue, but I am recommending no increase in students or days of hybrid in-person instruction while I monitor transmission rates in our community. I recommend schools continue serving students with the highest needs in cohorts of five. This approach ensures the students who need the most support have access to learning and to the extent possible avoids the yo-yo effect between hybrid and remote learning.

As of October 13, 2020, we are still in the moderate transmission range with 61.6 cases per 100K over the preceding 14 days. If we cross the threshold into the high transmission range, 75 confirmed cases per 100,000 population over 14 days, I will alert the school districts and watch our transmission rates closely for an additional 14 days. If high transmission conditions remain, I will recommend transitioning back to remote learning as per the Washington State Department of Health decision making framework for schools with exceptions for in-person learning opportunities for cohorts of up to five students with the greatest need. If moderate transmission continues during this 14 day pause, crossing into the high transmission range seems unlikely, and there is enough health care capacity and public health capacity to support a possible increase in cases, then I will recommend continuing to gradually phase in more in- person learning opportunities per the Washington State Department of Health decision making framework.

Additionally, I issued guidance on resuming athletics on school grounds. I recommend starting conservatively with the procedures and protocols similar to those in place over the summer as they were successful in preventing sports related outbreaks. This includes cohort groups of six players, masking and distancing, minimizing contact between players, and following strict CDC guidelines for cleaning. This guidance is largely in keeping with the Governor’s guidance on school sports for high transmission counties but differs in that initially scrimmages, intra-team competitions, and league games are not allowed. By starting cautiously, I am confident we can maintain protocols to keep our athletes safe while giving them the opportunity to train and practice.

I have been receiving really insightful questions from all of you about our recent spike in cases. The first question is how to interpret our case numbers with regard to the transmission framework devised by the state describing high, medium, and low transmission. In previous letters, I discussed the difference between PCR or molecular tests which test for genetic material from the virus and antigen tests which test for viral proteins. People who obtain PCR tests and test positive are confirmed cases and people who obtain antigen tests and test positive are considered presumed positive cases. In Thurston County we investigate both types of tests the same way and both types of tests are reported in our daily case counts.

While antigen testing is conducted throughout the state, at this time the Washington State dashboards only use confirmed case data (PCR tests) when calculating transmission rates (cases per 100K over 14 days). The decision framework data for schools opening use transmission rates calculated based on confirmed cases. This is consistent throughout the state. You can access this data on the COVID-19 Risk Assessment Dashboard. I calculate our Thurston County transmission rates, which include the confirmed cases (PCR tests) and presumed positive cases (antigen tests) and review local patterns to determine if additional restrictions are needed to keep our community safe and healthy.

I have also been asked about why initially there wasn’t evidence of a significant Labor Day bump. I did a retrospective chart review and found many people who had been symptomatic during the Labor Day infection window did not get tested until the end of their isolation period. Case investigation does not start until we receive a positive test result. Our investigators work backwards to determine when and how an individual likely became infected and who else may be at risk. The other important contributor to our spike is an accelerated spread of COVID-19 throughout our community due to contact with friends and family, as well as coworkers. When levels of community transmission are high, this in turn makes outbreaks more likely, and we are now seeing several outbreaks contribute to our case counts.

Thank you all for your insightful questions this week. Please continue to submit your questions to I am always interested in your thoughts and questions about COVID-19.

Remember to wear a mask in public spaces, maintain 6 feet or more between yourself and non- household members, avoid large gatherings and unnecessary travel, stay home when you are sick, and wash your hands. Together we can stop the spread of COVID-19 in our community!

Wishing you the best of health,

Dimyana Abdelmalek, MD, MPH Thurston County Health Officer

in-person learning, schools, transmission, moderate, remote, athletics, cohort, spike, case numbers, antigen testing


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