Public Health Director: State will open slowly

Sue Hansen, RN
Wednesday, April 22, 2020


As I look out my window today at the promise of spring in Montana, I am reminded of how different this spring is from life a year ago. COVID-19 has spread its ugly infection on the world with many countries unable or slow to contain it.

Last week was National Public Health Week. What a very appropriate time to remember and celebrate what public health does every day for our communities and our country and the very important role it has in crises such as a pandemic. Public Health constantly changes to address the needs of the population. It isn’t about the health of one individual, but is about the health of the population as a whole. Whether you think about it or not, public health is here for you 24 hours a day keeping you healthy and safe, whether its clean drinking water, disease prevention and control, vaccinations, or restaurant inspections, its always in the background ready to rise up to the occasion when new threats emerge.

I have been in public health since 1988……. a lot has changed! From a one-person office with a computer I really didn’t know how to turn on to how we operate today with several programs and 3 full-time staff. I have been through Y2K, 9/11, two Rainbow Gatherings, and H1N1 flu outbreak. COVID-19 takes the prize for the most time intensive, all-encompassing public health issue I have ever dealt with. But…public health has been anticipating a pandemic for many years, we didn’t know when, or how, or what virus would cause it but we have been proactive and have been working with community partners for years to develop plans and training to help us learn what our strengths and our weaknesses are and what gaps need to be focused on. Disaster and Emergency Services (DES), Law Enforcement, Barrett Hospital and all the other agencies and organizations are part of the Local Emergency Planning Committee or LEPC which are communitybased organizations that assist in preparing for emergencies.

Even though public health is not in the forefront of everyone’s mind as we see the devastation in the larger hospitals working against time to keep critically ill patients alive and keep their staff protected with limited personal protective equipment (PPE), public health is in the back ground helping manage the COVID response. Using a management process called “Incident Command System” or ICS, this standardized structure allows for a cooperative response by multiple agencies to organize and coordinate response activities. It ensures that the most pressing needs are met, and that precious resources are used without duplication or waste. We make decisions on what information goes to the media, what local resources do we have to help our responders, to how do we manage the enforcement of health department orders and mandates. The Beaverhead City-County Health Board also plays a very important role in the health of the community. Local boards of health are responsible for assuring health needs of their communities are met and policy and program development are completed to meet those needs. Obviously how this is done this looks different in very small populated counties compared to larger counties but they exercise a broad range of authority and bear a great responsibility for public health. Health boards have legal authorities and one very important component of those authorities includes appointing a local health officer. Our local health officer is Dr. Megan Evans. Dr. Evans has been instrumental in the local management of the public health response to COVID. It is upon the health officer’s authority that many decisions and mandates are implemented during responses to public health issues.

The COVID response in rural Montana has been great. Public Health has stepped up to the challenge. Although COVID infection has not yet reached many counties in Montana, every health department has prepared and stands ready to do what ever is needed to protect their citizens. One very important role of the health department is disease tracking. With COVID, this is extremely important.

When a positive patient is identified, the health department begins contact tracing. This can be a very time intensive procedure to investigate all the potential people who may have been exposed to the patient within a 16-day time period from diagnosis. As you can guess, this could include many people. Each of those people would be contacted, and asked to remain in quarantine until their test result is known. If they are positive, then we investigate all of their contacts, and so it can go on. Identifying contacts and keeping people in quarantine for 14 days or until negative testing results are known is crucial to limiting the spread of COVID.

Isolation is keeping sick people isolated so they don’t infect others. Quarantine is keeping people who may have been exposed away from the community to see if they may develop symptoms of the disease.

Currently, we don’t have the resources to test people who do not have symptoms but we know there are people who are not sick that are positive for COVID and can unknowingly spread the disease to others. This is the population that scares public health the most because of the risk to our high-risk population, our first responders and our healthcare workers.

For example, in Dillon, we have nine police officers. Let’s say one officer is exposed to an infected person during a call. That officer has no symptoms 48 hours before he/she becomes sick. The officer would expose other officers, possibly ambulance responders, dispatchers, sheriff deputies, the officer’s family, and other community members. Remember, we go back 16 days…..this exposure could potentially cause many of those that work at the law enforcement annex to be on quarantine. This one exposure could leave our law enforcement community crippled. The same thing could happen in the hospital and potentially leave our hospital with not enough staff to provide services.

From the economic side, this tiny little virus has caused major disruption. Our businesses have endured hardship with most doing it with grace because no one wants to spread this disease. However, it is time to plan for reopening…we can’t continue at this level.

Over the weekend, the governor put together a team of people from around the state to represent local public health, the healthcare system, businesses and industry, tourism, parks and recreation, etc. I was lucky enough to be one of the two local public health representatives to be on the “Reopen Montana” Planning Group. Our task was to come together and provide input to a plan that the governor will use as we look at the future of reopening Montana.

As you know, this will not happen quickly. The state will open slowly. We were tasked to develop strategies and criteria for what would happen at a high, medium high, medium, medium low, and low level. COVID is here to stay…how do we open up our economy and keep our community safe in the new normal. How do we give each county the ability to move through these levels that are appropriate for each community?

The small counties in eastern Montana that have not had any cases (nor have their neighbors) should not be at the same level as Gallatin county. But we must be cautious…businesses cannot yoyo back and forth to the level we are at now because many will not survive this a second time around. We also don’t want to have the issues that Toole County has with a population less than 4,000 with the highest fatality rate in Montana. The governor will let us know what that reopening plan will be this week. In closing, please Beaverhead County, respect the social distancing and handwashing guidance…this virus can’t spread if we remain diligent.