By San Juan County Health and Community Services Health Officer Dr. Frank James; San Juan County Health and Community Services Director Mark Tompkins; San Juan County/Friday Harbor Department of Emergency Management Director Brendan Cowan

COVID-19, and the coronavirus that causes it, are dominating the news, our conversations and likely, our imaginations.

Information regarding COVID-19 is developing and changing rapidly. We ask that you recognize the complexity and pace of this situation means that we won’t have all the answers as the understanding of the virus, and how it is spreading in Washington evolves. We’ll share with you where we’re at today and we promise to keep you updated as information changes. This won’t be the last time you hear from us.

As of today, March 5, 2020, there are no confirmed cases in San Juan County. We hope it stays that way, but much of what is written below is based on what happens if it does not.

This FAQ aims to answer some of the most common questions we’re hearing from the San Juan Islands community.

Where can I learn more general information about COVID-19?

The San Juan County Health and Community Services Department is maintaining a list of resources and information HERE. There are specific links for Spanish speakers, businesses, schools, and others. If you have unanswered questions or concerns about coronavirus, contact our hotline at 360-370-7500.

We’re also regularly posting information that we find useful or interesting on the County Health Department Facebook page at https://www.facebook.com/SJCPUBLICHEALTH/.

There is a lot of fear and anxiety about this. Is it really going to be that bad?

In short, we don’t know, and the numbers we need to really understand the implications of the disease aren’t yet available in a way that gives us a specific concrete picture.

For comparison’s sake, seasonal flu has an average mortality rate of about 0.1%. In the United States, between 3 -13% of people to get the seasonal flu each year.

For COVID-19 it is looking like the worst case mortality rate could be as high as 2% but is much more likely to be 1% or even less. Remember that 1% is ten times higher than the average flu year. That is significant.

It is also possible that COVID-19 could infect more people than the flu because it is a novel (new) virus, and people haven’t developed immunity to it. This is also significant.

The main message we think people should know is that there is a very real chance of this being worse than a bad flu season. That doesn’t mean it is a sure thing- it just means there’s a real chance and that we all need to be preparing for that, while also hoping for the best.

What other things do we have to know to better understand the risk?

One key piece of information is that in a “bad” recent seasonal flu year, our healthcare networks are often stretched to capacity. There is concern COVID-19 would tax our healthcare systems even further, resulting in diminished access to advanced care and significant disruptions to service.

A major factor that will impact the COVID-19 situation will be the intensity and duration of the outbreak. If we can slow the spread of the disease so that we face the impacts over a longer stretch of time, we increase our chances of managing the situation. If the impacts come in a high volume and quickly, our resources will be stretched even thinner. This is why social distancing and quarantine strategies used by public health around the world are so critical.

At this point, it is too late to stop the spread, but we can certainly slow it- and slowing it is important.

So, should we be canceling meetings and events?

We think that if you’re organizing an event or meeting that is bringing together 10 or more people and canceling or rescheduling or having the event remotely doesn’t cause you or others any real problems, well then we think you should do so. That doesn’t mean we’re requiring that, but just that limiting social contact at this stage of the disease’s spread is a pretty darned good idea.

OK, what about travel?

Kind of the same answer. Now is a good time to hunker down. If you have to go somewhere for reasons that are important (like medical care or to take care of important business or care for a family member), then you should do it and feel fine with that decision. But, now is probably a good time to think twice about travel for fun or diversion, especially if you’re heading to areas that are known to have a density of active COVID-19 cases.

Look, there is no black and white with any of this. Slowing down disease spread is really, really important on a community wide basis. We do that through hygiene and limiting social contact. Like everything in life, these decisions require balance and good judgment, and in the United States we trust our citizens to be part of the decision making process. There might come a time where the Health Department needs to make direct orders, but we’re really counting on the common sense, thoughtfulness, and resiliency to help the islands through this.

That sounds scary, is there any good news?

It is becoming clear that a relatively large percentage of COVID-19 patients, perhaps as many as 80%, have mostly mild symptoms. It is also possible that a number of people have the illness and have no symptoms at all. It is also becoming clear that most children are experiencing relatively minor impacts from the virus.

It is also possible that as the virus spreads it will evolve to become less virulent or transmissible and the virus will diminish on its own. There is no guarantee that will occur and there are no signs this is happening at this time.

We’re also hoping that COVID-19, like other coronaviruses, will diminish drastically during the summer. We don’t know if that will occur, and we don’t know if it will come back in the fall if it does, but the fact that other coronaviruses behave that way is certainly good news.

What would a coronavirus pandemic mean for San Juan County?

We remain very hopeful about the limited impacts of the COVID-19 in our islands. San Juan County is preparing for a range of possibilities – not to create fear, but to ensure we are ready to serve our community as needed and as we all learn more about the coronavirus.

Just like anywhere on the mainland, there is a chance our islands could see significant impacts in terms of reduced access to healthcare. There may be strain placed on our local clinics, hospital, and doctors’ offices as they struggle to fulfill their missions, given the increased pressure on the system, both locally and on the mainland.

There may be societal impacts due to a diminished economy, reduced spending, and people’s reluctance to travel or gather in public spaces. We’re already starting to see some of this for sure. People being home sick, taking care of loved ones, or school-age children having to stay home could all impact families and our local economy.

There may also be community impacts due to public health strategies needed to slow the spread of COVID-19. There’s no way to know what those impacts could be. At some point, it could be necessary to close schools, limit public gatherings, sporting or community events in order to prevent disease transmission. None of these options are needed at this time and we hope they will not be needed- but the islands certainly need to understand it is a very real possibility.

What do I need to do to prepare?

First, read this article we put out a little while back. Being prepared is relatively simple and achievable. Starting to get ready may help with the feeling of helplessness we all wrestle with given the headlines.

We want people to focus on steps they can take that are simple, common-sense based, and easy to do. There is no reason for panic or taking any drastic measures. The things we all should be doing are fairly straight-forward. Practice good hygiene, focus on self-sufficiency, talk through plans for a school closure, think about ways in which you can work remotely or minimize economic impacts to your business. Not every problem has a solution, but many will and that’s where we should be focusing our energy.

What is SJ County doing to prepare?

The County Health and Community Services Department has assembled a 40 or so person multi-disciplinary team to focus on planning for and enacting the response. This County team is there to provide logistical support, expertise, and information to our incredibly dedicated healthcare providers and emergency responders and to help ensure the County’s core missions of messaging and communication, disease surveillance and monitoring, and providing support for our senior community. There’s more of course, but those are some of the highlights. The focus changes quickly as the situation evolves.

This team is made up of both employees and volunteers from many different departments and agencies, representing a broad range of knowledge. It’s a complex and fast-moving response, but our goal is to ensure that the County’s efforts are rapid, aggressive, and well-coordinated with our partners. Since January, a steadily expanding team has been working on planning, communicating, and preparing for multiple contingencies. They’re working in close contact with schools, healthcare providers, libraries, EMS, Senior Services, public safety and others, including State and Federal agencies. This team is securing supplies, finalizing plans and talking with local healthcare providers about their plans to continue serving our communities during any potential impacts.

While we are all working together, this is a global healthcare crisis. No team, especially from a small community like San Juan County’s has the resources to prevent all of the impacts. We know there’s an innate community spirit to island life that will help the islands get through any crisis, whether it be a pandemic or an earthquake. It is ultimately the responsibility of ALL of us – individual islanders, businesses and other organizations need to take steps to prepare and to work together in any crisis, disaster or emergency.

This flyer was written with an earthquake in mind but has some general advice about adversity and cooperation that might serve us well in this moment.

Can we isolate the islands early on and prevent the spread of disease here?

While this seems to be an appealing idea, it is impractical in this day and age. People are likely contagious with COVID-19 before they show symptoms, so it likely ineffective to screen arrivals to the islands. The logistics of restricting all arrivals would take more resources than what we have available and the reality is that this type of isolation has been ineffective in stopping the spread of disease. Our islands depend on ferries for delivery of many essential goods, and people and trucks to deliver those goods once on the islands.

If I am sick, will I be confined to my house?

We do think that home isolation is a likely and reasonable strategy should we see COVID-19 in the islands, especially in the early stages of the spread. We also think it is likely that people with minor or moderate symptoms will be asked to stay at home and not visit hospitals or other providers in order to reduce the burden on our healthcare system. We will be releasing guidelines to help people evaluate their symptoms, provide effective home care, and evaluate their need for advanced medical care. This page on the County website has some good links from the WA Department of Health.

How or when will the decision to close schools be made?

The decision is made by the County Health Officer, a physician with extensive experience in infectious disease and transmission. It will be made based on active confirmed cases in the islands, and indications that there is active transmission of the illness on the local level. Remember, the decision to close school is not taken lightly. Closing schools is a strategy intended not to completely stop the spread, but to slow and limit it. It is one of the most vital tools in the public health toolkit.

Finally, what about power, water and other essential utilities — do we have to worry about a catastrophic collapse of our systems?

We don’t think so.

While resources might be strained, we’re not going to be experiencing a catastrophic collapse.

That said, this is a great opportunity to remind all of our residents that we are in the center of the Cascadia earthquake country, and we think every islander has a basic responsibility to prepare for the impacts of a major seismic event. Planning on what each of us would need to do after a major natural disaster where we face loss of power, water, ferries and other key services is absolutely something to spend more time learning about and being prepared for.