Seattle’s Virus Success Shows What Could Have Been

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SEATTLE — Facing the nation’s first widespread coronavirus outbreak, some of Washington State’s top leaders quietly gathered on a Sunday morning last March for an urgent strategy session.

The virus had been rampaging through a nursing home in the Seattle suburbs. By the time the meeting began, the region had recorded most of the nation’s first 19 deaths. New cases were surfacing by the hour.

As the meeting’s presentation got to the fifth slide, the room grew somber. The numbers showed a variety of potential outcomes, but almost every scenario was a blue line pointing exponentially upward.

“My God, what on earth is going to happen here?” the King County executive, Dow Constantine, said he was thinking as those in the room, increasingly uneasy about meeting in person, left the pastries untouched.

That gathering, three days before the World Health Organization declared a pandemic last March 11, set off a rush to contain the virus that included some of the country’s earliest orders to cancel large events, shutter restaurants and close schools, all in the hope that the dire possibilities in front of them would not come to pass.

One year later, the Seattle area has the lowest death rate of the 20 largest metropolitan regions in the country. If the rest of the United States had kept pace with Seattle, the nation could have avoided more than 300,000 coronavirus deaths.

During a year in which the White House downplayed the virus and other political leaders clashed over how to contain it, Seattle’s success illustrates the value of unified and timely strategies: Although the region’s public health experts and politicians grappled behind the scenes about how to best manage the virus, they came together to present a united front to the public. And the public largely complied.

“We could not afford to have mixed messages,” said Jenny Durkan, Seattle’s mayor.

The restrictions that have been in place off and on for the better part of a year have brought widespread disruption to lives and the economy. But as governors elsewhere have cited the economy as a reason to ease lockdowns, Seattle’s success showed that an alternative pathway was doable: Amid widespread economic turmoil, the state’s unemployment rate has been about average nationally, outperforming some places that have pressed ahead with wider reopenings, including Arizona and Texas.

There are numerous factors that have shaped the trajectory of the pandemic both locally and nationally. In part, public health experts said, Seattle may have benefited from its demographics: a healthy population living in small households and a lot of workers able to do their jobs from home. The city may have also have won more public support for the crackdowns from the shock of experiencing the nation’s first publicized deaths. The high humidity may have helped, scientists say, although the cold weather and gray skies probably did not.

Researchers said Seattle also profited from its network of research and philanthropic organizations focused on global health, politicians willing to listen to them, businesses that emptied their offices early and residents who repeatedly indicated a willingness to upend their lives to save others. Even as the year wore on, and the region’s case numbers were among the lowest in the nation, a survey found that Washington residents were still the most likely to stay home for Thanksgiving.

Ali Mokdad, a professor of health metrics sciences at the University of Washington’s Institute for Health Metrics and Evaluation, said he was convinced the Seattle model could have been replicated, positively affecting the trajectory of the virus across the country.

Instead, he said, state after state reopened sooner than appropriate and members of the public ignored health advice that at times was undermined by conflicting messages from political and business leaders. Seattle, he said, shows what could have been.

“We have so many lessons we have learned here,” Dr. Mokdad said. “Unfortunately, not many people were listening.”

Even before the state’s early stay-at-home restrictions were ordered, Seattle residents had shown a willingness to change their lives.

During the very first week of the outbreak, in March, Microsoft and Amazon — accounting for tens of thousands of workers in the region — encouraged people to begin working from home. Other companies followed. The University of Washington became the first large college campus to adopt remote learning. While the rest of the country was humming with business as usual, Seattle’s notorious traffic eased, and buses once packed with commuters were largely empty. Pike Place Market grew quiet.

Those early adjustments may have helped the region avoid some of the havoc seen in New York, where Mayor Bill de Blasio was saying as late as March 13 that “we want people still to go on about their lives.” The New York region soon surpassed Seattle in coronavirus deaths and still maintains the highest deaths per capita among large metropolitan areas.

Dr. Thomas R. Frieden, the former head of the Centers for Disease Control and Prevention and former commissioner of New York City’s health department, estimated that New York could have cut its spring death toll by more than half had it adopted widespread social distancing a week or two earlier. He said the city continued to have poor messaging about the virus.

As the year went on, after an initial round of lockdowns were ordered across the country, many states rushed to reopen against the advice of experts, triggering a rise in new cases. The Seattle area, where many restrictions remained in place, kept its numbers low through the summer. Although restaurants reopened in June, they were limited to 25 percent capacity indoors.

Other parts of Washington State had more trouble. In the more rural areas east of the Cascades, the virus spread among farmworkers, pushing Yakima County’s death rate to more than double that of King County, which includes Seattle, although Yakima County’s numbers were about on par with death rates seen in many other states.

As case numbers rose around the nation in the fall, John Wiesman, who was then Washington’s secretary of health, and Dr. Kathy Lofy, the state health officer at the time, monitored the area’s case counts. When cases jumped suddenly in November, he said, they advised Gov. Jay Inslee that there was no time to be lost.

“The governor was very clear as well: We’ve got to move now,” Dr. Wiesman said. Mr. Inslee’s renewed restrictions included the closure of restaurants once again. The state’s numbers remained lower than much of the country.

Researchers at the University of Oxford determined that Washington State’s suite of restrictions through the year, all told, were among the most stringent in the nation. Others with strict control measures, including Maine and Vermont, are also among the states with the lowest coronavirus numbers. Some smaller metropolitan areas, including other cities in Washington, Portland, Ore., and Raleigh, N.C., have performed better than the Seattle area; they also embraced broad restrictions.

But there were other states that imposed stringent controls that had serious outbreaks after initially keeping the virus under wraps. One of them was California.

Public health experts have cited a variety of potential factors in California, including more crowded households and the arrival of new virus variants that appear to spread more rapidly. Mixed messages emerged as Gov. Gavin Newsom and Mayor London Breed of San Francisco, who had promoted containment efforts, attended separate birthday parties at the French Laundry restaurant in the Napa Valley, ignoring their own best practices and angering a public weary of restrictions.

The push to reopen in many states was a response to the devastating economic consequences of long lockdowns, and Seattle has paid for its low virus numbers. These days, the city’s downtown retail areas are largely quiet, with many storefronts boarded up. Streets that were once packed with Amazon workers during lunch hours are now largely empty. Some businesses have shuttered for good.

Dr. Jeffrey Duchin, the health officer in Seattle and King County, said the city was still grappling with the right balance between managing the virus and allowing people to live their lives with more normalcy.

The consequences emerging are not just economic ones, he said, but depression, domestic violence, deferred medical care, a drop in other kinds of immunizations, the long-term impacts of children out of school. Still, he said, he is convinced they made the right decisions.

“The other unintended consequences can be addressed and mitigated over time, but you can’t bring people back from the coroner’s office,” he said.

While the industries built around tourism and services are struggling, others have flourished during the pandemic, including the health sector, grocery stores and the tech industry. Construction workers have been able to return to work, as have manufacturing workers at places like Boeing.

By the end of last year, the unemployment rate in Washington State was at 6.3 percent, a bit lower than the national rate, and many business leaders have accepted the governor’s extended lockdown orders without major objection.

“We all want to be able to open sooner,” said Rachel Smith, the chief executive of the Seattle Metropolitan Chamber of Commerce, “but we all want to do it when it’s safe.”

Ethan Stowell, who runs a namesake group of restaurants in the Seattle area, said the company began last year with about 400 employees. The number plummeted to just a handful early in the pandemic, then slowly climbed, with fluctuations during the fall restrictions, to about 140 now.

The restrictions have lasted far longer than anticipated, and Mr. Stowell said he still had concerns about the future of Seattle’s downtown, but he expected this summer to bring a resurgence, with pent-up demand and restrictions easing further. He expects to be back at prepandemic employment levels by the end of the year.

On Thursday, Mr. Inslee announced that as a result of low virus numbers and rising vaccine distributions, the state would open further on March 22, allowing restaurants to reach 50 percent capacity and the Seattle Mariners to host up to 9,000 fans per game at the start of the baseball season.

Mayor Durkan said the consequences of the protracted lockdowns have weighed on her every day. She said she had heard from business owners who have lost everything and laid-off workers who could not pay their rent. But the region simply did not have a choice, she said.

“It was so profoundly difficult because you knew what the human consequences would be,” she said. “There was no course in which there wouldn’t be devastating human consequences.”

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