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Public Health Essentials

A place to highlight the work of the Snohomish Health District as well as share health-related information and tips. Have an idea or question? Drop us a line at SHDInfo@snohd.org.

May 22

COVID-19 and Domestic Violence: May 22, 2020

Posted on May 22, 2020 at 8:51 AM by Kari Bray

The pandemic of the novel coronavirus disease (COVID-19) has amplified existing challenges in our community. Where there were cracks before, they’ve gotten wider, and people who were struggling to climb out are facing more obstacles. Many in Snohomish County are dealing with illness, loss, disconnects from social circles and supports, and/or economic hardship.

Domestic violence is one of the issues that is exacerbated during this crisis. This can include physical, emotional, or sexual abuse of children and adults.

The reality is that we won’t have a full understanding of just how much of an impact this pandemic has had on those experiencing domestic violence for many months or, more likely, years. 

But to get a better understanding of what we are seeing now, what resources are available in our community, and how people can help, we reached out to some local experts. We spoke with Lori Vanderburg and Anne Ewalt with Dawson Place Child Advocacy Center, Melissa Mertz with Providence Intervention Center for Assault and Abuse, and Vicci Hilty with Domestic Violence Services of Snohomish County.

What do we know about the impact of the pandemic so far?
When health orders designed to reduce the spread of illness first went into effect, namely the order to stay home except for essential business or errands, there was an initial decrease in calls for services and support related to domestic violence. 

“When people are living with an abuser in a lockdown situation, they can’t call,” Hilty said. “Domestic violence really leaves a trail of emotional pain. And when we say things like ‘stay home, stay safe,’ for some people, that’s not an option. For them, it’s stay home and try to survive.”

A few weeks later, the call volumes began to look more normal. For the last couple of weeks, calls to multiple lines have increased significantly. Questions are coming in to Domestic Violence Services about protection orders, how to navigate the legal system, and what to expect when leaving a violent situation.

Other people are struggling because they left an abusive relationship before the pandemic but now the person they left is contacting them during a vulnerable time, promising that things have changed and talking about financial support when, for many, finances are a serious concern.

“It’s hard to stay strong right now,” Hilty said.

There also likely has been fear of going in for medical care and getting exposed to COVID-19, so people may have hesitated to go in for an evaluation if they were assaulted, Mertz said. Hospitals and clinics are safe, and people should not be afraid to seek care.

“This was a problem before COVID,” she said. “It’s a new problem in the time of COVID.”

For children and teens, closures of schools and activities seem to have decreased reports during what is normally one of the busiest times of the year. Young people don’t have the same access to teachers, coaches, advisors, or other trusted adults they can confide in, and those adults (including a number of mandatory reporters) aren’t seeing children in person to notice signs of neglect or abuse and report it.

Usually, May is a busy month for reports to and referrals from Child Protective Services. That doesn’t appear to be the case this year, Vanderburg and Ewalt said.
 
There is good news about existing supports. Children and adults up to age 22 who were already part of programs or therapy have transitioned well to virtual or tele-health options, they said. 

Aside from unscheduled in-person visits, support services are active. People can call or message. There are hotlines and texting options. Visits can be scheduled for those who need interpreters or who are too young to effectively engage with someone on a screen. 

Overall, people are reaching out more for services as time goes on and health measures are modified or lifted. 

It will be quite some time before there’s a clear picture of how dramatic an impact this pandemic has had on domestic violence. Particularly with children, it may be years before they feel they are in a safe place to tell someone what they experienced, if they ever feel they can do so. Issues like sexual abuse remain taboo subjects for many, and the shame and fear associated with reporting can be overwhelming. There’s work to be done there to reduce shame and stigma so people feel safe in reporting violence. 

But when people are ready to talk, when they want to ask for help, the resounding message from the experts was this: “We are here.”

How can I get help?
For people who are experiencing violence, safety planning and self-care are both extremely important. 

Self-care means doing what you can to alleviate stress for you and your family. What works well for one person may not work for another. Find the things that help you manage your stress in healthy ways. Focus on what is in your control. Find safe, quiet spaces when and where you can. Look for virtual ways to connect with your social and support networks. Consider contacting the advocacy line or crisis chat if you need someone to talk to.

Safety planning includes knowing the resources that are available and where you would go or who you would trust in a personal crisis, such as escalating violence in the household.

You can call Domestic Violence Services or Providence Intervention Center for Assault and Abuse to talk with someone who can help walk you through safety planning. You can call anytime, day or night. Calls are free and confidential.
  • Providence Intervention Center for Assault and Abuse: 425-252-4800
  • Domestic Violence Services: 425-25-ABUSE (425-252-2873)
No one can tell you what to do, and the people on the other end of the line are there to help, not to order. You know your situation best, and the goal is to help you make the best and safest decisions for you. 

If you are in an emergency situation, you can text 911 if you are worried about being overheard on the phone.

Other resources:
  • National Crisis Text Line: 741741
  • National Domestic Violence Hotline: Call 1-800-799-7233 or 1-800-799-7233 for TTY, or if you’re unable to speak safely, you can log onto thehotline.org or text LOVEIS to 22522.
  • Care Crisis Line: 800-584-3578 or 425-258-4357
    Care Crisis Chat: www.imhurting.org 
  • Disaster Distress Helpline: Call 1-800-985-5990 or text TalkWithUs to 66746.
  • The Disaster Distress Helpline provides crisis counseling and support for anyone in the U.S. experiencing distress or other behavioral health concerns related to any natural or human-caused disaster, including public health emergencies.
  • Dial 2-1-1: If you need assistance finding food, paying for housing bills, accessing free childcare, or other essential services, visit 211.org or dial 211 to speak to someone who can help. 
How can I help someone in my life who may be experiencing domestic violence?
Everybody has a role in reducing violence.

Adults who usually make the call about a child who may be in danger are not interacting as directly with children. Other adults can step up. Friends, family or neighbors should call Child Protective Services if they believe a child is being abused. The statewide End Harm line is 866-363-4276, and the number for the region that includes Snohomish County is 866-829-2153. Making the call doesn’t automatically get someone in trouble or divide a family, said Vanderburg and Ewalt. It notifies someone who can look into the situation. Anonymous reports are allowed.

People can also contact Dawson Place at 425-789-3000. They have resources and support for child victims of physical or sexual abuse, and for their families. 

It can be challenging to help an adult in your life who is in a dangerous situation. You cannot force anyone to leave, nor should you.

Safely getting out of a domestic violence situation can look very different for different people. It’s easy for well-meaning friends or family to say “Why don’t you just leave?” without understanding the complexities. 

Violence tends to spike when someone tries to leave. The economic challenges and the fact that safe spaces may be limited during a pandemic create new hardships for those who want to leave.

If you are concerned about a friend or family member who may be experiencing domestic violence:
  • Talk to them. More importantly, listen to them. Call, video chat, or text. Use the mode of communication they are most comfortable with, and let them know that you are there to support them.
  • Don’t judge. Don’t blame or pressure. Trust them to know their situation best, and be there to support them as they navigate the difficult personal choice of whether and when to leave.
  • Know the resources. Have them available for the person you are talking to, and for yourself. Anyone can call the hotlines. If you are worried about someone you care about, call and have an expert talk you through things.
  • Speak up for children. If you are concerned about the safety of a child, you can contact Dawson Place at 425-789-3000 or call Child Protective Services at the statewide End Harm line (866-363-4276).
  • Be open about your own experiences, if you are in a place to do so. Talking about subjects that have been taboo, like child sexual assault, can help take away the shame and make others feel safer and less alone in reporting abuse. Investigations are more effective when people feel they can speak honestly and without fear of judgment.
  • Approach every conversation with the mindset of “What do you need? How can I help?” rather than “Here is what you should do.”
The experts we talked to agreed that it’s important for people to remember that not everyone is in a safe situation right now. Awareness of what others may be going through and a willingness to listen and support are crucial all the time, but especially during this crisis.

“In this time when people are focused on their physical safety and health, it’s important to talk about this, too,” Ewalt said.

Reminder: There are people ready to help, for those who are experiencing domestic violence and for those who are worried about someone else.
  • Providence Intervention Center for Assault and Abuse: 425-252-4800 (24/7)
  • Domestic Violence Services: 425-25-ABUSE, 425-252-2873 (24/7)
  • Dawson Place Child Advocacy Center: 425-789-3000 (M-F, 8-4:30)
May 20

COVID-19 and Contact Tracing: May 20, 2020

Posted on May 20, 2020 at 3:50 PM by Kari Bray

Just as testing is a key piece of the long-term response to the novel coronavirus disease (COVID-19), disease investigation and contact tracing are crucial, as well.

These topics have generated a number of questions, as well as concerns and rumors. We aim to address some of those here.

What is disease investigation and contact tracing?
When there is an outbreak of illness, disease investigators work to identify possible sources, track the spread, and notify people who may be infected before they further spread the disease or become severely ill. It’s a routine part of public health efforts for containing outbreaks and limiting the spread of tuberculosis, sexually transmitted diseases, hepatitis, and other communicable diseases in our communities. This has been a part of daily public health operations for decades. 

Step one is case investigation, where a person who has the disease is interviewed. During the current pandemic, that means anyone who has tested positive for COVID-19. An interviewer asks questions like date of birth, address, gender at birth, race, and ethnicity. They may ask about where you work and what your job duties entail, travel history, as well as the nature and timing of the illness. They will not ask for things like your social security number, financial information, or immigration status. 

Disease investigators also ask with whom an ill person had close contact. The goal is to identify people who were exposed. For COVID-19, that’s generally anyone who has lived in the same home or been within six feet of someone with COVID-19 for 10 minutes or more while the person was infectious.

This kicks off step two, which is contact tracing. Public health staff or volunteers call the close contacts to notify them of possible exposure and provide guidance on how long to quarantine, what symptoms to watch for, and what to do if they become ill. Public health workers are trained and required by law to not reveal the identity of the person who may have exposed the contact, and to protect the personal health information of the people they call.

When is the Snohomish Health District starting contact tracing?
Contact tracing for COVID-19 isn’t new. It started on January 20, when we received notification of positive test results for the first reported case in the U.S.

As for contact tracing overall, public health nurses and other Health District staff do tracing for outbreaks of many diseases. Some examples you may have heard about in recent years include measles, mumps, whooping cough, and hepatitis. And there are disease intervention specialists who work to identify, notify and provide resources to partners of patients with sexually transmitted diseases. The District also has a program focused on preventing the spread of tuberculosis. That work involves contact tracing, too. In fact, the roots of public health in Snohomish County go back more than 100 years to efforts by Red Cross nurses to contain tuberculosis.

So it’s important to remember that contact tracing is not a new effort, not for COVID-19 or for other diseases. It is part of the DNA of public health.

But COVID-19 is different.
Yes, it is. The scale of this pandemic means that contact tracing is a much larger effort that is needed all over the county, state and country. 

The newness of this disease and the lack of both immunity in the population and pharmaceutical interventions – like a vaccine or a proven treatment – also make it unique and challenging. Unlike measles, where high rates of vaccination can help slow or stop the spread in a community, we don’t have widespread immunity to COVID-19. We’re also still learning about the virus and the disease. For illnesses we’re familiar with, there’s a clearer list of symptoms and an understanding of how the illness typically spreads, how long someone is contagious, how long the virus is viable on surfaces, who is most vulnerable, etc. With COVID-19, these are things we continue to learn about.

The other thing that makes COVID-19 contact tracing different from other illnesses is measures like Stay Home, Stay Healthy and social distancing that are in place to help curb its spread. This puts a lot of weight on the success of investigation and tracing to allow more businesses and activities to resume while avoiding a substantial increase in cases that would threaten hospitals’ capacity to provide acute inpatient care. Quick detection and containment of outbreaks are also critical toward achieving this objective. 

So how many contact tracers do you need?
This is a long-term effort, and the exact number of staff and/or volunteers dedicated to contact tracing will likely fluctuate throughout as case numbers change.

The Health District has increased training and reassigned staff from other programs, hired new staff, and worked with volunteers through our Medical Reserve Corps to amplify our contact tracing work. 

Training is ongoing for temporary employees and volunteers with our Medical Reserve Corps to help boost that capacity from about 10 full-time equivalent positions as of early May to about 30 full-time equivalent positions for disease investigation and contact tracing. If cases and contacts get beyond the capacity of the Health District, the Washington State Department of Health (WA DOH) provides support and can draw on additional help, such as the National Guard staff who have been trained for this work by WA DOH and will be supervised by state or local public health workers.  

What happens if I test positive?
People who test positive for COVID-19 can expect a phone call from the Snohomish Health District or the Department of Health, often followed by an email with information on isolation and illness prevention. 

The phone call is to make sure you are aware of the positive test result and provide guidance on how long to isolate from others and how to prevent the spread of illness. The disease investigator also does an interview and will ask questions to identify others who may have been exposed. Then periodic follow-ups will be done via text or phone call to support adherence to home isolation directives, answer questions, or make referrals as necessary. Generally, the length of isolation is at least 10 days from the onset of symptoms and for at least 3 days after fever has resolved and cough or other symptoms have improved.

What happens if I’m a close contact of a case?
If you are called by public health because you’ve been identified as someone who was in close contact with a confirmed case, you’ll be asked to quarantine at home. That means staying home and away from others for 14 days, while monitoring for symptoms of illness. You’ll be provided with information on what symptoms to watch for, and if you develop those symptoms, we encourage you to contact your medical provider and to get tested for COVID-19.

If you develop symptoms or if you test positive, you will be asked to continue to stay home and away from others until at least 72 hours after your fever is gone (without fever-reducing medication), other symptoms are improving, and at least 10 days have passed since the start of symptoms.

Let’s talk about what doesn’t happen.
Rumors and misinformation have caused fear for some about what happens to themselves and their families if they are identified as either a case or a close contact.

First of all, the case interviews and contact notifications are almost always done by phone. Public health staff or public health-supervised National Guard members are not being sent to houses to round people up. Our priority is reducing the spread of illness, which means we want you to stay home and avoid in-person contact with others, including our disease investigators.
 
You may also have seen rumors about people being forced into isolation and quarantine facilities. If you do not have a safe place to stay during a COVID-19 illness due to unstable housing or inability to maintain distance from vulnerable members of your household, the county does have a location available. However, the preference is for people to isolate or quarantine at home. We do ask that you maintain distance from household members during your illness, but you can do that by keeping to your own room and limiting contact in shared spaces.

There has also been concern about children being taken away from parents or guardians if the child or parent becomes ill with COVID. If there is COVID in a household where children are present, the same steps should be taken as in other households – stay home and away from others, practice good cleaning and hygiene, and call your doctor if you (or your child) develop symptoms or if they worsen. It is a good idea to make a plan for who would care for your children if you were to become severely ill and needed to be hospitalized. We encourage you to talk to family, friends or neighbors you trust.

Our staff and volunteers also are trained to protect patient privacy. Information is provided in aggregate on our case counts page, but we do not provide personally identifiable health information. 

How can I help with contact tracing?
  1. Volunteers are welcome through our Medical Reserve Corps. They can support us with a variety of public health efforts, including drive-thru testing, call centers, and contact tracing during COVID-19. Learn more or sign up at www.snohd.org/MRC
  2. For paid positions, including temporary positions needed during this emergency, you can monitor for job postings at www.governmentjobs.com/careers/snohd.

For new staff or volunteers brought on to help with contact tracing, a three-hour course is required to start training. The course is through the Association of State and Territorial Health Officials.

Additional training is required before they begin actually doing contact tracing with the Health District. They also shadow public health staff conducting contact investigations and have closely supervised training calls prior to operating independently.  

Please remember that one of the best things you can do to help with contact tracing and the overall response to COVID-19 is to continue following guidelines to keep yourself and others healthy. By limiting close contact with others, you reduce the likelihood that you will become ill and you reduce the number of contacts in the event that you do. This helps keep contact tracing manageable for our team and others working to address this pandemic.
May 13

COVID-19 and Pets: May 13, 2020

Posted on May 13, 2020 at 11:19 AM by Kari Bray

Post by Jennifer Egger, Snohomish Health District

Pets are members of our family, so making sure that they are healthy and happy is important. Right now, our local veterinarians are working hard to keep their patients, clinics and employees safe from potential exposure to COVID-19. Because of this, your normal visit to the vet might look a little different. Here are some tips on what to expect when you need to seek care for your pet.

When to make an appointment
pet 3Veterinary clinics are currently moving toward re-opening all services for their patients. However, many are still postponing non-urgent procedures, so you may be asked to reschedule some care. That doesn’t mean routine care needs to be delayed for your pet. Please call your pet’s doctor if you need to know what types of appointments, tests and procedures they are able to provide at this time. If your animal has a need for an emergency visit, call your vet immediately. They will advise you on how to get treatment. Veterinary practices are working to serve your pets in the safest and most responsible way, and they may also have remote options for advising you on your pet’s routine or non-urgent care. They will be able to help point you in the right direction regarding when and how your animal should be seen. 

Visiting your veterinary clinic

Pet 5Many local veterinarians have developed new procedures to limit potential exposure to COVID-19. When you make an appointment for your pet, they should advise you on what these new practices are. Some clinics may ask you to stay in your car so that they can pick up or examine your animal directly from your vehicle. Because social distancing may be difficult in this situation, please wear a face covering to reduce the risk of spreading illness. Make sure that your animal is either leashed or in a clean, portable crate for easy transfer if needed. Do not send blankets or toys with your pet. When you pick up your animal after their visit, make sure you clean their crate with pet-safe antibacterial wipes or spray. 

Your doctor may also suggest telemedicine as an alternative to an in-person appointment. With telemedicine visits, vets can either speak to you over the phone or via video conferencing to determine what kind of treatment your animal needs. Please ask your animal’s care provider if this is an option that might work for you.


COVID-19 exposure
At this time, there is evidence that our pets are at low risk of catching or sharing COVID-19. More research is being done to determine how the disease may spread to or from dogs and cats. It does not appear at this time that companion animals are at high risk of getting or spreading the virus, but it’s important to be cautious because we still are learning about the virus that causes COVID-19.

Veterinarians are not currently testing pets for COVID-19 unless they have close contact such as being in a household with someone who has a confirmed case AND show significant symptoms, which are fever, coughing, difficulty breathing or shortness of breath, lethargy, sneezing, nasal/ocular discharge, vomiting, and diarrhea. Clinics are following expert advice from the CDC regarding how to proceed in the case that a pet needs additional testing or care for this condition. If an animal needs to be tested, veterinarians must work with the proper state authorities, namely the Washington State Veterinarian, to authorize that testing. More information on that is available on the Washington State Department of Agriculture’s website.

pet 4When making an appointment for your animal, it’s important to let clinic staff know if it has been exposed to someone with COVID-19. If you have recently tested positive or are exhibiting symptoms of the disease, we recommend that you isolate yourself from other humans and animals in your household. People who have tested positive should try to restrict contact with pets until they are recovered. If you can, establish a caregiver for your pet in the event that you are unable to do so. Make sure that you have written instructions that include your pet’s diet, habits and any medications. 

Keeping your pet safe
There are some simple steps we recommend in order to help keep your pet safe from potential COVID-19 exposure.
  • All animals carry germs. Please follow the CDC’s “Healthy Pets, Healthy People” guidelines regarding proper interactions with pets.
  • Owners should not let pets interact with people or animals outside the household. 
  • Maintain at least six feet of distance from other people or animals when walking your dogs. Avoid dog parks or public gathering places, particularly if they are crowded.
  • Keep cats indoors when possible.
  • Service animals should be permitted to remain with their handlers, in accordance with the Americans with Disabilities Act.
If you have any questions about the health or safety of your animals, please contact your veterinarian for guidance. They will be able to help you make the best decisions about how and when care is needed and address other concerns regarding COVID-19 and your pets.