HomeMy WebLinkAbout07132020 City Council Work Session City Manager Memo r
Memo
From: Scott W. Meszaros, City Manager
To: City Council and Seward Community
Re: COVID Recovery Plan Metric Analysis and Report
Date: July 9, 2020
Introduction
The purpose of this report is to provide Council with information regarding the City-wide
COVID-19 outbreak discovered on June 29, 2020, and an assessment of the risks
posed by this outbreak under the City's COVID-19 Recovery Plan.
Background
On June 29, 2020, the Seward Incident Management Team became aware of a rapid
increase in positive COVID-19 cases within the City. The City Manager, in his role as
Incident Commander of the City Incident Management Team, consulted with medical
advisors, the Mayor, Vice Mayor, and State of Alaska medical officers regarding the
scope of the outbreak and the immediate steps needed to preserve public health and
safety.
The City's medical advisors immediately recognized the dangers posed by the outbreak
and unanimously recommended the City Manager declare a "Code Orange" alert, which
would trigger the City's Community Outbreak Rules. The City's medical advisors
warned that the rapid increase in COVID-19 cases would continue to drastically
increase, overwhelming the City's medical care capacity and testing capabilities.
In response, the City Manager immediately activated the COVID-19 Recovery Plan,
which requires the City Manager to conduct an analysis of certain metrics before
declaring a "Code Orange" alert. The Mayor and Vice Mayor began working on
emergency regulations to increase social distancing and reduce the risk of COVID-19
transmission within the City before the 4th of July weekend. The City Clerk issued
numerous public information announcements and worked with the Incident
Management Team and the Chamber of Commerce to cancel all 4th of July events
within the City and notify the public of these changes.
At a special meeting held on July 2, 2020, Council adopted the emergency regulations
sponsored by the Mayor and Vice Mayor via Emergency Ordinance 2020-006, which
became effective immediately upon posting. During that meeting, the City Manager
advised Council that the Medical Unit leaders had recommended a "Code Orange" alert
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and warned that the City was likely going to experience an even greater increase in
COVID-19 cases in the coming days. The City Manager informed Council that he
expected to issue a "Code Orange" declaration in the next few days but, given the
potential economic consequences of a "Code Orange" declaration and the imposition of
restrictions on the personal freedoms of the public, he was waiting for data needed to
complete the COVID-19 Recovery Plan metric analysis. At that time, data regarding the
outbreak was limited to only a few days and while hundreds of tests had been
performed, the majority of the test results had not yet returned. Dr. Anne Zink, Alaska's
Chief Medical Officer, and Dr. Joe McLaughlin, Alaska's Epidemiologist, both attended
the meeting telephonically and answered Council's questions regarding the outbreak.
Over the last week, the City has received much more complete data regarding the
outbreak and the risks it poses to the community. The City Manager, relying upon
substantial input by the City's Medical Unit leaders, has determined the risks identified
under the COVID-19 Plan metric analysis will warrant a "Code Orange" declaration if a
substantial reduction in daily COVID-19 cases does not result from the social distancing
and facial covering regulations recently adopted by Council. While the City Manager is
not declaring a "Code Orange" alert at this time, he has scheduled a work session to
ensure Council and the public understands:
1) What a "Code Orange" alert means for the community; and
2) The metric analysis justifying a "Code Orange" alert.
City Attorney Wells will be present at the Council work session and will lead Council in a
discussion addressing both of these objectives.
Objective No. 1: Understanding What an "Orange Alert" Means for the Community
While many members of the public are familiar with the City's Recovery Plan and the
"Code Orange," "Community Outbreak Rules," and metric analysis adopted in that Plan,
the actual impact of the "Community Outbreak Rules" on individual activities and
business operations warrant additional discussion.
The Community Outbreak Rules are very simple. Rule 0-1 rolls back the City's
reopening efforts to the State's "hunker down" order that was in place Statewide
beginning in late March and ending April 21. Rule 0-2 requires individuals subject to a
medical quarantine order to comply with that order. The State's former "hunker down"
order essentially required Alaskans to stay home, except for essential services, and to
practice social distancing if they needed to go out. While the "hunker down" order
placed a great burden on Alaskans and Alaskan businesses, it substantially slowed the
spread of COVID-19 across the State. That order also was much more permissive than
it appeared at first glance. An individual subject to that "hunker down" order was still
permitted to enjoy outside activities such as running, hiking, fishing, berry picking,
hunting, and so on. They could go grocery shopping or head to the hardware store, both
of which offered "essential services." Restaurants were open for carry-out and delivery.
Retailers and any other business that could socially distance and had less than 10
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people on site at any one time were also classified as "essential." Hotels and lodging
operations could rent rooms to essential workers and those engaged in critical
infrastructure positions. Essential businesses included plumbers, electricians, car and
bike repair shops, transportation providers, accountants, attorneys, government
workers, construction workers, fish processing plants, medical professionals,
commercial fishermen, and many more. While the "hunker down" order had devastating
economic impacts on many businesses, its important to remember that it was not a full
"lock down." In the event a "Code Orange" is declared, it is important that the public
and Council fully understand what the consequences of that declaration will be. To this
end, the upcoming work session will go a long way to building public familiarity with the
Community Outbreak Rules. Also, the work session packet materials include draft
"Code Orange" information handouts and flyers.
Although the "hunker down" order adopted by the State and incorporated in the
Community Outbreak Rules was not a complete "lock down," it undoubtedly placed a
substantial burden on numerous businesses and deprived individuals of valuable social
interactions. For these reasons, the City's Recovery Plan only permits the City
Manager to declare "Code Orange" after completing a comprehensive analysis of
certain metrics and getting Council approval. Further, the imposition of Code Orange is
only intended to be temporary and only in place for the minimum amount of time
necessary.
Objective No. 2: Understanding the Metrics as Applied to the Outbreak
In assessing the risk COVID-19 poses within the City and determining if "Code Orange"
is justified, the City Manager, with guidance from the City's Medical Unit, considers four
metrics, namely: (1) epidemiology; (2) testing; (3) public health capacity; and (4)
healthcare capacity. The following is a summary of the metric analysis conducted by the
City Manager in light of the recent outbreak. In conducting this analysis, the City
Manager relied substantially on the City's Medical Unit and the data these advisors
have been working hard to provide the City as quickly as possible. This data summary
and analysis is substantially based upon data and circumstances from Friday, June 26,
2020, through July 2, 2020, which will be referred to as the "Assessment Period"
throughout the metric analysis. City Attorney Wells has been prepped on this analysis
and is prepared to walk through this analysis with Council at the work session.
1. Epidemiology
The first metric requires a review of COVID-19 trends and trend forecasting, which
warrants a "Code Orange" declaration when there is an increase in the transmission of
COVID-19 in Seward or a substantial increase in neighboring communities within
Seward's industry markets, fisheries or transportation lines that has not triggered a
change in the State's alert level.
During the Assessment Period, the State recorded 283 new cases of coronavirus,
including residents and non-residents. Four Alaskans required hospitalization for
COVID-19 during the Assessment Period and one additional death was reported. Of
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these cases, there were 27 new resident cases on the Kenai Peninsula, 21 of which
were in Seward. Seward had the third largest number of COVID-19 resident cases
during the Assessment Period. Wasilla had the same amount of cases as Seward while
Anchorage and Fairbanks had 99 and 24 cases respectively. The Kenai Peninsula also
had 10 non-resident cases, the exact locations of which were not identified.
The State of Alaska has projected an "epidemiological curve" as a predictor of the
upcoming growth of the spread of COVID-19 within the State. The State's
"epidemiological curve" chart is included below. As the State explains:
The analysis projects "growth or reduction in cases predicted in the
coming weeks based on the growth of cases in recent weeks. The most
recent 7 days (grey bars) are not included because there can be a delay in
reporting data. This model assumes exponential growth or reduction in
cases and can be a useful tool to visualize how quickly cases are
increasing or decreasing. This curve does not project what might happen
if more people start wearing masks or increase physical distancing; it
assumes Alaskans and visitors to Alaska do not change their behavior.
The dotted line is the average prediction, and the grey shaded area is
estimated error for the predicted rise in cases. Currently, cases are
predicted to double about every 14 days.
Epidemic curve by onset date, Alaska
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The City "epidemiological curve" would, based upon the other metrics, presumably
exceed that of the State. That said, recent data for the City is showing a reduction
rather than growth of cases, perhaps suggesting that City Council's recently adopted
social distancing restrictions and facial covering requirement is slowing the spread of
the virus within the City and altering the City's COVID-19 "forecast."
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2. Testing
In analyzing this metric, a problem arises if the City's testing capacity diminishes or
testing becomes unavailable at the community level and the Incident Management
Team and its Medical Unit determine that there has been a substantial increase of
COVID-19 positive cases and the evidence suggests that these cases are highly likely
to result in substantial exposure to COVID-19 within the City and protective measures
are necessary to curb the spread of COVID-19 before the pandemic overwhelms the
City's limited medical resources. The data provided for this metric was reported for the
assessment period of June 25, 2020, through July 3, 2020. As a result, the comparison
with State testing results is not exact. It is, however, still very helpful as the amount of
days analyzed are equal and the implications of the results remains unchanged.
During the Assessment Period, the State of Alaska reported 17,358 tests conducted
and a positivity rate for the Assessment Period of 1.47%. This means around 15 in
every 1,000 tests performed within the State came back positive. This rate was almost
double the rate from the previous week. It is important to note that not all positive tests
represent distinct positive cases as some patients with COVID-19 are retested.
However, the State reported that retesting had no significant effect on the Assessment
Period positivity rate.
In the City, approximately 937 tests were completed, resulting in 35 positive results
from June 25, 2020, through July 3, 2020. This results in a positivity rate of 3.73% if the
outstanding tests are included and 4.5% if the outstanding tests are excluded. In the
State's metric analysis, the State aims for one positive per 1,000. Thus, the City's
positivity rate is, at best, more than double that of the State.
The City's testing capacity, however, remains strong and all medical advisors report
sufficient test availability. Another important factor in considering testing, is the speed in
which results are generated. The faster test results are returned, the faster individuals
with the virus can be notified and isolated from others. This is also a key component of
effective contact tracing. Consequently, the increased wait times for lab results places
the City at greater risk of transmission.
3. Public Health Capacity
The City's public health capacity is significantly impacted by the commercial fishing
industry, tourism, and the influx of intrastate and interstate workers and visitors at
certain periods. During these periods, any COVID-19 positive test may warrant
temporary imposition of greater social distancing restrictions. The City's fish processing
facilities have not reported COVID-19 positive cases resulting from the outbreak.
Conversely, seasonal workers from the tourist industry have been reported within
1 It is worth noting that the data does not differentiate between data regarding
coronavirus cases within the City versus surrounding areas. Thus, these numbers
should be seen as encompassing patients both residing in the City and in nearby
unincorporated areas.
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resident and nonresident cases during the Assessment Period. Visitors have not been
a large portion of COVID-19 positive cases. The tests suggest that COVID-19 has
spread throughout the Seward community, rather than in any single industry.
4. Healthcare Capacity
This metric may warrant "Code Orange" when the City's limited ability to care for
COVID-19 patients alongside other patients reaches its limited capacity or the City
exhausts or is at risk of exhausting its minimal PPE supplies.
Currently, the Medical Unit is significantly worried about the City's healthcare capacity.
Staff members of City facilities have been among individuals testing positive, reducing
the medical facility work force by at least 10% and potentially more. While there are no
instances where healthcare providers have contracted the virus inside a Seward
healthcare facility and Seward's facilities follow rigorous sanitation measures, the risk of
exposure amidst the outbreak remains high.
The outbreak has definitely placed a strain on healthcare capacity within Seward. The
exposure of healthcare providers to the virus has impacted providers' ability to respond
to the other healthcare needs of the community. It is also worth noting that while
Seward has four patient beds available, there are two beds in two separate rooms.
Thus, if two COVID-19 positive patients are placed in care, there are no beds available
for non-COVID patients. This essentially limits the hospital bed capacity for COVID-19
patients to one.
Throughout the State, including within Anchorage, hospitals remain below capacity, with
ventilators and ICU beds available. According to a State report for the Assessment
Period, while 71 Alaskans have required hospitalization, there has not yet been a sharp
increase in need for hospitalization with the rise in cases in June. The State did note in
that report, however, that other states have seen that it can be several weeks before
people who get COVID-19 become ill enough to need hospitalization, so DHSS will
monitor hospital utilization closely in the coming weeks. The following is the State
healthcare capacity.
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Inpatient Bed ICU Bed Ventilator
Capacity Capacity Capacity
927 1_8K U 87 1,;8 U 44 34T
'Vurribe' of inpatient beds occupied ouL N.irnber of ICU beds occuo eC ouL of NJ"rb--r of li-_I'Lilatcr3 occupied out o'
of LOLaI.'Includ_-s COVID and non-COVID Lctal.(Ind ides COVID ano -ion-CCVID lvlal capac Ly.(Inc udes COVID and no'r
oalierts) pat enr,) -'_VID paL ews)
At the time of this analysis, the Anchorage critical care facilities have had the capacity
and availability to accept transported patients from Seward. As the hospitalization
capacity rises in Anchorage, this may also impact Seward's public health capacity.
While seriously ill patients are generally transported to hospitals outside the City, these
patients still often require in-patient care while awaiting transport.
"Code Orange"Recommendation
When weighing these metrics and balancing them collectively, a "Code Orange"
declaration would be warranted. This is especially true given the Medical Unit's support
for a "Code Orange" declaration. However, recent data following the Assessment
Period shows a reduction in COVID-19 positive cases and Council's recent adoption of
restrictions may be slowing the spread. Further, the State of Alaska is experiencing a
rapid increase of COVID-19 throughout the State and yet continues to remain open.
While the purpose of the "Code Orange" alert is to permit the City to deviate from the
State's phased reopening when the City's COVID-19 risk outpaces the State, it is not
yet clear that Seward's recent outbreak deviates from the State's current spike in cases,
which nearly doubled during the Assessment Period. Given the economic and social
impacts of a "Code Orange" declaration, and the recent decrease in positive cases, the
City Manager is reluctant to declare a "Code Orange" without Council directive.
However, in the event there is another increase in cases or the existing cases continue
to negatively impact healthcare and medical care capacity, the Council and the Seward
community should prepare itself for the "Code Orange" declaration.
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