How An Outbreak Showed Clark County Was Ready To Reopen

The first sign of the outbreak was a fax from a local clinic.

On a quiet Saturday in the middle of May, Clark County Public Health’s fax machine spat out a lab report: a single positive test for COVID-19. Two months into the pandemic, the machine had already hissed awake some 400 times before. No sirens blared when county health staff logged the report into a state database.

What the report didn’t say was where the person worked — a crowded fruit packing plant — and how learning that fact would jolt Clark County’s shorthanded staff and health care partners to test and interview scores of workers.

Three days later, the Vancouver facility would be mostly shuttered. Four weeks later more than 130 cases are linked to the outbreak — the largest in the Portland metropolitan area.

The timing could hardly have been worse. Clark County was about to reopen. And public health officials, overwhelmed and understaffed, were still a week away from reinforcements arriving.

The rush of cases was a preview of things to come. As economies reopen across Oregon and Washington, health experts say coronavirus outbreaks will be a part of daily life. Spotting and curtailing those outbreaks are key for the economy to reopen until a vaccine arrives.

Crisis mode

Around noon on Sunday, May 17 — the day after that first fax arrived at public health — Firestone Pacific managers learned that one of their roughly 180 employees had tested positive. Crisis mode kicked off in earnest.

“Please call me at your earliest convenience tomorrow to coordinate a response plan,” CEO Josh Hinerfeld wrote in an email. The company, he noted, would comb for workers who may have gotten too close.

Concerns ratcheted up the very next morning when Hinerfeld learned of a second case.

“The situation at our company is volatile,” he emailed the county. “Understandably, our staff are scared and eager for timely and relevant information.”

Related: Local Public Health Workers Report Hostile Threats And Fears About Contact Tracing

It would be Monday afternoon when the county’s communicable disease team came into the picture. A lone nurse investigator took the first step: asking Firestone Pacific for a list of potential exposures. The company sent back a list of names with contact information.

Then began the contact tracing — part telethon, part checkup — in which workers, using a form from the state Department of Health, interview people to better understand the spread.

What symptoms did the worker have? A cough? A fever? Had they been to the doctor? The nurse investigator also asked about other habits, like if they smoked or had any other preexisting conditions.

She asked demographic questions, like what race or ethnicity the person identifies as, but nothing as private as citizenship status or social security number.

She told the worker to isolate. Three other people who lived in the house would also have to quarantine.

“The first day was basically tracking down contacts and making sure those contacts were not working,” said Dr. Steven Krager, the county’s deputy health officer.

She was going to need help soon, however. By Monday evening, the fax machine delivered again. Four new presumed cases. The investigator found more ties to the plant.

“From the big picture,” Krager said, “it starts to become more important to look at the facility.”

Ready or not

Calls and questions revealed safety issues at Firestone Pacific, in Vancouver’s industrial western edge. There, machines flash-freeze berries and other fruit. Workers sort and pack.

Employees were told to wear masks during the pandemic, but the rule wasn’t strictly enforced, Krager said. They stood close together on the production line, and the investigator found workers shared paperwork.

Firestone Pacific closed its doors by Tuesday, May 19, on advice from county health officials. That day, six more people tested positive. County health officials now faced the task of testing and contact tracing everyone who worked on the production floor.

Related: Complaint Spurs State Inspection At Vancouver Facility Suffering Virus Outbreak

Clark County health officials expected something like this. They had prepared for a month, but the outbreak arrived too soon.

In late April, Gov. Jay Inslee conjured images of a fire brigade dousing virus flare-ups to reopen the state. He called for 15 contact tracers for every 100,000 residents. Clark County needed about 70. They had 17.

Plans to hire started soon after, but the county couldn't afford to hire until emergency funds from the federal government trickled down.

Money had arrived by the time Firestone Pacific closed, but the county hadn't yet approved a contract with a California nonprofit that specialized in building teams for contact tracing.

On Wednesday, May 20, the county’s top health official hopped on a video conference with the county’s elected leaders and urged approval.

“We really need to have this capacity on board and brought on pretty quickly,” said Dr. Alan Melnick, public health director.

Still, help wouldn’t be ready for days. The contact wouldn’t be officially signed until Friday. The nonprofit would need some time, too, actually hire help. The county had to make do with staff on-hand.

According to Melnick, the county pulled people from other departments, such as water quality. Many were trained to do health work when measles rippled through the community a year ago, infecting 70. Still, it wasn’t ideal.

“This has been a strain on our staff because we’re taking them away from other duties,” Melnick later told reporters.

While staff took on their new assignments, health officials knew Firestone Pacific’s facility would need a closer look, too. Like nursing homes at the start of the pandemic, food-processing sites are now viewed as potential coronavirus hotbeds.

Krager, who oversaw Cowlitz County’s response to a 16-case outbreak at Foster Farms in Kelso, Washington, said health officials had questions.

“The first questions for me are what are the working conditions like? Are they maintaining distance?” he said. “Even someone with mild symptoms, if you’re standing next to them for eight to 10 hours, it’s a significant exposure.”

Some Firestone Pacific workers reported as much.

Two complaints to the Washington Department of Labor and Industries echoed that mask-wearing wasn't enforced, and that as many as 30 workers would sit shoulder-to-shoulder at lunch and on breaks. They shared microwaves, refrigerators and drinking fountains, the workers said.

The state helped Firestone Pacific to develop a safety plan.

Testing became a bigger question, as it had been throughout the pandemic. How could all of these workers be tested quickly? Could the workers, most of whom don’t have insurance, even afford a test?

Weekend work

A line of men stood by the door to Vancouver Clinic’s urgent care in Ridgefield, waiting for the doors to open. It was 8 a.m. on a sunny Saturday, May 23, the start of Memorial Day weekend.

Alfred Seekamp, the clinic’s chief medical officer, had just pulled into the lot. Signs in the windows alerted most people that, for the day, the facility was unavailable. The workers at Firestone Pacific would be the sole clients.

“When I arrived, there was a group of people congregating in the parking lot, all wearing masks, all separated by six feet, and looking a little bit lost,” Seekamp said. “So I motioned them to follow me and we came into the lobby area and got them checked in. And the team really took over.”

Vancouver Clinic’s role in the Firestone outbreak had started two days prior, but it had been a county ally from near the start of the pandemic. To state officials, Melnick described the clinic as a strike team.

To nursing homes, businesses and other places where coronavirus cases bubbled, the county dispatched a team from Vancouver Clinic. They had tested nearly 1,000 people even before Firestone Pacific showed on the radar.

Testing started with Firestone Pacific — after agreeing to pay for every worker’s test — telling workers to go to any of Vancouver Clinic’s sites, where staff would administer a rapid test.

That didn’t last long. A wave of positive tests immediately rolled in. On Friday, the first day of mass testing, 28 of the 50 workers tested positive.

In a cohort so stricken, Seekamp said, false negatives become more likely. Clinicians switched to a slower, yet more reliable test. Everyone who tested negative would need to be retested.

“We were surprised at the high positive rate that we were seeing,” he said. “We also felt it would be better to centralize testing.”

At the Ridgefield urgent care, staff whittled through the list of workers needing tests. They clapped a tent together to pick up the pace and for the outdoor air to better whisk away germs.

Each and every person was tested. Staff placed a nasopharyngeal swab into their noses, to the back of their throat, then sent the specimen to the lab. Each time, they changed protective gear and sanitized surfaces.

“It was a very full day,” Seekamp said. “And to do it safely … all these things are time consuming, and you have to do it each and every time.”

Staff also gave fuller examinations to people who showed symptoms — such as coughs, fevers, loss of taste or smell — in case any needed to go the hospital. Few did.

Many workers were native Spanish speakers. Staff who spoke the language worked extra shifts to helped give instructions, translate documents and, ultimately, inform patients of the test results.

Deputized as contact tracers, public health staff called people who had tested positive and ran through the series of questions. They identified close contacts and told people how to isolate. If they so much as needed groceries, staff offered to go shopping.

The California nonprofit signed its contract the day before the mass testing in Ridgefield. Unable to start hiring, the organization sent some staff to aid.

By Tuesday, May 25, nearly 250 had been tested. Eighty-four tested positive, most of them workers.

A harbinger

To state and local health officials, the weekend confirmed conflicting truths.

The Washington Department of Health, which had warmed to the idea that Clark County could start reopening bars, restaurants, salons and other trades, viewed it as proof to the contrary. The outbreak drove Clark County’s case counts above the state standards.

That weekend, the state told seven counties to begin reopening. Clark County was told to wait.

Yet the response to Firestone's outbreak also demonstrated the county was ready, said Melnick, the public health director. Very few cases emerged outside of the outbreak, he contended, while the county acted decisively to quell the spread.

In emails with the state, he pointed out that health officials urged Firestone Pacific to close early, with few confirmed cases, before they could know how far the virus spread.

“We closed the plant on Tuesday, even though we had no way of knowing until late Monday that there might be an outbreak associated with the facility,” he wrote to Secretary of Health John Wiesman. “We eliminated transmission there.”

Melnick added that the sweep of tests caught many cases that could have otherwise gone undetected. It was a “timely and effective” response, he told the state.

As testing and contact tracing efforts lassoed the spread, fewer positive cases emerged. Close to 40 more people would test positive in the days to follow.

Since then, the California nonprofit — Public Health Institute — has gotten a foothold. Health officials say 20 workers started training the first week of June.

On June 4, another potentially ominous lab report arrived. Investigators that day discovered at least five cases tied to Pacific Crest Building Supply, a cabinet maker in Ridgefield.

Melnick spoke to reporters the next day. State health officials had, three weeks after the first reported case at Firestone Pacific, given Clark County the go-ahead to reopen.

The county had the staffing now, Melnick said, and officials knew how important it was to close a facility early and test aggressively.

“COVID-19 is still with us. It hasn’t really gone anywhere, and as businesses start opening it, it’s more likely we’re going to see situations like this,” he said. “Firestone, Pacific Crest, may be a harbinger of other outbreaks to come and we’ll need to be able to address them.”