Health Inequities – a Further Review

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June 15, 2020, Skagit County Public Health issued a press release and a call to action on racism and health inequities. We wanted to provide some additional information and context about that call to action. Examining health disparities and inequities is not new to Skagit County Public Health or the Population Health Trust, which is the community advisory committee that guides the department’s health assessment and planning. The Population Health Trust adopted a vision for health equity that guides this work:  

“Health Equity means that everyone in our community has a fair and just opportunity for healthy living. This requires that we address and remove barriers to individual and community health that arise from poverty and discrimination (whether based on race, education, gender identity, sexual orientation, job status, housing status, or disability) that result in compromised health and powerlessness, and are often derived from lack of access to: good jobs with fair pay, quality of education, healthy housing, nutritious food, safe environments and active lifestyles, and quality health care.”

The COVID-19 pandemic has highlighted deep-seated inequities that are impossible to ignore.  We are still learning about these impacts, but four immediate examples include: a disproportionate share of COVID-19 disease burden among communities of color, unequal healthcare access, employment circumstances that disadvantage some groups compared to others, and an unequal social safety net.

  1. Disproportionate COVID-19 Disease Burden

In May, 75% of identified Skagit County COVID-19 cases were from members of the Latinx community, even though the group represents only 18% of the county’s population.  We know that there are consistently higher rates of infection in communities of color throughout Washington State and nationally. According to the Washington State Department of Health, 37% of the people diagnosed with COVID-19 are White, while 68% of our population as a whole is White.  Statewide, members of the Latinx community make up 13% of the population but represent 43% of the people diagnosed with COVID-19. This is a clear and indisputable health inequity. This is a clear and indisputable health inequity. As is noted below, primary reasons for this inequity include unequal healthcare access, differences in employment circumstances and an unequal social safety net.    

  • Unequal Healthcare Access

Sadly, although communities of color are most impacted by COVID-19, those same communities are less likely to have health insurance and access to medical care. As the table below illustrates, the uninsured rate for Latinx adults in Washington State is nearly four times the rate of White residents. Native Americans and African Americans also are less likely to have health insurance compared to White residents.

 LatinxNative American/ Alaska NativeBlack/African AmericanWhite
Adult Uninsured Rate in Washington19%17%11%5%
  • Differences in Employment Circumstances

In Skagit County, workplaces are a major source of COVID-19 spread. Many people take for granted that their jobs offer them the ability to work from home or take time off when they are sick. Frontline workers face tough economic and health choices, and there are stark racial differences in employment situations. Many of these workers were laid off while others continued in essential services that involve a high degree of interaction with others and consequently place them at greater risk for COVID-19 infection.

Nationally, nearly a quarter of employed Latinx and African American workers are employed in service industry jobs compared to only 16% of White workers. Also, Latinx workers account for 17% of total employment but 53% of agricultural workers. In Skagit County, where agriculture is such an important part of the economy, Public Health is working with the farming community to foster safe working conditions for farmworkers. 

4. Unequal Social Safety Net    

The coronavirus crisis is not just a pandemic; it is also an economic crisis. Unfortunately, we do not have a social safety net that helps everyone equally. Many non-citizens did not qualify for the federal stimulus checks. Even citizens married to non-citizens were locked out of these payments.  Children who live in mixed immigration-status households were also penalized and no one in their family received a stimulus payment.

Millions of people lost their jobs, including people whose presence in the US is based on a temporary visa, and some workers find themselves in limbo where they do not qualify for unemployment payments and cannot seek new work. The process to receive unemployment benefits is confusing for people with limited English skills, who work non-traditional or ‘gig economy’ jobs, or for people who are self-employed. 

These are just a few of the health equity issues that have become more apparent during the COVID-19 pandemic, and this just scratches the surface of health equity issues in our community. We know there are similar inequities in chronic disease rates, educational outcomes, housing, and other economic segments of our community.

Skagit County Public Health and the Population Health Trust will continue proactively exploring these and other health equity topics. In response to the current crisis, this process will start with listening sessions where Public Health will reach out in consultation with the communities that are most impacted. 


Skagit County Race & Ethnicity Data from US Census 2018 American Community Survey 5 Year Estimates,

Kaiser Family Foundation estimates for uninsured (nonelderly) adults based on the Census Bureau’s American Community Survey, 2008-2018:

Viruses don’t discriminate, But We Do, Washington State Department of Health, June 19, 2020:

Labor Force Characteristics by Race & Ethnicity, 2018:  

4th of July

This year’s July 4th – Tips for a fun and safe holiday

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While pets and wild animals everywhere rejoice, many Skagitonians are disappointed that July 4th community fireworks displays have been canceled due to COVID-19. This is just one more thing that the pandemic has taken away from us!

But all is not lost! It won’t feel exactly the same, but there are still fun ways to celebrate our nation’s independence. Here’s a short list of alternative ways to commemorate the United States’ 244th birthday, while maintaining social distancing and following Phase 2 guidelines so we can all get through the holiday safe and healthy.

What NOT to doWhat you CAN do instead
Invite a large group of friends, extended family or neighbors over for a backyard barbeque.Keep your gatherings limited to no more than 5 non-household members, stay outside, wear a mask when you’re near others, and skip the potluck or buffet-style meals; it’s not ideal, but everyone should bring their own food and drinks. And it can’t hurt to keep hand sanitizer in close reach and use it often!Family challenge: Who can make the most delicious and creative red, white and blue treat? Click here for some inspiration.WATER BALLOON FIGHT! Water balloon dodgeball?First Annual Lawn Games Olympics. Bocce, long jump, DIY obstacle course, whatever you want! THERE CAN BE ONLY ONE CHAMPION!Gather around a fire pit and roast marshmallows. Maybe try some of these gourmet s’mores recipes!
Go to a fireworks display where non-household members have gathered.Set off your own (legal!) fireworks or light sparklers with your family. Keep a bucket or water or a hose nearby, just in case. Involve your kids in making a holiday craft. Maybe paint a flowerpot red, white and blue, or create a festive wreath (out of fabric, pompoms, pinwheels, or whatever!) for the front door.Watch a patriotic or America-themed movie. Disney+ will be streaming a filmed version of the hit Broadway musical “Hamilton” starting July 3rd. And of course, there’s always “Independence Day.”Go somewhere dark and watch for shooting stars. It still gets cold at night, so dress warmly and bring along hot chocolate and blankets.
Attend a July 4th parade.Take a scenic drive east on the North Cascades Highway, where you’re bound to see some bald eagles.Visit a nearby state or national park (check if they’re open first). Just be sure to maintain social distancing and bring a mask, hand sanitizer, snacks and water with you. Keep in mind that bathroom facilities may not be open, so … be prepared.Gather your family and put on your own parade for the neighborhood. Pinterest has lots of ideas for DIY noisemakers, and here are a few more.Go on a virtual tour of all 50 states in our beautiful country. You can even visit the Liberty Bell in Philadelphia or Arlington National Cemetery in Virginia. This list is a good place to start.

It’s going to look a little different this year, but you can still find fun ways to celebrate Independence Day. It’s normal to feel disappointed, especially if you really look forward to the community events. Hopefully, you can turn this forced change into an opportunity to start a new family tradition.  

Whatever you do, please be sure to keep your pets safely indoors. While community fireworks displays have been canceled, individuals will still be setting off their own, and this can be very terrifying for animals. The ASPCA, Petfinder and Banfield Pet Hospital have some tips to keep your furry family members safe while you celebrate.

Phase 3 Progress

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It’s been three weeks since Skagit County moved to Phase 2 of the governor’s Safe Start plan. Three weeks is the minimum amount of time a county has to wait before applying for the next phase. During this time, the county has to meet several metrics—the most important of which is positive case numbers—showing that it has the COVID-19 outbreak under control. Friday, the Skagit County Board of Health met with Skagit County Public Health and decided not to apply to move forward to Phase 3, because the County does not meet all the metrics.

“Of course, this is disappointing,” Public Health Director Jennifer Johnson said in a press release. “But unfortunately, we’ve seen an uptick in positive cases over the past several weeks that have prevented us from being able to move forward, per the Safe Start—Reopening Washington plan.”

In this post, we’ll take a look at the metrics the state is using and see how Skagit County measures up.

METRIC: Fewer than 25 positive cases per 100,000 people (32 Skagitonians) in the last 14 days

In order to meet this metric, Skagit County would need to see no more than 32 positive cases over the last 14 days. We’ve had 36 positive cases over the last two weeks. While we recently saw a decrease in cases, which helped get us to Phase 2 of the governor’s Safe Start plan, since then we’ve experienced a disturbing increase in the rate of positive cases.

Right now, most of our current cases are linked to extended family gatherings and celebrations, people traveling to visit family or friends both in and out of state, and we continue to see workplace transmission from worksites within Skagit County and adjoining counties. For many weeks now, most people becoming infected are of working age, born between 1970 and 2000. Positive cases usually show up about two to three weeks after exposure, and you can see the increase in cases three weeks after Memorial Day, indicating that people gathered against state and local health guidance.

“We have primarily seen cases tied to unauthorized gatherings, travel outside of the immediate community and workplaces,” said Dr. Leibrand. “It’s disappointing to see so many cases tied to activities not authorized under Phase 2. We hope the community will view this as a wakeup call and start taking the guidance more seriously.”

Below is a graph showing our County case data based on the numbers you can find on the Skagit County website. These numbers differ slightly from the state data, as Skagit County bases its case data on when the positive test result comes in, and the State bases its data on when the positive test was collected. The state also has a 6-day lag time to ensure it has all positive test results in before it publicizes its data. The state is using its own data when determining whether a county has met the metrics to move forward. While the data may differ slightly, the story told is the same: Our cases continue to rise faster than we’d like. The state shows that we have a positive rate of 27.1 cases per 100,000 Skagit County residents. Public Health expects this number to rise to 29.4 percent by June 29th and 30th, due to the six-day delay in the state data.

Skagit County COVID-19 positive case data.
Data as of June 26, 2020

Is Skagit County meeting the metric? NO

What can you do to help the County meet this metric? Minimize your risk of infection so you (and your close contacts!) don’t add to the case count. It’s not fun, but the best thing you can do is continue to stay home as much as possible. If you do go out, there are ways you can protect yourself:

  • Wear a mask (now required whenever you’re in indoors in public or if you’re outdoors in public and can’t maintain six feet of physical distancing)
  • Stay as far away from non-household members as possible (six feet minimum)
  • Wash your hands or use hand sanitizer often
  • Don’t touch your face
  • Limit the number of non-household members you come into close contact with to five or fewer per week. Any single gathering of more than five people (who don’t all live together) are prohibited during Phase 2.
  • Stay home if you’re feeling unwell, even just a little unwell, except to get tested. The drive-thru testing site in the Skagit Valley College parking lot is open Monday-Friday, 9am-4pm. Please bring your insurance card or the information from your card (plan name, group number, and individual identification number). With this information, insurance covers the cost of the test with no co-pay from you. If you don’t have insurance, the state will cover the cost.

METRIC: COVID-19 hospitalizations is flat or decreasing

Skagit County has been seeing a relatively flat hospitalization rate, between zero and three people hospitalized at any given time over the last few weeks.

Is Skagit County meeting the metric? YES

METRIC: Health care system readiness

The state defines health care system readiness as having less than 80% of the licensed beds full, and less than 10% of licensed beds occupied by suspected and confirmed COVID-19 cases. According to the state’s Risk Assessment Dashboard, 75.7% of Skagit County’s hospital beds are occupied, and only 0.6% of them are occupied by COVID-19 patients.

Is Skagit County meeting the metric? YES

METRIC: Average number of tests performed per day during the past week is 50 times the number of positive cases (maximum of 2% positive test rate)

According to the state’s Risk Assessment Dashboard, Skagit County is testing 56.8 people per positive case reported, a positive rate of 1.8%. It’s important that the county continues to test a lot of people to keep the ratio of positive test results low. Also, testing is the only way to find asymptomatic or presymptomatic people and have them isolate in order to stop them from spreading the virus to others in the community.

Is Skagit County meeting the metric? YES

METRIC: 90% of cases reached by phone or in person within 24 hours of a positive lab report

Skagit County Public Health contact tracers attempt to contact 100% of all positive cases within 24 hours of their notification of the case. Last week, they were able to successfully reach every single positive case within this time frame.

Is Skagit County meeting the metric? YES

METRIC: 80% of contacts reached by phone or in person within 48 hours of receipt of a positive test report on a case

Skagit County Public Health contact tracers attempt to contact 100% of close contacts of positive cases within 48 hours of notification of the case. Last week, they were able to successfully reach 92% of close contacts within this time frame.

Is Skagit County meeting the metric? YES

METRIC: 80% of cases are contacted daily during their isolation period

Is Skagit County meeting the metric? YES

METRIC: 80% of contacts are contacted daily during their quarantine period

Is Skagit County meeting the metric? YES

METRIC: Maximum of one outbreak (defined as two or more non-household cases epidemiologically linked within 14 days in a workplace, congregate living or institutional setting) per week

In June, Skagit County Public Health has investigated about one outbreak per week among employees at workplaces.

Is Skagit County meeting the metric? YES

Determining whether it’s safe to reopen is not something Skagit County leadership takes lightly. We’re all eager to open back up fully and return to some sense of normalcy. Skagit County is meeting most metrics—our healthcare system is prepared, our contact tracing team is absolutely incredible—but our case counts are too high for us to proceed.

“We want to reopen, but as the metrics show us, it’s just not safe right now,” said Board of Health Chair Commissioner Ron Wesen. “My colleagues and I will continue to watch the metrics closely, and consult with Public Health. As soon as we are able to do so safely, we will apply to move forward.”

It’s up to all Skagit County residents to do their part to help the county reach Phase 3. We need everyone to practice social distancing and good hand washing; we need everyone who is medically able to wear a mask, even if you find them uncomfortable (we all do!); we need everyone to limit their contact with people they don’t live with. This isn’t easy for anyone. But the more consistent we all are, the sooner we’ll be able to move on. Help us get there.

Do Masks Make a Difference?

To wear or not to wear: Do masks make a difference?

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You’ve heard it hundreds – maybe thousands – of times over the last few months: Masks save lives! But do they? Does it really make a difference if I wear a mask when I go out in public?

Pre-COVID-19, there wasn’t a lot of research done about the effectiveness of masks. But in the last few months, out of necessity, several studies have been completed on whether masks reduce viral transmission. While there are outliers, the overwhelming consensus is that masks do help prevent the spread of COVID-19.

Every time we cough or sneeze, talk or even just breathe, we expel tiny respiratory droplets (and sometimes, embarrassingly, saliva). These droplets act as a vehicle for germs like COVID-19, helping them spread far and wide. Think of when you exhale in the winter. Your breath cloud lasts several seconds and spreads out around you before dissipating. Or think of when you’re walking near someone who is smoking or vaping. You can smell it even if you’re standing several yards away. You can see or smell the spread of these respiratory droplets.

Masks help minimize the spread of these potentially infected droplets by keeping most of them inside your mask rather than expelling them to the world, meaning if you’re infected, it’s less likely you’ll infect others if you’re wearing a mask. Additionally, studies are showing that even basic cloth face coverings can help prevent you from contracting the virus when others around you are infected.

A study, led by a Texas A&M University professor, found that not wearing a mask dramatically increases your risk of contracting COVID-19. The authors state that wearing masks prevented as many as 66,000 infections in New York City in a three-week period lasting April 17-May 9. During this time period, New York City saw approximately 93,000 positive COVID-19 cases, but without masks, this number could have been 71% higher.

One of the study’s co-authors, Mario Molina, told a Texas A&M publication: “Our study establishes very clearly that using a face mask is not only useful to prevent infected coughing droplets from reaching uninfected persons, but is also crucial for these uninfected persons to avoid breathing the minute atmospheric particles (aerosols) that infected people emit when talking and that can remain in the atmosphere tens of minutes and can travel tens of feet.”

A review of 172 observational studies from 16 countries across six continents looked at something else we have all heard about by now: social distancing. While we recommend that you stay at least six feet from non-household members, the study found that the farther you are away from someone, the lower your risk of either spreading or contracting the virus. So six feet at a minimum, but farther is better.

The same authors also reviewed 39 studies that looked at the efficacy of wearing face masks, including N95 respirators, surgical masks and cloth face coverings. They found a significant decrease in the risk of infection among people who wore masks. While N95 respirators were most effective in health care settings, cloth face coverings provide protection to the general public in non-healthcare settings. The World Health Organization (WHO) recommends that cloth masks consist of at least three layers to increase their efficacy.

The study authors stress, however, that keeping your distance from others and wearing a mask do not provide complete protection against COVID-19. The best protection is and always will be staying home as must as possible. But knowing that we can’t go on like that forever, if you do go out, these are simple ways to lower your chances of contracting or spreading the virus. But don’t forget to wash your hands or use hand sanitizer frequently!

Finally, I’m feeling healthy today. Sure, sure, I have seasonal allergies, but they’re not contagious! So why do I have to wear a mask right now? It has become clear over the last few months that COVID-19 can spread even if an infected person is feeling fine. The virus can spread for up to three days before someone is symptomatic. And even more concerning, many people never develop symptoms at all or, more commonly, have such mild symptoms that they don’t even realize they’re sick. But these people, lucky as they are, can still spread the virus, potentially to someone who will end up on a ventilator or even die.

A study out of Cambridge and Greenwich Universities in Great Britain found that wearing a mask any time you’re in public is twice as effective at reducing the transmission rate as wearing a mask in public only after you become symptomatic. Masks are an easy and cheap way to reduce the spread of the virus. Masks really do save lives.

Of course, we know that there are some people who genuinely can’t wear masks. It’s not that they find them uncomfortable or hot; it’s not that they fog up their glasses; it’s not that they don’t like the way they look; it’s not that they think they’re a sign of weakness or fear. There are people who have medical or behavioral health conditions that make wearing a mask dangerous for them or inhibit their ability to communicate. It’s incumbent upon all of us to ensure that people who cannot wear a mask are protected, even if they cannot protect themselves. When you wear a mask, you’re protecting yourself and everyone around you. Wearing a mask is a sign that you care about others, people beyond yourself. It’s part of being a community.

We’re all tired of COVID-19. We want to get on with our lives. Masks, as annoying as they are, will help us get there faster by decreasing the spread of the virus. COVID-19 will be with us for a while; no one knows for sure how long. Wearing a mask will help us get to some sense of normalcy before a vaccine is developed.

If wearing a mask means that I can go shopping, get my hair cut, or visit a friend, then I consider it a small price to pay. I’d rather the bottom half of my face be uncomfortable than be stuck at home for another three months!

COVID-19 Antibody Testing

Antibody Testing

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There has been a lot of talk about COVID-19 antibody testing, and even more questions. When can I get it? Where can I get it? Is it even accurate? What does it mean if I test positive for antibodies? It’s a complicated topic, but we’ll try and make some sense of it for you.

First, let’s start with the basics:

What are antibodies?

Antibodies are proteins created by your body to fight off pathogens, like bacteria and viruses. Your immune system makes specific antibodies to each particular pathogen you encounter and successfully fight off. Your body also makes antibodies when you receive vaccines, so you can get the same immune benefit of having an illness without having to go through the discomfort of actually having the illness. These antibodies remain in your blood after you’ve fought off the infection, and antibody tests, also called serology (fancy way of saying blood) tests, can detect them.

How long do antibodies last?

This completely depends on what the antibody is designed to fight. Some antibodies, like those against chicken pox and tetanus, potentially last decades or even a lifetime. Others, like those that fight against the common cold, have shorter lives, usually just a few months.

The common cold is often caused by coronaviruses. If antibodies against the novel coronavirus behave in the same way, immunity to COVID-19 may not last very long. It’s possible that the antibodies will last for years, or it’s possible that people will be susceptible to reinfection much quicker than that. Once a vaccine is produced, you might need just one immunization in your lifetime or you may need a yearly vaccination in order to stay protected. It’s just too early to tell.

Can an antibody test tell me if I have COVID-19?

No, it can take 1-3 weeks – or longer for some people – after infection for your body to start making antibodies, so a serology test can only tell you if you may have had the virus in the past and now have antibodies to it. If you want to know if you have an active infection, you’ll need a viral test that looks for virus DNA. These tests are generally a nasal swab test or a nasopharyngeal swab test. You can request a test from your health care provider or go to the drive-thru testing site at Skagit Valley College, Monday-Friday, 9am-4pm.

Many people have wondered if the drive-thru testing site will start offering antibody testing. At this time, there is no plan to do so. The main goal of the drive-thru testing site is to catch active cases and stop the virus from spreading. 

Are COVID-19 antibody tests accurate?

Well, that depends. Some tests are more accurate than others. There are a lot of tests floating around that are completely bogus. Your best bet is to contact your health care provider and get the test from them. But even with the most accurate serology test, there is a chance that you’ll receive a false positive, meaning the test says you have antibodies but you really don’t.

Even if you do have antibodies present in your blood, indicating you’ve had the infection, we do not know how long those antibodies will last. You might be protected this week, and vulnerable to reinfection next week. Or you might be protected for months or years. Nobody knows for sure!

For both of these reasons, it’s important that you don’t view a positive antibody test as a free pass to do whatever you want. You still need to follow social distancing guidelines, wear a mask in public, try your very hardest not to touch your face or mask, and wash your hands or use hand sanitizer often. We know it’s not what you want to hear, but it’s the truth, and we want you to know the facts so you can keep yourself safe and healthy.

If you want more information about serology testing, the CDC and FDA have plenty of research available. Please note that not all tests that are available have been approved by – or even applied for approval from – the FDA, so if you want to take an antibody test, talk to your healthcare provider so you can ensure the test you take (and spend your money one) is FDA approved.

So, why bother getting an antibody test at all?

Skagit County has tested thousands of people for active COVID-19 infections, but we know that many people who had COVID-19 were never tested. It’s possible that they had mild or completely asymptomatic cases of COVID-19 and never knew they were sick, or caught the virus before tests were widely available. They may have never been formally diagnosed with COVID-19 but still have antibodies present in their blood.

Antibody tests can be used to get a general sense of how widespread COVID-19 has been in the community. While it might not be a good idea to base your individual actions on your antibody test result, experts can use the data of a population to form their health recommendations going forward. You can learn more about the research being done here. Researchers can also use the data to figure out what exactly it means to have antibodies in your system: Are you immune to reinfection? For how long? 

Additionally, there is ongoing research into whether “convalescent plasma” – a specific part of the blood – from those who have recovered from COVID-19 can be used as a treatment for those who are seriously ill from COVID-19. If you have antibodies in your blood, you could help scientists develop a treatment that potentially saves lives. You can find out more information about donating your plasma and where you can do so here. There are locations in Bellingham and Everett, and several others in King and Pierce counties.  

Right now, there are a lot of unknowns about antibody testing and what a positive test result means for your future health. This is a new virus, and we’re still learning a lot about it. As researchers find out more about COVID-19, Skagit County Public Health will share this information with you. Your health is our priority.

Recovering from Disasters: Common Phases and Experiences

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We’ve been hearing a lot about phases recently as Washington State rolls out its approach for reopening businesses and physical distancing measures. With Skagit County now officially in Phase 2 of the Governor’s Safe Start plan, it is exciting—and relieving—to begin seeing things get back to somewhat “normal.” At this time, it is important to be thinking about some other phases: specifically, the phases of recovery that we may be experiencing in regards to our mental and emotional health.

The Substance Abuse and Mental Health Services Administration (SAMHSA) provides a thought-provoking graph titled, “Phases of Disaster,” which tracks a typical community’s response to a disaster. A large-scale disaster can take many forms, such as natural disasters (hurricanes or tornados) or human caused (acts of violence or terrorism). And though it may not seem like it when we are hunkered down in our living rooms, we are currently in the midst of a very different type of crisis.

“Phases of Disaster” Adapted from Zunin & Myers as cited in DeWolfe, D. J., 2000. Training manual for mental health and human service workers in major disasters

According to the graph, it is normal (and even expected) that an individual or community may feel the effects of a disaster for quite some time—a year or more in some cases. There are six phases of recovery written into this model. This is how the phases are defined:

Phase 1: Pre-Disaster
This is the period of time before a disaster takes place and is “characterized by fear and uncertainty.” In the case of COVID-19 and Washington State, this would have been prior to the State’s first confirmed case back in March, when we were reading news about the spread in other countries. 

Phase 2: Impact

This is when the disaster takes place and is “characterized by a range of intense emotional reactions … [and] can range from shock to overt panic.” For many, this phase of the pandemic began when the state reported its first positive case or when schools and businesses began to shut down in late March. We can all recall feeling unnerved during this time as we began to see our daily routines changed suddenly.

Phase 3: Heroic
People come together during disasters. Skagit County witnessed so many amazing acts of heroism, from health care staff and first responders on the front lines, to people volunteering as Meals on Wheels drivers, to  large amounts of donations to non-profits helping those in greatest need. And we continue to hear new stories of compassion. While it comes as no surprise that our County would step up to a challenge, it is also amazing to see how these selfless actions are tracked on this graph.

Phase 4: Honeymoon

The opening of our drive-thru testing site in mid-April is a perfect example of the Honeymoon Phase, when disaster assistance becomes readily available. This time is “characterized by a dramatic shift in emotion,” when “community bonding occurs.” It is also when optimism peaks and people believe everything will return to normal quickly.

Phase 5: Disillusionment

For some, it may feel like we are in this phase now. This is when “optimism turns to discouragement and stress continues to take a toll.” It might also be a time when “negative reactions, such as physical exhaustion or substance use, may begin to surface.” Constant media bombardment, reporting an increase of new cases after a few days of low numbers, and other triggering events in the news can all greatly impact our ability to recover. This phase can last for months, and it is normal to experience periods of emotional highs and lows throughout. If you are feeling disillusioned, please know that this is a very human reaction, and that there is help available.

Phase 6: Reconstruction

Reconstruction is possible when “individuals and communities begin to assume responsibility for rebuilding their lives, and people adjust to a new normal.” Even still, it is typical to grieve over losses during this phase. While our County is well on its way toward Reconstruction, it is important to give ourselves some grace as we continue on our collective road toward recovery.

SAMHSA lists the following suggestions for coping with a disaster:

1. Talk with others who understand and accept how you feel. Reach out to a trusted friend, family member, or faith-based leader to explore what meaning the event may have for you.

2. Body movement helps to get rid of the buildup of extra stress hormones. Exercise once daily or in smaller amounts throughout the day.

3. Take deep breaths. Most people can benefit from taking several deep breaths often throughout the day. Deep breathing can move stress out of your body and help you to calm yourself. It can even help stop a panic attack.

4. Listen to music. Music is a way to help your body relax naturally. Play music timed to the breath or to your heartbeat. Create a relaxing playlist for yourself and listen to it often.

5. Pay attention to your physical self. Make sure to get enough sleep and rest each day. Eat healthy meals and snacks and make sure to drink plenty of water. Avoid caffeine, tobacco, and alcohol – especially in large amounts. Their effects are multiplied under stress and can be harmful, just making things worse.

6. Use known coping skills. How did you handle past traumatic events like a car crash or the death of a loved one? What helped then (such as more time with family, going to a support group meeting)? Try using those coping skills now.

The impact on our collective, and individual, mental and emotional health cannot be understated or ignored at this time. For some people, recovery from the COVID-19 pandemic will be quick and relatively painless. For others, recovery may need to take place on several levels: emotional, social, economic, and even physical. And while we all must deal with the impacts of the pandemic on our own terms, we must also carry the impact as a community, and learn to rebuild, readjust, and move forward with patience and understanding.

If you are feeling stressed or anxious, depressed or lonely, please know that these are all common reactions to a crisis. The Disaster Distress Helpline is dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. This service is toll-free, multilingual and confidential. Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor. For more resources click here.

So remember, wherever you may be at on your road to recovery, please know that your feelings are valid—and even backed by science!

A Call to Action – Racism and Health Inequities

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Skagit County Public Health is repulsed and outraged by the senseless killing of George Floyd. We wholly stand with the nationwide demand that those involved be called to justice. Systemic biases are prevalent in our society and harm people of color in numerous areas of their lives. Public Health is acutely aware structural racism impacts the health of many Skagitonians. Although health inequities often do not receive the same attention as violence against people of color, such disparities are just as deadly.

COVID-19 has laid bare the socio-economic disadvantages that people of color in our community face due to racism and inequity. Nationwide, Black Americans are dying from COVID-19 at three times the rate of white Americans. Last month in Skagit County, 75 percent of identified COVID-19 cases were members of the Latinx community.  These are just a few of many stark examples of how COVID-19 is disproportionately impacting communities of color and highlight the existing inequities in our systems.  Further, although the Centers for Disease Control and Prevention’s existing data does not indicate a disproportionate level of COVID-19 among Native Americans countrywide, there is undeniable evidence demonstrating racism severely affects the health of Native Americans. This reality is crucially important given that Samish Indian Nation, Sauk-Suiattle Indian Tribe, Swinomish Tribal Community and Upper Skagit Tribe are among the Skagit community.

Racism is a public health threat that cannot be ignored. These unacceptable injustices require action and real solutions.  We recognize and know that Skagit Public Health must intentionally strive to do better. Our mission is to serve all Skagit County residents and create positive health outcomes and living conditions for everyone.

We are making a commitment to equality, justice, and inclusion. We realize the answers to these issues are found from the wisdom and experience among our local Black, Latinx and Tribal communities.

With the support of our County Commissioners and Board of Health, we will establish an Equity Task Force lead by leaders within Skagit’s Black, Latinx and Tribal communities. Given the immediate threat of COVID-19, we will continue to focus coronavirus response efforts on assisting communities disproportionately impacted by the pandemic.

As we continue to move forward in service, we welcome guidance on ways we can do better. We ask for community feedback. You can reach us at 360-416-1500 or by email at

Person using Nicotine

Tobacco & Vapor Products “Talking Points” : COVID-19 Edition

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People who smoke may be more likely to develop serious health complications from COVID-19. Smoking weakens the immune system, making it harder for your body to fight off viral infections – especially those attacking the lungs, like COVID-19. Additionally, initial findings suggest that vaping may increase lung inflammation and exacerbate lung infections. Need help quitting? Call 1-800-QUIT-NOW or visit


To say that our kids are dealing with a lot right now would be a grave understatement. Between figuring out remote schooling, the uncertainty of schedules and daily life at home, and the rising anxieties over health and safety, the mental well-being of our youth is of pressing concern. And while our inboxes are full of tips and tricks for keeping youth occupied, there are other—perhaps more troubling—issues that may not be getting as much attention.

While it may seem like decades ago, one of the most concerning trends we were seeing at the end of 2019 and beginning of 2020 was the youth vaping epidemic. Washington Healthy Youth Survey results were showing a dramatic spike in youth usage between 2016 and 2018, and the perceived risk associated with frequent use was alarmingly low among 8th and 10th graders in Skagit County.

In the fall of 2019, national media sources began reporting on the growing number of cases of vaping-associated lung disease, and these reports were causing many lawmakers to pursue legislation that would place stricter enforcements on vapor products. On January 1, 2020, Washington State officially raised the legal age for purchasing tobacco products to 21 years of age.

The seriousness of youth tobacco usage has not waned, though we now are living in much different times. If anything, our efforts to push forward with prevention efforts is all the more important now during the COVID-19 pandemic, while youth are grappling with so many new and unprecedented struggles, and may be relying on substances, like tobacco, to cope. Experts are still trying to gauge the impacts of COVID-19 on people using tobacco, but we do know that there is conclusive evidence that smoking weakens the immune system, increases the risk of infectious diseases and respiratory infections, and is a major cause of chronic health conditions and cancer. We also know that there is growing evidence that vaping can harm lung health, and nicotine can be extremely harmful for the brain development of teens and young adults.

For these reasons, parents must be extra vigilant about monitoring the mental health and substance use of their kids. Talking to children about tobacco use can be overwhelming—even without a global crisis taking place! It is best to begin the conversation early on, and continue these messages as they grow up. Expect that your child will have questions, and be prepared to answer these with facts, not fear-driven responses. Remember that parents can have a positive influence on youth’s behavior, so long as the conversation is honest, open and understanding. In order to help guide the conversation, we have created a list of helpful information that can inform your conversations:

  • Smoking/vaping and COVID-19

Currently, experts do not yet know if there is a direct correlation between COVID-19 infection and tobacco smoking/vaping. However, this is what the World Health Organization (WHO) has to say:

“Smoking impairs lung function making it harder for the body to fight off coronaviruses and other respiratory diseases. Available research suggests that smokers are at higher risk of developing severe COVID-19 outcomes and death. … There is no evidence about the relationship between e-cigarette use and COVID-19. However, existing evidence indicates that electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS), more commonly referred to as e-cigarettes, are harmful and increase the risk of heart disease and lung disorders. Given that the COVID-19 virus affects the respiratory tract, the hand-to-mouth action of e-cigarette use may increase the risk of infection.”

  • Signs of nicotine poisoning and withdrawal in youth

With school campuses closing abruptly and families at home practicing social distancing, some kids may have increased their tobacco use in order to deal with stress, while others may be dealing with withdrawal if they can no longer get access to tobacco products. It is important to be familiar with the signs of both nicotine poisoning (if someone is consuming too much), as well as nicotine withdrawal.

Nicotine poisoning (a.k.a. “Nic-Sick”)

  • Nausea or vomiting
  • Stomachache and loss of appetite
  • Increased heart rate and blood pressure
  • Headache
  • Mouth watering
  • Quick, heavy breathing
  • Dizziness or tremors
  • Confusion and anxiety

Nicotine withdrawal

  • Having cravings for tobacco products
  • Feeling down or sad
  • Having trouble sleeping
  • Feeling irritable‚ on edge‚ or grouchy
  • Having trouble thinking clearly and concentrating
  • Feeling restless and jumpy
  • Having a slower heart rate
  • Feeling more hungry or gaining weight

To find out more about the above symptoms, visit resources such as the American Lung Association or the Centers for Disease Control and Prevention (CDC).  

  • Next steps: Cessation resources

If your child is using tobacco products, the best thing to do is to encourage them to quit, and support them throughout their journey. There are a host of resources available to youth dealing with tobacco dependence, many of which are free and easy to use without having to leave the house! Here are some great resources:

  • WA DOH 2Morrow: a free app to help teens and young adults quit vaping or smoking. There is also free cessation counseling for tobacco and vaping or marijuana dependency available
  • SmokeFreeTeen: free app services and texting services available for smoking, vaping, smokeless tobacco cessation
  • The Truth Initiative’s This Is Quitting program: text DitchJUUL to 88709 for free vape cessation support

Lastly, it is important to take care of yourself if you or your child smokes or vapes and is trying to quit.

  • Parents can text QUIT to (202) 899-7550 to sign up to receive text messages designed specifically for parents of vapers, and can find a community of support at
  • Visit for a list of specialized free programs to help you quit smoking. Programs include: Veterans, Women, Moms,Teens, 60+, Spanish and others. Text, chat, and and a variety of other free supports available.

Want other “Talking Points” from Skagit County Public Health? Visit our webpage here!

Flying during the Pandemic

Flying during the Pandemic

Reading Time: 4 minutes

Stay Home and Stay Healthy, the Washington State’s COVID-19 emergency order, began a little over two months ago. But it seems like it was a completely different time—a time without Zoom and face masks, and when five feet did not seem like an unsafe intrusion on personal space. While it has been frustrating to build new routines and redefine our “normal,” the Stay Home and Stay Healthy order is working; it is keeping us, and our community, safe. Being a Public Health employee, and knowing the importance of Stay Home and Stay Healthy, made my decision to KEEP my Memorial Day travel plans incredibly tough.

Like many others, I booked airfare and solidified travel plans in early fall of 2019. And then COVID-19 happened. Unlike many others, my flight did not get canceled. It did get rescheduled several times, but never canceled.

Picture me singing Should I Stay or Should I Go by The Clash in my head. Because that is exactly what I did. “It would be wrong of me to go,” I thought to myself. “This trip isn’t technically essential…I could risk getting others sick.” I worried and I felt guilty. However, after weighing the pros and cons, and speaking with family and co-workers, I decided that going was the right decision for me.

I knew that my travel destination/plans were fairly low risk. I would be visiting two national parks, both of which had protocols in place to keep visitors safe during the pandemic. But getting to and from my destination—spending time in an airport and on an airplane—made me nervous.

My Experience in the Airport and Beyond:

I was pleasantly surprised! When I first arrived at the airport, it was empty…or almost empty. There were a couple of people but not many. It was very easy to maintain a six-foot distance from everyone. Also, almost immediately upon entering the airport, an announcement coming from the PA system stated that “masks are required.” I took a couple more steps and saw visual signs mirroring the same message. I looked around and sure enough, most people were wearing masks. I let out a sigh of relief and kept walking.

I walked up to one of the Alaska Airlines kiosks with the intention of printing my boarding pass. It was closed, and so were the surrounding kiosks. Experiencing some confusion, I asked for assistance and was directed to a specific section of kiosks that were open and being wiped down between users. After I printed my boarding pass, I walked straight through security. Literally, there was no line. A TSA agent did confirm my identity and in doing so, I had to remove my mask. Given that there was no one around me and my mask was off for less than five seconds, I felt safe.

While sitting at the gate, an Alaska Airlines agent announced that masks are required on all Alaska flights. This message was reaffirmed by the flight attendants and we were asked to keep our masks on during the entire flight unless eating or drinking. Bottled water and a snack mix were distributed. However, no beverage or snack cart services occurred. To help with social distancing, all passengers were given an entire row to themselves unless traveling with a family member. Therefore, I stretched out, watched some Netflix and before I knew it, arrived at my destination. My experience flying back to Seattle was nearly identical.

Tips or Things to Think About when Flying/Traveling during COVID-19

  1. Plan Ahead.

While airports may have implemented strict protocol for keeping passengers safe during COVID-19, not all states have. Some states are still “open” which means people may not be taking the same safety precautions you are used to.  Research your destination and the state’s current COVID-19 plan/order. The CDC provides a list of questions to reflect on, that may help you decide if traveling is the right choice for you and your family.

If you decide to travel, protect yourself and others during your trip. Use your best judgement—social distance (keep six feet of physical distance from other), wear a mask, practice hand hygiene and cleanliness, even when others are not!

  • Be Flexible.

Airlines are doing their best to keep everyone safe during this difficult time. This may result in flights being canceled or changed. So, it is extremely important to be flexible, check your email and flight reservation regularly. My flight departure time changed three times and reduced the length of my trip by seven hours.  

Depending on the airline and your desire, you may be able to cancel your flight and be refunded, given a voucher or simply change your day/time of flight without paying any additional fees. However, this is not guaranteed.

  • Come Prepared.

Airports and airlines have implemented protocol for keeping passengers safe during COVID-19. But this does not mean that your risk of exposure is zero. Come prepared and stay safe with hand sanitizer and disinfectant wipes, a water bottle and snacks.

  • Wearing a mask was required in the airport and during my flight. Bring a mask/face covering! If you do not have a mask, come prepared to ask for one once you arrive at the airport.
  • Airport bathrooms are often spread out and hand washing stations are not always close by. Try not to touch your face. But if you are like me, and not touching your face is nearly impossible, make sure you have hand sanitizer and use it frequently! You may also find yourself sitting in a seat, or touching surfaces that have not been recently cleaned. Along with hand sanitizing, bringing and using disinfectant wipes may be beneficial.
  • Do not assume that all stores and restaurants within the airport will be open. From my observation, about 50% of them were closed. Also, the airline you are flying with may not providing in-flight beverage and snack services. So, fill up your water bottle after going through security, and bring snacks if you think you’ll be hungry.

Find more advice and Travel FAQ’s here  

Please remember:

If you feel sick prior to traveling, stay home. From my observation, airlines are being more accommodating than normal regarding cancelations, refunds, vouchers, and flight changes.

If you feel sick during or after traveling, self-isolate and get tested. If you are experiencing severe symptoms, please consult your primary care physician for advice on next steps.

Announcing Phase 2 in Skagit County

Skagit Moves into Phase 2

Reading Time: 3 minutes

You may have heard that Washington State has launched the “Safe Start” phased plan in addressing COVID-19. Under this approach, counties may apply to the Washington State Secretary of Health to allow additional activity in their communities. On June 5, Skagit County was approved to move to Phase 2 of Governor Inslee’s Safe Start plan.

How Did Skagit County Qualify to Move to Phase 2?

The Safe Start plan sets targets that counties much reach before moving to the next phase. The plan includes targets for COVID-19 activity, hospital readiness, testing, case and contact investigation, and protecting high-risk people. For example, over the two weeks prior to our application, Skagit County had 10 COVID cases per 100,000 people, which is well beneath the target of 25 per 100,000. Skagit County was also able to show that it had enough hospital beds available, and met contact and case investigations targets. Testing capacity also is available; Skagit County tests an average of 191 people per day with the ability to increase the number of tests if demand increases. 

What Changes Will Occur in Phase 2?

Some additional businesses and services will be able to open, and some small, infrequent gatherings can happen. Examples of Phase 2 expansions include:

  • In person retailers who are able to use physical distancing can open.
  • Personal services, like hairstylists, who are able to use physical distancing and protective measures can open.
  • Manufacturing businesses and office-based businesses can open, using physical distancing and telework when possible.
  • Small gatherings of five or fewer people from outside one’s immediate household are allowed, once per week.

Governor Inslee also changed guidance to allow for outdoor religious gatherings of up to 100 people, and in Phase 2. Religious gatherings indoors with 25 percent capacity or no more than 50 people, whichever is fewer. You are legally able to participate in these activities, but Skagit Public Health has concerns about the health risks involved in any large group gatherings. As we learned from the Skagit Chorale Outbreak study, COVID-19 is highly contagious and spreads quickly through large groups. So, remote or web-based events or services are safer. If larger groups gather for services, it is vital that people practice good physical distancing and that everyone wears a mask. Additionally, high-risk people should continue to stay home.

Staying home is the safest thing you can do right now, but that is not possible for everyone. As Phase 2 starts, people should think through their personal risk factors, and use all recommended practices to limit the spread of COVID-19. These practices include:

  • Everyone who is medically able to should wear masks in public.
  • Large-scale summer events should still be canceled. Skagit County Public Health will continue to evaluate events as summer progresses.
  • Physical distancing of at least six feet should still be used.
  • People at higher risk of severe illness should stay home and away from large groups.
  • Employees are still encouraged to telecommute if possible.
Safe Start Reminders

People in high-risk populations are strongly encouraged to limit their participation in Phase 2 activities and business services. High-risk populations are currently defined by the CDC as:

  • People 65 years and older
  • People who live in a nursing home or long-term care facility
  • People of all ages with underlying medical conditions, particularly if not well controlled, including:
    • People with chronic lung disease or moderate to severe asthma
    • People who have serious heart conditions
    • People who are immunocompromised
    • People with severe obesity (body mass index [BMI] of 40 or higher)
    • People with diabetes
    • People with chronic kidney disease undergoing dialysis
    • People with liver disease

One other important change is that beginning June 8, all employees must wear a cloth facial covering, unless they working alone in an office, vehicle, job site, or when the job has no in-person interaction.  Employers must provide their workers with appropriate masks for their job duties.

What Happens After Phase 2?

If Skagit County continues to meet the Safe Start Plan targets, we can move to Phase 3 in as soon as three weeks after qualifying for Phase 2. However, if the virus is spreading rapidly, a county may need to return to an earlier phase until the virus is more under control. That is why all Skagitonians should take precautions to limit their contact with people outside their households, wear masks in public, and maintain good social distancing. 

For More Information

Governor Inslee’s Safe Start Website: