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Vaccine a game-changer | Wenatchee may bring students back full time

WENATCHEE — With teachers and staff now being vaccinated for COVID-19, Wenatchee Superintendent Paul Gordon says full-time in-person classes could resume by mid-to-late April.

It is still a tentative plan but Gordon told the Wenatchee School Board on Tuesday that “vaccines have made a significant difference in how we’re thinking about progressing forward” and perhaps leaving the hybrid learning model now in place.

Paul Gordon

Wenatchee superintendent

To aid the board decision, Gordon said the school district is surveying parents, staff and students (6-12 grades) about a return to full-time classes. The staff survey was sent out Monday. The parent survey is being sent out today. Students will get the survey in class next week.

Gordon wants to get 4,000 responses, which he said is two times higher than usual for similar surveys.

“We really want to make sure we’re asking some straightforward, direct questions about returning full in-person learning or continuing the hybrid learning for our school district,” he said. “We’re hoping to get a large percentage of our parents, staff and students to take this very brief survey.”

At the next board meeting on March 23, Gordon indicated he would bring the board the survey data collected along with information from state and local health officials on the best guidance moving forward.

Board member Julie Norton, who has been pushing for returning students to school for full-time instruction, encouraged the board to find reasons to open schools rather than reasons to keep schools in hybrid.

“I felt like the presentation last time was about, ‘Look, this is why we can’t do it,’ ” Norton said. “That’s fine if it is physically, technically not possible to do something. I want to make sure we are evaluating it because we got slapped in the face with data last week about how bad the failure rates are. Hybrid is not working.”

Board member Michele Sandberg asked how lunch would be handled, noting one of the main reasons the board chose the AM-PM schedule was to avoid bringing students together for lunch.

Gordon said students would continue with the grab-and-go sack lunch. The lunchtime would be staggered and spread out, especially outside when the weather is nice. Sandberg asked how this would affect the grouping of students now in place.

Kelly Lopez, the district’s executive director of human resources, said contact tracing would be very difficult with the lunch piece and lack of grouping of students, especially at middle school and high schools. This would significantly increase the workload of the district nurses, she said.

Lopez also cautioned the board about entire classrooms being forced to go home for 14 days, due to contact tracing.

“If I test positive in a classroom with all of you and we’ve had our masks off for lunch — this is not six to eight kids but 16 to 25 kids, so it would be difficult for a teacher to keep everyone socially distanced,” Lopez said. “If I test positive, I have exposed the entire classroom. That entire classroom has to go home for 14 days.”

Board member Martin Barron said he was glad the administration will gather more information in the next two weeks, recognizing circumstances are not the same week to week.

“We’re playing a guessing game looking forward. I think we’ve been well reminded not only today but on other occasions, there is a disruption cost every time we make a transition. Thinking through that process is very important,” Barron said.

Board President Laura Jaecks said she was encouraged by the COVID numbers going down in the community although she fully expected the situation to continue to shift between now and March 23.

“It’s impossible where we will be when that meeting rolls around but it is super encouraging to see the numbers going down,” Jaecks said. “I don’t think we can come to a conclusion tonight because we don’t know what is going to come to us on March 23.”

Photo: Changing out old glory
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State House passes new version of bill aimed at public health reforms

OLYMPIA — A sweeping bill that aims to restructure Washington’s public health system has passed its first hurdle in the state House of Representatives despite concerns from some county officials about the timing and some specifics of the bill.

The bill, proposed by Democratic Spokane Rep. Marcus Riccelli, would create new regional service centers to support local public health jurisdictions, change the makeup of local public health boards and establish an advisory board to oversee the state’s public health system. It passed 56-41 with mixed reactions.

“We need to come together for predictable, stable public health that we’ve woefully underfunded,” Riccelli told The Spokesman-Review. “This helps us leverage new resources so we can make our way toward fully funded public health services.”

The bill began as an idea from Gov. Jay Inslee to regionalize the state’s public health system, but it has changed drastically since its first introduction.

The new version of the bill is the outcome of a bipartisan compromise between Riccelli, Republican Rep. Joe Schmick of Colfax, and others, after Republicans and local public health officials raised concerns that a total regionalization could take away local control and funding.

As passed Monday, the bill would establish four regional comprehensive public health district centers to coordinate shared services across local health jurisdictions and the state. Counties have until Jan. 1, 2023, to choose which district they plan to join, with two forming on each side of the state.

These districts would provide shared services to all local health jurisdictions. For example, a small local health jurisdiction that does not have an epidemiologist or a poison expert could use one through the shared service center.

Schmick said public health officials have had conversations about how to address the lack of shared services for years, and this idea builds upon that.

Each regional district center also will have two newly created positions: a regional health coordinator who will coordinate services and a regional health officer who will provide support for local health officers. A regional health officer may also step in locally if a local health officer is fired or leaves.

This plan will expand what many health jurisdictions already are doing with shared services, but it would require all counties to join, Riccelli said.

The bill leaves much of the function of the regional centers up to the Foundational Public Health Services Steering Committee, which would be tasked with determining standards and practices for the regional centers. It also would recommend how funding is allocated for shared services.

In the floor debate Monday, Republicans had concerns that even the new regional approach was taking away local control. Rep. Jim Walsh, R-Aberdeen, said this bill could be a “slippery slope” that could lead to less control at a local level.

Schmick said the new version keeps autonomy at the local level. The regional districts are meant to be “a supporting role,” he said.

“The goal is trying to leave as much authority with local counties as possible,” he said.

Some at the county level have similar concerns.

The state association of county commissioners as well as the Spokane County commissioners still oppose the legislation even in its current form. Commissioner Mary Kuney, who also is the chair of the Spokane Regional Health District Board of Health, said the proposal should wait.

“This isn’t the time to do this; let’s get through this (pandemic), and let’s take a look to see how things went,” Kuney said.

All of the new regional services are dependent on the state allocating more funding to public health in the next biennium. The creation of the regional centers only will happen if the state provides foundational public health services with at least $60 million for 2021-2023, slightly more than half of what it currently receives.

Many local health officials were concerned these new services would split the current funding, which they say is already less than what is needed. Riccelli said this proposal wouldn’t do that.

“We put the null-and-void clause in to say we’re serious about the need to be funding,” Riccelli said. “This would be a significant investment.”

If that $60 million is met, the funding breakdown still would prioritize local health jurisdictions. The first $30 million would be used how it always has been, allocated by the state to local jurisdictions. About 65% of funds above that first $30 million would be allocated toward shared services in the next biennium. The remaining funds would be allocated locally by the Department of Health.

Schmick said there still are some legitimate concerns from counties about the funding piece of this proposal.

Public health has been underfunded for years, and currently on the Spokane Regional Health District Board of Health, the county, not the cities with representatives sitting on the board, are paying for public health. This discussion of local funding sources has cropped up multiple times in the last year during SRHD board meetings, and Riccelli’s bill brings it to the surface, as well.

”If you’re trying to get cost efficiencies then doing some regional things makes sense for counties that can’t afford it versus those that can,” Kuney said.

However, she noted the bill goes beyond that with additional positions, including four regional health officers and coordinators that will need to be paid.

Beginning in 2024, the bill authorizes the Department of Health to allocate all funding based on recommendations from the Foundational Public Health Services Steering Committee.

Throughout this session, the Legislature has been looking at different ways to increase funding to public health, including a tax on sugary drinks and a “covered lives assessment” where health insurers are charged $1.54 per member per month.

Neither proposal made it out of committee on its own, but both could make their way into a final budget proposal at the end of the session.

Another portion of the bill involves changing the composition of local public health boards, a proposal Riccelli has worked on since last fall after the SRHD fired former Health Officer Dr. Bob Lutz.

Riccelli expressed disappointment in the firing of Lutz, which he called an example of how politics has infiltrated public health. If Riccelli’s bill passes, it would require each local health board to include an equal number of city and county elected officials and nonelected officials. Nonelected officials are chosen from three categories: public health, health care facilities and providers; consumers of public health; and other community stakeholders, such as nonprofits or business communities. It must also include a tribal representative if the county is home to tribal land.

An amendment passed Monday that would limit the requirements for local boards of health to apply only to counties with a population under 800,000, specifically to address concerns from Snohomish County where the board is currently composed of 15 county and city officials.

The proposal as it is written would increase the number of board members on the SRHD Board of Health, however, broadening membership to local stakeholders and medical professionals in the community. Kuney registered concern that Spokane County would have to comply, while Snohomish, King and Pierce Counties would not have to comply with the new board member requirements .

”It’s concerning to me that ... if this is really good policy, that they’re choosing to not make it uniform across all counties,” Kuney said.

The bill also creates a public health advisory board that will determine the use of the state’s public health funding, provide feedback on public health, monitor the performance of the public health system, and develop long-term goals for public health in Washington.

Its most immediate task will be analyzing the state’s COVID-19 public health response, Riccelli said.

Kuney, like some House members on Monday, said she is perplexed at what the bill is trying to accomplish. Kuney said she wants to have these conversations and work toward solutions. S he is hopeful the Legislature will let the proposal die to work on other solutions.

”What are we trying to fix here?” she asked. “That’s what I still don’t know.”

Some Republicans expressed concern Monday the bill was moving too fast. Riccelli and other Democrats have argued the pandemic has shown the importance of adequately funding public health and creating shared services across the state.

Inslee first proposed the idea in December and made public health a priority in his budget proposal. While the bill looks different than his idea, it likely will have his support. When asked about the bill’s changes last month, Inslee said he hadn’t looked at the full proposal but he would be supportive of a plan that puts science at the forefront of public health decisions.

”If that would advance that cause, I support it,” Inslee said in a news conference.

The bill now heads to the Senate for further consideration where it will likely face more changes. It’s a work in progress, which was always meant to be a sessionlong discussion, Riccelli said.

State ag exports crimped by cargo-container shortage

WENATCHEE — In Wenatchee, tens of thousands of boxes of apples that should be on their way to the Middle East and Asia are piling up instead in warehouses.

In Ellensburg, it’s a similar story for mountains of hay bales that would otherwise be on container ships bound for Japan and South Korea.

The problem isn’t a lack of demand: Foreign buyers are eager for farm goods from Washington and other states. But thanks to the strange effects of COVID-19 on global shipping, U.S. farm exports are barely moving.

In normal times, “We ship 10 to 15 containers of fruit every week into Taiwan,” says Dave Martin, export sales manager for Stemilt Growers in Wenatchee, one of Washington’s biggest tree-fruit exporters. “This week, we will not have a ship.”

The shortage of cargo space has backed up Stemilt’s huge packing operations and idled dozens of truckers who normally haul the 40-foot-long containers to the ports of Seattle and Tacoma. It has also prompted Stemilt’s foreign buyers to look to competitors in countries such as Chile, where the apple harvest is just starting. “Those sales are lost,” Martin says of the numerous foreign shipments Stemilt has forgone since November, when the shipping crisis became severe.

The cargo-space crunch is the latest symptom of a global trade system that was unbalanced even before the pandemic, but is now so lopsided that entire sectors are at a virtual standstill.

Since the start of the pandemic last spring, Americans have spent far less on services, such as dining out, and far more with Amazon and other online retailers. That in turn has sparked a surge in imports from Asia.

The wave of mainly Chinese goods has overwhelmed some West Coast ports, especially in Los Angeles, where ships often sit for days waiting to unload. And because some of those ships, once they unload in Los Angeles, go pick up cargo at other West Coast ports, bottlenecks in Southern California have meant major delays for exporters waiting to load their goods in Seattle and Tacoma.

“We are now experiencing unprecedented eastbound cargo volumes coming out of Asia to the U.S., and it’s creating huge disruptions within the supply chain,” says John Wolfe, chief executive officer of the Northwest Seaport Alliance, which manages marine cargo operations in the ports of Seattle and Tacoma.

But the surge in Asian imports has had another effect on Northwest farmers. Because U.S. demand for Asian products is so high, shipping companies can now make far more money sending empty containers back to China as soon as possible, rather than take the time to refill them with American farm products.

It’s simple economics: Because a container of Chinese electronics, apparel and other exports is generally worth more than one filled with American farm products, shippers can charge more per eastbound container load, says Peter Friedmann with the Agriculture Transportation Coalition in Washington, D.C. For that reason, it’s more profitable for carriers to speed that container back to Asia for another high-value load than it is to wait for several days while a U.S. exporter fills the container with hay or apples or some other low-value product. Pound for pound, the value of American apples or potatoes or “is a mere fraction of the value of a container load of, say, Adidas running shoes,” Friedmann says.

That imbalance has meant more empty cargo containers leaving the ports of Seattle and Tacoma: In January 2020, just 37% of the containers exported from Seattle and Tacoma were empty, according to NW Seaport Alliance figures. This January, just over half went back empty. (Due to the greater weight of American exports, outbound ships always carry some empty containers.)

In fact, eastbound cargo is now so much more profitable — around $6,000 per container on average, versus $3,500 or so for westbound containers — that some cargo ships that unload their Asian goods in Southern California now skip scheduled calls at Seattle or Tacoma and head straight back to Asia.

That has meant fewer vessels calling in Seattle and Tacoma during the pandemic: Vessel calls in January 2021 were down nearly 20%, to 125, from a year earlier, according to alliance figures. “The shipping lines are in a rush to get their vessels and [container] equipment back to Asia to capitalize on those high-value cargo shipments out of Asia to the U.S.,” says Wolfe.

For exporters in Washington and elsewhere in the U.S., that east-west imbalance has created massive ripples up and down the exporters’ supply chain.

Ships are routinely delayed or canceled outright, often with little time for exporters to make alternative arrangements.

Before the pandemic, truckers could pick up an newly emptied container at the port in a few hours and drive it back to Eastern Washington to fill with produce, says Bryan Gonzalez, with Washington agricultural exporting firm FC Bloxom & Co. These days, Gonzalez says, drivers can wait all day for a container — and in a few cases, they were told to “come back tomorrow.”

Those delays create additional and expensive backlogs at processing plants and packing sheds. And things are about to get worse as exporters who haven’t sold all of last year’s crop now brace for this year’s harvest.

In a few months, for example, hay farmers in the Pacific Northwest will start cutting the first crops of 2021, “and we’ve still got a lot of last year’s crop that needs to be moving,” says Ellensburg hay exporter Mark Anderson. His company, Anderson Hay, normally sells 90% of its product to foreign buyers, but now struggles to find cargo space.

“It’s become, really, a complete supply chain meltdown on the Pacific Ocean,” Anderson says, who worries that some customers may switch to Australian hay.

Trade economists and policymakers expect the capacity shortages to fade as the pandemic ends and normal consumer patterns return. But many exporters fear that by then, they may have permanently lost some market share.

“My biggest worry is that suddenly what seemed like a blip in exports and a temporary problem becomes, well, now China is going elsewhere for their apples and their cherries and their hay,” says Rep. Kim Schrier, D-Sammamish.

Schrier knows farmers and exporters have little leverage in a shipping business that is now dominated by just a handful of massive, foreign-owned firms, whom exporters can’t afford to offend. “Their hands are tied,” she says.

Instead, she wants the federal government to pressure shipping companies to make more room for American exports on westbound ships by minimizing the empties they take back to Asia.

Schrier says that the Federal Maritime Commission is already exploring whether shipping companies’ practices violate U.S. shipping law — and thinks the threat of federal action or a congressional inquiry could induce shippers to “think twice” and stay in U.S. ports long enough to load more full cargo containers. Two of the ports’ biggest carriers — MSC and Maersk — did not respond to requests for comment.

”Sometimes, just pushing into investigating an issue is enough to make things happen,” Schrier says. “But if not, we are prepared to work ... with the federal Maritime Commission to make sure we have fair agreements” for shipping.

COVID-19 vaccines for children and teens are coming, experts say

LOS ANGELES — As adults in the United States continue to line up for their COVID-19 vaccines, children and teens have largely been kept out of the queue. That could soon change.

The nation’s top infectious diseases expert says that by fall, he expects to have data showing that children and teens age 12 to 17 can start rolling up their sleeves for COVID-19 shots. Younger children could follow in the first quarter of 2022.

“We project that high school students will very likely be able to be vaccinated by the fall term — maybe not the very first day, but certainly in the early part of the fall for that fall educational term,” Dr. Anthony Fauci said Sunday on CBS’s “Face the Nation.”

Children appear to have largely been spared the worst ravages of COVID-19, often suffering mild or minimal symptoms. And student vaccinations are not needed for safe school reopenings, experts say. Still, a wide-scale vaccination of America’s children and teens could offer some peace of mind to families — and would provide welcome aid in the effort to achieve herd immunity against the coronavirus.

“When you get the overwhelming majority of the population vaccinated, the level of virus in the community gets so low that the risk of infection is going to be minuscule,” Fauci said this week during a virtual event held by Tufts University.

Currently, no COVID-19 vaccine is authorized for use in children under the age of 16. But several vaccine makers are already testing their shots in younger teens and some pre-teens, and others have committed to doing so soon.

It’s all part of a push to get as many Americans protected against the virus as possible. And it can’t come fast enough for many doctors.

The American Academy of Pediatrics issued a call late last year for manufacturers to include children in their clinical trials because there’s no other way to judge whether the vaccines are safe and effective for them.

“If we do not add children to these research trials very soon, there will be a significant delay in when children are able to access potentially life-saving vaccines. This is unconscionable,” academy President Dr. Sara “Sally” H. Goza said in a statement late last year.

It’s true that children appear to be far less impacted than adults, particularly the elderly. Despite accounting for 22% of the U.S. population, as of March 9, children under 18 made up 11.6% of nearly 22 million cases, and less than 0.2% of nearly 383,000 COVID-19 deaths, according to the Centers for Disease Control and Prevention. (The U.S. has more than 29 million cases and more than 527,000 deaths, according to current Johns Hopkins University data.)

But that still amounts to a lot of needless suffering and tragedy, said Dr. Robert Frenck, a pediatric infectious disease specialist at Cincinnati Children’s Hospital Medical Center. Data from the CDC show that 428,502 children ages 4 and under have been sickened with COVID-19 since the start of the pandemic, and 94 of them have died. Another 2,078,245 kids between the ages of 5 and 17 have had COVID-19, and 194 have died.

“These are ... healthy kids that should have had a normal life ahead of them, and COVID changed that,” Frenck said.

Writing in the journal Clinical Infectious Diseases, several doctors made the case that vaccinating children was a critical move in the fight against the pandemic — not to mention crucial to protect youth against unnecessary suffering and risk of death.

“The direct COVID-19 impact upon children is greater than that observed for a number of other pathogens for which we now have effective pediatric vaccines,” they wrote. “Additionally, the role of children in SARS-CoV-2 transmission has clearly been underappreciated.”

The researchers pointed to several studies that suggest children may be effective transmitters of the virus. Among them: a number of studies comparing virus levels in the respiratory tract of children to that in adults; and a CDC study of a Georgia summer camp where 44% of the 597 attendees, trainees and staffers were infected.

Frenck was one of the authors of that editorial. He pointed out that there are roughly 75 million people under 18 years of age, and we’ll have a hard time achieving herd immunity without them.

“If you didn’t vaccinate that group you’re going to have a large part of the populations that’s not vaccinated,” he said in an interview.

Vaccine makers won’t have to start entirely from scratch when they test their wares in children, because they’ll have the vaccines’ demonstrated safety and efficacy in adults as a starting point.

To begin, companies will start with teenagers, whose responses to the vaccine are expected to be the most like what’s been observed in young adults. Then they’ll work their way into younger and younger cohorts, all the way down to infants, said Dr. Yvonne Maldonado, a pediatric infectious disease vaccinologist at Stanford University.

Pfizer, which included 16- and 17-year-olds in its Phase 3 clinical trial, has now fully enrolled its trial for 12- to 15-year-olds. Younger age groups would follow.

Fauci said in a briefing last month that vaccine trials for 12-year-olds down to 5- to 6-year-olds would likely start around April, though it would likely take a year for results to come in.

”That’s how we do all vaccine trials,” Maldonado said. “We always start with adults and then we work into children.”

While researchers aren’t expecting any big surprises when it comes to the vaccine’s safety and efficacy in children, the data need to be gathered.

”Sometimes children respond the same to vaccines as adults do but sometimes they don’t,” Maldonado said. “It’s very different for each organism, each type of disease, each vaccine — so there’s no one answer to that question, and that’s why you have to do a trial each time.”

The COVID-19 vaccines from Moderna and Johnson & Johnson were only tested in adults; as such, they’re only authorized for use in those age 18 and up. Like Pfizer, Moderna has begun testing its vaccine in minors, while Johnson & Johnson has committed to doing so in the first half of 2021. (So has AstraZeneca, though its vaccine has not yet been authorized for use in any age group in the U.S.)

Dr. Richard Malley, a pediatric infectious disease specialist at Boston Children’s Hospital, said the trials in minors will be looking at whether the vaccines are able to induce an immune response. Essentially, investigators will vaccinate half their minors and give the other half a placebo and then, weeks later, test their blood for the presence of coronavirus antibodies. Those results will be compared to the antibody levels seen in adults.

That’s a little different from the way clinical trials are done in adults, where tens of thousands of participants were administered either vaccines or placebos and researchers simply watched and waited to see how many cases of COVID-19 emerged in each group. (The vaccines were deemed effective because the people who got them were far less likely to become ill than the people who got the placebos.)

But it would take a long time to recruit enough children for that type of a trial and then wait for enough COVID-19 cases to draw conclusions about its efficacy, Malley said. So-called immunogenicity trials are much more time-efficient, partly because they’re based on the idea that if vaccinated children produce antibodies at roughly the same level seen in vaccinated adults’ blood, it’s reasonable to assume that children would have about the same level of protection.

”That’s a bit of a leap of faith,” Malley said, “but it’s a reasonable one.”