Coronavirus cases in Montgomery County continue to surge as hospitals prepare for a peak.
As of Friday morning, the county had 4,754 cases and 236 reported deaths from the virus.
Dr. Travis Gayles, the county’s health officer, told the County Council during its virtual meeting on Thursday that there has not yet been a peak in cases.
The majority of the county’s patients who have died have been older than 65. Gayles said the county has broken down 210 deaths in the county by race:
● 99 white
● 57 African American
● 28 Hispanic
● 18 Asian
● 8 other
When those counts are broken down into rates, there are 29.6 African American deaths per 100,000 residents.
Other rates of deaths per 100,000 residents were 28.5 “other,” 19.9 whites, 13.5 Hispanics, and 11.2 Asians.
“The numbers suggest that we are surging and haven’t quite hit our peak,” Gayles said.
The hospitalization rate for coronavirus cases in the county is 21%.
Two local hospitals, which Gayles did not name, are in the “red zone” for acute bed capacity, which is for patients who have severe illnesses and need more attention and care. There are no “red levels” of ventilator usage in the hospitals at this point, he said.
Washington Adventist Hospital in Takoma Park is receiving patients with less severe conditions and illnesses from White Oak Medical Center in Silver Spring and Shady Grove Medical Center in Rockville. This will free up space in the two hospitals for extended support for patients and Washington Adventist plans to build out space for up to 200 additional beds, Gayles said.
The state data initially released on cases and deaths in nursing homes did not distinguish them by staff members and residents, and when the outbreaks happened, Gayles said. The state followed up with another set of data that did include the breakdown of cases and deaths by employees and residents a day later.
“In the setting of nursing homes, an outbreak is considered one case,” he said.
The majority of the cases in the county’s nursing homes were in late March and early April. That was also the time period when the Centers for Disease Control and Prevention released guidance that asymptomatic individuals did not transmit the virus, which the agency has now corrected.
The CDC also wasn’t advising medical employees to wear protective equipment with all patients at that time.
Gayles said the county and state have created teams to support nursing home staff with testing.
Any nursing home residents who have symptoms are receiving tests which are sent to the state’s public health lab for analysis within a 24-hour period. Nursing home employees were encouraged to seek testing through their primary care providers.
All residents and employees at nursing homes are now to get tested under a new order Gov. Larry Hogan announced Wednesday.
Employees who test positive for the virus will be discharged to quarantine at home. The testing will be prioritized at nursing homes based on outbreaks or rising threat risk.
Project HOPE, an international health and humanitarian relief organization, will also be sending additional staff to help the county with testing in nursing homes and setting up mobile testing for group homes or other facilities.
Additional county teams to support group homes and home care providers are also being formed.
The county is currently offering limited testing at three sites — the Vehicle Emissions Inspection Program site in White Oak in partnership with the state, the Wheaton Library and Community Recreation Center, and the Upcounty Regional Services Center in Germantown.
The Germantown site will be testing on Mondays and the Wheaton site will be testing on Wednesdays. The VEIP site is testing on Tuesdays and Thursdays. All sites are conducting tests only appointments, which are booked until May 5.
Appointments can be made with an order for a test by a primary care provider. The county health department is finalizing the setup of a hotline that residents who don’t have a primary care provider can use to connect with one over the phone and potentially be approved for a test.
The county is working to potentially provide more testing through the Montgomery Cares clinics. Five are open for in-person visits. The majority of the residents who have been tested have been referred from the clinics.
Gayles said the county is working with two local labs — LabCorp and Quest Diagnostics — and is finalizing logistics of working with another, GeneDX in Gaithersburg. Staff members are working on finding and vetting other private labs.
Gayles said a team of 50 full-time staff members — senior disease control employees and school health nurses — is working on tracing the cases in the county.
In addition, the state has sent two response teams who are working in the county to help prevent homelessness and support Impact Silver Spring to identify and assist families in crisis. Those families are in the ZIP code areas reported to have the most cases, Gayles said.
When asked by Council Member Gabe Albornoz whether the county would receive any of the 500,000 test kits the state purchased from South Korea, Gayles said he didn’t know and the county was still waiting on answers from the state.
Mike Ricci, a spokesman for Gov. Larry Hogan, did not respond to a request for comment Thursday.
“We’re bound by the tests that we have available and there are simply not enough of them,” Albornoz said. “It’s frustrating for everyone. … It’s not that we’re holding back. It’s not that we don’t want to test. It’s not that we don’t have a system in place. There are simply not enough test kits out there to meet the current demands.”
Gayles said the county is trying to “turn over every rock to see how we can increase access.”
The CDC released guidance last weekend to open up testing for asymptomatic people. Gayles said he would like to open testing to all essential employees and anyone who has had in-person contact with a known case.
“We have submitted language to the state to say that we would like to put out information to add recommendations in terms of who should be considered in that asymptomatic piece,” Gayles said. “That will be going out. We’re working on language to put that out.”
‘Tense exchanges’
Council Member Hans Riemer asked when the council would receive answers to questions sent to the county executive, chief administrative officer and health officer.
Gayles said the council would get the answers as soon as possible. Riemer replied that his answer was not “satisfactory” and that the council needs answers to its questions right away.
Riemer said the high number of cases and deaths in nursing homes could have been mitigated if there were an “aggressive” early response, with testing for all employees and residents.
“I don’t want to cast blame for that, but I just think it’s an example of being behind the curve that is having a big impact,” he said. “My understanding is that there is testing and capacity available. So contrary to comments made moments ago, there are companies providing testing for a service. What is lacking is really the direction as to who should get tested and under what circumstances.”
Gayles said he didn’t agree that testing capacity is just a question of who is directing the tests and what the criteria are.
“We’re trying to have conversations about how we can scale up and do large-scale testing,” he said.
Riemer said there were “structural issues with authorities.”
“I’m very confused about your role overall,” Riemer said. “I know that you are part of a state structure, so it appears to me that, oftentimes, decisions we could make locally are deferred to state-level decisions or we don’t make a decision locally because we are waiting for a statewide decision. It appears that way to me, that as a state-chartered health officer, you’re responsive to a state decision-making process first.”
Gayles said that was not correct and provided an example of strategies that the county has taken before the state, including creating “action” teams to support county services and his issue of a health order for residents to wear masks in grocery stores and other public places.
He said he was not going to get into a “back-and-forth” with Riemer. “Your characterization of my role is not accurate,” he told Riemer.
“Anything that we do from a health officer standpoint or public health services is guided not by the state, but is guided by public health principles,” Gayles said, adding that decisions are made on science and data.
Council Member Craig Rice said the County Council also sits as the board of health and has the ability to push the health officer for what it would like to see implemented in the county.
“Our interests are in protecting the public,” he said.
Council Member Nancy Navarro said county officials need to work together to find ways to increase testing.
“I do not like a display of tense exchanges between our health officer and our board of health,” she said. “I don’t think it helps anybody. What I want is for us to work in a proactive, in a quick fashion to scale up and find as many initiative, strategic ways of figuring out how to address this.”
She said testing should be concentrated in the county’s ZIP code areas with the highest number of cases.
Friedson asked how many test kits are in the county’s inventory, what its testing capacity is with private lab partners, and what the needed testing capacity to significantly increase testing.
Gayles said the county has to get more information from the private labs to see what they can offer in capacity.
“As their capacity has increased … they’ve been sending out more kits to folks,” he said, adding that the two labs have added a good supply to the county.
Gayles said the health department is working on getting a count of how many people are essential employees, employees and patients in nursing homes, and those who have had contact with known cases.
Friedson said the lack of information on how many tests the county has and how many are still needed are the roots of the council’s frustration.
Briana Adhikusuma can be reached at briana.adhikusuma@moco360.media.
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