How did the COVID Economic Downturn affect Health?

COVID-19 Economic Recession & Okanogan Community Health: February, 2021 CHI meeting summary

The connection between the economic health & wellbeing:

Health is influenced by many factors, not just disease. Overall health is affected by emotional, intellectual, social, physical, environmental, spiritual, and financial factors.

Okanogan County’s health indicators are poor in mental health, chronic disease, food security, obesity, and access to exercise. Okanogan’s socio-economic indicators are also poor relative to the state, we have a high adult & child poverty rate and limited availability of living-wage jobs. Ultimately, health and wellbeing is influenced most strongly by socio-economic factors; when economic downturns deteriorate socio-economic status, health and well-being suffers.

The impact of the economic downturn on community health:

High COVID-19 exposure & illness among farmworkers: COVID-19 hit farmworkers (one of our most vulnerable populations) in the summer of 2019 at the peak of cherry season, when many people are earning 80 - 90% of their annual wage, seasonal population grows, many multi-household childcare collaborations are needed so people can work, and many people cannot afford to take time off. Not a good environment for pandemic management, we didn’t have the protections in place to protect an essential workforce.

Rising stress and anxiety among mothers: Many mothers have taken the burden of all child rearing responsibilities during school closures (including home schooling), while continuing to work their paid job.  Mothers are dealing with rising stress, depression, anxiety. 

Absence of childcare prevents people from working: High turnover at businesses, many can’t work because they don’t have childcare or don’t have childcare that will be able to provide their kids sufficient education.

Lack of internet or phones severely limits access to resources: Those without phones or internet access can’t get the services they need. Lack of broadband is a growing issue that now affects school learning, remote businesses, telemedicine, precision agriculture, and other new technologies.

Kids with disabilities struggle to get sufficient support: Families who have children with disability are not able to get many of the resources they need, e.g. speech or physical therapy. Some are not getting the healthcare they need out of fear of COVID exposure.

High stress among front-line healthcare workers: Hard on staff, hard on clients. Social workers hear tough stories every day; the economic struggle is hard for clients, but it’s also hard on staff. Most state services immediately entered a hiring freeze, preventing reinforcements from coming in. 

High financial and emotional stress among small businesses: Recession has affected small businesses tremendously. Many who were otherwise prepared for a “rainy day” could not make it through a full year of being closed. Some are laying people off, closing permanently, or choosing to not re-open. Businesses were not given forbearance or deferment on their loans (unlike individuals), they were required to pay high overhead expenses, including rent. Government funding was able to help some of these people, but many were worried they would lose their homes if their business failed. Family owned and operated businesses were uniquely affected because every single household member lost income.  Stress levels were high among business owners: changes to opening, closing, and  funding put them on an emotional rollercoaster.

What we learned: socio-economic stabilizers in an economic downturn

Protect our workforce and invest in our most vulnerable populations: If workforce can endure, we are better positioned to support the economy

Increase community health infrastructure: In the pandemic, this involved direct outreach workers, increased contact tracing, and support with isolation and quarantine but community health systems should be mobilized in recessions in multiple ways.

Create affordable, accessible childcare options: Childcare is critical to essential workers, demand for childcare, particularly among 0 - 3 is very high when people need to work to make ends meet. A safe place for kids to go when household stress is high is critical.

Increase food support and cash assistance: People needed more than “usual” benefits, and many people who previously qualified accessed this support for the first time.  

Make access to benefits as quick and efficient as possible: Community health entities made all forms completable electronically and enabled people to get food benefit cards the same day. Not having to go in-person has been helpful for those who live far away.

Deliver direct financial assistance to small businesses: Partner with state, county, and municipalities to administer grants directly to small businesses,  including help with overhead expenses.

Provide 1:1 assistance to businesses most affected: Educate businesses on newly-available resources and re-look at business models, such as shifts to online retail and use of social media

Distribute more, high quality food: Good nutrition is critical for families to learn and people to stay healthy.

Prevent evictions; help with heating, utilities, and other essential costs: No one should lose the ability to be safe in their homes during a financial crisis.

How can we be more resilient to future economic downturns?

Increasingly flexible businesses: Adjust business models in recession times (e,g, brick and mortar vs. remote) and look for cost reduction opportunities.

Ensure childcare is available and affordable: Early childhood education lays the groundwork for healthy adults and enables workers to be flexible during downturns, it should be reliable and well funded.

Utilize the post-downturn period to step into new ideas that fit a changing market: Support innovators post-pandemic as they develop new ideas and approaches to business

Help household’s understand their monthly expenses and budget: Train people to spend money thoughtfully and reserve funds for critical expenses or crises. 

Develop and invest in a stronger safety net (housing, schools, apple health, etc.) and address generational poverty: Preserve health insurance coverage, nutrition programs, housing subsidies etc. to improve health in ways that bouey the economy

Reduce poverty in general: Develop the Okanogan economy in ways that reduce unemployment and poverty.

Poverty and the economy:

“What are we missing out on because of the poverty that our county faces? What’s the opportunity cost? If we can lift people out of the impoverished conditions they live in, what would their contribution to the Okanogan economy be?”

“Why should we work to eliminate poverty? Because poverty costs money. Just in January, Okanogan County issued 1.9 million in food benefits. This money goes into the economy (which is good), but what would we do to attract a business that would bring in a $2 million payroll? We need to find a solution to the high unemployment and high poverty rate we have in this county.”

How has Okanogan’s economy changed?

Long-term Labor Market Trends in the Okanogan County Economy:

• Average annual Okanogan County unemployment rate in 2020 (9.4 percent) was still less than the rate in 2010 (10.7 percent) - during the “peak” of the recent Great Recession.

• However, the average annual nonfarm job loss-rate of minus-5.6 percent countywide in 2020 was worse than the minus-3.9 percent loss-rate in 2009.

• Agriculture lost jobs at an annualized loss rate of minus-2.5 percent (down 1,260 jobs) from 2009-2019. Conversely, transportation and warehousing added jobs at an annualized growth rate of 15.5 percent (up 306 jobs).

Recent Labor Market Trends (2019 - 2020)  in the Okanogan County Economy

• Unemployment rate rose from 6.8 percent in 2019 to 9.4 percent in 2020. COVID related layoffs drove rates up from April through November 2020. 

• The Okanogan County nonfarm market lost 710 jobs in 2020 (down 5.6 percent). Washington state lost 160,900 jobs in 2020 (down 4.6 percent)

•  Sectors losing jobs in 2020: over eighty percent of jobs lost were in leisure and hospitality (down 250 jobs) or state and local government (down 330). 

•  Sectors gaining jobs in 2020: federal government (up 40 jobs) and manufacturing (up 20 jobs).

• Unemployment rate rose from 6.8 percent in 2019 to 9.4 percent in 2020. COVID related layoffs drove rates up from April through November 2020. 

•  The Okanogan County nonfarm market lost 710 jobs in 2020 (down 5.6 percent). Washington state lost 160,900 jobs in 2020 (down 4.6 percent).

• Sectors losing jobs in 2020: over eighty percent of jobs lost were in leisure and hospitality (down 250 jobs) or state and local government (down 330). 

• Sectors gaining jobs in 2020: federal government (up 40 jobs) and manufacturing (up 20 jobs).

The State of COVID-19 in Okanogan County: January, 2022

January 27, 2022 Okanogan CHI Meeting Summary

Overview of current COVID activity in Okanogan County:

• This COVID variant acts more like a flu or a bad cold (Omicron stays in the upper airway), far fewer people are hospitalized than previous variants, not a lot of hospitalized children so far.  

• People are testing multiple days in a row when they have been exposed or have symptoms, they can be negative with the first test and not get a positive result until day 4 or longer.

• Many clinics are running out of testing supplies, DOH is working on solutions

• We may be nearing a peak in this surge (we are usually 1-2 week behind the westside of the state).  School athletics are furthering cross-county infection. 

• DOH is likely to shift from reporting positive tests to reporting hospitalizations because the reporting is too demanding to keep up with.  

• Vaccination rate is relatively flat at 48% across the county, see your town’s vaccination rate here. Misinformation is the biggest challenge to getting more people vaccinated.

How are our hospitals and clinics doing in this surge?

Hospitals, clinics, and many nursing homes are struggling with capacity:

• There are above average numbers of people in hospitals and healthcare facilities in general who are not necessarily COVID affected.

• Many patients could be staying at home or seeing a provider, instead they are coming into Emergency Departments. Some of the disease care that was put off during COVID is now accelerated into more extreme health issues, which increases the overall work of healthcare facilities.

• Significant operational challenges are arising as staff test positive and cannot return to work until they are clear again.

• Hard to transfer a patient to a higher level of care or ICU because beds are full in other places and extreme weather hampered movement several times this winter.

• “We're in a world of hurt for healthcare professionals.” Many people are leaving healthcare, they are burned out and tired, leaving a shortage of healthcare workers in the wake, e,g, there are 73 openings at confluence for Medical Assistants.

There are more positive people testing positive than are being reported on the COVID site.  How do we best help explain his discrepancy? 

There are more positive COVID-19 cases in the community right now than are represented in the incidence rate on the OCPH data page. Before cases can be reported, they are verified and entered into the Washington State Disease Reporting System (WDRS). This is where DOH and LHJs pull data from to track cases across the state. In Okanogan County right now, there is likely a ~3-5 day lag between when someone tests positive using an antigen (rapid) test and when that case appears in the OCPH update (assuming that OCPH is notified of the positive test--we know not every positive home test result is reported to OCPH!). 

OCPH has moved to a weekly reporting window to allow for that lag time and to compare weekly trends that can indicate when the current surge appears to have peaked and begins to decline. Besides home tests, OCPH must manually enter all positive test results from EMS testing (AeroMethow, Fire District 15), some schools (those who are not using the CDC Simple Report tool, which links directly to WDRS) and Mid-Valley Hospital & Clinic. It takes approx 15 minutes to manually enter one positive test result into the database. To make it easier to report a home test kit positive result, OCPH has just launched an easy online reporting form 

https://okanogancountycovid19.org/home-test-for-covid/. Instead of calling OCPH, community members can fill out the quick form online, and then OCPH will follow up.

People have COVID symptoms but often don’t test positive for 5 days or more.  How should employers navigate this in their policies and practices?

Employers should set their guidelines and communicate the plan with employees. It might involve something like asking employees the following when they come to work: 

1. Do they feel ok (fever, scratchy throat)?,

2. Does anyone in their household have covid?

3. Were they in close contact (indoors, less than 6' apart for more than 15 min) with someone who was covid pos? 

If yes, the employer could ask the employee to take a rapid test (ideally, employer would have home-tests on hand and they could do one right then). If employee tests negative, but has symptoms, employer could choose to have them stay home or make sure all employees wear N95 masks in indoor work spaces. If employee has a fever, they should stay home until the fever has been gone for >24 hrs without meds.

If someone has symptoms and they are at work, N95 masks for everyone inside is the best way to keep all employees safe. Anyone who tests positive, should isolate at home for 5 days, and then wear an N95 mask for another 5 days. The updated CDC guidance for isolation/quarantine after exposure, or positive COVID-19 test, is here: https://okanogancountycovid19.org/tracing-isolation-quarantine/

How can CHI members best support the capacity challenges facing hospitals and other healthcare entities right now? 

Spread the message:

• Go to the appropriate place for appropriate services so we can get doors open for community visits and ERs, help healthcare use its resources very well right now

• Keep people out of emergency rooms when possible

• Come to your providers’ appointments when they are scheduled (health systems are working hard) 

Support long-term plans to grow the healthcare workforce:

• To try to get more people into the profession through tracks that community colleges, hospitals, public health and clinics are developing (we’ll talk about that more at the CHI)

• Leverage community health workers to keep healthcare engaged with patients

This is time to support each other. There is no quick fix to covid or staffing shortages, healthcare folks could all use care and support right now.

[CHI Meeting Announcement] 1/27/22 State of COVID-19 in Okanogan County

Our CHI network of more than 40 organizations across Okanogan County plays a critical role in COVID-19 response. This meeting is set-up to answer your questions, and position you all as key messengers and community-weathervanes for COVID-19. We encourage you to share this meeting invitation with others in your organization

To help us best organize this meeting, please send us any questions or COVID-19 specific topics you'd like our public health and community partners to discuss.

Okanogan County Childcare and Early Learning in Crisis

Written by Jodi DeCesari, Okanogan County Child Development Association; Dani Reynaud, Little Star School; and Brad Halm, Little Star School

September 23, 2021

A robust childcare and early learning system is a critical part of the fabric of our community, and we need more of it here in Okanogan County! High quality early learning helps our children develop social-emotional skills such as motivation and empathy that serve them throughout their lives. It is also vitally important to our community and our economy: without it, most parents cannot work, cannot attend school, and cannot seek support services for mental and physical health issues. 

Unfortunately, childcare is in crisis across the country and in Okanogan County:

• Okanogan County has approximately 2,789 children under the age of five. As of 2020, there were only a total of 40 early learning providers with a capacity to serve 683 children (24% of children ages 0-5).  

• As of June 2020, COVID-19 caused 44 childcare providers in our region (Okanogan, Chelan, Douglas, and Grant Counties) to close their doors temporarily, losing 900 slots.¹ 

• An estimated 47% of children in our region with all parents in the workforce DO NOT have access to early learning in a licensed childcare, Head Start, or ECEAP program.¹    

• Lack of childcare impacts our local economy. In our region, it is estimated that employers incurred $71.1 million in cost from breakdowns in childcare coverage that led to employee absenteeism.

• OCCDA’s 2021 community survey found that 75% of families need childcare, and 50% of those have tried to access child care and have been unable to do so.

• The Early Learning sector has historically received low reimbursement and stagnant funding, which contributes to the difficulties of attracting, recruiting, and retaining high quality and qualified employees. 

Private and nonprofit child care providers (like Little Star Montessori School) are typically not eligible for federal or state funding, which leaves most parents burdened with high tuition bills. And even with high tuition, early learning teachers are only paid a fraction of what K-12 teachers earn (and most don’t receive health insurance or other benefits). This short video from Childcare Aware of America excellently summarizes the problem of low provider pay and high childcare cost.

Head Start and ECEAP programs (like OCCDA) receive federal and/or state funding so families do not have a tuition burden, but slots for children considered over-income are limited. Teachers in these programs typically receive a benefits package, albeit often much smaller than their K-12 counterparts, and the wage scale still doesn’t come close to matching that of K-12 staff. 

Another key issue that limits childcare availability is the difficulty of opening a new facility or in-home program. Licensing requirements are complex and startup costs high, and given the limited potential for growth in teacher wages there is little incentive for those interested in providing childcare to start new programs. 

COVID-19 has added an additional layer of difficulty for childcare providers. Frontline teachers are exhausted, administrators are stretched thin while implementing new safety policies, and finding enough staff to remain open is an incredible challenge. COVID quarantines and new regulations are further reducing the staffing pool, and providers are taking on the burden of additional costs such as cleaning, HVAC improvements, and COVID prevention supplies. Leadership teams have limited capacity to plan, fundraise, or access available expansion funding, as we are now often helping to clean bathrooms or covering in a classroom. 

To truly support families, we need a strong network of licensed facilities and flexible in-home care providers in each community. And this will not be a reality until we have adequate public funding to provide fair teacher pay and benefits. 

We need our community’s, and our CHI’s help and advocacy to advance solutions that work:

• Expanded public funding at the state and federal for early learning in the form of tuition assistance for families and expanded reimbursements for providers.

• Intelligent regulation that ensures safety and high quality programming, but is achievable for those wanting to start new childcare programs.

• Expanded grant funding to help new in-home providers cover startup costs and to fund construction of new facilities.

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Written in partnership by:
Jodi DeCesari, Okanogan County Child Development Association; Dani Reynaud, Little Star School; and Brad Halm, Little Star School

ChildCare Aware of Washington. (2021). Child Care in Okanogan County. https://childcareawarewa.org/wp-content/uploads/2021/01/2020-County-Data-Okanogan.pdf

Washington Stem, North Central Early Learning Collaborative, & Washington Communities for Children. (2021). State of the Children: Early Learning & Care, North Central Region.

Wildfire Smoke, Air Quality & Local Action

Written by Elizabeth Walker, PhD

August 13th, 2021

Most of Okanogan County has been engulfed in smoke since late June when BC fires started up. We now have our own set of local wildfires, and Winthrop is getting national and global attention for having some of the worst air quality in the world this month. 300, 400, 500+ AQI. Anything over 250 is considered hazardous to our health, and anyone suffering through this knows how hard it can feel.

This isn’t the kind of attention anyone wants.

Wildfires and smoke aren’t going away for the foreseeable future, and they are likely to get worse before they get better.

Research on Wildfire Smoke and Health

Research continues to reveal that wildfire smoke is detrimental to health at lower exposures and contributes to more types of disease than previously appreciated. The lung and heart have long been identified as targets for the particular matter (PM2.5) found in smoke, but recent evidence has now implicated PM2.5 in diseases of the skin, nervous system, liver, kidney, immune system, as well as low birth weight for exposed pregnant women. Alarmingly during the pandemic, correlations between exposure to wildfire smoke and increased cases of Covid-19 have been observed; this is biologically plausible as smoke is known to increase susceptibility to respiratory infection. Smoke-induced stress from disrupted daily routines, inhibited ability to be outdoors, and social isolation is compounded by evacuation notices, visible flames, and the hypervigilance of keeping tabs on fire activity when wildfires are local. Mental health and wellbeing are very much at risk due to smoke and fires.

In Okanogan County, it is also important to consider that these large annual doses of wildfire smoke come on top of poor winter air quality due to woodsmoke, localized exposures from outdoor burning, and smoke from prescribed fire necessary to restore forest health and prevent catastrophic wildfire. Even before you include wildfire smoke, our region has been identified by the Washington Department of Ecology as an “area of concern” for our persistent PM2.5 levels that threaten to violate the National Ambient Air Quality Standard (NAAQS).

Intense periods of unhealthy air quality due to wildfire smoke – such as repeatedly experienced in Okanogan County over the last 10 years - are increasingly appreciated as disasters, with specific actions that can be taken towards preparedness, response and recovery. The good news: we know how to do this, and we have a committed and growing cadre of professionals and organizations helping with disaster preparedness and response. The CHI and its members will recognize ourselves in playing a role, both individually and organizationally. If you are interested in participating in wildfire smoke readiness, or have questions, please contact Liz Walker at Clean Air Methow.

Response (steps to take now):

• Ensure N95 masks are widely available. Distribute at places where people already are – fire information boards, health clinics, post offices – as well as town halls and county public health. Okanogan County Public Health has a large supply.

  • Fit and comfort are critical. A full seal around the mask’s edge must be created for protection.

  • For the first time, masking in wildfire smoke is now recommended for children. KN95s come in smaller sizes and are more likely to achieve the necessary fit.

• Promote the importance of clean indoor air. Without active filtration in wildfire smoke, indoor air is frequently as bad as outdoor air.

  • Help create equitable access to clean indoor air.  For example…

    • Ensure vulnerable populations, especially households with children, those with underlying health conditions, or those on fixed or limited incomes – have the ability to create clean indoor air. Box-fan air cleaners can be built for about $45; Room One in Twisp has a box-fan air cleaner distribution program. More of these programs are needed to reach everyone in the community.

    • Circulate information on how to create a “clean room” indoors. 

• As community health professionals, model healthy behavior.

  • Ensure your work buildings and home have clean indoor air. Upgrade HVAC systems with the highest-rated MERV filter they can handle, use or supplement with HEPA air purifiers or DIY box-fan air cleaners as necessary.

  • Wear a N95 mask when the AQI exceeds 150 (or lower!)

  • Ask patients and clients how wildfire smoke is impacting them, and provide information and resources to help protect physical and mental health. 

Recovery (what comes next)

• Debrief, collect information from the community, and analyze successes and needs

  • Ex. KN95s in small sizes were not available this year through Okanogan public health and challenging to find online. Can we get these for next year?

• Develop and implement a comprehensive plan to become a “smoke-ready community” that identifies and helps support and fund key partners to carry out their specific roles.

  • Modeled and usefully piggy-backed onto efforts to become “fire-wise” or “wildfire-ready”, smoke ready communities 1) know their sources of air pollution, 2) are actively working to reduce them, and 3) have resources to protect their vulnerable community members

  • Smoke-readiness incorporates not only wildfire smoke disasters, but also long-term strategies to reduce exposure to air pollution. This includes exposure-reduction interventions such as mask-wearing and ensuring clean indoor air, AND improving air quality wherever possible such as through reduction of outdoor burning and decreasing woodsmoke from home-heating. Diverse partners will include those focused on air quality, county health, social and health services, emergency/disaster response, municipalities, those involved in fire-wise efforts, etc…

Preparedness (doing it better next time):

• Broadly advertise and support community partners in “Smoke-ready week,” the second week of June to encourage preparedness.

• Clean Air Methow has developed a “smoke-ready checklist” that is available for anyone’s use and dissemination online, in print, or pdf.

• Coordinate partner meetings ahead of smoke season to ensure awareness of information, resources, and a communication plan.

Local non-profit projects dedicated to smoke-readiness

www.cleanairmethow.org

www.okcleanair.org