Western Washington State COVID-19 Experience: Keys to Flattening the Curve and Effective Health System Response

Abstract

Background: Washington State experienced the first major outbreak of COVID-19 in the US and despite a significant number of cases, has seen a relatively low death rate per million population compared with other states with major outbreaks, and has seen a substantial decrease in the projections for healthcare use, that is, "flattening the curve." This consensus report seeks to identify the key factors contributing to the effective health system disaster response in western WA.

Methods: A multidisciplinary, expert panel including individuals and organizations who were integral to managing the public health and emergency healthcare system response were engaged in a consensus process to identify the key themes and lessons learned and develop recommendations for ongoing management of the COVID-19 pandemic.

Results: Six key themes were identified, including early communication and coordination among stakeholders; regional coordination of the healthcare system response; rapid development and access to viral testing; proactive management of long-term care and skilled nursing facilities; proactive management of vulnerable populations; and effective physical distancing in the community.

Conclusions: Based on the lessons learned in each of the areas identified by the panel, 11 recommendations are provided to support the healthcare system disaster response in managing future outbreaks.

Figure 1

Timeline of COVID-19 events in Washington state. This timeline represents the progression from the initial case and first death from COVID-19 in Washington state to the series of events leading to effective physical distancing in the community.

Figure 2

Institute for Health Metrics and Evaluation (IHME) projections for cumulative deaths per million people by state. This figure was based on the IHME model as of April 12, 2020 with projections to April 20, 2020 by state for the 7 states most effected by COVID-19. Cumulative deaths per million population are shown over the days since 1 reported death per million was documented.

Figure 3

Institute for Health Metrics and Evaluation (IHME) projections for Washington State: All hospital bed requirement. The IHME published an initial estimate of total hospital beds required for COVID-19 patients in Washington State on March 25,2020 (light pink line, shaded pink area represents CIs). New projections were published on April 12, 2020, which incorporated all hospital bed use up to that date (dark pink line) showing a significant reduction compared with initial projections.

Figure 4

Western Washington Regional COVID Coordination Center (WRC). The WRC has 4 pillars of activity including 2 surveillance pillars that provide situational awareness of hospital resources and COVID-19 status in congregate settings and 2 coordination pillars that include coordination of resources and support for long-term care facilities and distribution of patients across area hospitals to level-load the system. EMS, emergency medical services; PPE, personal protective equipment.