COVID-19 ripped through communities east of the Cascades, killing people at twice the rate of Western Washington

Dec. 20—SOAP LAKE, Grant County — For months, McKay Healthcare and Rehab staff kept its elderly residents safe from COVID-19. But in late October, the virus slipped into the center's 8-decade-old building.

By mid-December, 15 of the 31 residents had died from the disease.

In the struggle to fight the virus, some staff members worked 24-hour shifts to cover for co-workers who tested positive and had to stay home.

As Christmas approaches and wreaths decorate the center's long narrow hallway, the outbreak is over. But most of the beds are empty. So McKay's administrator, Erica Gaertner, says she is forced into an economic reckoning, and must reduce hours or pay of some of the employees with whom she joined in the searing struggle to save lives.

"These are hard conversations. The very people who got us through this are the very ones I have too many of," Gaertner said.

The death toll at nonprofit McKay, located in a farming community of fewer than 1,500 people at the edge of a remote mineral-rich lake, is stark evidence of the long reach of COVID-19 across Central and Eastern Washington.

The virus, in its early days in Washington, largely cut a swath of illness through the Puget Sound region. The first casualty east of the Cascades — an elderly resident of the Grant County town of Quincy who died March 7 — was a disturbing new development. As the year crawls to an end, COVID-19 has killed more than 1,000 residents east of the Cascades, a per capita rate double that of Western Washington counties, according to a Seattle Times analysis of state Department of Health and county statistics.

The deaths were part of a broader surge of illness that has hit much of rural America this fall.

In Grant County, more than half the 73 deaths reported as of Dec. 16 happened within the past six weeks. This month, infections have climbed so sharply that public health workers have largely given up on comprehensive tracing of cases.

Vaccines have arrived at a Moses Lake hospital, offering the prospect that 2021 will be a much better year. But here, as elsewhere in America, the rollout to the broader population will take months during a winter in which COVID-19 will continue to kill. In a part of Washington where skepticism runs high over lockdowns — and even the severity of the threat — it is still uncertain just how many people will opt to get vaccinated.

One hopeful sign for the future is how Grant County residents, at times have come together to fight the virus as a common foe. Earlier in the year, for example, Quincy-area farmers developed a plan to stagger workers' pay days and bus trips into town, to ease crowding in stores that residents feared could accelerate the spread of the infection.

"Our town really stepped up," said state Rep. Alex Ybarra, a Republican lawmaker and son of farmworkers who reached out to growers to help forge the agreement.

But COVID-19 often has proved to be a divisive presence.

Some residents continue to rail against the statewide restrictions that have once again shut down indoor restaurant dining. Others, though their numbers are dwindling, still shrug off wearing masks, angering Allen Dearie, the Latino owner of Central Market.

Dearie says he has repeatedly endured tense moments asking maskless customers, most of whom are white, to cover-up. He put some of the blame on President Donald Trump, who won nearly 66% of the Grant County vote last month and has failed to embrace masks.

"They got an attitude and they get mad," Dearie said. As he spoke, he eyed a maskless construction worker who had stopped to order lunch from the store's to-go counter that features tacos and burritos. "If I get sick, I have to shut down my store," Dearie said.

Another flashpoint in the Grant County pandemic saga has been the nearly 50 cases of the virus traced by public health officials to a Nov. 7 wedding with some 300 guests in adjacent Adams County. Eleven of the guests worked in the Moses Lake School District.

Wedding guests also included employees of a Moses Lake long-term care facility, Lake Ridge, that subsequently got hit with an outbreak that killed at least 16 residents. The Grant County Public Health District determined staff went to work "while contagious and before they knew they were ill," but reported "it will not be known" which deaths are directly tied to them. The county also is investigating possible links to wedding guests at another long-term care center where at least nine deaths have occurred.

This wedding, labeled by media as a super-spreader event, triggered an angry backlash that hit even the McKay staff, none of whom attended the wedding and whose coronavirus outbreak began more than a week before the Nov. 7 gathering.

"I was not prepared for that. It was just nasty, hurtful, rude, misinformed comments," Gaertner said of the social media fervor. "It was just devastating."

Such online assaults have added more challenges to the already daunting work of public health officials as they reach out to people who may have been exposed to the coronavirus. Even some people showing symptoms, or living with those who have tested positive, are now declining requests to get tested.

"I think that we have moved on from 'It's a hoax,' to 'It's not as big a deal as we think it is,'" said Theresa Adkinson, the administrator of the Grant County Public Health District, who has spent weekends assisting her staff in contact tracing. "In a lot of the phone calls, people are angry and they want to yell ... We are not here to judge ... We are working insane hours to keep them safe and dealing with constant confrontation."

A hospital's grim battle

In March, Samaritan Healthcare, Grant County's largest hospital, put elective surgeries and other nonessential services on hold to prepare for a spring surge in COVID-19 cases that never arrived. Instead of an influx of county residents infected with the virus, the 50-bed hospital suffered a 40% decline in patient volumes and took a financial hit as revenue fell by $15 million.

In September, the number of patients with COVID-19 still remained low — averaging around five. But things changed dramatically during the next three months as the virus in Grant County — mirroring broader national trends — escalated sharply.

In December, the COVID-19 patient count — on many days — has been more than triple that of September. In a recent visit, the hospital was treating 18 infected patients, including nine in a fully occupied 12-bed intensive care unit.

If COVID-19 cases continue to climb, staff — not bed space — will be the most precious and scarcest resource. Soaring infection rates have made even temporary recruits difficult to hire.

Fatigue is another concern.

At Samaritan, this month is usually highlighted by prime-rib Friday, where hospital leaders don Santa hats and aprons to deliver the meals in a morale-boosting cafeteria service that extends deep into the night.

The event was reluctantly scrapped, and some staff are picking up extra 12-hour shifts to cover for those who have tested positive or had to quarantine. Julie Nishida, a registered nurse and supervisor, says that she runs to reduce stress but that the stress never ends. "Every day, you have to actively tell yourself to keep going," she said.

In the hospital's intensive care unit, the COVID-19-positive patient rooms are marked on doors with red paper wheels, and registered nurse Sandy Martin adds goggles and a face shield to her protective wear before she goes inside. The 73-year-old Martin has worked for 45 years at the hospital and has been one of the stalwarts on the ICU this fall.

"This has probably been the worst thing in my whole career," Martin said. "Retirement is looking a little bit better."

The big majority of the COVID-19 patients cared for by Martin and other Samaritan staff eventually go home. So far, there are fewer than a dozen deaths among the more than 100 infected patients who have received care at the hospital.

This reflects, in part, the transfer of some higher-risk patients with underlying conditions to larger hospitals with more specialty care. That has helped the patient census at Samaritan to trend toward younger patients, mostly under 65, and many in their 30s and 40s, who have a better chance of surviving the disease.

Staff also cite improvements in care — with less of the intrusive intubation and more use of the drug Remdesivir, an antiviral, as well as steroids and anticoagulants to prevent blood clots.

This past week, the hospital marked another step forward as it became a regional center for coronavirus vaccination. The first shipment of 975 Pfizer-BioNTech doses arrived last week. Deliveries are expected to continue on a weekly basis well into 2021.

Some 75 hospital staff with the highest priority were selected to be given the first of the two-dose vaccine last week along with other front-line medical workers.

Martin won't be among the first to get shots. Though undaunted by the risks of 12-hour work shifts during the pandemic, she is wary of the vaccine. "With my age, I just would like to see how it's going in the general public before I jump right in and get it," Martin said.

When the virus gets in

In the Puget Sound region, long-term care centers were hit hard early on with dozens of deaths that warned the nation of the staggering risks of COVID-19 in such facilities.

In Grant County, there were only a few reports of such outbreaks through the spring and summer, and The Cambridge in Quincy has been able to reach December without any staff or residents testing positive for coronavirus. One firm rule: Residents who visit family return to 14-day quarantines.

"We're not going to take any chances, and they are prepared for it," said Linzi Michel, the Cambridge administrator.

In five other Grant County long-term care centers, the virus has turned deadly, killing 42 people — mostly this fall — with another six deaths expected to be confirmed in the days ahead, according to Adkinson, the public health district administrator.

At McKay, Gaertner describes the initial attempts to limit the number of infections in a building — initially built as a hospital back in 1937 — that lacks modern ventilation and still has up to three beds in rooms. Even in the best of circumstances, this can be tough duty with some patients suffering from dementia or in an end-of-life situation requiring extensive bedside help.

When the virus struck, much of the 42 staff got infected, including Gaertner, who still has a cough and suffers from shortness of breath. So as the outbreak intensified, only a skeletal crew was available to help move coronavirus-positive residents to isolation quarters.

"We just worked until we couldn't anymore," said Gaertner, whose husband at one point moved a cot into her office so she could catch a few hours of sleep.

By the first week in November, the infection had overwhelmed the staff, and the decision was made to evacuate 24 patients — many of them with deep family roots in the Soap Lake region — more than 90 miles to a Pasco center that has a unit designated by the state to assist in caring for the elderly with COVID-19. That effort took four days. Vans filled with McKay residents in wheelchairs traveled south past the fields and sagebrush lands.

Most of these men and women would never make it back to Soap Lake, according to Gaertner. They died in Pasco, away from loved ones and the McKay staff who had cared for them. The county as of last week had reported 11 deaths at the care center, with one more pending review. Gaertner said she can confirm 15.

Seven who survived the virus have returned to McKay, where the staff has hung a banner just inside the main entrance. "Welcome home, we missed you," it said.

Seattle Times staff reporters Mary Hudetz and Manuel Villa contributed to this report.

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