How the State With the First Major Outbreak Contained Coronavirus

Communication and coordination helped Washington state keep its COVID-19 death rate low.

Before the coronavirus pandemic had reached every state in the U.S., the first confirmed case of COVID-19 happened in Washington state, which became the site of the country's initial outbreak. But despite emerging as the most virulent hotspot early on, Washington was able to get the situation under control—keeping its death rate relatively low while the death tolls in other states skyrocketed. So how was Washington able to get the situation under control? According to a new report, Washington state contained coronavirus with a coordinated response that helped flatten the curve.

The American College of Surgeons (FACS) report, which was released on the Journal of the American College of Surgeons website ahead of publication, reflects the findings of 26 experts who analyzed Washington's response to its coronavirus outbreak. They found that communication and coordination were key to containing the virus, and that this collaborative effort allowed for increased testing, support for high-risk populations, and the establishment of social distancing measures.

Washington is far from being completely out of the woods: As of June 18, The New York Times reports around 28,270 coronavirus cases and nearly 1,230 deaths in the state. But as the FACS article notes, the state has maintained a death rate of 5 percent of infected individuals, which is lower than the national rate of 5.7 percent, and significantly lower than the 8 percent rate in New York, the state that became the epicenter of the pandemic in the U.S.

"Along with the governor's stay-at-home and physical distancing orders, preexisting relationships across the healthcare system were critical in facilitating this response," the FACS report's co-author Eileen M. Bulger, MD, chief of trauma at Harborview Medical Center in Seattle, said in a statement.

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By different medical centers staying in close communication with each other at the start of the crisis, doctors and experts were able to get a handle on the state's most immediate needs—which hospitals were going to be in danger of running out of beds, which groups of people were in need of extra care, and what kind of long-term care facilities (LTCF) could be established to mitigate these problems.

"Normally we exist in a competitive landscape, but there was great willingness for each system and entity to do what they could to address the region's needs," said lead author Steven H. Mitchell, MD, medical director of the emergency department at Harborview Medical Center and medical director of the Western Washington Regional COVID Coordination Center (WRC).

Bulger noted some of the ways this communication helped contain Washington's crisis: "We were able to keep many of these patients in the nursing facilities and not overwhelm the hospitals by evacuating entire facilities," she said. She also pointed to the University of Washington virology laboratory understanding the need for widespread coronavirus testing and developing their own testing platform. The coordinated response also identified and provided aid to populations that they recognized could be hardest hit by the virus: immigrant and minority communities, homeless people, and people in prisons.

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At this point, the outbreaks in states across the U.S. are too far along to follow Washington's model of early coordination. Nevertheless, the FACS report provides useful information for communities to follow in the event of future epidemics, or any kind of disaster that could otherwise overwhelm health care systems. "Whether it's a pandemic or other type of large-scale disaster that occurs, it's critical for regions to prepare to develop communication structures that support situational awareness and patient distribution strategies," Mitchell said. "Otherwise, facilities get overwhelmed and patients suffer." And for states that are struggling to contain coronavirus, These 5 States Are Headed for Another Lockdown, Virologist Says.

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