Funding, new law curtailing local handling of COVID

Editor’s note: This version corrects attribution on a quote from an audience member. It corrects misreporting on CDC recommendations for people who are fully vaccinated and exposed to the virus.

The Hill County Health Department, between a lack of funds and having it's authority curtailed by Montana House Bill 702, is having trouble keeping up with the pandemic amid a nationwide surge driven by the delta variant.

During a special meeting of the board Wednesday about changes that need to be made to quarantine policy in the wake of HB 702, Hill County Health Department Public Health Director Kim Berg, also the Hill County health officer, said the department, for the first time since the beginning of the pandemic, doesn't have the resources to get in touch with every close contact of a COVID-19 case, even as some staff are dropping all other duties to work exclusively on the pandemic.

After the meeting she said the department has already had to let two staff members go because they don't have the money to pay them and they may lose more in the coming months.

She said the department does have a disease intervention specialist coming in the next few weeks and she still has two part-time contact tracers on staff until November, but the situation is very concerning.

In the meeting, Berg said last year the department had access to CARES Act funds that allowed it to deal with pandemic and the massively increased workload that came with it, but that money is gone and no additional funds were obtained to keep the department sustainable during this time of massively increase work.

She said the department received no funds from the American Rescue Plan Act, which she said could have been used to bolster her department and keep it sustainable had the Hill County Commission allocated and asked for it.

Hill County Commissioner Diane McLean said Berg should have told the commission what the department needed, and Berg said while she didn't make specific asks she reached out multiple times by email ask for funds to keep the department sustainable.

After the meeting Berg said she sent the commissioners an email months ago asking about their plans for how to use ARPA funds along with suggestions about holding public meetings on the subject, but received no reply.

When she saw in the Havre Daily News that the commission was talking about how to use the money, she said, she reached out again to ask why no funds were being allocated to public health given the fact that the pandemic was still ongoing but received no answer beyond that the commission's primary use for the funds was the Milk River Levee project.

This morning, Hill County Commissioner Mark Peterson said he hasn't had a chance to go back through his emails and look for what Berg sent him, and the commission was unaware that ARPA funds could be used for that purpose.

He said the commission has since looked into the issue and possible solutions to it and he hopes to set up a meeting with Berg to alleviate the problem.

The lack of resources factored into Berg's recommendation that the department cease issuing quarantine orders entirely now that Montana House Bill 702 prevents them from making recommendations based on a person's vaccination status, she said.

Berg said Montana House Bill 702 prevents public and private entities from discriminating against the unvaccinated, so the department has been effectively barred from following guidelines set forth by the Centers for Disease Control and Prevention.

CDC recommends vaccinated people get tested 3-5 days after the date of being exposed to COVID-19 and wear a mask in public indoor settings for 14 days after exposure or until a negative test result comes back, but they don’t need to quarantine. It recommends vaccinated people who test positive or are experiencing COVID-19 symptoms isolate.

CDC recommends unvaccinated people who are exposed to the virus quarantine and that they isolate if they are infected with the virus.

Hill County Attorney Karen Alley said even if someone volunteers that information to the department, it can no longer provide recommendations based on it due to the law.

Berg said the law's primary effect is on COVID-19 for now, but ultimately it affects all communicable diseases for which there is a vaccine, which will affect the work of public health long after the pandemic is over.

Given these circumstances, she said, her department has worked with Alley to create two plans for how to handle quarantine orders from now on.

The first option was to quarantine everyone and their close contacts regardless of vaccination status.

Berg said, from a public health standpoint, this option will provide the most protection to the people of Hill County, but, on a practical level, will be very difficult for the department due to the workload it would create for and an already strained workforce that no longer has access to extra funds to deal with the pandemic.

She said it would also disrupt schools and workplaces, many of which don't have policies in place for extended sick leave that would be needed by so many people.

Option two would be to cease issuing quarantine orders altogether and ask that people follow CDC guidelines when making the personal decision whether to quarantine, trusting them to make the right decision.

Berg said this option does pose a risk by people who choose not to follow CDC recommendations and may lead to greater community spread, but, under the circumstances, it may be the best the department can do, at least for now.

She said the decision between the two options can be evaluated and changed later, but these are the best options they have at this point.

Health Board member Erica McKeon-Hanson said she understands where Berg is coming from, but she can't in good conscience support a measure like Option 2 that will put the public in greater danger.

She said the board has a duty to protect the public from communicable disease and if the department doesn't have the resources to do that, those resources need to be provided by those that have the power to do so.

She also expressed a general frustration that this is a choice that even has to be made when public health experts know what needs to be done and vaccine status is a relevant factor to take into account when making recommendations.

Berg said she understands McKeon-Hanson's concerns, but it needs to be acknowledged that quarantining people who are vaccinated is unfair to them.

This was echoed by Hill County Commissioner Diane McLean, who said the whole reason she got vaccinated was so she wouldn't need to do things like quarantine.

Of the four public attendees three voiced opposition to option two.

Havre Public School Board Chair Curtis Smeby said public health experts know how to keep people safe and the Legislature's efforts to interfere with them is unacceptable.

He said the inconvenience caused to the vaccinated by being quarantined is unfortunate, but given the nature of COVID-19 as a serious and ongoing public health crisis, that inconvenience is absolutely justifiable.

However, Smeby said, he would prefer to see Hill County follow suit with others and take the third option, following CDC guidelines in defiance of the state, and if need be see the state in court.

"We have laws in this country, let's use them, but let's challenge them when they are inappropriate, and this is clearly in appropriate," he said.

This sentiment was echoed by another attendee Cal Long, whose wife, Pamela, also expressed concern with the prospect of the board implementing option two.

Long said people in the community are at risk, including children who are returning to school who are in danger, especially with the U.S. medical system strained.

"Why not err on the side of caution?" she asked.

She said the county has public health experts they should listen to.

"We also have freedom," audience member Charlotte Faust said.

Exactly, Long said, she has the freedom to not get exposed to COVID-19.

The board voted 3-2 to recommend option 2 with all three commissioners voting yes and McKeon-Hanson and board member Kristi Kline voting no.

The recommendation will be discussed and voted on at next week's Hill County Commission business meeting, at which point it would be implemented.

McKeon-Hanson thanked the department and all of its employees for all of their hard work over the course of an extremely difficult 18 months likely with more hardship to come.