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Exclusive: Tight monoclonal antibody supply hobbles state rollout – Local and national COVID update

Seven states used up 70% of the nation’s monoclonal antibody supply in 7 weeks.



Knowledge is the best tool to fight against fear. A wise person chooses to be informed so they can make sound decisions. To join the fight against COVID misinformation, you can share this update through your social media platform of choice.

Editor’s Note: An earlier version of this story reported Medical Lake School District had 290 positive COVID cases, based on a news report from KREM Channel 2 Spokane/Coeur d’Alene, owned by Tenga, Inc. KREM updated and corrected the story on the evening of September 20. We have updated our story to reflect the change.

[KING COUNTY, Wash.] – (MTN) A lot of data was released today that provided a mixed bag of news. In an exclusive story, plans to expand access to monoclonal antibodies in Washington have been hobbled due to tight national supply. The drugs are effective for some people as an early intervention to lessen the severity of COVID symptoms.

The number of new cases was unchanged over the weekend, while hospitalizations decreased about 7% in a week. ICUs remain more than 90% occupied statewide and the number of COVID-related deaths is part of the reason for the decline in total patients.

There were new COVID cases reported in all three school districts, with Bothell High School dealing with 9 confirmed cases between students and staff. The Northshore School District started COVID testing of all students, using a technique called “pool batch testing.”

If you think those numbers are concerning, Medical Lake School District in Eastern Washington with 1,979 students and staff, reported 60 confirmed COVID cases since school started 3 weeks ago. In contrast, the Bellevue School District with more than 20,000 students has reported 37 confirmed cases since August 27.

Governor Inslee formally requested military assistance from the federal government to prop up exhausted staff at Washington hospitals.

At Lumen Field, 68,500 Seahawks fans gathered to watch the Hawks lose their home opener in overtime. It also appeared that most fans decided that they didn’t need masks. We’ll see how that plays out in a couple of weeks.

New vaccination numbers show a positive trend statewide. We also unlock what demographic is keeping the vaccination rate so low in the northern half of Kirkland. Pfizer has formally applied for emergency use authorization of its vaccine for 5 to 11-year-olds after completing Phase 2 and 3 testing in multiple countries.

Alaska, Idaho, and Montana continue to struggle while the latest data out of Oregon indicates the worst is over. In another part of America, one of the last places on Earth where COVID had never been detected ran out of luck.

In misinformation, we address a dangerous rumor that Idaho is operating under a universal DNR rule. (hint – it’s not)

This update uses the latest data from the Washington State Department of Health (WSDOH), released on September 20, 2021.


Washington State Update for September 20, 2021

Washington state COVID update

The number of new cases has settled at a lower level from two weeks ago but remains unsustainably high. but. In the South Central Hospital Region, which includes Benton, Franklin, Klickitat, Walla Walla, and Yakima counties, new cases are 833.4 per 100K, a decrease from Friday. In the Central Hospital Region, which represents King County, the rate is 295.1, statistically unchanged from Friday.

Percent of Total Population Fully VaccinatedAverage 14-Day New Case Rate (unadjusted)
50.00% or above (13 counties)521.1 (up)
40.00% to 49.99% (17 counties)753.6
28.10% to 39.99% (9 counties)806.4 (up)
14-Day New COVID Cases per 100K average by Vaccination Rate, Not Adjusted for Population

Through September 19, Washington’s statewide 14-day rolling average was 489.8 COVID cases per 100K, which is statistically unchanged from Friday. Lincoln County reported an eye-popping 1,502.3 new cases per 100K. Counties in the 1,000.0 to 1,399.9 range include Franklin (1,135.8) and Stevens (1,197.7). Counties in the 800.0 to 999.9 per 100K range include Adams, Asotin, Benton, Chelan, Clallam, Douglas, Garfield, Grant, Grays Harbor, Lewis, Okanogan, Pend Oreille, and Yakima. It is worth noting that Okanogan County is at 994.7, just under the 1,000 threshold. We will see the impact that Labor Day had on the 14-day average, as many test sites were closed on the holiday Monday.

The Johns Hopkins Washington State Overview is reporting alarming positivity rates. Positivity for the last 30-day rolling average is reported at 15.09% and the 7-day rolling average 24.16%. We do not believe these numbers accurately represent the test positivity rate and are a statistical anomaly.

Pediatric and adolescent cases increased again, with all school districts across the state back to in-person classes. Hospitalizations are up again for children birth to 11 while dropping for adolescents 12 to 19 years old. The highest rate of new cases is among people under 50 years old.

Hospitalizations were mixed with ages birth to 11 increasing, 12 to 19 years old increasing, and 20 years old indicating slight decreases for people 35 to 64 years old and a significant decrease among people over 80. There is a dark reality hidden in what looks like good news, which we cover in the hospital status section.

Age Group7-Day Case Rate7-Day Hospitalization Rate
Ages 0-11230.0 (up)1.2 (up)
Ages 12-19267.0 (up)2.1 (down)
Ages 20-34240.4 (up)6.5
Ages 35-49220.510.5 (down)
Ages 50-64167.218.1 (down)
Ages 65-79114.924.0
Ages 80+118.5 (down)33.3 (down)
7-day case rate and 7-day hospitalization rate is per 100K within the age group – the target for 7-day case rate is <25.0, but there are other factors such as vaccination rates within the age groups, how many total tests within the 7-day period, and the positivity rate within each age group

The USA Today COVID Tracker had not been updated when we went to press.

Governor Inslee formally requests federal assistance to support Washington hospitals

Governor Jay Inslee (WA-D) sent a letter on Friday to Jeffrey Zients, the COVID-19 Response Coordinator, formally requesting “the deployment of Department of Defense medical personnel to assist with the current hospital crisis.” Oregon and Idaho made similar requests, with federal teams arriving in Oregon during the August peak, and arriving in the Idaho Panhandle two weeks ago.

“Once the Delta variant hit Washington state, COVID-19 hospitalizations skyrocketed. From mid-July to late August, we saw hospitalizations double about every two weeks. The hospitals have surged to increase staffed beds and stretch staff and have canceled most non-urgent procedures, but are still overcapacity across the state.

“For these reasons, I have directed state agencies to request assistance from the federal government to provide Washington State with medical staff resources to help meet staffing needs in hospitals and in long-term care facilities. To date, the Washington State Department of Health has requested 1,200 clinical and non-clinical staff through the General Services Administration contracting process offered through FEMA.

“I am further requesting the deployment of Department of Defense medical personnel to assist with the current hospital crisis. In announcing the COVID-19 Action Plan, the President indicated that more clinical teams would be available. That assistance will be of significant value in Washington state.

“While there are hopeful signs that the current wave of infection is peaking, and some states are beginning to see declines, we have not yet seen that effect here. Washington State has historically lagged the country in previous COVID-19 waves, and the same pattern is playing out with the enormous impact we are seeing from the Delta variant.”

Last week, the state asked for 1,200 clinical and non-clinical staffers from FEMA to support hospitals and long-term care facilities. Last week in a press conference with the Washington State Hospital Association, hospitals leaders indicated they had already requested National Guard resources. According to the state officials, Washington National Guard members are already deployed supporting COVID response, flood, and climate-related disasters in the other part of the country.

EXCLUSIVE: Washington state won’t open public monoclonal antibody pop-up clinic

The Washington State Department of Health won’t be opening public clinics for appointment-based or walk-up monoclonal antibody treatments. WSDoH spokesperson Charlie Boisner told Malcontent News, “Washington is not looking to establish pop-up clinics, like other states have adopted, as a method to administer mAb treatments.”

Monoclonal antibodies are lab-engineered immune system proteins developed using similar processes as the FDA-approved mRNA Pfizer vaccine. For COVID-positive patients with mild symptoms and who don’t require supplemental oxygen, the therapy has shown to be highly effective in triggering a strong immune response. However, for those who have been symptomatic for more than a week with worsening symptoms, the therapy is not recommended.

In several southern states, pop-up clinics were opened in libraries, schools, and other government buildings. In early September, Washington State Secretary of Health Dr. Umair Shah stated the state was looking to expand access to the early intervention treatment. Mr. Boisner indicated the state was continuing on that course. “We are focused on engaging with partners at the local level, with either the appropriate infrastructure in place or interest in establishing this infrastructure, to facilitate these treatments.”

In Florida, over 40,000 people were given monoclonal antibodies, and it is credited with preventing 10,000 hospitalizations. The success of the program came at a heavy price for emerging hotspots in the Mid-Atlantic, Appalachia, Montana, and the Pacific Northwest. In six weeks from mid-July to the end of August, seven Southern states went through over 70% of the national supply.

On Monday, Health and Human Services Assistant Secretary for Preparedness and Response announced the federal government would no longer allow hospitals and other health clinics to directly order the medication.

“The rapid increase in demand for monoclonal antibodies has significantly constrained supply. To assure an equitable distribution of what has now become a limited resource, the federal government has reverted to the method it used from November 2020 through February 2021 for allocating monoclonal antibodies,” the undersecretary said.

To provide a more equitable allocation, distribution will be based on the number of COVID-positive patients and hospital capacity. National requests for September and early October currently outstrip the remaining supply. On Thursday Regeneron, the maker of Regen-COV, announced the Biden Administration contracted the company to produce 1.4 million new doses, more than doubling the existing order.

“Given this reality, we must work to ensure our supply of these life-saving therapies remains available for all states and territories, not just some,” a Health and Human Services spokesperson said.

We asked Mr. Boisner about the supply issue and how this would impact Washington. “While we are anticipated to experience an impact to our supply of mAb products, we are not able to increase our allocation requests at this time. While this change has presented a challenge to navigate, we will work through the process and develop a system that allows for effective and equitable distribution of mAb treatments.”

Washington State Department of Health considering adding new tests sites in Spokane

The Spokane Regional Health District requested two new COVID tests sites and the Washington State Department of Health is considered two locations. Officials recommended locating the new centers at Spokane Community College and Spokane Falls Community College.

Staffing is the biggest challenge to opening the sites.

“When we get to this level all of our systems get stretched,” said Lacy Fehrenbach, Deputy secretary of COVID-19 response. “We’re all facing staff shortages and the people that administer tests are similar people and types of health care professionals that administer vaccines and they’re the same folks that work in our hospitals and clinics across the state.”

Washington children who lost father to COVID say Fox News host Tucker Carlson ‘played a roll’ in his death

The daughter of an unvaccinated man who died of COVID-19 told CNN’s “New Day” on Monday she believes Fox News host Tucker Carlson and misinformation “played a role” in her father’s vaccine hesitancy.

“He wasn’t by any means far-right. He was right in the middle, and he consumed media from both sides, and just some of the misinformation on one of those sides made him hesitant,” Katie Lane said. “He was going to wait for FDA approval, but by the time that Pfizer had been approved, it was already too late.”

Katie said that her father said he “wished he was vaccinated” during his final call with his wife.

“His final words to my step-mom on a Facetime call was that he wished that he was vaccinated,” she said.

Carlson, a right-wing commentator and the country’s most-watched cable news host, has for months spread false and misleading information about the COVID-19 vaccines and has refused to reveal whether he’s been vaccinated.

60 students, staff and family members test positive for COVID in Medical Lake School District

KREM in Spokane initially reported that almost 300 students, staff, and family members in the Medical Lake School District had tested positive for COVID over a 3 week period.

KREM Correction and updated story on September 20, 2021

Medical Lake School District serves located on the outskirts of Spokane, has 1,749 students and 230 staff. Over the weekend the district posted a message from School Superintendent Tim Ames, revealing 60 students, staff, and family members had tested positive for COVID since the start of school, 3 weeks earlier. Ames wrote that most of the cases were in the district’s high school.

“In the first three weeks of school, we have tested approximately 290 people including staff and students. This has put a constraint on our supply of testing kits and we are waiting for more to arrive within a few days.  However, this has unfortunately limited our ability to test all who request it.  If you have the opportunity to test your symptomatic student through an outside provider that would be greatly appreciated and beneficial to you getting the results sooner than later.”

The message from Mr. Ames didn’t indicate how many students were in quarantine. Last week the district moved to virtual education for a day. No explanation was provided on why the decision was made. According to the KREM article, the cases started among members of the high school football team.

When compared to the Bellevue School District, the 60 confirmed cases in a district with less than 1,750 students is alarming. Since August 27, the district in Bellevue has reported 37 confirmed cases, while supporting more than 20,000 students.

Seahawks overtime loss at Lumen Field witnessed by 68,500 mostly maskless fans

Social media and the rights and freedom community erupted on the airways and on social media, during the Seahawks home opener loss to the Tennessee Titans. For some, the discussion was over a blown 15 point lead but for others, it was the spectacle of mostly maskless fans despite the state mandate.

There has been no comment on the situation by the Seahawks, the NFL, Mayor Jenny Durkan, King County Executive Dow Constantine, or state officials. Fans 12 and older were required to show proof of vaccination or a negative PCR test to attend the game. Prior to game time, long lines formed to enter the park.

Editor’s Comment: Let’s hope that the percentage of fake vaccinations cards and tests results were low.

Travel Advisories

We recommend avoiding all travel to Spokane, Lincoln, Yakima, Klickitat, Benton, Franklin, and Walla Walla counties, along with Alaska, Idaho, and Montana. Hospital resources in these regions, except Lincoln County, are so constrained that you may receive inadequate care if you experience a medical emergency.

We recommend avoiding travel to Lincoln County because the number of new cases per 100K residents exceeds 1,500.

Thank you

Thank you to our new subscribers and those of you who have made one-time contributions. On behalf of the entire team, thank you for helping us keep the lights on!

In August, King County Health Officer Dr. Jeff Duchin mentioned the N95 Project as a trusted source for N95 masks. A check on the website showed that a 50 count box of United States manufactured N95 masks are available for $40.00. We recommend wearing N95 masks indoors as they provide the best protection against COVID when properly fitted.

No promotional consideration has been given, or requested from the n95 project or any manufacturer of masks


Number of vaccinated Washington state residents increases

The Washington State Department of Health released updated vaccination numbers for the state and its 39 counties. On Monday, 75.8% of all residents 12 and over have received at least one dose, and 68.9% were fully vaccinated.

Every county showed an increase in vaccination rates, with several Eastern and Southwest Washington counties making significant gains. In San Juan County, 72.9% of residents are fully vaccinated, the highest in the state. Stevens County was in last place with 28.1% fully vaccinated.

The two counties have a stark difference in the number of new COVID cases. San Juan County was 57.7 cases per 100K people on Monday, the lowest state. Stevens County was 1,197.7 the second highest in the state.

Pfizer to apply for EUA FDA approval of vaccine for 5 to 11 year olds

Pfizer Inc. announced the results from a Phase 2/3 trial of the Pfizer-BioNTech COVID-19 vaccine indicating it was safe and effective in children 5 to 11 years of age. The company has applied for Emergency Use Authorization (EUA) with the Food and Drug Administration.

“Over the past nine months, hundreds of millions of people ages 12 and older from around the world have received our COVID-19 vaccine. We are eager to extend the protection afforded by the vaccine to this younger population, subject to regulatory authorization, especially as we track the spread of the Delta variant and the substantial threat it poses to children,” said Albert Bourla, Chairman and Chief Executive Officer, Pfizer. “Since July, pediatric cases of COVID-19 have risen by about 240 percent in the U.S. – underscoring the public health need for vaccination. These trial results provide a strong foundation for seeking authorization of our vaccine for children 5 to 11 years old, and we plan to submit them to the FDA and other regulators with urgency.”

The Phase 1/2/3 trial initially enrolled up to 4,500 children ages 6 months to 11 years of age in the United States, Finland, Poland, and Spain from more than 90 clinical trial sites. Children in the study were given two low doses 21 days apart. The dose

The Pfizer site states, “emergency use of the product has not been approved or licensed by FDA, but has been authorized by FDA under an Emergency Use Authorization (EUA) to prevent Coronavirus Disease 2019 (COVID-19) for use in individuals 12 years of age and older.”

It seems likely this will be used to spread a fresh round of vaccine misinformation. The FDA-approved Pfizer vaccine, called Comirnaty, is FDA authorized for individuals 16 years of age and older. The Pfizer-BioNTech COVID-19 vaccine and Comimaty are the same formulations and currently is EUA approved for use in 12 to 15-year-olds.

There is speculation that the FDA could authorization the EUA by the end of October, but no timetable has been provided.

Does vaccination make a difference?

The Washington State Hospital Association Coronavirus Tracker provides some insight on the effectiveness of vaccines among all patients in Washington Hospitals. Currently, King County is the third most vaccinated county, and on average, 1 of every 772,000 residents is dying due to COVID. Benton County is 44.6% vaccinated, and 1 of every 11,632 are dying due to COVID daily.

King County, Washington is reporting over 85% of age eligible residents are vaccinated with at least one dose. The highest rates of positivity are in areas with low vaccination rates statewide. The FDA has provided full approval of the Pfizer vaccine for anyone 16 and over.

COVID vaccines are free for anyone over 12 years old, and no appointment is necessary at most locations. Lyft and Hopelink provide free transportation, and KinderCare, the Learning Care Group, and the YMCA offer free childcare during vaccination appointments or recuperation.

For information on getting a vaccination in King County, you can visit the King County Department of Public Health website.

Malcontent News

Hospital Status

According to the DoH COVID Dashboard, 21.3% of all acute care patients hospitalized in Washington have COVID. A hospital system caring for this many COVID-positive patients in acute care is considered to be under “severe stress.” ICUs are at 90.8% of capacity statewide, with 36.0% of ICU patients fighting COVID. The total number of hospital patients declined over the weekend.

The 7-day rolling average hospital admission rate for new COVID patients is 174 a day. The Department of Health reported there were 1,578 COVID patients statewide on September 19 and 277 on ventilators. That is a 6% drop in the last 7 days but it isn’t all good news.

During a COVID wave, new cases rise first, followed by hospitalizations, and finally deaths. The Washington Hospital Association reported that on Sunday, 30 patients died due to COVID-related illness. Between most hospitals suspending almost all elective surgeries and the increased number of deaths, hospital capacity is improving.

EvergreenHealth released its weekly update today, reporting 38 COVID patients under care in Kirkland, one less than a week ago. The hospital reported 76% of all patients and 75% of ICU patients were unvaccinated with 5 on ventilators. Of the 8 vaccinated patients, 75% were more than 60 years old. Data has shown that a vast majority of breakthrough cases are among people over 70 who have multiple health issues.

EvergeeenHealth Kirkland patient update for Monday, September 20, 2021

All eyes are on Eastern Washington hospitals with neighboring Idaho still operating under crisis standards of care.

Providence Chief Medical Officer Dr. Dan Getz said things are continuing to worsen inside Eastern Washington hospitals as they continue to care for a surge in patients that have halted non-emergency surgeries and stretched their staff to a breaking point.

“Although we’re not practicing crisis standards of care on this side of the state, we still feel like we’re in crisis,” Dr. Getz said.

Hospitals in Spokane are caring for 221 COVID patients, almost unchanged from last week.

Back to School

School DistrictStatusQuarantinesClosures
BellevueYELLOW– Bellevue (4)
– Chinook (1)
– Enatai (32)
– Highland (3)
– Interlake (2)
– Newport (3)
– Newport Heights (19)
– Puesta del Sol (2)
– Sherwood Forest (11)
– Spiritridge Elementary (23)
– Stevenson Elementary (2)
– Tillicum (8)
– Willburton (3)
Lake WashingtonYELLOW– Alcott Elementary (2*)
– Ella Baker Elementary (3*)
– Community School Elementary (7)
– Dickinson Elementary (2*)
– Eastlake High (1*)
– Einstein Elementary (1*)
– Evergreen Middle School (1*)
– Benjamin Franklin Elementary (2*)
– Robert Frost Elementary (9)
– Inglewood Middle School (3*)
– Juanita Elementary (2*)
– Juanita High School (1*)
– Kamiakin Middle School (3*)
– Helen Keller Elementary (1*)
– Peter Kirk Elementary (2*)
– Kirkland Middle School (1*)
– Lake Washington High (1*)
– Lakeview Elementary (1*)
– Kirkland Middle School (37)
– Muir Elementary (1*)
– Redmond Elementary (2*)
– Redmond Middle School (1*)
– Redmond High School (1*)
– Rose Hill Elementary (1*)
– Rose Hill/Stella Schola Middle School (2*)
– Thoreau Elementary (4)
– Mark Twain Elementary (3*)

NorthshoreYELLOW– Arrowhead Elementary (12)
– Bothell High School (62**)
– Canyon Creek Elementary (19)
– Canyon Park Middle School (5)
– Cottage Lake Elementary (12)
– Crystal Springs Elementary 31)
– East Ridge Elementary (25)
– Fernwood Elementary (10**)
– Frank Love Elementary (24)
– Hollywood Hills Elementary (10)
– Inglemoor High School (5)
– Innovation Lab High School (6)
– Kenmore Elementary (17)
– Kenmore Middle School (38**)
– Kokanee Elementary (29)
– Leota Middle School (3)
– Maywood Hills Elementary (13)
– North Creek High School (16**)
– Northshore Middle School (9**)
– Ruby Bridges Elementary (6)
– Secondary Academy for Success (9)
– Shelton View Elementary (17**)
– Skyview Middle School (78)
– Sunrise Elementary (27)
– Timbercrest Middle School (23)
– Westhill Elementary (6)
– Westhill Elementary (6)
– Wellington Elementary (52)
– Woodin Elementary (10)
– Woodinville High School (21)
– Woodmoor Elementary (20**)
Local Districts Scorecard – * indicates positive cases only ** indicates 5 or more confirmed positive cases

Seven more schools in the Lake Washington School District reported active-COVID cases over the weekend. Parents were notified this morning that 7 students at Community School Elementary had a COVID exposure, which happened outside of the school district.

One school in the Bellevue School District reported 3 new confirmed cases among students and faculty. The district does not report the number of quarantines.

Northshore School District now has 7 schools reporting 5 or more confirmed COVID cases. The district has 333 students and faculty in quarantine and 30 new positive cases in the last week – 18 students and 15 staff members. There are 9 confirmed cases at Bothell High School, 7 among staff members.

The Northshore School District started doing “pool batch testing” among all students on Monday. Testing will be conducted weekly at each of our school buildings over the course of three days. Students in grades K-12 will be tested.

The tests are self-administered by each student and adult in the classroom, while a trained teacher or a school-based COVID supervisor observes. Instead of the “long swab” that goes in the back of the nose, this test is a short, small swab. This type of testing provides privacy for each individual. If further confirmatory testing is required, every individual’s privacy will be protected throughout the process, including during contact tracing.

Families can opt out of the process by completing an online form.

King County COVID vaccination rates – at least one dose ages 12 to 19 – by zip code as of September 20, 2021

Vaccination rates among adolescents 12 to 19 years old decrease significantly in an east-west line that intersects Juanita Bay of Lake Washington. In Kirkland, the vaccination rate among the age group who have received at least one dose is 90.7%, compared to 98034, with a rate of only 65.7%.

We will continue to recommend that parents in the Bellevue and Lake Washington School Districts request better transparency on their publicly facing COVID dashboards.


King County Public Health updated the vaccination rates by zip code, with the numbers improving throughout the region. The northern half of Kirkland continues to lag behind the rest of the local area. Vaccination rates dropped from the last update because the county is now using the population and demographic data from 2020. Previous reports used the 2019 census estimate.

King County COVID vaccination rates – at least one dose all ages – by zip code as of September 20, 2021
Zip CodePercent vaccinated, at least one dose, 12 and older
Vaccination rates for those 12 and older by zip code – at least one dose

National Round-Up

The United States reached another grim milestone as the number of total COVID deaths broke the record set by the 1918 Flu tonight. While hospitalizations nationwide dropped below 100,000 with the surges ending in Florida and Texas, the number of people dying continues to climb. The CDC reported on Friday the 7-day moving average rose to 1,448 people dying of COVID a day, a 17.4% increase from last week. Total hospitalizations dropped 5.7% to just over 97,000.

Johns Hopkins University Cumulative Case Tracker is reporting 36,794 new cases and 291 deaths nationwide. Very few states provide data 7 days a week. Monday numbers are always artificially low. Tracking the moving average is a better way to understand national trends.

The Biden Administration announced the United States will accept vaccinated air travelers from 33 countries, including China, beginning in November. The decision, announced by White House coronavirus response coordinator Jeff Zients, marked an abrupt shift for President Joe Biden’s administration, which said last week it was not the right time to lift any restrictions amid rising COVID-19 cases.

Vaccinated travelers will be accepted from most European countries including France, Germany, Italy, Spain, and Greece. Additionally travelers from Britain, Ireland, South Africa, China, India, Brazil, and Iran. Officials also announced that non-essential travel to Canada and Mexico will remain blocked at least until October 21.


The situation in Alaska remains dire, with the state seeing the third-highest rate of growth for new cases in the United States. Statewide 16 ICU beds were available Monday morning, a slight improvement from last week. The results aren’t from a reduction in patients, but due to crisis standards of care deferring all but emergency surgeries. The 7-day rolling average for new COVID cases grew to 780 per 100K on Monday, with 2,054 new confirmed cases over the weekend.

America Samoa

The small United States territory in the middle of the Pacific Ocean was one of the only places on Earth that had not been touched by COVID. Over the weekend, that changed. Commercial air travel was suspended to the island in March 2020 and wasn’t restored until last week. On Saturday, the first commercial flight flew out of Honolulu with 260 onboard. When the plane landed, a vaccinated passenger, who started to become symptomatic during the flight, tested positive for COVID.

The person, who has not been identified, had been visiting the U.S. mainland, before traveling to Hawaii. Everyone was required to have a COVID test before the flight, with all passengers and crew testing negative.

The COVID-positive person was moved to quarantine at a facility in Pago Pago and for now, doesn’t require hospitalization. The other 259 people on the plane were moved to a quarantine location where they will need to stay for 10 days to be tested and monitored.

On Sunday, 3 more people tested positive.


Idaho remains in crisis standards of care statewide and added 2,302 new confirmed COVID cases over the weekend with 36 deaths. To put this in perspective, Washington has 427% more people than Idaho and reported a similar number of deaths. The fatality numbers do not include non-COVID patients that died from deferred treatment or people who died in their homes.

A message left on an Eastern Idaho hospital’s whiteboard by Dr. Kenneth Krell, Director of the hospital’s ICU, went viral over the weekend.


State officials in Montana are scrambling to prevent falling into the same trap that Idaho is in. Three large hospitals in Bozeman, Billings, and Helena are operating under crisis standards of care or are preparing to. Hospitals in Missoula remained very stressed as new COVID cases exploded across the vast state.

Governor Greg Gianforte’s office is in discussions to ask the Department of Veterans Affairs to accept otherwise ineligible patients at its facilities.

Gianforte, along with the state Department of Public Health and Human Services and Disaster and Emergency Services, “initiated discussions” with the VA and the federal Assistant Secretary for Preparedness and Response over the weekend, DPHHS spokesperson Jon Ebelt said in an email Monday.

States can request to send patients to a VA hospital by submitting a formal request to the Federal Emergency Management Agency.


The worst appears to be over in Oregon, as new cases, hospitalizations, and deaths all declined last week.

“During Monday, Sept. 6, through Sunday, Sept. 12, 2021, OHA recorded 12,997 new cases of COVID-19 infection – an 11% decrease from the previous week,” the Oregon Health Authority said in a news release.

The state recorded 281 new infections per 100,000 people during that week. Baker County, in eastern Oregon, experienced the highest rate of infections at 686 new infections per 100,000 people; the county population is little more than 16,000 people.

OHA noted 79% of statewide cases were classified as “sporadic,” meaning it could not trace them back easily to an event that’s likely to blame for the COVID-19 exposure. This contrasts with what OHA calls “clusters” or “outbreaks” that would be considered vectors for other infections. The high number of untraceable cases has been the norm throughout 2021 in Oregon, but the percentage has increased steadily since January.


There is rampant misinformation that Idaho is operating under a universal do not resuscitate order. This is not true. The false claims are coming from a section within the state’s crisis standards of care plan. In situations where a hospital can no longer support mechanical ventilation of ICU patients, the guidance recommends that no attempt at resuscitation be made if the patient goes into cardiac arrest.

“Adult patients hospitalized during a public health emergency, when crisis standards of care have been declared (and a hospital is using the mechanical ventilation allocation framework due to demand for ventilators exceeding supply), should receive aggressive interventions; however, they should receive NO attempts at resuscitation (compressions, shocks or intubation if not yet intubated) in the event of cardiac arrest. The likelihood of survival after a cardiac arrest is extremely low for adult patients. As well, resuscitation poses significant risk to healthcare workers due to aerosolization of body fluids and uses large quantities of scarce resources such as staff time, personal protective equipment, and lifesaving medications, with minimal opportunity for benefit. This universal DNR order does not apply to pediatric patients; however, pediatric patients requiring a ventilator after resuscitation would enter the ventilator triage protocol after resuscitation, just like other patients needing ventilator access.”

COVID Impact

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