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Pacific Northwest is in crisis – Local and national COVID update for September 18, 2021

New data points to a new normal as hospitals in Alaska, Idaho, and Montana start to collapse.

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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.

[KING COUNTY, Wash.] – (MTN) After a relatively quiet week for COVID news, things exploded over the last 24 hours, creating a super-sized update for today.

New COVID cases in Washington state were declining but now appear to be on a new unsustainable plateau. The gap between the highest and lowest vaccinated Hospital Region grows to the broadest level to date. One county’s new case rate has increased so high a new category had to be created.

Washington hospitalizations also plateaued, and ventilator use remains at near-record levels. In Olympia, St Peter’s Hospital reported 10 COVID-related deaths in 24 hours. We spent a lot of time examining reports that Eastern Washington hospitals are overrun with Idaho residents seeking treatment. We did not find any credible reports to support these rumors. We share our opinion on what Washington state should do to prevent our hospital system from joining our Pacific Northwest neighbors.

New cases and hospitalizations are up for children and adolescents statewide, and new COVID cases were reported in all three school districts we track. Snohomish County reported a 433% increase in active COVID cases at childcare centers and schools. In Yakima County, officials report 25% to 35% of new COVID cases among children. Parents in West Seattle and Olympia think COVID quarantine rules for unvaccinated adolescents are unfair.

Hundreds gathered in Olympia, and smaller pockets of protesters were across Washington, defying outdoor masking guidelines to protest against vaccine mandates. Some have adopted a view that harkens back to a dark time in world history.

Officials reported more than 20 people who have attended the Washington State Fair were COVID positive when they were there.

Most applications for religious exemption by Washington State Patrol employees have been rejected. In contrast, unions leaders representing 71,000 healthcare workers in Washington state say that the state is in an “unprecedented crisis.”

The University of Washington is seeking volunteers for a study of a new COVID vaccine booster. Phase 2 testing will include individuals vaccinated with the Pfizer, Moderna, or Johnson and Johnson vaccine.

We expanded our travel advisory again to include the state of Montana and Lincoln County in Washington.

In vaccination news, the FDA votes on booster shots for people who received the Pfizer vaccine. An editorial in the British Medical Journal about the potential connection between COVID vaccinations and menstruation was misrepresented as a study in numerous headlines. The update is very late tonight, in part because we pored through reports and data to give you a lot more insight.

In regional news, the stories coming out of hospitals in Alaska, Idaho, and Montana are gut-wrenching. It is not hyperbole to state the ability to deliver medical care in all three states is collapsing.

Finally, in the misinformation section, we address an oldie but a goodie – do masks cause carbon dioxide poisoning? (no)

This update uses the latest data from the Washington State Department of Health (WSDOH), released on September 17, 2021.


vaccinationhospitalsschoolslocalnationalmisinformation

Washington State Update for September 18, 2021

Washington state COVID update

The last week of data indicates Washington has stepped down to a slightly lower plateau versus seeing a continued decline. In the South Central Hospital Region, which includes Benton, Franklin, Klickitat, Walla Walla, and Yakima counties, new cases are 888.5 per 100K, a significant increase. In the Central Hospital Region, which represents King County, the rate is 290.0. This is the widest gap in new cases between the two hospital districts.

Percent of Total Population Fully VaccinatedAverage 14-Day New Case Rate (unadjusted)
50.00% or above (12 counties)488.8
40.00% to 49.99% (18 counties)750.8 (up)
27.30% to 39.99% (9 counties)768.0
14-Day New COVID Cases per 100K average by Vaccination Rate, Not Adjusted for Population

Through September 17, Washington’s statewide 14-day rolling average was 489.2 COVID cases per 100K, which is statistically unchanged. Lincoln County reported 1,438.9 new cases per 100K, one of the highest rates recorded in any Washington county since new COVID cases have been tracked. Counties in the 1,000.0 to 1,399.9 range include Franklin (1,254.7) and Stevens (1,138.9). Counties in the 800.0 to 999.9 per 100K range include Adams, Asotin, Benton, Chelan, Clallam, Douglas, Grant, Grays Harbor, Lewis, Okanogan, Pend Oreille, and Walla Walla. It is worth noting that Benton County is at 989.8, just under the 1,000 threshold, and Yakima County moved up to 791.2, just under the 800 threshold. We are concerned when we get to the middle of next week, and the test data from the Labor Day weekend is out of the 14-day rolling average, we will see another jump in the numbers.

The USA Today COVID Tracker also indicates a flattening over the previous week (when you adjust for the dip in weekend reporting and the bump when the data from over the weekend is reported). If you think we’re alarmists, we’re not the only journalists seeing this trend.

One other piece of discouraging news comes out of the United Kingdom. Healthcare experts highlighted how Delta peaked in the U.K. (and Israel) after 45 to 60 days before rapidly declining as a predictive model for the United States. The U.K. reported a record 26,911 new cases and a record-high number of hospitalizations – 8,339 patients. Even more worrying, 81.6% of all U.K. residents are fully vaccinated compared to 51.4% of the United States.

The Johns Hopkins Washington State Overview is reporting alarming positivity rates. Positivity for the last 30-day rolling average is reported at 15.23% 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.

Today is the third day of updated data from the WSDOH, and we are feeling more confident about tracking trends now. Pediatric and adolescent cases increased. This isn’t surprising now that in-person school is back across all of Washington state. Hospitalizations for ages birth to 11 increased about 30%. However, the total number of children hospitalized is small, so don’t read too much into that bump.

New cases among all other age groups were flat or down slightly. With total new cases appearing to be settling on a plateau, this may be an early warning sign that new pediatric cases are increasing the overall number. This could have significant implications for states outside of Washington, particularly Alaska, Idaho, Montana, and Wyoming (read our national round up).

Hospitalizations also increased for ages 35 to 49 and people 80-years old and above. Both jumps were large enough to be notable but not alarming.

Age Group7-Day Case Rate7-Day Hospitalization Rate
Ages 0-11208.4 (up)1.0 (up)
Ages 12-19248.6 (up)2.4
Ages 20-34232.26.5 (down)
Ages 35-49220.013.2 (up)
Ages 50-64160.319.8
Ages 65-79114.2 (down)24.8
Ages 80+126.839.1 (up)
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 reported 56 deaths on Thursday and an additional 56 deaths on Friday.

Snohomish County reports active COVID cases among childcare centers and schools increased 433%

new Snohomish Health District report shows the rapid increase in cases associated with childcare facilities, K-12 schools, higher education, and youth sports and camps over the last month. For the two weeks ending September 16, there were nearly five times as many investigations in K-12 settings (202) than the previous period ending September 2 (42 investigations). There were 367 confirmed and probable cases and more than 2,100 close contacts involving childcare, schools, and youth sports during that timeframe.

The number of investigated cases in Snohomish County among child care centers, public and private K-12 schools, higher education, and athletic and youth camps increased from 950 to 2,160 – a 433% increase in two weeks.

“When cases occur among students or staff, and they will, we work with the schools to optimize the number of individuals being quarantined and try to prevent transmission in the school,” said Dr. Chris Spitters, Health Officer for the Snohomish Health District. “From time to time, there may be a classroom or two in a school that may need to be temporarily closed depending on the number of cases, but those episodes won’t necessarily call for any change in school-wide, district-wide, or county-wide operations. We need students, families, and teachers to work with us to get cases down and keep the impacts small.” 

Hundreds gather to protest vaccine mandates in Olympia while others do flag waves across the state

About 200 people gathered outside the state capitol to protest vaccine mandates. “I don’t think we should be forced into any medical treatment,” said Scott Sohler, who traveled from Tri-Cities to protest.

Only a handful of people there were wearing masks while standing on the side of the road, waving signs and hearing from the cars which support their cause. At least one protester held a sign with the hashtag, “pureblood.” Anti-vaccination adherents claim the reference is from the Harry Potter books. The term originated in Nazi Germany, where people were required to have a “Blood Certificate” to get married and have children. The idea was to have purebloods to ensure the survival of the Aryan race.

Olympia officials had begged people to stay away from the city due to a planned Proud Boys rally on the same day. On the Internet, several anti-vaccination groups along with counter-protesters advised their followers to stay away.

Today, the group Waking UP Washington organized several flag waves across Washington state with small groups dotted along I-5.

More than 20 people who worked at or attended the Washington State Fair were COVID positive

Two weeks into the Washington State Fair in Puyallup, Karen Irwin, COVID-19 communications lead for the Tacoma-Pierce County Health Department, reported to the News Tribune, “We are investigating more than 20 cases among Pierce County residents who attended or worked at the fair during their contagious or exposure period.”

So far, 435,000 people have attended the fair, scheduled to end on September 26. At a vaccination clinic within the fairgrounds, 235 people have received vaccinations. On Friday, 50% of all residents in Pierce County were vaccinated.

Because Washington state is highly vaccinated, the current R0 is R1.1 (forecasted range R0.7 to R1.5) for all residents. If this is accurate, the impact shouldn’t be significant unless an infected person has an unusually high viral load, a super spreader, or moves around through highly unvaccinated groups.

25% to 35% of new COVID cases in Yakima County are children and adolescents

Dr. Marty Brueggemann, Chief Medical Officer of Yakima Valley Medical Hospital, reported 25% to 35% of the positive tests from the Yakima Valley College location are among children and adolescents from birth to 19-years old. The increase in positive cases has not impacted the Yakima School District, and Dr. Brueggermann praised the district’s work while expressing concern for other schools in the region.

“Certainly, the schools have seen a lot of activity that they’re navigating. You probably saw that the Tribal School in Toppenish basically canceled school for the next two weeks after going quarantine, essentially hit the reset button,” Brueggemann said.

Washington state job growth slowed in August

State-level unemployment data was released yesterday by the Bureau of Labor Statistics and individual states. In Washington, job growth slowed, with just under 17,000 new jobs created. The job market through Washington could best be described as white-hot overall, with tens of thousands of unfilled positions at every skill level.

Most applications for a relegious exemption by Washington State Patrol have been rejected

The Washington State Patrol (WSP) reported that of 364 religious exemptions applications received, 284 had been reviewed, and all were rejected. Initially, 373 applications were submitted, but nine employees rescinded their requests.

We did an extensive write-up earlier in the week on why seeking a religious exemption, particularly on the grounds of being morally and religiously against abortion, is a dead end.

In an interview with radio personality Jason Rantz, WSP spokesperson Chris Loftis addressed the question of why it was “safe” for troopers last year to work without vaccination, but it is safe this year.

Editor’s Note: Really?

“As to your inquiry regarding relative exposure probabilities, I would suggest you direct it to qualified epidemiologists, but from my laymen’s perspective, it presupposes that lower or varied risks is [sic] somehow unworthy of attention. As we have all seen, the pandemic, it’s [sic] impacts, and response strategies have evolved over time as more has become known.”

When pressed on why the bar was so high for a religious exemption and all requests rejected to date, Loftis wrote, “…the search for accommodation can be difficult as by its very nature, working for WSP often has a significant public engagement component.”

According to the Officer Down Memorial Page, COVID has been the leading cause of line of duty deaths among police officers in the United States in 2020 and 2021.

Moving to our opinion, if we read between the lines, it appears state officials are concerned about long-term liability. Suppose an asymptomatic unvaccinated trooper were to pass COVID to a member of the public while on duty, and that person became hospitalized or died. In that case, it seems this would be a significant legal exposure.

Additionally, an asymptomatic or symptomatic officer with COVID couldn’t work for 14 days and could force others to quarantine.

West Seattle and Olympia families claim school guidelines for quarantining students are unfair

Jeremy Gollyhorn is upset with decisions about his child who had a COVID exposure at Denny International Middle School in Seattle. The 12-year old student is unvaccinated, and following state and national guidelines, is required to quarantine for 14 days. If they were vaccinated, they would have been permitted to return to class with a strong recommendation to get tested 3 to 5 days after the exposure.

Gollyhorn said it makes no sense.

“Vaccinated people can still spread COVID too, so what’s the difference there?” he said.

Maggie May Willis, the parent of a 14-year old daughter who attends school North Thurston School District, echoed the same complaint to KING 5 news.

“It’s not fair,” said Willis, who reported her daughter chose not to get the vaccine because she did not think she needed it.

On September 8, we analyzed the new case, hospitalization, and death statistics in King County for the vaccinated versus the unvaccinated. It is correct that vaccinated people can still become infected with COVID. Still, the number is extremely low, and most breakthrough cases are among the immunocompromised and people over 70 years old.

University of Washington seeking volunteers for COVID booster shot study

Researchers at the University of Washington School of Medicine are enrolling volunteers for a COVID-19 booster vaccine trial.  Volunteers will participate in the second stage of a phase 1 vaccine trial. Phase 1 vaccine trials are designed to test the safety and tolerability of and immune response to a new vaccine.

In the first stage of the trial, the experimental vaccines were given to unvaccinated volunteers. In this second stage, the vaccines will be given as a booster shot to volunteers who have already been vaccinated against SARS-CoV-2.

Unlike current vaccines, the trial vaccines seek to elicit an immune response to multiple SARS-CoV-2 proteins in addition to the spike protein that is targeted by currently available vaccines made by Moderna, Pfizer, and Johnson & Johnson.

The hope is that by targeting a number of coronavirus proteins, the vaccine will provide protection against a wide variety of SARS-CoV-2 strains and variants. The vaccine candidates were developed by Gritstone bio, headquartered in Emeryville, CA.

“With the emergence of the Delta and other COVID-19 variants, we need to stay ahead of the virus by developing effective vaccines that will aid in the prevention of all strains of COVID,” said Dr. Anna Wald, director of the UW Medicine Virology Research Clinic and head the UW School of Medicine’s allergies and infectious diseases division. She is the trial site principal investigator. 

“We hope that these investigational vaccines enhance and broaden the immune response elicited by vaccines currently available in the U.S.,” said Dr. Tia Babu, acting assistant professor at the University of Washington School of Medicine and a trial investigator.

To enroll, participants must be age 18 or older, healthy, without significant allergies, without a history of prior SARS-CoV-2 infection, and have been vaccinated against COVID-19 at least four months prior to enrollment. Persons over age 60 are encouraged to participate.

Participants will be asked to:

  • Make nine to 14 or more in-person clinic visits and also will receive one to two telephone check-ins with study staff over 12 to 14 months.
  • Receive one or two injections of investigational vaccine.
  • Have blood drawn several times to monitor safety and to see whether the vaccine results in an immune response.
  • Keep track of how they’re feeling after the injection.

Interested participants should contact the UW Medicine Virology Research Clinic: gritstone@uw.edu or 206-520-4340

Washington state nurse unions urge immediate action to prop up hospitals

Washington unions that represent 71,000 healthcare workers are appealing for immediate action, saying that the state is on the brink of an “unprecedented crisis.” The Washington State Nurses Association, SEIU Healthcare 1199NW, and the UFCW 21 made a joint statement warning that the combination of work conditions, pay, chronic staffing shortages, and the ongoing “fifth wave” of COVID cases is decimating healthcare workers.

“Amid the fifth wave of COVID, spurred on by the Delta variant, and hospi­tals overflowing with patients who need critical care, our state health care workers continue to heroically perform their jobs a year-and-a-half into this pandemic,” said Julia Barcott, chair of the WSNA Cabinet and an ICU nurse at Astria Toppenish Hospital. ​“But nurses and other front­line workers are people, too. We’re losing overworked nurses to overwhelming burnout, the distress of working short-staffed, better-paying traveler nurse jobs, and even for signing bonuses of up to $20,000 to move to a different hospital. We’re worried for our patients and the impact of the staffing crisis on the care they receive.”

This isn’t just a crisis for front­line workers, it’s also a public health crisis. Because hospi­tals were already under­staffed well before the coron­avirus pandemic hit, we are now seeing a new story every day about a regional hospital at maximum capacity. Without immedi­ately addressing the shortage of staff and unten­able workloads for front­line workers, there could be dire conse­quences to Washington’s health care infrastructure.

“Chronic under­staffing is a disaster for patient care. Health care workers don’t want to see patients stuck in overflowing ICUs or being treated in ER hallways, or be forced to turn away ambulances at the door, but that’s the reality of health care right now,” said Faye Guenther, UFCW 21 presi­dent. ​“Hospi­tals need to immedi­ately respond to this patient care crisis. That means focusing on meaningful, sustain­able solutions that will recruit and retain quali­fied caregivers in every department.”

As many anti-vacci­na­tion activists falsely conflate the staffing crisis with looming vaccine deadlines for health care workers, it’s impor­tant to under­stand that health care staffing short­ages predate the coron­avirus pandemic. As a result of years of staffing and manage­ment decisions, many hospi­tals already didn’t meet adequate staffing for average patient levels. COVID exacer­bated this already strained infra­struc­ture, and hospi­tals’ response to the pandemic has only worsened this preex­isting crisis. 

“What’s really driving this crisis is that hospi­tals have spent the last two decades balancing their budgets on the backs of health care workers and patients,” said Jane Hopkins, RN, execu­tive vice presi­dent of SEIU Health­care 1199NW. ​“COVID has been a stress test on our health care system, and we are seeing the system fail that test due to management’s choice to under­staff. Reten­tion bonuses for front­line workers who have stayed on the job, adequate pay for extra hours worked, and aggres­sive hiring to staff at full capacity would go a long way right now.”

Opinion: To save Washington hospitals it’s time to close the borders

Military leaders, analysts, and planners evaluate the capabilities of a force using combat effectiveness. Combat effectiveness takes more into account than the number of well-trained soldiers and the quality and quantity of available equipment. It considers leadership, psychological stress, the level of support on the battlefield and the home front, and the clarity of mission. If enough of these factors deteriorate, a military unit or even an entire army can become “combat ineffective.” Our medical community has been combat ineffective for months, and no one is doing anything about it. It is time for a strategic retreat and for officials in Washington state to close the doors to out-of-state COVID patients.

You can keep reading our opinion on Malcontent News.

Travel Advisories

We are expanding our travel advisories today. 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 1,400.

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

Vaccination

FDA panel votes against COVID booster shots for all, but recommends expanding the existing booster shot guidelines

The booster shot program the Biden Administration wanted to start on Monday for people who received the Pfizer vaccine will, at the minimum, be delayed. On Friday, an FDA panel voted 16-2 against booster shots for all. The vote was widely reported in news sources as breaking news.

FDA officials took a break and had a second vote to recommend booster shots for those over 65, at high risk for severe COVID-19, or who work in jobs with significant exposure to COVID patients. The panel voted 18-0 in support of the guidelines.

If the recommendation is authorized, this will expand the current booster shoot guidelines released in August. A third dose was approved for immunocompromised individuals who received the mRNA vaccines from Pfizer and Moderna.

Medical conditions that warrant a second dose include receiving active treatment for cancer, organ transplant recipients, recipients of a stem cell transplant in the last 24 months, moderate to severe primary immunodeficiency, advanced or untreated HIV infection, people under treatment with high-dose corticosteroids such as prednisone, and those being treated with immunosuppressive drugs.

Vaccination impact on menstruation is being researched

When COVID first erupted across the globe, many infected women of childbearing age reported changes in their periods. Anecdotally, there are reports from women that periods became heavier after receiving the COVID vaccine, and others reported a change in their cycle.

The BMJ, the journal of the British Medical Association, published an editorial recommending an investigation into the possible link between the COVID vaccine and changes in menstruation. This story was widely run and in some publications misrepresented as the results of a study in the headlines. The editorial included this quote.

“Most people who report a change to their period after vaccination find that it returns to normal the following cycle and, importantly, there is no evidence that covid-19 vaccination adversely affects fertility. In clinical trials, unintended pregnancies occurred at similar rates in vaccinated and unvaccinated groups.”

On May 18, the Royal College of Obstetricians & Gynecologists issued a statement responding to reports and a BBC News article outlining reported impacts of the COVID vaccine on periods.

“Anecdotally, some women seem to be reporting heavier periods after receiving the COVID-19 vaccine, and we would support more data collection in this area to understand why this might be the case.”

“If you do notice any bleeding that is unusual for you, then we would recommend you contact your doctor.  You can also report any concerns or possible side effects of the COVID-19.”

The Medicines and Healthcare Regulatory Agency in the United Kingdom has a website similar to VAERS in the United States called Yellow Card. People can report suspected side effects of “medicines, vaccines, medical devices, and test kits.” Weekly reports are available at the Medicines and Healthcare Products Regulatory Agency website. Just like VAERS, anyone can submit a Yellow Card report. Unreviewed data should not be considered indicative of any trend.

A study on the Potential Effects of COVID-19 Vaccination on Menstruation received $1.67 million in funding from the United States National Institute of Health on August 30. The study is a joint project conducted by Boston University, Harvard Medical School, Johns Hopkins University, Michigan State University – East Lansing, and Oregon Health and Sciences University – Portland.

Information on how to participate in the study is not available yet.

An article by Randy S. Morris, M.D., Board Certified in Infertility and Reproductive Endocrinology, and the Medical Director of IVF1 found neither COVID nor the COVID vaccine impacted fertility. The report, SARS-CoV-2 Spike Protein Seropositvity from Vaccination or Infection does not Cause Infertility, studied 143 women who underwent Frozen Embryo Transfer (FET) from January 1to May 7, 2021.

All the participants gave serum samples and were tested for the presence of anti-SARS-CoV-2 spike IgG. Testing revealed 55 women who had COVID antibodies in their bloodstream. Participants were notified of the presence of antibodies, 35 were vaccinated, and 20 had experienced a COVID infection. None of the women who had COVID were hospitalized.

Dr. Morris wrote in the discussion section of his article, “In vitro fertilization with FET is an excellent method to study the impact of various factors on implantation since it bypasses many of the variables that normally impact a woman’s ability to conceive, such as ovulation, fertilization, and preimplantation embryo development. The current study failed to identify the difference in the implantation or pregnancy rates between women with documented seropositivity to the spike protein and women without seropositivity.”

They found no significant difference in a successful transplant rate among women who had no COVID antibodies (73.9%), those who were vaccinated (80.0%), and those who had natural immunity (73.7%).

Dr. Morris is a respected subject matter expert in this field. Before being part of the research group, women seeking IVF treatment to become pregnant received an extensive and detailed baseline study of their physiology and reproductive potential.

A connection to seeking fertility treatment in the first place due to the COVID vaccine cannot be made. The study was conducted from January 1 to May 7, 2021, and the first public COVID vaccine was received on December 14, 2020. It takes months of testing and preparation to perform a FET. The Mayo Clinic has an excellent article written in laypersons terms explaining the process of InVitro Fertilization.

The report does have limitations. The sample group of 143 participants is small and limited to women with a history of reproductive issues. The sample size of women who have antibodies due to a COVID exposure was limited to 20 people, which is very small. Reports typically aren’t peer-reviewed but do receive scrutiny from reputable journals before publication.

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, 22.4% 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 91.5% of capacity statewide, with 36.2% of ICU patients fighting COVID. All of these numbers are unchanged.

While ICU utilization has remained close to 90%, the number of patients in the ICU with COVID continues to increase. This is due to three factors. Hospitals are operating under “contingency care” protocols statewide and have canceled most elective surgeries that would require post-surgical ICU resources. Additionally, the surge of new cases that started in August is running its course. The timeline from infection to symptoms, hospitalization, ICU, and death can be 4 to 6 weeks, particularly among otherwise healthy individuals. Finally, Washington state hospitals are caring for dozens of out-of-state COVID patients, many of them critically ill.

The 7-day rolling average hospital admission rate for new COVID patients is 183 a day. This is down from a peak of 193 and above the winter surge, where daily admissions peaked at 115 a day. The Department of Health reported there were 1,649 COVID patients statewide on September 16 and 274 on ventilators. Hospitalizations declining 9% from September 9 to September 14 but appear to have plateaued.

Yakima Valley Memorial Hospital, which said they were approaching the need to move to crisis standards of care last week, reported the situation has improved, but the facility remains exceptionally stressed. The hospital is at 103% capacity, with 45 patients treated for COVID, 95% unvaccinated. On Thursday, 75 employees of the hospital had to stay home.

Hospitals in Spokane are treating 231 COVID patients. Providence Sacred Heart Medical Center and Providence Holy Family Hospital have 816 beds combined, including NICU, PICU, and pediatric beds. On Thursday, Spokane hospitals had one ICU bed available, and one patient spent 16 hours in the emergency department before a bed could be found for them.

Providence St. Peter Hospital in Olympia reported ten patients died of COVID in 24 hours from September 15 to 16. The day after, Providence Hospitals in Olympia and Centralia were caring for 91 COVID patients, with 81% unvaccinated. In the ICU, there were 23 patients and 18 on ventilators, 96% unvaccinated. On September 8, we explained that percentages of unvaccinated versus vaccinated don’t tell a complete story.

Back to School

School DistrictStatusQuarantinesClosures
BellevueYELLOW– Bellevue (4)
– Chinook (1)
– Enatai (32)
– Highland (3)
– Interlake (1)
– Newport (3)
– Newport Heights (19)
– Puesta del Sol (2)
– Sherwood Forest (11)
– Spiritridge Elementary (23)
– Stevenson Elementary (2)
– Tillicum (8)
None
Lake WashingtonRED– Alcott Elementary (1*)
– Carson Elementary (2*)
– Dickinson Elementary (1*)
– Eastlake High (1*)
– Einstein Elementary (1*)
– Ella Baker Elementary (1*)
– Robert Frost Elementary (9)
– Juanita Elementary (2*)
– Juanita High School (37)
– Kirkland Middle School (37)
– Peter Kirk Elementary (1*)
– Redmond Elementary (2*)
– Redmond Middle School (1*)
– Rose Hill Elementary (1*)
– Rose Hill/Stella Schola Middle School (1*)
– Thoreau Elementary (4)
– Kamiakin Middle School (140)
– Mark Twain Elementary (3*)
NorthshoreYELLOW– Arrowhead Elementary (12)
– Bothell High School (48**)
– Canyon Creek Elementary (19)
– Canyon Park Middle School (5)
– Cottage Lake Elementary (12)
– Crystal Springs Elementary (28)
– East Ridge Elementary (17)
– Fernwood Elementary (10**)
– Frank Love Elementary (14)
– Hollywood Hills Elementary (10)
– Inglemoor High School (5)
– Innovation Lab High School (4)
– Kenmore Elementary (15)
– Kenmore Middle School (38**)
– Kokanee Elementary (24)
– Leota Middle School (2)
– Maywood Hills Elementary (11)
– North Creek High School (16**)
– Northshore Middle School (9**)
– Ruby Bridges Elementary (6)
– Secondary Academy for Success (7)
– Shelton View Elementary (18**)
– Skyview Middle School (78)
– Sunrise Elementary (21)
– Timbercrest Middle School (23)
– Westhill Elementary (6)
– Wellington Elementary (48)
– Westhill Elementary (6)
– Woodin Elementary (5)
– Woodinville High School (21)
– Woodmoor Elementary (19**)
Under Investigation
Local Districts Scorecard – * indicates positive cases only ** indicates 5 or more confirmed positive cases

The Lake Washington School District data hasn’t been updated since Friday of last week. We have a confirmed report from the Lake Washington School District of one COVID case at Kirkland Middle School and 36 exposures.

Three more schools in the Bellevue School District have reported cases and quarantines.

Northshore School District now has 7 schools reporting 5 or more confirmed COVID cases. The district has 313 students and faculty in quarantine and 23 new positive cases in the last week – 22 students and one staff member.

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

Kirkland-Bellevue-Woodinville

No update

National Round-Up

Johns Hopkins University Cumulative Case Tracker is reporting 207,886 new cases and 2,635 deaths nationwide. Most states do not provide daily updates, so the number released on Friday tends to be inflated and represents multiple days of data. Tracking the moving average is a better way to understand national trends.

According to a Wall Street Journal article, internal reports within Facebook show that the social media giant has completely failed at stopping the spread of COVID misinformation.

Editor’s Note: No shit.

Alaska

The COVID crisis in Alaska is deepening, with Providence Alaska Medical Center still operating under “crisis standards of care.” The inability to transfer patients to the largest and best-equipped hospital in the state is having a ripple effect on other hospitals.

Alaska has no state standard for “crisis standards of care,” forcing hospitals to make independent decisions. Government officials started forming a committee this week. Meanwhile, the state legislature considered more pressing matters.

State Rep. David Eastman (Wasilla-R) tried to force a non-binding vote in the House to declare the Nuremberg code “remains just as valid today as when it was written in 1947.”

Some anti-vaccination advocates believe that the distribution of COVID vaccines is a violation of the code, established after the full measure of Nazi atrocities in human medical experimentation was discovered. State Rep. Sara Hannan (Juneau-D) was in a race to the bottom, declaring Nazi experimentation on prisoners “produced results.”

“I did not mean to imply any support for NAZIs nor their experimentation in any way. My remarks were incorrect, insensitive, and hurtful. I am sorry and will strive to do better,” said Hannan.

Dr. Gina Wilson-Ramirez, an ER physician in Anchorage, described the situation at Providence. ER wait times for people with severe chest pain, and people are dying waiting to be treated. The waiting room for the emergency department is so full, portapotties were placed in the parking lot, and people were asked to stay in their cars. In the waiting room itself, doctors are now treating patients. Two COVID patients waited more than 8 hours before being seen and required oxygen.

Dr. Ben Westley, who also works at Providence, discussed a situation with two patients who needed dialysis to stay alive, but there was only one machine. Both were critically ill, one in their 30’s and the other older. Doctors decided to ration care between patients, putting one on dialysis during the day and the other at night.

The next day, the older patient was still declining, and there was still only one machine. The younger patient became prioritized for treatment.

Another patient who had COVID needed ECMO, which isn’t available in Alaska. After searching within the Providence network and five other facilities, no location could be found, and the man died.

“The way we’re getting equipment freed up is mainly when we’re discontinuing care on people. And it’s not always because they’re living,” said Dr. Wilson-Ramirez.

At Mat-Su Regional Medical Center near Wasilla, emergency department director Dr. Tom Quimby said he’s seen emergency patients wait as long as five hours. The 125-bed hospital has 42 COVID patients, and the ICU is at 100% capacity – every patient with COVID and on ventilators. Over 50% of the patients arriving in the emergency department have COVID.

Military leaders at Joint Base Elmendorf-Richardson, a critical facility to national defense, declared a public health emergency.

“We’ve all seen COVID-19 cases continue to spread rapidly across our nation, the state of Alaska, and in our local community,” U.S. Air Force Col. Kirsten Aguilar, 673d Air Base Wing and JBER commander, said in a statement Friday. “After close consultation with JBER mission commanders, I have decided to declare a Public Health Emergency.”

Commanders advised personnel to avoid places that do not require masks or social distancing, and the base has moved to Health Protection Condition Bravo.

Alabama

Alabama had more residents die than born in 2020, for the first time in recorded history.

There were 64,714 deaths and 57,641 births in 2020. Harris, holding his weekly update on the state’s efforts against the COVID-19 pandemic, said data going back more than a century showed it was the first year in which the births and deaths data was flipped. He added it could happen again in 2021 if the state continues with its current trend.

“The numbers of deaths have, unfortunately, not declined at this point,” Harris stated of Alabama’s death rate, which includes at least seven pregnant women.

Popular YouTube vintage resellers Dusty and Tristan Graham, who espoused anti-vaccination views and conspiracy theories on their channel, both died of COVID. Tristan Graham, who had previously survived bone cancer, died at home on August 25. Dusty Graham died on Thursday.

Arkansas

Kendall Case, 23, was determined to be fully vaccinated despite having an allergic reaction to the first dose of the Moderna vaccine. She followed the CDC’s guidelines that recommend taking the Johnson & Johnson shot after a reaction.

Little did she know, she would become a rare statistic.

“I started to go into anaphylaxis shock – my mom was there with me – I had my EpiPen ready. We were prepared if something happened, hoping it wouldn’t because it wasn’t supposed to compare to statistics and ingredients – everything we thought,” said Case.

Per the CDC, two to five people per million vaccinated in the U.S. experience anaphylaxis after a COVID-19 vaccine.

California

Beginning October 7, the Los Angeles Rams will require all home game attendees ages 12 and over to provide proof of COVID-19 vaccination or a negative COVID-19 test result taken within 72 hours of game day to gain entry into SoFi Stadium. This mirrors similar policies established by the Buffalo Bills, the Las Vegas Raiders, and the Seattle Seahawks.

District of Columbia

Eva Baisey, known as one of the longest living heart transplant recipients in medical history, has died from COVID-19 at age 55.  She passed away on September 12, 2021 — more than 34 years after receiving a heart.

Georgia

Nicki Minaj fans gathered outside the Centers for Disease Control and Prevention headquarters in Atlanta to defend the rapper and her tweet about a friend of a cousin and his swollen testicles and infertility that he blamed on the COVID vaccine.

Nicki Minaj told the truth to me! Fauci lied to me!” protestors chanted, referring to infectious disease expert Dr. Anthony Fauci. “You know Fauci’s lying!”

During the demonstration, the protesters, who donned face coverings and gloves, called on others to question the vaccines’ reported efficacy.

“Nicki, the queen of rap, stand up,” one protestor said.

Florida

The state Department of Health reported 75,906 new coronavirus cases this week among Florida residents to bring the cumulative total to 3,485,163. With 2,468 more fatalities on record, 51,240 Florida residents have died.

This week’s 2,468 deaths reflect an increase from the 2,448 reported last week, but deaths can take several days or weeks to be reported.

Karen Weiskopf spoke to reporters inside police headquarters in St. Petersburg. Less than a month ago, her husband, officer Michael Weiskopf died from COVID.

While she was vaccinated, her husband had refused to take it. “There was so much information floating around. He didn’t have all the facts,” she said about why her husband wasn’t vaccinated.

“My purpose is to make sure no one goes through what he went through. There wasn’t one day, one hour, one moment that he didn’t suffer,” she said. “This did not have to happen.”

Florida has had 63 law enforcement officers die of COVID.

GOP leaders in Hillsborough County are scrambling after Gregg Prentice died of COVID and took how to access the financial information of the Hillsborough County Republican Executive Committee to the grave with him. Prentice, who was 61, died one day after being diagnosed with COVID and was staunchly against wearing masks.

Friend Jason Kimball blames Tampa General Hospital for the 61-year-old’s death, alleging staff “illegally intubated” Prentice the day before he died. During a Sept. 13 Tampa City Council meeting, Kimball requested an investigation be launched. However, members of the City Council denied any wrongdoing or mistreatment from the hospital.

“My public comments are really going to be about Tampa General Hospital,” Kimball said at the council meeting. “There’s a dire situation going on right now…that I don’t think anyone is aware of, and I have firsthand knowledge of it. They’re intubating everyone entering Tampa General Hospital as a first line of action. They’re using fatality-treatment protocol, and I think that the city council really needs to do an investigation…They’re intubating people illegally. …When you call 911, and you go to that hospital, you’re going into a bad situation.”

Councilman John Dingfelder quickly shut down Kimball’s comment, blasting it as “dangerous.”

Hawaii

Approximately two weeks ago, Honolulu started requiring so-called vaccine passports to enter certain businesses. Yesterday state officials reported hospitalizations had dropped 25%.

Idaho

The crisis in the Gem State is deepening, with doctors and nurses now working in impossible conditions and forced to make unthinkable choices. In Idaho’s St. Luke’s Health System, patients are being ventilated by hand — with a nurse or doctor squeezing a bag — for up to hours at a time while hospital officials work to find a bed with a mechanical ventilator, said chief medical officer Dr. Jim Souza.

Over the past seven days, 1/2 of 1% of every person in Idaho tested positive for COVID.

Chris Roth, president, and CEO at St. Luke’s Health System in Boise said the overwhelming patient volumes result from COVID-19 patients and historic levels of traditional patient care, with the latter primarily brought on by pent-up demand from patients delaying care last year because of COVID-19.

“I’ve never seen any volumes even close to what we’re seeing in my history at St. Luke’s of 14 years,” Roth said.

St. Luke’s had a record 173 COVID-positive admissions to its hospital at the end of August, breaking the 172-admissions record back in the December surge. It recently broke the record again with 281 COVID-19 admissions.

“If we continue on this course over the next several weeks, St. Luke’s Health System will become a COVID health system,” said Roth, noting it will consume every resource and bed it has with coronavirus patients. The vast majority of St. Luke’s ICU patients are COVID positive, with 98% of them unvaccinated.

Although state officials reported a steady number of 170 ICU patients across the state, the number isn’t increasing because there is no more ICU capacity.

To free up space, hospitals are discharging patients that still require critical care, such as high flow oxygen delivery. Norco Medical President Elias Margonis said the company had seen an increase in customers seeking specialty oxygen equipment that flows at a rate of 8, 12, or 20 liters per minute rather than the standard 4 or 5 liters per minute, he said.

Primary Health Medical Group, Idaho’s largest independent primary care and urgent care system, is so swamped with patients they have been forced to close early, with wait times stretching for hours.

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.”

On Friday, Governor Brad Little, Attorney General Lawrence Wasden, House Speaker Scott Bedke, and Senate Pro Tempore Chuck Winder threatened to sue the Biden Administration over the federal employee and OSHA vaccination mandates.

In Ammon, protesters gathered against vaccine mandates. “There is a huge pushback against vaccine mandates,” protest organizer and association spokeswoman Halli Stone said. “You can see there is a great deal of sentiment. People care. If they have a point to rally, they come out. They hate being told they have to take an experimental vaccine that has been proven to be dangerous.”

Many protestors at the event were adamant they were not anti-vaccine. Still, multiple people shared they are not getting vaccinated and have concerns about its safety, despite the FDA saying vaccines are safe.

Editor’s Note: There is a term for this. It is called gaslighting.

Indiana

Indiana University Health required all 36,000 employees to be vaccinated by September 1 or face termination. On Thursday, a spokesperson for the nonprofit health care organization told Newsweek that 125 employees resigned from their jobs after refusing to take the COVID vaccine.

IU Health said that employees who didn’t comply with the September 1 deadline were placed on a two-week unpaid suspension period ending September 14, with the 125 employees resigning afterward, according to the spokesperson.

“A total of 125 employees, the equivalent of 61 full-time employees, chose not to receive the COVID-19 vaccine and have left the organization,” a spokesperson said.

“Most of the employees who chose not to be vaccinated worked part-time, less than part-time or have not worked for a number of months.”

Mississippi

New Jersey, which long led the nation with the highest rate for COVID-19 deaths, now has dropped to second place, behind Mississippi.

Mississippi’s death rate from COVID-19 is 308 per 100,000 people, as of Sept. 17. New Jersey’s is 306. Louisiana and New York, respectively, have the next-highest rates, with 288 and 281 per 100,000 people.

Mississippi’s top health official said Thursday that the numbers of new virus cases are still “far more than we’d like to see” and warned that more deaths would follow.

“We’re recording well over 2,500 (cases) a day, in recent days, far more than we’d like to see,” said State Health Officer Dr. Thomas Dobbs. “A lot of that’s going to translate into the tragedy.”

Montana

Hospitals from Billings to Missoula are instituting or preparing to initiate “crisis standard of care,” with St. Peter’s Health being the first facility to make the declaration on Thursday.

“It is really dire,” said Dr. James McKay, chief physician executive for Providence Montana, who oversees St. Patrick Hospital in Missoula and St. Joseph Medical Center in Polson. “It has never been this bad.”

Officials at Billings Clinic said the transition into crisis care could occur “rapidly” and that it would also impact patients with conditions unrelated to COVID-19. The number of COVID patients at the hospital in Missoula has increased dramatically in recent weeks, and that many are younger, some in their 20s and 30s. The hospital has turned an ambulance garage into a makeshift triage area for COVID patients to handle the increase.

Missoula County officials say they expect an area hospital will get help from the National Guard next week. The Montana governor’s office confirms St. Patrick Hospital’s request for assistance from the National Guard was received at 9:45 a.m. Friday.

Governor Greg Gianforte on Friday announced that the Montana Department of Public Health & Human Services (DPHHS) had issued an emergency rule designed to ease the strain on hospital capacity across the state.

The temporary emergency rule waives regulations to make it easier for hospitals to transfer certain patients to other healthcare facilities, freeing up needed hospital beds.

Gianforte said in a news release: “As our hospitals and health care workers continue to work around-the-clock to deliver life-saving care to Montanans, this new tool will help reduce the burdens our providers face. We will continue to work with hospitals and providers to support their ongoing response.”

Additionally, the Montana Department of Labor and Industry has started reaching out to nurses, nurse practitioners, and other medical workers whose licenses may have expired or retired to ask for help. 

“The Department hears regularly from employers, including health care providers, who have been impacted by the ongoing workforce shortage. With COVID-related hospitalizations increasing statewide, at the Governor’s direction, the Department is looking at ways to mitigate the health care worker shortage and ensure there are no unnecessary delays in the licensure process for individuals qualified to provide medical services,” wrote Jessica Nelson, public information officer for the department. 

Total COVID cases have jump 55% in the last two weeks, outstripping COVID ravaged Idaho.

New York

Three women from Texas assaulted a host at a popular New York City restaurant after she asked for proof they had been vaccinated against COVID-19,

The three women repeatedly punched the host at Carmine’s on the Upper West Side and broke her necklace Thursday afternoon after she asked for proof of vaccination, which is required to dine inside at a restaurant in New York City, police said in a news release.

All three women are from the Houston area and have been ordered to appear in a New York court on October 5 after receiving citations for misdemeanor assault and criminal mischief. The 24-year old victim was treated at a New York hospital and released. She is expected to recover fully.

Jeffrey Bank, the CEO of Carmine’s, said the restaurant was forced to hire security. “It’s ridiculous that she’s sitting here saying, ‘Please don’t assault me.’ It’s just surreal,” Bank said, adding the restaurant was hiring security. “We want everyone to feel safe. Is it necessary? I don’t know, but after last night for sure, we’re going to have it.”

Hundreds of people filled Times Square in New York City to protest against vaccine mandates as part of the World Wide Rally for Freedom.

“We will push back against widespread propaganda by producing our own media, and advancing our own narrative, instead of succumbing to the one being pushed on us. We will not accept the rampant politicization of science and medicine, and we will return these institutions to being neutral sources of information for the benefit of society, over government and corporate interests,” a press release about Saturday’s event reed on the organizers’ website.

Another protest in Syracuse, New York, attracted hundreds more.

Oregon

State officials reported that five people had been hospitalized for ivermectin poisoning, including two that required critical care.

Between August 1 and September 14, the Oregon Poison Center at OHSU saw a total of 25 cases of “Oregonians intentionally misusing ivermectin to treat or prevent COVID-19.” Of those cases, five had to be hospitalized–two people became so severely ill that they had to be admitted into the ICU.

The poison center reported that recent cases displayed various symptoms, including mental confusion, balance issues, low blood pressure, and seizure. Patients sickened by the drug ranged in ages from the 20s to 80s. OHSU said there was an even split between men and women who took the drug and between people who were attempting to treat COVID-19 and trying to prevent getting the virus.

In Salem, Oregon, 500 people gathered to protest vaccine mandates. Luke Yamaguchi, an Albany nutritionist who serves on the board of the protest sponsor, Oregonians for Medical Freedom, slammed Gov. Kate Brown’s mask mandate for school children and in outdoor public spaces — drawing jeers and laughs from the unmasked assembly.

“Mandated medicine has no place in a free country,” said Yamaguchi. “Who is to say that you will necessarily agree with the next vaccine that is mandated?”

Officials reported 1,002 people with coronavirus in hospitals across the state, which is 25 fewer than Thursday. There are 287 people with coronavirus in intensive care unit (ICU) beds, one more than Thursday.

The OHA said 58 available adult ICU beds out of 658 total (9% availability) and 369 adult non-ICU beds out of 4,246 (9% availability).

Within the next week, analysts anticipate death rates in Oregon will peak. Carlos Crespo, a professor at the OHSU/PSU School of Public Health, said people should remain cautious.

“We’re in September, and our cases, our hospitalizations, our deaths are actually higher than they were last year. So I don’t think we should lower our guard. We should actually apply the tools that we have that we know work,” he said.

Peter Graven, analytics director of OSHU, said all cases are tipping downwards in Oregon, and breakthrough cases are just a small fraction of the total number for the state.

Texas

Parents in a conservative corner of Texas are turning one of Governor Greg Abbott’s “pro-life” mantras on its head, arguing in a federal lawsuit that his school mask policy is threatening the lives of their children.

The lawsuit against the Allen Independent School District argues that children have a constitutional “right to life.” They’re suing the school district and board to make them require masks and seeking to represent all 21,000 or so of its students — roughly a third of whom are too young to be vaccinated. Allen is about 25 miles northeast of Dallas in a red part of the state.

The school district said in a statement that it couldn’t address specific claims while the case proceeds but that it “strongly disagrees that the students’ constitutional rights have been violated by leaving masks as an option for students and staff.”

The district “continues to work proactively and professionally with parents who have questions or concerns about Covid-related issues,” it said. “The vast majority of these concerns have been resolved without the need for litigation.”

Wyoming

In the rugged and rural state, 95% of all COVID-related deaths since May 1 have been among the unvaccinated.

On Wednesday, there were 45 COVID-19 patients at the Wyoming Medical Center and 43 at the Cheyenne Regional Medical Center. Four hospitals had no available intensive care unit beds on Wednesday. Three had only one ICU bed open. While ICU beds are not exclusively used to treat COVID-19 patients, when hospitals deal with surges in these patients, that can put a strain on their ability to care for other types of critical-needs patients.

More alarming is the growing number of pediatric patients. Wyoming has 37 hospitals and no dedicated children’s hospitals. Pediatric resources are already stretched to the limit in the state. Officials are concerned that the state will run out of resources and have limited options to transfer patients to other regions.

Misinformation

Last Year Dr. Steven Arthur LaTulippe of Oregon became famous for claiming that wearing a mask causes carbon dioxide poisoning and instructing his patients not to wear masks.

LaTulippe was recorded dismissing the importance of masks in a speech at a “Stop the Steal” rally in Salem on November 7, 2020.

“I hate to tell you this, I might scare you, but I and my staff, none of us, once wore a mask in my clinic,” he told the crowd, reported The Huffington Post. “And how many problems did we have in our clinic from that? Zero.”

The Oregon Medical Board issued an emergency revocation of his medical license in December 2020. On September 2, the board made a final order permanently revoking his license for “dishonorable or unprofessional conduct; repeated negligence in the practice of medicine; and gross negligence in the practice of medicine.” He was also fined $10,000.

For those requiring further clarity, wearing a surgical, examination, cloth, KN-94, KN-95, or N-95 mask does not cause carbon dioxide poisoning among adults or children.

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