Ashley Ausman of the DPHHS State Public Health Laboratory prepares samples for RNA extraction to conduct COVID-19 testing.
By Eric Dietrich, Montana Free Press, and Katheryn Houghton, Bozeman Daily Chronicle 3 mins ago
As Gov. Steve Bullock moves to roll back emergency measures enacted to slow the COVID-19 pandemic, he has said he’ll take a data-driven approach to reopening Montana’s economy while minimizing the risk of a second-surge outbreak.
State officials are keeping a close eye on the number of laboratory-confirmed cases. However, they aren’t tracking the number of Montanans who’ve been tested in each county, a metric national experts say is important to fully understand how the outbreak is playing out in different parts of the state.
Testing has been in short supply across the country. Counting methods vary, but the U.S. has tested 4.6 million people, or roughly 1.4 percent of the population, according to data from Johns Hopkins University & Medicine’s Coronavirus Research Center. Montana has tested 11,875, or 1.1% of its population.
While some local health departments can provide figures on the number of tests conducted in their jurisdictions, those numbers are often imperfect.
Since there’s currently no vaccine for the disease, public health experts say testing for COVID-19 doesn’t change how patients are treated. Testing does show how much of a presence the virus has in specific locations, which is a primary factor employed by elected officials, health experts and the public in determining how quickly to scale back social distancing and closure measures.
Two Bozeman Health employees help a patient learn how to self-sample at a drive-through COVID-19 testing site Thursday, April 23, 2020, in Bozeman.
Jon Ebelt, a spokesperson for the state Department of Public Health and Human Services, said the state has what it needs to understand how the virus is spreading in Montana communities.
“We receive every piece of data we need from counties,” Ebelt said.
Bullock unveiled a plan Wednesday to reopen Montana’s economy, citing the state’s comparatively low COVID-19 case counts and apparent success at flattening the outbreak’s curve. The plan involves three phases of easing social distancing directives, and lets local governments adopt more stringent rules at their discretion. As he monitors the reopening, Bullock said, he is considering the number of confirmed cases, including how many are new each week, as well as hospitalization numbers, testing capacity and supplies of protective equipment.
“Decisions are going to be driven by the ongoing data and the science, not politics,” Bullock said at an April 14 press briefing.
However, health experts say county-level testing counts are valuable data. Aaron Katz, a health policy professor with the University of Washington School of Public Health, said without knowing how many people have been tested in each county, officials can’t see shortfalls in testing from one place to the next. Without that, it’s difficult to chart the state’s rate of infection over time.
“I don’t believe they should be promoting that they have zero positive cases in our county. It’s just that they haven’t been testing people.”
—Karen Swigart, Miles City
“When you don’t know that, it’s really hard to make a good judgment of when to loosen up controls,” Katz said.
In an effort to assess what information is available on local COVID-19 testing, journalists with Montana Public Radio, Yellowstone Public Radio, the Bozeman Daily Chronicle, Lee Newspapers and Montana Free Press teamed up to ask the local health officials serving each of Montana’s 56 counties how many of their residents had been tested for COVID-19 as of April 8.
After two weeks of follow-up calls and emails, we heard back from 53 counties, with 43 providing a figure for how many tests had been conducted on their residents either as of April 8 or by the date they responded. The responses indicate there has been wide variation in how many COVID-19 tests have been conducted in different parts of Montana, from upwards of 1,000 tests in some urban counties to fewer than 10 — or none at all — in some rural counties.
Those figures, however, come with significant caveats.
While most local health departments provided figures on the number of tests conducted on their residents, many cautioned that their figures were imprecise.
The state’s disease monitoring system, designed to identify and contain contagious outbreaks, is focused on tracking positive cases. Negative test results are a second-tier priority, meaning they’re not always reported to local health departments.
Kalispell Regional Healthcare braces for the arrival of COVID-19 as seen on the afternoon of March 18, 2020
By Amanda Eggert 23 hours ago
It might come as a surprise to many that amid the public health emergency caused by COVID-19, health care workers are being hit hard with layoffs, furloughs and reduced hours. But that is in fact the case, as medical associations and public health agencies direct health care providers to cancel or postpone elective surgeries, primary care appointments, and other forms of non-urgent health care in order to preserve hospital workers’ personal protective equipment, ensure providers have adequate bandwidth to respond to the pandemic, and limit the spread of COVID-19 infection. As a result, hospital employees and other health care providers including dentists, ophthalmologists, surgical technicians, physical therapists, nurses, in-home care providers and office support staff are feeling the effects of a massive slow-down in one of Montana’s largest industries.
Last month, 3,345 workers in the health care and social assistance industries filed new unemployment claims with the Montana Department of Labor and Industry, which represents 5% of the industry’s total statewide workforce and a 1,157% increase over the number of industry claims filed in March 2019. Just two economic sectors — accommodation and food service (9,883 claims), and construction (4,048 claims) — logged higher volumes of new claims.
Such a staggering workforce reduction is having a profound impact in Montana. Approximately 20% percent of the state’s total personal income and 17% of its employment are sourced to the health care industry, according to economist Robert Sonora, who directs health care research at the University of Montana’s Bureau of Business and Economic Research.
Sonora said health care is labor-intensive — and therefore an important job engine — and a significant contributor to Montana’s economic base, meaning many of the dollars spent on health care come from outside of the state (Medicare payments made to hospitals by the federal government, for example).
COVID-19 has seriously destabilized that base. By the Montana Hospital Association’s estimation, Montana’s GDP is being reduced by $96 million per week due to reduced use of hospital services. Those service reductions translate to substantial revenue losses, and many hospitals are watching their reserves dwindle as a result. Now they’re making difficult calculations about how to make payroll and cover other expenses.
On April 13, Kalispell Regional Healthcare, which employs more than 4,000 people across a 13-county area of Montana, announced that it is furloughing roughly 600 employees. Without the furlough, the company projects it would lose more than $16 million in revenue per month. The move was prompted by “the compounding effect of the loss of patient volumes, cancellation of elective surgeries, and the closure of entire service lines,” CEO Craig Lambrecht wrote.
“Effective immediately KRH executives, physicians and executive directors will be taking reductions to their salaries. In addition, KRH will begin the necessary process of furloughing and reducing hours/shifts for certain employees. The furlough will impact about 600 employees,” the release said, without specifying which employees would be furloughed, or given mandatory suspensions from work without pay.
Kalispell Regional Healthcare is one of more than 100 hospitals across the country that have furloughed staff since late March, according to information compiled by Becker’s Hospital Review. It is the only Montana hospital named in the report.
Billings Clinic, which operates a 304-bed hospital in Billings and has relationships with critical access hospitals and clinics throughout the state, has committed to keeping its employees on payroll, chief human resources officer Jonathan McDermott said April 10. He said elective surgeries and clinic visits account for most of the company’s revenue, and with those income streams weakened, Billings Clinics’ revenues are “significantly down.”
In order to continue paying employees, Billings Clinic has reduced some workers’ hours and shuffled employees whose positions or skills are currently in lesser demand into different roles. For example, some staffers are screening potential COVID-19 patients when they enter the hospital, a number of employees are working at an ad-hoc daycare set up by Billings Clinic at the Billings Public Library to meet essential health care workers’ childcare needs, and others are sewing face masks and surgical gowns. McDermott praised employees’ flexibility as they’ve adapted to the new roles.
“Most [of our employees] tell us that they’re very happy to have the opportunity to continue to work, even if it is in a different capacity,” he said. “It’s not lost on them that some of their neighbors [and family members] aren’t working right now.”
In Glasgow, Frances Mahon Deaconess Hospital CEO Randall Holom said he’s managed to keep his approximately 250 employees on payroll despite the “fairly significant” hit to his company’s bottom line he expects to see when he reviews forthcoming financial statements.
Holom said his team is looking at funding options through the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act, as well as support from state and local financial institutions. In the short term, Holom reports that Frances Mahon Deaconess has enough reserves to continue paying employees who’ve been sent home, but he said he worries about other rural Montana hospitals that are in more marginal financial positions.
The ability of rural hospitals to survive the COVID-19 pandemic has also been on lawmakers’ radar. Last week, Sen. Jon Tester sent a letter to U.S. Department of Health and Human Services Secretary Alex Azar urging him to ensure that the $100 billion set aside in the CARES Act for public, for-profit and nonprofit health care providers doesn’t discount rural hospitals’ needs. Many “already financially fragile hospitals face catastrophic cash shortages,” Tester wrote. “Tens of thousands of rural [Americans] will lose access to their nearest emergency room [without intervention].”
Hospitals aren’t the only health care providers facing bleak financial outlooks and difficult decisions. COVID-19-related service reductions have also dealt a swift blow to dentists, optometrists, physical therapists, and other outpatient care providers who fall under the “ambulatory care services” grouping.
State unemployment numbers don’t break out claims by specific occupations, but the U.S. Bureau of Labor Statistics found that ambulatory care services — a category encompassing physicians’ offices, dentistry practices, outpatient care centers, home health care, medical and diagnostic laboratories and other health care services — is the segment of the health care and social assistance industry that suffered the greatest job losses last month. These providers’ payrolls fell a whopping 41% across the country since the first of March.
Missoula Bone & Joint, a 15-physician orthopedic practice with a surgery center, urgent care clinic and on-site physical therapy, has seen a dramatic slowdown to its business that’s led to a 25% workforce reduction. Physicians are no longer performing elective procedures at the outpatient surgery center that opened just last December. CEO Sami Spencer said that since elective surgeries account for about 90% of patients, the financial losses are significant. The clinic also has experienced a drop in business of about 60%, she said.
Spencer said that since March 23, more than 50 of the business’ 200-plus employees have been laid off, and the rest are working reduced hours. Employees that have been laid off include physician assistants, nurses, surgical technicians, athletic trainers, patient transporters and front desk staff.
She said Missoula Bone & Joint workers who filed for partial unemployment benefits have reported receiving checks. Those who are seeking the full benefits were still waiting, last she’d heard. (The volume of claims is “unprecedented,” according to a press release from the Montana Department of Labor and Industry. More than 41,000 requests for payment were submitted to the unemployment office in a two-day period last week. The agency has trained or reassigned more than 100 employees to facilitate claims processing.)
Some businesses that are able to maintain their payrolls are doing so with the help of federal funding that’s been made available by recent federal legislation.
“As we move through the peak of COVID-19 in Montana, we anticipate many of these health care and social assistance employees will be brought back.”
—Mike Peery, Montana Department of Labor and Industry
Peter Schmieding, a dentist who treats patients at two rural clinics in south-central Montana, dropped off his application for the Paycheck Protection Program on the first day applications were accepted. He gave it to a banker he’s known for years — a smart move, given that the program is in high demand, with varying levels of cooperation from eligible banks. The program, which was created by the CARES Act and is run by the U.S. Small Business Association, will help him keep his hygienist on payroll even though she’s not currently working. It will also help cover some of his revenue loss.
Schmieding, who’s been a dentist for 39 years, said he considers himself lucky compared to other business owners: his overhead is low, he owns his facilities outright, and he has just two employees to support. He knows that’s not the case for many dentistry practices.
He isn’t seeing as many patients as he did before COVID-19 — some days he’ll treat four or five, and other days he won’t see any, he said — but he’s still available to treat urgent needs like an abscess or a tooth extraction.
“I feel l need to do my part,” Schmieding said. “A lot of the emergencies we see would [otherwise] end up in the ER.”
He’s treating these patients at considerable personal risk. “If I’m working 10 inches away from a [patient’s] mouth, then [I’m] probably more at risk than a physician,” he said.
Schmieding has been staying away from his residence in Bozeman so he won’t unwittingly bring COVID-19 home to his wife, whose immune system has been weakened by radiation and other forms of cancer treatment. As of April 10, he said, he’d been sleeping at his clinic in Ennis for a couple of weeks rather than driving home after work.
Although his family is looking at expenses that can be trimmed, he doesn’t anticipate being financially strapped indefinitely. He said he thinks demand for his services will pick back up once COVID-19 starts receding.
Mike Peery, a director of labor market information with the state, echoes that optimism. He wrote in an email to Montana Free Press that he anticipates many lost and furloughed jobs will return.
“As demand for [smaller specialty health care provider workers] change, and as we move through the peak of COVID-19 in Montana, we anticipate many of these health care and social assistance employees will be brought back,” he said. He added that the Department of Labor has noted a recent increase in job postings for personal and home care aides, medical health services managers, nurses, home health aides and social workers.
Kalispell Regional Healthcare CEO Lambrecht indicated that he, too, believes his business will recover.
“I am confident that we will ramp back up quickly once it is safe to do so,” he said.
April 13, 2020
Governor Steve Bullock today issued a Directive to provide emergency rental assistance to help families with limited financial resources make ends meet during the unprecedented economic situation caused by COVID-19.
“COVID-19 is taking a significant economic toll on families, businesses and our entire state, and finding ways to mitigate those hardships is one of my top priorities,” Governor Steve Bullock said. “For families that can’t make their housing payment right now because they’ve lost income due to COVID-19, this Directive will help prevent a months-long rent backlog from coming due all at once.”
The Directive adds to Governor Bullock’s temporary suspension of certain evictions, foreclosures and service disconnections by creating a program to provide rental assistance to households experiencing substantial financial hardship due to COVID-19. The Department of Commerce will announce details on eligibility and the application process on or before April 17, 2020.
The program will also include relief funds specifically for households with children eligible for the Temporary Assistance for Needy Families (TANF) program.
The state is exploring additional funding options for families who are not TANF-eligible, including federal CARES Act relief money.
The Directive is effective through April 24.
A sign indicates pipeline construction as crews establish a worker encampment northeast of Hinsdale in Valley County, Montana. Photographed April 2, 2020
Montana Gov. Steve Bullock is allowing Canadian pipeline company TC Energy to begin construction this month of the Keystone XL oil pipeline in Montana, categorizing the pipeline as an “essential” project exempt from his statewide stay-at-home directive, despite the acknowledged threat that hundreds of out-of-state pipeline workers pose to state efforts to stem the spread of the coronavirus.
At press time, there is one recorded case of COVID-19 in remote eastern Montana’s Roosevelt County. The counties Keystone XL is slated to traverse have yet to report any cases. Current U.S. maps of COVID-19 cases show that these counties are currently the largest uninfected area in the Lower 48 states.
Officials in Valley County, where Keystone XL would cross under the Missouri River shortly after entering Montana from Canada, are working hard to keep it that way.
On March 28, Valley County officials ordered that all new arrivals to the county are subject to a 14-day quarantine, retroactively including pipeline workers who arrived as early as March 26. Bullock ordered a similar state-wide quarantine policy for new arrivals to Montana on Wednesday, April 1.
Valley County Health Officer Dr. Anne Millard said during an April 1 livestreamed Q&A that the 14-day quarantine applies to pipeline workers only when they are on personal time.
“I can’t stop the TC Energy folks from going to work, but when they are not working they really should be in their rooms and staying there,” Millard said.
Bullock’s March 26 directive defining those allowed to work during the pandemic contains broad exemptions for health care, human services, and “essential infrastructure” workers. The directive says essential infrastructure “shall be construed broadly to avoid any impacts” on those industries. It specifically allows for construction, public works construction, maintenance operations, utilities, power generation, production of raw materials, oil and biofuel refining, transportation, petroleum and fuel, and mining.
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A footnote to the directive references a March 19 U.S. Department of Homeland Security memo providing federal guidelines for work considered essential. That memo includes “workers for crude oil, petroleum and petroleum product storage and transportation, including pipelines,” and those “supporting new and existing construction projects, including, but not limited to, pipeline construction.”
The governor said in a Friday, April 3, press conference that he has “had conversations with everyone from the premier of Alberta to conversations with individuals at TC Energy,” and that he shares local concerns about an influx of out-of-state pipeline workers.
Bullock spokesperson Marissa Perry told the Associated Press on March 30 that “TC Energy holds a tremendous responsibility to appropriately manage or eliminate this risk and we will continue to monitor the plans for that response.”
Asked why Bullock’s directive allows for construction of Keystone XL if it poses specific concerns regarding transmission of the disease, Perry said in an email Friday that the governor adopted the DHS guidelines in whole so as “not to single out specific projects, in order to maintain consistency and treat industries equitably.”
According to the DHS memo, its list of essential infrastructure is advisory, and not a federal directive or standard.
“Individual jurisdictions should add or subtract essential workforce categories based on their own requirements and discretion,” the memo reads.
“The governor continues to evaluate the measures TC Energy is putting in place to ensure they are effective in managing risk — and will seek additional measures if necessary to protect the health and safety of the community,” Perry said.
Since President Donald Trump resurrected Keystone XL soon after entering office, multiple lawsuits by environmentalist and indigenous rights groups have attempted, sometimes successfully, to block construction in the courts.
“We have a rest home here, and in Carter County, and it just doesn’t make sense to me that we would be exposing these people to increased risk without their knowledge, without their consent.”
—Baker farmer Wade Skikorski
Plaintiffs won an injunction in Montana federal court in 2018 that halted pipeline construction, but the Trump administration effectively overruled the courts last June, and construction was allowed to resume. A lawsuit by the same plaintiffs with the same goal and before the same judge was introduced in March, and is awaiting a ruling.
Keystone XL’s potential threat to the human health has long been a cornerstone of the anti-pipeline movement, with activists often highlighting potential impacts to drinking water, as well as sexual violence associated with temporary influxes of pipeline workers, but human-to-human transmission of the coronavirus has added a new angle of concern.
In another lawsuit against the pipeline filed in 2019 by the Fort Belknap Indian Community in Montana and the Rosebud Sioux Tribe in South Dakota, plaintiffs filed an order on March 17 asking the courts to stop construction of Keystone XL due to the threat posed by the coronavirus to Native Americans on the proposed route.
“Additionally, in light of the outbreak of SARS-CoV-2 and COVID-19, the transient nature of the construction workers constructing and living in these man-camps pose serious and immediate public health and safety threats to the Tribes,” the filing said.
TC Energy responded to the filing by stating that the tribes failed to raise concerns about the coronavirus during public comment periods in 2014 and between Oct. 30 and Nov. 18, 2019. The first cases of what would become known as COVID-19 were reported to the World Health Organization by the Chinese government on Dec. 31. Montana officials announced the state’s first COVID-19 cases on March 13.
Wade Sikorski’s family has been farming since 1911 in Baker, where an on-ramp to Keystone XL will allow for the export of fracked oil from the Williston Basin to refineries and ports to the south. While Sikorski says oil has been good to Baker and the rest of Fallon County, he says he’s observed an intensification of severe weather during his lifetime that he attributes to climate change, and he opposes the Keystone XL pipeline for the sake of protecting the family farm from the impacts of climate change.
He says the coronavirus is a whole new reason to oppose Keystone XL. He’s observed pipeline construction before, and the continuous movement of people within communities that it requires. He says a TC Energy representative told him at a company event in early March that somewhere between 600 and 800 pipeline workers will be in Baker for construction.
“We have a rest home here, and in Carter County, and it just doesn’t make sense to me that we would be exposing these people to increased risk without their knowledge, without their consent,” Sikorksi said.
“It’s a pretty substantial risk that they would be taking if the virus started running rampant through here,” he said.
ABOUT HUNTER PAULI
Hunter Pauli is a Seattle-born, Missoula-based freelance investigative reporter and graduate of the University of Montana School of Journalism.
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