EVANSVILLE — Groping for answers to the same COVID-19 surge that bedevils much of the rest of the country, local health officials have finetuned their messaging against the stubborn virus.
There have been some misses, and some losses. Mask mandates that many local residents cordially, or defiantly, ignored. The Vanderburgh County Health Board took a big swing on Thursday, recommending sweeping new restrictions on bars, restaurants and public gatherings that city and county officials promptly rejected as too much. The health board had to rely heavily on 12-county regional data offered by the Indiana State Health Department, which took control of all local COVID-19 data four months ago.
It's been seven months since the first case emerged in Vanderburgh County, and cases, hospitalizations and death counts continue to rise.
Joe Gries, administrator of the Vanderburgh County Health Department, isn't talking anymore solely to the people who won't listen. Gries is talking to people who are willing to wear masks and practice social distancing — but who somehow fail at the crucial moment. They let their guard down.
"Maybe they’re wearing a mask, and they go up and they hug a lot of people because it’s a funeral. I get it," he said. "It’s part of what we do, being human beings, having that close contact to make sure you’re consoling other people."
More: COVID-19: City, county won't act on VCHD recommended restrictions on bars, restaurants, groups
More: Coronavirus: State report lays out where clusters of Evansville cases came from | Webb
Gries paused. He was talking about the ISDH report's reference to 26 coronavirus cases that have been associated with a funeral in Evansville last month.
"It’s so difficult, but that really close contact can be a risk. Where’s the balance? You tell people not to go to your friend’s or family member’s funeral? I don’t know that I can make that statement," he said.
“There are other risks, too. Going out to bars on the weekend and sitting with friends and drinking for a couple of hours and watching a ball game and listening to music and dancing and getting in close proximity. You’re not wearing a mask when you’re drinking. I get it. I was young too once."
Indiana Gov. Eric Holcomb adopted a tougher tone during his regular Wednesday afternoon COVID-19 briefing.
Exasperation creeping into his voice, Holcomb complained of people he said are "acting like this won’t affect them, or it won’t fatally affect them, or they’ll get through it."
The governor turned his gaze to long term care centers. ISDH's statewide COVID-19 dashboard reported Friday that more than 2,100 long term care center residents have died because of the virus.
"It does not start inside our long term centers. It starts outside, in the community. Those rates have a lot to do with community spread. That’s the origin," Holcomb said.
"This has everything to do, again – I’ll say it for the fifth time – has everything to do with our actions and our inactions. It’s because too many are ignoring science and are rolling the dice as if, again, somebody’s going to pay that bill for us."
State Health Commissioner Dr. Kristina Box, who disclosed Wednesday that she and two members of her family had tested positive for COVID-19, pleaded with listeners in her joint appearance with Holcomb.
More: Evansville leaders 'not close contacts' after Indiana health commissioner contracts COVID
"Please be careful. Please, please be responsible," Box said. "And if there’s people around you not being responsible, especially if they’re people that you love and you’re close to, point out to them the importance."
Joe Gries has a plea of his own.
"If you feel uncomfortable and you don’t feel like you want to be in this crowd, don’t go. Don’t go to this event. Stay away," he said. "The reduction in numbers is only going to help reduce spread."
'We continue to be headed in the wrong direction'
Reluctant or unable as they are to provide hard, specific data about their capacity and the ways it is being stretched in the current COVID-19 surge, local hospital systems are willing to acknowledge they're slammed. Both major systems issued assurances that they can handle it — for now, at least.
But it's hard to tell. You can filter on Vanderburgh County data on ISDH's statewide dashboard, but the available hospitalizations and ICU bed and ventilator usage data is for District 10, not the county.
Asked whether Ascension St. Vincent Evansville has more coronavirus patients now than at any other time in the pandemic, Dr. Heidi Dunniway, chief medical officer of Ascension St. Vincent South Region, said yes.
"That is true for the entire region, including Ascension St. Vincent," Dunniway said.
"At Ascension St. Vincent, we are not at capacity at this point, but as I said, we are busy, no question, with increasing COVID patients as well."
Deaconess Health System President Dr. James Porter didn't make himself available for an interview, but he sent an email stating that Deaconess' "current hospital census is very high, and the past three weeks have been our first major surge in COVID-19 patients."
Managing the hospital census is a fluid process — a snapshot in time in an ever-changing environment, Porter wrote. Discharges, admissions and surgeries are always happening. Dunniway made similar remarks.
"Today our beds were 88% occupied between Midtown and Gateway," Porter wrote on Thursday. "Any day above 85% occupancy is a very busy day, which requires staff to work around the clock to manage throughput (discharges and admissions)."
Deaconess staff is strained to the max, Porter wrote.
"We are concerned about the ability to keep this intensity up over a long period. These high census days, and the urgency that surrounds this high patient need, affects all departments of the hospital, but especially our bedside staff in the ICUs and other hospital units," he wrote.
Then the Deaconess hospital system chief got down to brass tacks.
"I wish we could see an improvement on the horizon; however, the positivity rate on testing performed by Deaconess is 13.9% for the month and 14.7% for the past seven days," he wrote. "... The number of people needing to be tested is more than 1,200 per day."
Like Holcomb, Gries and other state and local decisionmakers, Porter put the onus for containing COVID-19 on the public. He didn't hold back.
"We continue to be headed in the wrong direction, and the only thing that can change that is for people to stop spreading it so widely to each other," he wrote. "Gathering in groups — especially indoors, especially without masks, especially without social distancing — is causing this surge."
Health department: Contact tracing is helpful but limited
COVID-19 contact tracing in Vanderburgh County transitioned from the local health department to ISDH months ago. The data resides with the state, which contracted with Virginia-based Maximus for $43 million annually to do the work.
Maximus, a provider of government services worldwide, announced in September that it was doing contact tracing for communities in five states. Maximus has recruited, hired, trained and deployed home-based contract tracers and disease investigators to work in Indiana, Florida, Kentucky, Missouri and Arizona.
Evansville resident Christi Wilke doesn't know which contractor employs the contact tracers she dealt with when her 13-year-old daughter got a positive test result last week.
Wilke does remember getting a call from “the health department.” But first she got a text message.
"The text message states that you have someone tested positive for COVID, and they give you a number to call," she said.
A contact tracer — a patient, persistent, exacting contact tracer — grilled her for more than an hour, Wilke said.
"They wanted to know everywhere (the daughter) had been. She had been to her dad’s that weekend before, so they wanted to know all three of them (her father, her stepmom, her stepsister), they wanted to know the address, their phone numbers," she said.
"They wanted to know any stores that she had been to, and I told them WalMart. They wanted to know which Walmart. Her dance studio she goes to, I had to give them that name and address. Any kids that she had been in close contact with."
Someone else representing the health department called a few days later to ask if Wilke wanted to fill out a questionnaire. She passed. She had already spent an hour on the phone. But she was impressed.
"I think that the health department was pretty thorough," Wilke said.
Gries said Maximus made one particularly savvy move.
"They hired people from all over the state to have at least some local knowledge," he said. "So if somebody says, ‘I was at Turoni’s on the East Side,’ they know what that means."
But contact tracing is limited by its very nature, the health department administrator said.
"It’s difficult to say where somebody contracted this," he said. "The contact tracing is more geared toward, 'Can we identify those people you were around for more than 15 minutes within 24 hours, so we can then reach out to them because they need to now quarantine.' That’s really the focus of that survey and those interviews."
Unless you can tell a contact tracer you're certain you were in the presence of someone confirmed to have COVID-19, contact tracing will always be limited as a tool, Gries said.
"There’s a lot of people that, they don't know they were around a confirmed case because maybe that person who had the virus, was asymptomatic (and) they weren’t even a confirmed case when they were around them," he said.