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At Billings Clinic, the emergency room is turning away ambulances.

In Bozeman, health care workers who are supposed to be quarantined because of exposure to COVID-19 are having to work.

Ravalli County emergency room doctors say the community is “on the brink of disaster.”

As COVID-19 continues to spread uncontrolled across Montana, four hospitals are operating beyond their capacity, schools and businesses are closing and officials are pleading for people to follow public health guidance.

“The alarm is undoubtedly ringing loud. It will be a long winter for our state and our nation,” Gov. Steve Bullock said in a press conference on Thursday.

Bullock declined to implement further public health restrictions, such as a return to a stay-at-home order, saying Montanans can’t afford to be out of work and the state can’t afford to help them out if they are. Bullock said much of that inability has to do with “the lack of a federal response to this virus.”

“The virus is still here. It certainly did not disappear. Congress has not passed another relief package. They have not done so since March,” Bullock said. “I have grave concerns … about sending tens of thousands of Montanans to the unemployment line without enhanced benefits. How will those Montanans keep the heat on? How will they keep their families fed?”

So far, Montana has allocated $1.23 billion of the $1.25 billion awarded to the state through the Coronavirus Aid, Relief and Economic Security (CARES) Act, and the state is unable to fund additional unemployment benefits such as the $600/week initially awarded through the CARES Act, and now expired. 

Bullock, a Democrat who lost his bid for Steve Daines’ Senate seat Nov. 3, and whose term ends in January, said his administration is working with Republican Gov.-elect Greg Gianforte’s transition team on COVID-19 issues, but has not yet met with Gianforte to discuss the state’s response. 

State Medical Officer Dr. Greg Holzman said he shared Bullock’s concern about re-implementing a stay-at-home order, though he said that would “definitely help” slow the spread of the coronavirus. 

“If we were to move back to Phase One, families who live paycheck to paycheck would be in dire straits,” Holzman said.

Holzman asked businesses to make sure all employees and customers wear masks, and said the general public should reconsider social gatherings. 

Bullock said that if people followed the restrictions currently in place, that would help. Universal mask usage alone could save 600 lives, he said, citing a University of Washington model.

“We do have [restrictions] in place that are not being followed,” Bullock said.

“Please stop the arguing about what one does not want to do, and ask yourself, ‘What can I do? What can we do to help protect our communities and decrease the stress and burden on all our frontline workers?’”

—State Medical Officer Dr. Greg Holzman

Many of Montana’s larger communities, including Missoula, Cascade and Gallatin counties, have started to implement restrictions beyond the state’s directives, yet they are registering more COVID-19 cases than ever. Gallatin County had a record 286 new positive cases announced Thursday. 

With caseloads spiking to record levels, most long-term care facilities in the county have COVID-19 cases. The health department is struggling to make contact with everyone who tests positive, making it very difficult to slow the spread of the disease, Gallatin City-County Health Officer Matt Kelley said Thursday.

“It is really serious and significant,” Kelley said.

Though Bozeman Health still has bed capacity, the hospital has another problem: staffing. Kallie Kujawa, Bozeman Health incident commander, said the hospital is now asking its asymptomatic employees who have been exposed to COVID-19, and are therefore directed to quarantine, to return to work after seven days instead of the recommended 14. 

“We could have the beds, but if we don’t have the staff to care for the patients it can be extremely challenging,” Kujawa said.

Kujawa said the hospital tests employees before they return from quarantine to work, but with test results often taking more than 24 hours to return, waiting for those results is not always an option.

“If we have two spine surgeons in the community, we can’t wait for results to come back and wait for them to care for a trauma,” Kujawa said. “We would want to test them, we would want to have those results, but we’re challenged there as well.”

Kujawa said the majority of health workers who are exposed to the coronavirus are exposed outside of the workplace. 

In Park County, Health Officer Dr. Laurel Desnick, who has declined to implement restrictions beyond those directed by the state, said the vast majority of virus transmission is happening at private residences. Park County is struggling to keep up with contact tracing and record keeping, including removal of active cases from the state’s database, Desnick said.

“We’re just focused on the new cases,” Desnick said.

Desnick said the most important message she can convey is to cut back on socializing. Other exposure risks are less negotiable. 

“School is a priority. Going to work is a priority. When you see numbers going up like this, you worry about the hospital two weeks from now. Four weeks from now is when you see people starting to die,” Desnick said. “Changing the pace of infection isn’t something that happens quickly, but we certainly have the power to make it change for the better.”

Holzman said that without federal help, the responsibility to keep safe is on the public.

“Please stop the arguing about what one does not want to do, and ask yourself, ‘What can I do? What can we do to help protect our communities and decrease the stress and burden on all our frontline workers?’” Holzman said. “Let us all work together — public health, community health systems, chambers of commerce, county attorneys, police chiefs, citizens, everyone. … Really this is all on us.” 

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Johnathan Hettinger

Johnathan Hettinger is a journalist based in Livingston. Originally from Central Illinois and a graduate of the University of Illinois, he has worked at the Midwest Center for Investigative Reporting, the Livingston Enterprise and the (Champaign-Urbana) News-Gazette. Contact Johnathan at jhett93@gmail.com and follow him on Twitter.