This story was originally published Oct. 11, 2021, and updated with additional information Oct. 19, Oct. 22, Nov. 10, and Nov. 23, 2021.
Recommendations are based on interviews with medical professionals in Montana. This article should not be construed as medical advice. Please consult with your physician before making any medical decisions.
WHAT EXACTLY IS COVID-19?
Coronaviruses are a particular family of viruses, and according to the National Institutes of Health, there are hundreds of them that circulate in animals including bats, pigs and camels. The specific coronavirus at the root of the current pandemic is known as SARS-CoV-2. SARS stands for “severe acute respiratory syndrome.” When you hear it referred to as a “novel” coronavirus, that’s another way of saying it’s new. COVID-19 is the name given to the disease caused by SARS-CoV-2, which typically presents as a respiratory infection.
WHAT’S GOING ON WITH COVID-19 IN MONTANA RIGHT NOW?
New COVID-19 cases in the state have declined gradually over the past month from an early October peak. On Nov. 22 the state reported 511 new cases, 5,911 active cases, 266 active hospitalizations and an aggregate death count of 2,567. The decline in new cases has noticeably improved Montana’s national ranking. According to the New York Times, average daily new case numbers ticked up by 29% nationally over the past two weeks. As of Nov. 22, the paper listed Montana as having among the nation’s lowest average number of new daily cases per 100,000 people — a 14-day decrease of 21% — and reported that the state has seen a 22% decrease in average daily hospitalizations per 100,000 people. State data shows that Montana’s vaccination rate is currently at 50% of the state’s eligible population (this percentage dropped in mid-November when children ages 5-11 became eligible for the vaccine, expanding Montana’s overall eligible population). You can check MTFP’s coronavirus report, updated Monday through Friday, for the latest Montana-specific information.
HOW ARE WE DOING THE HOLIDAYS THIS YEAR?
After scaled-down fall and winter holidays in 2020, people are eager for holding in-person celebrations with friends and extended family. Many medical professionals, including the CDC, are not recommending forgoing group gatherings but are stressing that everyone in attendance should take precautions to prevent the spread of the virus.
First and foremost, those who are eligible to get vaccinated should do so (keep reading for much more information about vaccines). Anyone who is sick or showing symptoms should not attend or host a holiday gathering. If there are several unvaccinated people at a gathering, mitigation strategies such as wearing masks, holding the celebration outdoors or increasing ventilation space will decrease the risk of spreading the virus among guests. For groups with mixed-vaccination statuses, this holiday safety quiz suggests a big picture strategy: “Focus on solutions instead of arguing about vaccines.”
Whether attendees have gotten vaccines or not, some experts have suggested taking a rapid antigen test in the days leading up to and the day before a gathering. Boxes of at-home COVID-19 tests are sold at most pharmacies but are often in short supply.
I NOTICED THE STATE’S NUMBERS ON COVID DEATHS LAST YEAR CHANGED. WHY IS THAT?
Montana’s Department of Public Health and Human Services has been tracking lots of different data on the COVID-19 pandemic and distributing it to the public in a number of ways. And yes, the numbers of deaths attributed to COVID-19 last year and this year have fluctuated in the agency’s reports, with the total for 2020 apparently increasing in more recent reports. However, that’s not necessarily a sign that those deaths weren’t previously reported.
DPHHS Public Information Officer Jon Ebelt explains that the numbers reported daily on the agency’s COVID-19 dashboard are a point-in-time snapshot. As agency staff collect more information about reported deaths, that information may cause data fluctuations elsewhere. For example, Ebelt said, the state’s dashboard listed 961 total deaths on Dec. 31, 2020. That number accurately reflected known information at the time. But on further investigation, some deaths reported to the state in 2021 may actually have occurred in 2020. When those deaths are properly catalogued, the total for 2020 goes up.
“It’s important to keep in mind this data is considered provisional and reconciliation between our data sources is ongoing,” Ebelt said via email. “Even 2020 death certificate data is still provisional, but should be finalized soon.”
WHAT CAN I DO TO REDUCE MY RISK OF GETTING COVID-19?
Every medical expert Montana Free Press spoke with said the most important thing you can do is get vaccinated. Beyond that, there are lots of steps you can take to mitigate your risk of contracting the virus. Those include washing your hands regularly, maintaining six feet of social distance from people you don’t live with, and avoiding crowded indoor spaces and poorly ventilated areas. The Centers for Disease Control also says that if you have to cough or sneeze, you should cover your mouth and nose with a tissue or your elbow and immediately wash your hands afterwards.
The most notable precaution, and the one we’ve all become familiar with over the past year and a half, is wearing a face mask. MTFP wrote about the science behind masking in September, but health care providers continue to stress that face coverings are a safe and easy method of protecting yourself and those around you from COVID-19.
“We’re just going to keep putting it out there,” Montana Nurses Association Executive Director Vicky Byrd said. “Wear a mask, whether you’re vaccinated or not.”
IS THERE A PARTICULAR TYPE OF MASK I SHOULD USE?
Among its many COVID-19 related resources, the CDC has a webpage solely dedicated to the various kinds of masks people might use during the pandemic. Those range from disposable surgical masks — the blue ones you occasionally see lying in garbage cans or on sidewalks — to the heavier-duty N95 masks, which are technically called respirators, not masks. According to numerous sources including Johns Hopkins University, masks should be made with at least two layers of fabric and cover the nose, mouth and chin without any large gaps. The CDC recommends that if you’re going to use a neck gaiter as a facial covering, you should fold it over into two layers.
Health care providers are continuing to study different types of masks to learn more about their varying levels of effectiveness. For now, Byrd’s advice is “something is better than nothing.”
HOW CAN I KEEP MY CHILD SAFE?
The same methods that work for adults work for children, too. In fact, some public school districts have made masking a requirement. Not everyone is OK with that, but it does conform with the CDC’s current recommendations for K-12 schools.
WHEN CAN I GET TESTED FOR COVID-19?
Because Montana is dealing with a high volume of COVID-19 cases right now, the Montana Department of Public Health and Human Services is prioritizing COVID tests at the state lab. That means if you are symptomatic or hospitalized, or are involved in a large-scale outbreak of the virus, your test will be top priority. According to information obtained from DPHHS via email, asymptomatic patients, individuals who are participating in surveillance testing, people who are undergoing elective surgery and people who are planning to travel are next on the priority list. DPHHS has also helped enable long-term care and assisted living facilities to ship tests directly to state-contracted labs for processing, and is working to beef up rapid on-site testing for schools as well.
“DPHHS is providing funding to K-12 school districts and private schools to support staffing, equipment and supplies to conduct COVID-19 screening/testing of school staff and students,” DPHHS Communications Director Jon Ebelt wrote via email. “DPHHS is also providing schools directly with COVID-19 rapid antigen test kits. The goal of this is to prevent and mitigate the spread of COVID-19 among students and school staff to help keep schools safe and open.”
If you are planning to travel out of state, DPHHS has a list of locations where Montanans can get travel-tested for COVID-19. The CDC also maintains a travel planner where you can search your travel destination for COVID-19 guidelines and restrictions specific to your travel destination.
CAN’T I JUST TAKE A TEST AT HOME?
This year, the U.S. Food and Drug Administration has approved several at-home rapid test kits for COVID-19, which are designed to be inexpensive, easy to use and widely available over the counter. The manufacturers of these tests are still working to keep up with demand, but the White House recently announced it plans to invest $1 billion to quadruple the number of kits on shelves by the end of the year. Check with your local Walgreens, CVS or other drugstore for availability in your area.
HOW CAN I GET THE COVID-19 VACCINE?
There are a lot of ways to get vaccinated in Montana right now, and if you’re 16 years old or older, you’re eligible to get the shot (the Pfizer vaccine has also been approved for children as young as 5). Some local health departments around the state are continuing to offer weekly public vaccine clinics this fall, and hospitals and pharmacies throughout the state are still booking appointments for people looking to get vaccinated. The CDC has a dedicated search engine that can help you locate the nearest vaccination options in your area at vaccines.gov.
CAN MY CHILD GET THE VACCINE?
On Oct. 29, the FDA expanded emergency use authorization for the Pfizer vaccine to include children age 5-11. The FDA further noted that based on thorough evaluation, the vaccine was shown to be 90.7% effective in preventing COVID-19 within that age range — a rate of effectiveness comparable to that among people age 16-25. On Nov. 2, the CDC followed the announcement with one of its own, issuing a recommendation that the estimated 28 million children in the U.S. between 5 and 11 be vaccinated, and encouraging health care providers to “begin vaccinating them as soon as possible.”
“Vaccinating children will help protect them from getting COVID-19 and therefore reducing their risk of severe disease, hospitalizations or developing long-term COVID-19 complications,” the CDC announcement said. “Getting your children vaccinated can help protect them against COVID-19, as well as reduce disruptions to in-person learning and activities by helping curb community transmission.”
The CDC added that plans are underway to scale up distribution of pediatric COVID-19 vaccinations starting Nov. 8. In Montana, larger communities began scheduling appointments for child vaccinations early that week, with Missoula County holding its first vaccine clinic for kids age 5-11 on Monday. According to Lauren Wilson, vice president of the Montana Chapter of the American Academy of Pediatrics, the initial rollout of child vaccinations has been slightly trickier in rural pockets of the state.
“We’re seeing in larger communities that there are multiple ways to get the vaccine, but in some smaller towns in Montana parents are struggling to find out where they can get their children vaccinated,” Wilson said.
For more information about whether and how to get your child vaccinated, consult your child’s pediatrician or your local health department. And if you have any questions about the safety of the vaccine or potential side effects in children, the Mayo Clinic has an extensive FAQ on those very subjects. Neither the Moderna nor the J&J vaccine has yet been approved for use in people under the age of 18.
WHO IS ADMINISTERING THE VACCINE?
In a nutshell: medical professionals. Depending on where in the state you’re getting jabbed, that could be a doctor, a nurse, a pharmacist or an EMT volunteering at your local mass vaccination clinic. But medical training is a requirement.
Montana did recently expand its list of authorized inoculators in response to the fall surge and a subsequent uptick in vaccine demand. On Sept. 14, the Board of Pharmacy reinstated an emergency rule that temporarily waives limits on the number of pharmacy technicians or technicians-in-training that a pharmacist can supervise in administering vaccines. The emergency rule had been lifted in June when Gov. Greg Gianforte rescinded Montana’s state of emergency declaration, and was reinstated last month to help resolve concerns about staffing shortages expressed by pharmacies in August. The rule also extends to the administration of other inoculations including the influenza vaccine.
WHEN CAN I GET A VACCINE BOOSTER?
On Sept. 22, the FDA granted emergency use authorization for a booster to Pfizer’s COVID-19 vaccine. Only certain groups are currently eligible, including patients 65 and older, patients between 18 and 65 with underlying medical conditions, and those age 18 to 65 who are at greater risk of COVID-19 exposure due to their occupational setting. People can’t receive the booster until six months after their second Pfizer shot. Local health departments in Montana’s larger cities are already offering boosters to eligible individuals. A complete list of county and tribal health departments, including contact information, can be found on the DPHHS website.
On Oct. 20, the FDA also granted emergency use authorization of boosters for the Moderna vaccine and single-dose Johnson & Johnson (i.e., Janssen) vaccine. The Moderna booster is now approved for the same cohort as the Pfizer booster, and may be administered at least six months after the second Moderna shot. The Janssen booster is approved for all people 18 and older and may be administered at least two months after the initial shot. The FDA also granted approval to mix and match, meaning people can get any of the available FDA-authorized boosters regardless of what vaccine they originally received, provided they meet the eligibility requirements for that booster.
SHOULD I BE TAKING ANY ADDED PRECAUTIONS IF I’M PREGNANT?
While researchers are still working to understand the impacts of the novel coronavirus on pregnancy, according to the American College of Obstetricians and Gynecologists reports do suggest that pregnant women are at higher risk of more severe illness with COVID-19. The ACOG has its own FAQ addressing a long list of issues related to COVID-19 and pregnancy. Those include all the health precautions mentioned above, as well as keeping all prenatal and postpartum care visits and following up with your doctor about any questions you have on the subject.
CAN I TAKE ANYTHING AT HOME FOR COVID-19?
A number of home interventions have been rumored to help prevent and treat COVID-19 infection over the past year, including hydroxychloroquine and, more recently, the horse deworming agent ivermectin. Carley Robertson, a family medicine specialist in Havre and president of the Montana Medical Association, said those therapeutics have been “really debunked in the medical literature” and the FDA is not recommending their use.
“[People] should not go down to Big R or North 40 or whatever and buy ivermectin that is designed for livestock. They should not be doing that,” Robertson said. “Those are formulated for veterinary use. They are not formulated for human use.”
I HEARD THERE’S A NEW PILL TO TREAT COVID?
Yes, and it’s called molnupiravir. It was developed by the multinational pharmaceutical giant Merck, which has applied to the FDA for emergency use authorization. The pill is designed to prevent positive COVID-19 cases from becoming severe. You can read more about molnupiravir in this FAQ published by Yale Medicine. However, Merck’s pill has not yet been approved by the FDA, and scientists are still working to understand its potential effects on a variety of people.
IF I DO GET COVID-19 OR DEVELOP SYMPTOMS, WHAT SHOULD I DO?
Montana Hospital Association President Rich Rasmussen told MTFP that if you’re feeling any symptoms of COVID-19, it’s important that you get tested. If you do have it, he said, your condition could deteriorate rapidly, and you have the ability to spread the disease to others. The quicker you get on top of the situation, the faster health care professionals can help you and keep the illness from getting worse.
WILL I BE REQUIRED TO QUARANTINE OR ISOLATE?
The answer depends on your situation and where in Montana you’re living. For starters, there’s an important distinction to make between quarantine and isolation. The former, as recommended by the CDC, is strictly for individuals who have been exposed but have not yet been confirmed to have COVID-19. The latter is for people who have tested positive.
Isolation is still a tactic being used throughout the state to prevent the spread of the virus, and public health officials have encouraged people with symptoms to remain home even if they haven’t received their test results yet. Hayley Devlin, public information officer for the Missoula City-County Health Department, said people in isolation should maintain as much separation from others in their household as possible. That means sleeping in different rooms, using different bathrooms and wearing face masks when interactions are necessary.
“If the person is feeling well enough to at least get out of bed and go to the door, I would recommend whoever is helping them, just set the food by the door and walk away,” Devlin said. “There are cases, though, where people are so sick they can’t get out of bed, so I would just recommend [that you] wear a face mask, a face shield if you have it … and hand them stuff as quick as possible.”
The quarantine picture changed this summer with the implementation of House Bill 702, which bars government agencies and private companies from discriminating based on vaccination status. Following the CDC’s recommendations on quarantine — namely, that unvaccinated people don’t have to — would potentially put counties in violation of HB 702. Missoula County is still sending quarantine orders to close contacts of positive cases, but other counties throughout the state have adopted softer language, referring to quarantine as a “recommendation” or “instruction.” Laurel Riek, administrator for the disease control and prevention division in Lewis and Clark County, said her office is continuing to encourage close contacts to follow CDC guidelines. For vaccinated people, that means wearing a mask and getting tested between three and five days after exposure. For unvaccinated people, that means quarantining for 10 days and getting tested between five and seven days after exposure.
“That is our expectation,” Riek said. “It does not have the weight of an order.”
WHAT SORT OF TREATMENT WILL I RECEIVE IF I DO GET COVID-19?
That’s going to depend heavily on a number of factors, including how severe your symptoms are and whether you have any underlying medical conditions that could exacerbate the situation. Robertson said most people who get COVID-19 won’t end up in the hospital. For patients who are able to deal with the disease at home, providers may recommend extra doses of vitamin C, vitamin D, zinc or melatonin to aid the immune system. Robertson said a two-week regimen of low-dose aspirin is routinely used to reduce certain symptoms such as nausea, and occasionally patients may be asked to come into a clinic for a liter of IV fluid. Consult with your physician before starting any medication regimen.
If you are not vaccinated and are at risk of progressing to a more severe case of COVID-19, Butte family physician Wendy Grace, who has been treating COVID patients both in and out of hospital settings, said you may also receive an infusion of monoclonal antibodies, a treatment the FDA approved for emergency use last fall. That may also be the case for people with diabetes, high blood pressure, or people who are immunocompromised. However, Rasmussen cautioned that Montanans shouldn’t count on the treatment being available, which is one of several reasons he encourages people to get vaccinated.
“There is no guarantee that the hospitals will have the monoclonal antibodies to treat you. They’re in short supply,” Rasmussen said. “[Montana] is doing a great job of distributing them across the state, but at any given moment, you don’t know what that supply is at that particular facility that you present to.”
WHAT IF I DO GET HOSPITALIZED?
According to Robertson, most COVID-19 patients who are sick enough to require hospitalization are typically put on oxygen and receive a few days of steroids. Treatment can involve a host of health care professionals including a physician, a team of nurses, a pharmacist, a respiratory therapist and a physical therapist. Because COVID-19 can have a wide range of negative effects on various organs and bodily systems, those professionals will be on alert for any complications that might arise.
“COVID can cause kidney failure, it can cause respiratory failure,” Grace said. “It can cause strokes, it can cause blood clots in your lungs. All of these things typically require support in the hospital.”
Rasmussen said COVID-19 patients who are hospitalized should also expect to be separated from the rest of the hospital population to reduce the spread of the virus. For the most part, he added, how the hospital handles your situation when you walk in the door will likely be the same throughout the state.
“We know that every patient is at risk for a potential bad outcome because of the severity of this illness,” Rasmussen said. “So whether you’re in a small facility or you’re in a larger community hospital, the approaches are going to be the same: evaluating the level and the acuity of the disease and immediately delivering appropriate resources to address the condition.”
I’VE HEARD SOME HOSPITALS ARE SO SLAMMED THEY’RE USING “CRISIS STANDARDS OF CARE.” WHAT DOES THAT MEAN?
Crisis standards of care are a set of guidelines that health care facilities use to determine how to allocate resources to patients when those resources are limited. If a hospital has two patients in need of ventilation and only one ventilator, Rasmussen said, they have to determine which of those patients has the higher likelihood of surviving if put on ventilation. Montana’s crisis standards were carefully developed by practicing physicians, medical ethicists and clergy to be as “compassionate” as possible, he added, but it’s still “a tough decision for clinicians to find themselves in.” Even so, the uptick in COVID-19 hospitalizations this fall, coupled with the need to continue treating pregnant mothers, grandparents suffering heart attacks and children with broken bones has put health care facilities across the state in a bind.
“Our ICU rooms are at capacity,” Rasmussen said. “And I believe for the last several weeks, more than 50% of our patients in our ICU were COVID patients. We do have a large supply of ventilators and we have not exceeded our ventilator capacity, but we have exceeded, in many instances, our capacity within these intensive care units.”
WILL I GET SICKER IF I GET THE DELTA VARIANT?
Based on what she’s read, Grace said the short answer is no. However, Delta is significantly more transmissible, making it more likely that someone might catch it.
“It’s approximately 10,000 times more transmissible,” Grace said. “So it means more people will get sick in your immediate circle if you are infected … It’s still COVID. It’s still bad.”
According to the American Society for Microbiology, the existing COVID-19 vaccines are largely effective against the Delta variant.
IS THE RISK AND TREATMENT FOR CHILDREN DIFFERENT?
Kalispell pediatric hospitalist Courtney Paterson said that while it’s true children generally don’t get as sick as adults when they get COVID-19, they can still “get pretty sick.” She’s cared for a range of young coronavirus patients from newborns with fevers to teenagers who have ended up in the ICU on ventilators and multiple medications. It may be less common, she said, but it’s “certainly possible.”
“The biggest thing is that when kids are critically ill like that, they truly need a dedicated pediatric space,” said Paterson, who also serves on the Montana Chapter of the American Academy of Pediatrics’ executive committee. “And so this isn’t as simple as if a 12 year old gets critically ill, we’ll just put them in the adult ICU with all the other adult COVID patients. That’s really not our best practice of care.”
Paterson explained that treating a child with COVID-19 requires a dedicated pediatric team, and specialized strategies to help make them more comfortable. At Logan Health, she said, that has included allowing parents to be at their child’s bedside and staff wearing badges displaying their faces without personal protective equipment. Windows in pediatric spaces have also allowed health care workers to interact with young patients safely while their faces are uncovered.
“When we’re outside the room with our PPE off, we can actually play games through the glass so that they know what we look like without all that stuff on,” Paterson said. “It is a process to constantly reassure patients they’re in a safe place so that we try to alleviate anxiety.”
One specific COVID-19 associated issue that health care workers have to be on the lookout for with pediatric patients is multisystem inflammatory syndrome in children, or MIS-C. As the COVID-19 infection begins to wane, Paterson said, a child’s immune system can become confused and begin attacking the body instead of the virus. That can result in ongoing fever, stomach pains, vomiting and skin rash. It’s rare, Paterson added, but it’s where hospitals have seen the most morbidity among children from COVID-19.
“We had quite a few kids here in Kalispell in the last year that have come in with that and needed ICU-level support because their body is so inflamed [that] it’s attacking all of their organs, that they need critical care to be able to get through that,” she said.
I DON’T HAVE COVID-19, BUT I STILL NEED TO GO TO THE HOSPITAL. WHAT SHOULD I DO?
The medical experts interviewed by MTFP said that if you do need treatment, you should not delay seeking it. Whether it’s chest pain or a broken bone, putting off a hospital visit could make the situation worse. However, Butte physician Grace noted that if you can avoid the hospital right now, you should. Facilities are overwhelmed and resources are stretched thin. If a trip to the emergency room or clinic is unavoidable, she said, hospital staff will guide you through what to do to keep yourself and those around you safe.
“We’re asking people to wear masks, and most hospitals are limiting visitors to some degree,” Grace said. “But I think trying to avoid the hospital in the first place is the trick.”
I HAVE MORE QUESTIONS. WHO SHOULD I TALK TO?
Unanimously, everyone interviewed for this story agreed you should consult your primary care physician. And if you don’t have one, they recommend you get one.
“You start with your provider,” Byrd said. “Don’t go to Google, don’t go to Snapchat, don’t go to Facebook.”