A new order from Yellowstone County Health Officer John Felton placed tighter restrictions on group gatherings and places of worship but largely left restaurants and bars alone Monday, after the county exceeded the 565 new COVID-19 cases per week per 100,000 population threshold set last week.
Bars, restaurants, food courts, cafes, breweries, and wineries will be required to close no later than 12:30 a.m. Felton walked back an earlier consideration to further restrict capacity at those establishments to 25 percent. Instead, he kept the limit at 75 percent, the current level after speaking with local business owners. Felton said he heard none would survive if capacity was reduced to 25 percent.
"Our decision (on capacity) was because this dramatic increase (in cases) came on so rapidly, we at least need to give our community the chance to prove together that we can slow this down,” Felton said.
Restaurants can offer take-out or drive-thru past 12:30 a.m., according to the order.
The size of public or private group gatherings was limited to 25 people as part of the order. Places of worship are capped at 50 percent capacity and must comply with masking and physical distance requirements.
The terms of the health officer order take effect on Oct. 14 at 8 a.m. and be re-evaluated in four weeks, Felton said.
If the COVID-19 case trend continues upward, Felton said another more restrictive order would be considered.
“At that time, if the COVID-19 case rate continues to exceed 40 cases per 100,000 people (per week), I, in concert with our medical advisers, will determine the need to issue another health officer order. We need to understand that our inability to control the spread of this disease is not sustainable," Felton said.
Felton said he issued the health-officer order to slow COVID-19 spread across Yellowstone County, which has the highest number of active cases in the state at 1,487 on Monday, according to the state tracking map.
Last week, Felton said he'd issue new restrictions if the weekly rate of infection rises above 40 at the end of October, or if the rate rose above 50 during any week. On Friday, new cases reached 598, above the 50 percent threshold that would trigger more restrictions.
“The numbers tell the story of how dramatically our situation has worsened over the last three months," Felton said.
The increase in Yellowstone County cases over the last three months is large. In the first 10 days of August, the county saw 265 new cases. During the same time in September, the county saw 331 new cases and by the first 10 days of October, 886 new cases were reported, Felton said.
The restrictions also aim to slow the burden of COVID-19 patients in the local hospitals, Felton said. Since Oct. 1, the Billings hospitals have seen between 81 - 96 COVID-19 patients on any given day, Felton said.
“This health officer order is a call to everyone to do your part to reduce the spread of the disease. It is not up to public health or our hospitals or our doctors and nurses or our businesses alone to overcome the threat of COVID-19. It is up to each of us individually and all of us collectively to do what we know is right to protect those around us from sickness and death," Felton said.
Mike Bush, SCL Health chief medical officer, urged the community to take the order seriously, because COVID-19 is taking a toll on the health care system, its workers and killing community members.
“The impact that COVID-19 is having on our neighbors and our most vulnerable is incredibly tragic and if you come see what I see inside the hospital for them, you would understand why we are all taking these actions," Bush said.
The hospitals are implementing their plans for surge capacity, turning offices into hospital rooms and expanding intensive care units, said Nancy Iverson, a registered nurse at Billings Clinic and director of patient safety and infection control.
"We are turning offices into hospital rooms. We are expanding our intensive care units. The specially trained and experienced health care workers, the doctors, nurses, respiratory therapists, our environmental services workers and lab techs and everyone in health care are stretched and our systems are strained," Iverson said.
During the first round of health officer order closures in March, the Billings hospitals canceled elective surgeries to prevent the risk of disease spread. SCL Health, has now reduced the number of elective surgeries, Bush said.
“We are taking steps where we are reducing, not canceling, but reducing the volumes of elective (surgeries) that we are doing," Bush said.
Billings Clinic Foundation President Jim Duncan nodded in agreement that elective surgeries are also slowing down.
Felton was joined at the press conference by members of the medical/technical team, made up of local infectious disease doctors and leadership from Billings Clinic and SCL Health St. Vincent Healthcare. Felton said he worked with the team to draft the health officer order.
"We owe these physicians and nurses more than we can possibly express," Felton said. "Last Friday, we all agreed that we should try less restrictive measures first to give our local citizens the opportunity to take measures required to slow the spread before imposing more significant restrictions on our business community.”
Felton said the restrictions of phase 2 of Montana Gov. Steve Bullock's plan to reopen the state are not having the desired effect in Yellowstone County. That's part of the reason for the new restrictions, he said.
People have seen wait times for contact tracing rise to between 24 - 48 hours, Felton said. That is another reason for the restrictions to try and slow the spread.
“This morning, RiverStone Health has a backlog of 300 positive cases that have not been assigned to contact tracers. Positive tests from the state lab are now taking 72 hours or longer to be reported because of the volume," Felton said.
Felton urged people who are infected with COVID-19 or are a close contact to quarantine or isolate at their homes immediately and not to wait on the call for the health department to take action.
The health officer order requests other things of the community to prevent COVID-19 spread. It asks employers to encourage working from home and asks residents to limit their number of close contacts to no more than six people per week.
Exceptions to the group gathering restrictions include cafeteria settings on college campuses or nursing homes, along with child care facilities.
The group gathering restriction will not prohibit people from voting in person in the Nov. 3 election.
Iverson urged people to keep up with the safety protocols of masking, hand washing, sanitation and physical distancing to slow the spread across the county and prevent more deaths.
“COVID-19 is very real and it is having a significant effect on our daily lives, the health of our people that we know and love and our health care systems. If our community takes personal responsibility, we will see a difference, but it’s going to take all of us. Our friends, our neighbors, our businesses and our officials must join together for the good of everybody," Iverson said.
Watch the full news conference below: