As COVID-19 cases rise in Montana and the start of the school year nears, Gov. Greg Gianforte is encouraging more Montanans to get vaccinated but said he would not consider measures like a statewide mask requirement.
“It’s concerning, the uptick. I’m not going to say it’s not,” Gianforte said. “It’s why we continue to message around the importance of people considering getting one of these safe and effective vaccines.”
As students, including those under the age of 12 and therefore too young to be vaccinated, prepare to go back to classrooms, the number of new coronavirus cases in Montana is again growing exponentially, according to the state health department’s epidemiology report from the end of July. That comes after a relatively calm spring when vaccines became widely available to adults.
The spike coincides with delta becoming the dominant variant detected in Montana, making up 95% of variants sequenced at the state lab and showing up in at least 48 counties.
According to data emailed out by the state each morning, Montana went from adding an average of nearly 54 cases a day the week of July 5-9 to an average of 287 daily new cases last week.
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But vaccination rates have also climbed as case counts increase. The state reported an average of 1,536 shots administered each day last week, including more than 4,000 from over the Aug. 7-8 weekend. The average number of daily shots was 923 the week of July 12-16.
Vaccinations against the coronavirus are incredibly effective and safe, based on both the studies that led to their emergency use authorization and results from the more than 4.64 billion shots administered worldwide.
From Feb. 15 to the end of July, Montana has documented just 788 cases of breakthrough infections, or a fully vaccinated person testing positive for the virus. That’s just 4% of cases in that time. And only 9% of breakthrough cases have been hospitalized, including 14 people who have died. The state has marked 1,730 deaths from the coronavirus since the spring of 2020.
Recent data shows 9 in 10 hospitalizations for COVID-19 were for the unvaccinated, a statistic Gianforte pointed to in an interview last week.
“It’s clear the vaccine works,” Gianforte said. “It helps protect people. I would just really encourage folks to speak with their doctor about whether the vaccine is the right thing for them. I know I’ve gotten mine, and I would encourage other people to consider getting vaccinated. (It’s) the best way to protect yourself and your family.”
When Gianforte, a Republican, was vaccinated earlier this year he invited media to cover the first shot in an effort to promote uptake.
He’s also signed laws passed by the GOP-majority Legislature earlier this year that bar employers from requiring a COVID-19 vaccine for workers, including at hospitals. In April, he issued an executive order prohibiting the state from requiring or developing so-called vaccine passports and banning businesses from requiring customers to provide documentation of their vaccine status to gain access or service.
“I’ve been pretty consistent in the messaging ... people should consider getting vaccinated,” Gianforte said. “We’re not going to mandate them. We’re going to rely on personal responsibility."
The state’s public service announcements focus heavily on encouraging people to speak with their doctors about vaccinations. That choice was informed by polling done by the state health department, the governor said.
“One of the things we’ve seen is that the most trusted source of information is their doctor,” Gianforte said. “That is why we’re encouraging people to speak with their doctor in our PSAs … rather than Adam (Meier, head of the state health department) or myself getting on TV and saying ‘Go get vaccinated.’ It’s more important that they hear from their doctor because that’s really the trusted source of information.”
Meier said the most recent wave of PSAs was released in mid-July, adding that was around the same time as the increase in vaccination rates. The spots heavily feature doctors and nurses. The health department now also has good information on vaccine efficacy and how it dramatically reduces COVID-19 hospitalizations and deaths, he added.
“We’ll be looking at those types of things as well to understand how we can incorporate that into our messaging, because I do think as ... people see people they know that have been vaccinated and have not had significant adverse side effects, they may become more trusting," Meier said. "If they see somebody who has become infected and has had a hard time, that can become pretty eye-opening for people.”
But even with the recent jump in uptake, many Montanans still haven't gotten shots. The state’s vaccination rate reached 49% of the eligible population by Friday. That lags behind the national rate of 59% of those ages 12 and up fully vaccinated, according to data from the Centers for Disease Control and Prevention. According to state data, 450,016 Montanans were vaccinated by Friday, which is about 41% of the state.
Gianforte said one of the concerns he hears from people who haven’t been vaccinated is that it's “experimental.”
He also criticized recent CDC guidance issued in light of the delta variant and recommending “universal indoor masking for all teachers, staff, students and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place.”
Gianforte called that recommendation “all over the map.”
“They’ve been erratic and their actions have undermined public confidence in their advice,” Gianforte said. “Telling people that are vaccinated to mask when they’re indoors undermines the confidence in the efficacy of the vaccine, particularly amongst the unvaccinated, which are the ones we’re trying to encourage to get vaccinated.”
Gianforte called the recommendation problematic, citing data showing that children have less severe outcomes to the coronavirus than those ages 65 and older. Montana has not marked a pediatric death from COVID-19 and recent reporting from National Public Radio cited a fatality rate of 0.00% to 0.03% and hospitalization rate of less than 2% for children. The same story, however, noted last week kids now make up about 15% of all new cases nationally, a 31% increase from the week before.
“Their guidance related to school openings and masking ... the evidence here in Montana is people under 20 are not susceptible to severe consequences like elderly people,” Gianforte said. “And we've heard from hundreds of parents that they want their kids back to the classroom in some kind of normal scenario because it's important for learning. It's important for the mental health of the kids. And it's what parents want, and no one cares more about their kids than the parents do. So for the CDC to kind of give mixed messages is not helpful.”
While Montana pediatricians agree that COVID-19 harms children significantly less than older people, they also emphasize that it is not without risks.
"I would argue we’ve already seen bad outcomes here," said Lauren Wilson, the vice president of the Montana chapter of the American Academy of Pediatrics. Wilson treats hospitalized children and those in the pediatric intensive care unit in Missoula.
"We don't have any reported pediatric deaths, but we have certainly seen long COVID and pretty severe illness with long-term consequences from SARS-CoV-2 in children. (There's) neurological effects, cardiac effects, fatigue, concussion-like symptoms."
While data is collected on multisystem inflammatory syndrome in children who have had the coronavirus, there's not good information collected about other effects, Wilson said.
When she speaks with parents, Wilson said she acknowledges the risks and benefits of mitigation measures.
"A lot of the things we have to prevent COVID are not particularly harmful to kids but can keep kids from having long-term health impacts from the disease," Wilson said. "When I talk to parents, I say the thing we know about COVID is that though most kids do well, some don't and it makes sense to do your best to try to prevent your child from getting ill both because of the effect on them but also because of the spread to family members."
'Delta is different'
Pediatricians in Montana also are observing the variant follows a new playbook.
“Kids for so long were such a small part of the story, and we’re starting to see with delta that’s not the case,” said Kathryn Lysinger, a general pediatrician in Yellowstone County.
“We are definitely learning that delta is different,” Lysinger said. “When we were first seeing the original variant of COVID, kids didn’t seem to be transferring the infections as often. They seemed to be less susceptible to getting infected and when they did, they weren’t as sick. With delta, we are definitely seeing an increase in both the numbers of kids that are becoming positive and the number of hospitalizations.”
Earlier in the week, Yellowstone County sent out a press release warning of the rising risk the virus posed there. “The number of cases in young people is especially concerning because schools will be back in session later this month,” the release read. The most recent week’s worth of data for the county found nearly 18% of new cases were for those under the age of 19, and of that nearly half were kids under the age of 10.
Lysinger said while that number is still low, it’s going in the wrong direction.
Anecdotally, she said the county has seen more outbreaks in day cares, which was not common earlier in the pandemic even as children attended those facilities while schools closed in the spring of 2020.
The approach to keeping children safe as school starts this fall, Lysinger said, is two-fold.
First — “We know that what protects kids is the more adults in their life that are vaccinated,” Lysinger said. “If we can create a bubble around kids of vaccinated adults, that will significantly decrease their risk.”
The second prong, Lysinger said, is using mitigation practices that helped earlier in the pandemic. “Until all kids are able to be vaccinated, we recommend ongoing masking in all kids,” Lysinger said.
“Masks work best if everyone around you is masked. That’s why we’re encouraging everyone to wear a mask.”
Missoula County Public Schools recently adopted a universal mask mandate for at least the first six weeks of classes and Helena Public Schools gave their superintendent the authority to issue a mandate for K-8 schools. The Bozeman School Board is set to discuss masking requirements.
Superintendent of Public Instruction Elsie Arntzen, a Republican, has emphasized parents' role in decisions about mask use in schools.
"As the superintendent has previously reiterated, she urges school boards and administrators to ensure the voices of Montana parents and families are heard before making decisions about children going back to school, particularly decisions regarding universal masking of students," spokesperson Chris Averill said last week. "The OPI has heard from parents throughout the state who are concerned about the impact of universal masking on their kids’ academic, emotional and social development, particularly for elementary-aged students and students with disabilities and who believe strongly that wearing face masks and other coverings should be optional, voluntary and a matter of family choice."
Gianforte, meanwhile, has iterated a statewide mask mandate is not on the table.
“It’s pretty simple. In our experience of last year, mandates don’t work,” Gianforte said. “They haven’t been effective, they didn’t diminish the spread of the virus. Personal responsibility does. I trust Montanans to make the best decision for themselves and their families.”
Asked about those who cannot be vaccinated, Gianforte said they have other options.
“I think it's personal responsibility. If someone has underlying health conditions, there are measures they can take to protect themselves,” Gianforte said. “Even if they can't get vaccinated, they can optionally choose to wear a mask in places. They can avoid crowded locations. They can maintain social distance. There's a lot of things people can do. But for folks that choose to get vaccinated, they have a level of protection that allows them to bring some normalcy back to their life. I think that's important.”
Gianforte also said teachers have had access to vaccines since April 1 and he pointed to what he said were mitigation measures for those who can’t get vaccinated.
“There are other measures you can take. You can choose to wear a mask. We're not saying don’t wear a mask, we’re just saying we’re not going to make you wear a mask.”
Back to normal?
The desire to get back to a life that looks a lot more like things did 20 months ago is understandable. But the road to get there goes through more vaccinations and the use of mitigation measures in schools, Lysinger said.
“I really worry about having to go remote, temporarily missing school. All that time away from school is becoming more consequential,” Lysinger said. “The more kids are vaccinated, we’re going to keep kids in school, which is by far what our entire goal is — to keep kids safe, healthy and in school."