Coronavirus czar Marsh discusses West Virginia’s response
WHEELING — As the tendrils of the COVID-19 pandemic began to wrap themselves tighter around West Virginia, as the number of people in hospitals, on ventilators or had died continued to climb, Gov. Jim Justice and the experts he leaned on to combat the virus had to make vital, life-saving decisions.
Chief among them: how can the state get and keep COVID metrics at manageable levels?
By the end of 2020, the state had effective weapons in the fight — a pair of vaccines that had proved effective in getting the job done. Yet how should the state distribute those vaccines?
Dr. Clay Marsh, vice president and executive dean of West Virginia University Health Sciences, has been part of that expert group from the beginning. He is the state’s coronavirus response coordinator, more commonly known as West Virginia’s coronavirus “czar.” In the early days of the pandemic, he and the rest of the response group came upon studies and statistics that showed them their mission was pretty cut and dried.
“We’ve boiled it down to we really want to save lives and protect health,” Marsh said. “Once you’re clear on that, then the decisions you make are pretty easy.”
Deciding on a direction was easy. Making sure everyone moved in that same direction wasn’t always so easy. Yet, as a year has passed since the pandemic’s start, West Virginia has been hailed by many as a success story in taking on the virus.
As Marsh and other state experts devised a plan, they happened upon a set of numbers that made the state’s focus clear. Justice often has repeated it during his COVID briefings: age, age, age.
The average age of death in West Virginia, Marsh said, is 77. Of the state’s COVID deaths, 77.5 percent are people over 70, 92 percent are people over 60 and 97 percent are people over 50. Half the state’s deaths came at long-term care facilities.
Another set of statistics from the Centers for Disease Control were what Marsh called “mindblowing,” and doubled down on the idea that age was a crucial component.
“Compare 18-29 year olds, the healthiest population, and you look at 50-65 year olds,” he said “Risk of death for 50-65, 30 times higher than 18-29 years old, risk of hospitalization four times higher. For (ages) 60-75, risk of death 90 times higher, risk of hospitalization five times higher. For 75-85, risk of death 220 times higher, risk of hospitalization eight times higher. Over 85 years old, risk of death 630 times higher, risk of hospitalization 13 times higher.”
West Virginia, Marsh said, did not want to see the scenes that had already unfolded in Europe, with hospitals over capacity and mortality rates skyrocketing. So when the Pfizer and Moderna vaccines started getting shipped into the state, the process became clear: vaccinate frontline medical personnel to make sure hospital staffing remained strong, vaccinate long-term care residents to reduce the spread in those facilities and vaccinate the older population first to fortify the state’s most vulnerable population.
The state wanted to move quickly, and to do so, officials made a bold decision to break away from what the rest of the country was doing. West Virginia decided not to join in the Federal Retail Pharmacy Program, the first state to do so. The program is a collaboration between the federal government, national pharmacy chains and states to distribute the vaccine locally.
State officials wondered if there was a more effective system for West Virginia. They talked to the Joint Interagency Task Force for vaccines. They talked to the heads of the state long-term care and pharmacy associations. And they came to the decision that, in West Virginia, the best plan was to work with local independent pharmacists and county health departments to get shots in arms.
Striking out on your own can go one of two ways: you can be hailed a visionary or you can be stuck out on an island regretting your decision. Marsh said state officials were confident in their choice, because they trusted the experts who knew the hurdles they faced specific to West Virginia.
“In retrospect, you could have said, that may have been really stupid, too,” Marsh said. “But I think the whole point is we were so focused about who are we? We wanted to solve the problem for us, our state and our people.
“And it worked out well, but it worked out well because it was critical and very specific to us and how we operated,” he added. “And we never thought we were better than anyone else.”
In the end, the decision looks like it paid off. As of late February, Marsh said, there was a week-to-week 72 percent drop in the number of deaths and a 70 percent drop in the number of hospitalizations in West Virginia. Fewer people are in intensive care units and nursing home outbreaks have plummeted to nearly zero. As of Friday morning, there were 323,811 people in West Virginia with at least a first dose of vaccine and 208,994 who were fully vaccinated.
That’s not to say there haven’t been errors, and Marsh mentioned several. At the end of December, 42 Boone County residents were mistakenly given regeneron rather than a dose of COVID vaccine. Some early vaccination clinics were first come, first served, which led to long lines outside in cold weather.
Some clinics were scheduled without any security as to how many doses they’d receive. When West Virginia introduced the Everbridge statewide registration system, there were, Marsh said, “a thousand lists in a thousand different places.”
The important part, Marsh said, was that the state learned quickly from those mistakes.
“The idea that we’ve become much more agile and much more willing to continue to learn and try things — and we’ve messed up, too, that’s for sure — but that’s been a really key feature,” he said. “We’re constantly trying to listen to what people have been telling us, and if we’re doing something that people are going, ‘Oh, that’s terrible,’ then of course we’re listening and trying to adjust.”
As COVID-19 metrics in the state continue to improve, people from all over the United States have asked West Virginia officials how they have been so effective. Justice has appeared frequently on national cable news shows. Marsh testified before a congressional committee. West Virginia’s story has been told in numerous national publications.
The solution, Marsh said, came down to keeping goals simple and following the best path for the state. The finish line of the pandemic remains in the distance, yet Marsh said everyone in the fight remains steadfast in seeing the race through.
“This is a mission,” he said. “This is a mission of heart and spirit for many of the people involved. And that’s been very inspiring.”