In one of his patented straight talk moments, Council Member Craig Rice has implored residents to wear masks and heed social distancing requirements if they want schools to open for in-person instruction. Rice said today, “If we cannot control community spread, if we can’t get folks to do what they need to do, we are not going to open back our schools. So let me just be very clear. By folks refusing to do the things that we know are going to lower community spread and keep the community safe, it then in turn forces us to keep our schools closed.”
Amen, Council Member. Video of Rice’s remarks appears below.
The Montgomery County Medical Society has released the statement below praising county health officer Travis Gayles.
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FOR IMMEDIATE RELEASE September 18, 2020
MONTGOMERY COUNTY MEDICAL SOCIETY RECOGNIZES TRAVIS GAYLES, M.D., MONTGOMERY COUNTY (MARYLAND) HEALTH OFFICER, FOR HIS LEADERSHIP DURING COVID-19 PANDEMIC
Statement from Annette Pham, MD, FACS, President, MCMS
On behalf of the Executive Board of Montgomery County Medical Society, a professional association representing more than 1,600 physicians practicing in and/or living in Montgomery County, we wish to thank Travis Gayles, M.D., Montgomery County Health Officer and Chief of Public Health Services, for his exemplary leadership during the COVID-19 pandemic.
We commend Dr. Gayles for putting science first. Given the nature of the novel virus, his insistence on the use of scientific public and population health guidelines has been critical to ensuring the safety of Montgomery County residents. The reason that COVID-19 cases in Montgomery County have not been greater is due, in large part, to the aggressive public affairs and collaborative public health initiatives under his direction.
Sometimes these decisions have been unpopular; however, we commend Dr. Gayles for being a physician first using his medical knowledge and experience, strategic leadership, and passion for and dedication to our community’s health to tackle the challenges associated with COVID-19. His efforts have been professional, fair, and tireless. He is committed to the best interests of ALL Montgomery County residents.
The medical society has appreciated his collaboration with our organization to ensure physicians in our community have been kept informed throughout this crisis. We look forward to continuing collaborative efforts to also advocate for our patients as we head towards the next phase of recovery.
We are fortunate to have Dr. Gayles lead Montgomery County’s public health efforts. He is a critical asset to our county.
One dimension of the current COVID crisis that has not been addressed so far is the impact on county employees. Many county employees, especially in public safety and transportation, are essential workers who have to interact face-to-face with the public. How are they doing in terms of their exposure to COVID-19?
The county’s COVID dashboard contains some data on county employee exposure. As of this morning, the county reported that 1,102 of its employees had missed work due to “a COVID-19 related exposure.” Of those employees, 1,037 had returned to work, 72 were currently in quarantine and 3 had passed away. Exposures by department are shown in the table below.
Overall, 10% of county employees have missed work due to exposure. The four departments with the highest rates of missed work are correction (38% of positions), fire and rescue (16%), transportation (12%) and police (11%).
However, exposures do not equal actual cases of COVID-19. I asked county health officer Travis Gayles for actual COVID cases by department and the county’s Office of Human Resources supplied them. The table below shows cases by department and compares them to cases among county residents.
Countywide, COVID cases account for roughly 2% of the population. For the most part, the case rates among county employees are near that level or lower.
Overall, the data shows that the county is doing a decent job of protecting most of its employees from COVID. Some departments have experienced significant scheduling challenges due to quarantine procedures from exposures. But those same quarantines may have helped limit the spread of the virus in employee work sites. This data suggests that as an employer, the county has done its part to contain COVID-19.
Montgomery County’s COVID-19 dashboard is a great resource for judging the county’s progress in its efforts to control the coronavirus. Unfortunately, it’s not so great at enabling comparison with other jurisdictions, most of whom don’t release data at that level of detail. Inter-jurisdictional comparison is relevant because both public health and economic competitiveness cross state and county lines. Also, if local leaders facing similar circumstances make different decisions, that’s important for voters to know.
MoCo is about average for the region in terms of cases per capita. It is above average on deaths per capita. Prince George’s County has been hardest hit in terms of cases and, along with D.C., on deaths.
The data above illustrates the historical impact of COVID-19 but it’s less helpful in understanding recent trends. The table below shows cases in the two most-recent 7 day periods (8/24-8/30 and 8/31-9/6) relative to population.
During the 8/24-8/30 period, MoCo had the lowest cases per capita of any large jurisdiction in the region. During the following week (8/31-9/6), MoCo was below the regional average and about equal to Baltimore City, Howard, Fairfax and Loudoun. It’s worth noting that MoCo’s cases per capita increased over the two weeks.
MoCo is one of just four jurisdictions in Maryland (along with Baltimore City and Anne Arundel and Prince George’s counties) that is not reopening in line with the state’s phase 3. MoCo’s cases per capita in the most recent week are roughly equal to or lower than Howard, which is proceeding to stage 3, and most of Northern Virginia, which has been operating under Virginia’s phase 3 (which is less restrictive than Maryland’s) since July 1.
Here’s the bottom line, folks: if reopening is a data driven decision, then the facts do not point exclusively in one direction. As seen here and in Part One, supporters and opponents of reopening can each point to data that reinforces their respective points of view. Anyone who says that the data is completely with them is mistaken.
That said, each side bears a burden in making their argument.
County Executive Marc Elrich must explain why he continues to resist reopening despite improvement in the majority of the county’s tracked measures. He must also explain why some jurisdictions with similar or higher recent COVID case rates have proceeded to greater economic liberalization than MoCo, especially in Virginia.
The critics have a different problem. Elrich has been very consistent in saying that public health is his top priority. In making that judgment, he is far from alone among MoCo residents. Critics have to acknowledge that further reopening creates greater risk. They must also explain why public health should not be considered the county’s sole top priority, or at the very least why concessions on that issue are justified by economic recovery.
Last week, Governor Larry Hogan announced that Maryland would enter phase 3 of its reopening, which included a partial lifting of restrictions on indoor theaters, outdoor venues, retail stores and religious institutions. County Executive Marc Elrich said he was a “bit disappointed” with the decision and said the governor “has again taken us by surprise.” Declaring “this is not party time,” Elrich declined to follow the state’s reopening plan, which he is allowed to do under the governor’s executive orders.
Jurisdictions around the state are split. Anne Arundel, Montgomery and Prince George’s Counties are not proceeding to phase 3. Baltimore City is not either, although it is relaxing some restrictions. Most of the rest of the state, including large jurisdictions like Baltimore County, Frederick and Howard, are moving into phase 3 with a handful of small counties not making announcements yet.
Elrich has said time and again that his reopening decisions are made based on data and science. Elrich’s critics say he is not balancing economic needs with public health and that county restrictions are driving MoCo residents to spend money in neighboring jurisdictions.
Who is right?
First, let’s look at MoCo’s COVID-19 dashboard, which tabulates 10 quantitative data points and 7 qualitative data points identified by the county as relevant to its progress. At this writing (Sunday, September 6), 4 data points (intensive care unit bed utilization, percentage of ventilators in use, test positivity and hospitalizations) have been rated adequate on at least 80% of the days since the county went into phase 2. No data points have been rated inadequate on a majority of those days, although one (acute care bed utilization rate) was close. This is not a perfect record, but it’s a decent one.
The record looks stronger when these numbers are compared to the worst days in May. Let’s look at the county’s weakest measure: acute care bed utilization rate. This measure has averaged just above 70% in the last couple weeks. It topped out at 82% in early May. Bear in mind that this is the county’s weakest measure and it has shown improvement.
Now here is one of the county’s strongest measures: the percentage of the county’s ventilators in use. In the second week of May, this measure peaked at just over 60%. It has now been under 30% since mid-August.
The qualitative criteria are even better. As of September 6, 4 criteria were judged to be met and 3 were making progress.
Elrich and his critics can each find support for their arguments in this data. Elrich can say that not every measure is where it should be and that the trend of improvement is not as robust as it was in June or July. Those who disagree can say that most measures have been improving, and if that is not enough to justify further reopening, then what is?
All of the above is just one dimension of the issue. In Part Two, we shall see how MoCo compares to its neighbors.
In a retort to County Executive Marc Elrich’s decision to not follow the state’s phase 3 reopening of businesses, Governor Larry Hogan’s office has released a letter written by Elrich asking the governor to relax restrictions on live entertainment. Specifically, Elrich asked Hogan to allow live entertainment, which was at that time prohibited, in front of audiences of 50 or less people. Hogan’s phase 3 reopening, which is scheduled to take effect tomorrow, allows live performances with audiences of 50% capacity or 100 people indoors and 50% capacity or 250 people outdoors, whichever is less.
Elrich’s defense of the live entertainment industry will be appreciated by musicians, comedians, actors and other performers. But those in other industries that are affected by the county’s refusal to follow the state into Phase 3, such as retail and religious establishments, will inevitably ask: what about us?
Stories in Bethesda Beat and the Washington Post have confirmed a disturbing aspect of the dispute between Montgomery County and Rockville lab AdvaGenix, with which the county had a contract to provide COVID tests that was later terminated. Specifically, the county’s contract with AdvaGenix prohibits it from disclosing to the public how much it is obligated to pay the company.
Bethesda Beat filed a Maryland Public Information Act (MPIA) request with the county to obtain its contracts with AdvaGenix and Bio-Reference Laboratories, another testing lab. According to Bethesda Beat, the county took 53 days to answer the request despite plainly having the contracts in its possession, a violation of the 30-day requirement in state law. Both contracts had pricing terms redacted.
The images below are from the AdvaGenix contract as posted online by the Washington Post. Note how pricing references are redacted and the parties agreed to keep “all information and matters regarding pricing” confidential.
The county’s public information officer cites provisions in the MPIA preventing disclosure of trade secrets as the reason for redacting pricing data in the contract. He has a point: according to the state’s Attorney General, the MPIA indeed “prevents disclosure of trade secrets, confidential commercial or financial information, and confidential geological or geophysical information, if that information is furnished by or obtained from any person or governmental unit.” However, that doesn’t mean that the county had to agree to specific contract provisions keeping pricing confidential. In fact, the county’s MPIA response database is full of requests for and disclosures of county contract information, including pricing schedules.
A contractor’s pricing schedule for inmate phone calls released in response to an MPIA request.
Pricing secrecy benefits a county contractor in two ways. First, if the company’s pricing is protected from disclosure, that makes it harder for a potential competitor to undercut it in the future. Second, secrecy makes it easier for a contractor to charge higher prices to other customers. For example, if another county knows that the company is charging MoCo X dollars per unit, why would it agree to pay more? This is all very helpful to contractors but not so helpful to taxpayers.
MoCo’s secrecy agreement occurs in a context of widespread variation of COVID test prices. The New York Times reported that COVID test charges in Texas vary from $27 to $2,315 per test. That range is facilitated by the common practice of hospitals and insurers to keep COVID test prices secret, as MoCo does. Last year, President Donald Trump issued an executive order requiring hospitals “to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items and services, in an easy-to-understand, consumer-friendly, and machine-readable format using consensus-based data standards that will meaningfully inform patients’ decision making and allow patients to compare prices across hospitals.” When the American Hospital Association sued to keep prices secret, it lost in U.S. District Court. (It will no doubt appeal.)
Montgomery County Government is actually more anti-transparency in the case of COVID test pricing than Donald Trump. Think about that.
Unlike out-of-pocket costs paid by hospital patients, MoCo’s testing costs don’t directly hit the wallets of those being tested. But they do hit residents’ wallets through their tax bills. On top of that, possible litigation with AdvaGenix looms. The fact that MoCo taxpayers do not know how their tax dollars are being spent is highly problematic. And that is the case because their county government wants it that way.
Montgomery County Government has announced that it is terminating its contract with AdvaGenix, a Rockville lab, to provide COVID-19 testing. When the county signed the contract in May, County Executive Marc Elrich called it “a game changer” and the company was expected to provide up to one million tests over the course of a year. Instead, the county has stated that about 19,000 tests were provided under the contract and has advised residents and county employees who received them to get retested.
The company is pushing back hard. Its founder, Dr. William Kearns, told WJLA-7, “We are being slandered… I think there’s a lot more going on here than meets the eye.” Kearns further said, “Our tests are very accurate… Saying anything otherwise is nonsense.”
AdvaGenix was a major player in the county government’s testing program, although the private sector has supplied many more tests than the county. It’s unclear what the county’s plan to resume ongoing testing will look like going forward. There are also MANY more questions to be asked about this and, so far, few answers.
The county’s press release appears below.
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Montgomery County Announces Termination of AdvaGenix Contract For Immediate Release: Tuesday, Aug. 18, 2020
Montgomery County announced today that it has terminated its contract with AdvaGenix, the Rockville-based company that had been providing and processing tests for the County Government’s free COVID-19 test clinics. This action was taken following the cease and desist directive and order issued by the Maryland Department of Health on Aug. 14, 2020, prohibiting AdvaGenix from processing COVID-19 tests.
In response to the State’s announcement last week, the County has been working to restore its testing capacity and reopen testing sites. The Maryland Department of Health has committed to replace the weekly supply of tests for the next four weeks. County officials are working to identify additional test sources to support the County Government’s effort to offer broadly available free tests.
On Thursday, Aug. 13, the County announced it was temporarily suspending tests at County-sponsored clinics. Testing at these clinics was designed primarily to serve asymptomatic individuals. The County continues to provide testing to symptomatic individuals using existing partnerships with other labs. Since the beginning of the COVID-19 pandemic, more than 265,000 COVID-19 tests have been administered to County residents. Tests provided by AdvaGenix were approximately 8 percent of these tests.
Montgomery County Government has sent the email below to county employees regarding the suspension of COVID testing by county vendor AdvaGenix. County employees, particularly first responders and essential workers, were among the first people to receive the tests. The email tells employees, “Although the data we have reviewed does not suggest that the test results were affected by the apparent flaws in AdvaGenix’s lab process, we encourage you to take advantage of one of the other COVID-19 testing resources to be re-tested.”
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From: “MCG.Postmaster” MCG.Postmaster@montgomerycountymd.gov Date: August 14, 2020 To: #MCG_All <#MCG_All@montgomerycountymd.gov> Subject: COVID-19 Testing Update
On May 21, 2020, the County announced the signing of an agreement with County-based testing firm, AdvaGenix, to provide COVID-19 testing to County employees and the general public. Since that date, the County has been working to expand free testing for asymptomatic residents and employees using the AdvaGenix tests, with more than 19,000 tests administered in the last 2 months. Unfortunately, yesterday that momentum came to a halt. As you may have seen, the County has suspended the AdvaGenix testing program after learning that the Maryland Department of Health had issued an order formally halting testing at their lab.
Your health and safety are our top priority. Therefore, we want to provide you with some guidance as to what this situation means to you. In the interim, County officials are working rigorously to determine an alternative source of test analysis so the testing program can resume.
First, all Department testing schedules are suspended until further notice. We are identifying new testing options so that we can have an employee testing program back up and running as soon as possible. There are a multitude of free testing options that remain available to anyone who needs or wants to be tested, including local urgent care centers, CVS locations, hospitals, etc. For additional testing sites, visit the State of Maryland’s Testing Locator page, which can be found at https://coronavirus.maryland.gov/pages/symptoms-testing#siteapp, or call the County’s Testing Helpline at 240-777-1755.
Second, for those of you who were tested by AdvaGenix, you should receive an e-mail from AdvaGenix informing you of what has happened. Although the data we have reviewed does not suggest that the test results were affected by the apparent flaws in AdvaGenix’s lab process, we encourage you to take advantage of one of the other COVID-19 testing resources to be re-tested.
Third, the County’s asymptomatic individual testing program using the oral swab or saliva method has been temporarily paused. However, the County will continue to offer free public testing using a variety of nasal tests. In fact, the state has already committed to provide us with 20,000 nasal kits while we transition to a new self-administered test.
Finally, the County’s testing program through AdvaGenix was only a very small piece of the overall available market for tests in Montgomery County. To date, more than 261,000 COVID-19 tests have been administered to County residents. The AdvaGenix test only accounted for 8 percent of the total. Once again, there are a multitude of free testing options that remain available to anyone who needs or wants to be tested, including local urgent care centers, CVS locations, hospitals, etc. For additional testing sites, visit the state’s Testing Locator page, which can be found at https://coronavirus.maryland.gov/pages/symptoms-testing#siteapp, or call the County’s Testing Helpline at (240) 777-1755.
If you have any additional questions, please contact Don Scheuerman at Don.Scheuerman@montgomerycountymd.gov.
Everyone involved in our testing effort is deeply disappointed with this development. It is so very frustrating that communities across our country are having to invent and reinvent testing programs since the federal government refuses to take responsibility for a national strategy.
Yet, in these difficult times, we have no choice but to pull together as a community to survive the pandemic. Together, we will overcome this newest obstacle. Together we will beat this frustrating virus.
The county’s press release provided no reasons on why the testing was suspended. However, yesterday afternoon, Elrich sent a memo to the county council elaborating a little more on the issue. Elrich wrote:
On Wednesday, August 12, 2020 we were alerted that our supplier of tests and lab analysis, AdvaGenix would be receiving a Cease and Desist order from the State Office of Health Care Quality (OHCQ).
The order is allegedly being issued following a joint site visit by the Center for Medicaid Services (CMS) following a previous site visit earlier this week during which they identified several procedural problems related to the handling of test kits in the laboratory.
While the test kits and the analysis process used by AdvaGenix are not in question, we are awaiting formal notification from the Maryland Department of Health (MDH) on the exact nature of the problem and what corrective actions will be required by the company. We expect to receive notification from the State sometime Thursday, August 13, 2020.
As a precaution we have canceled testing in locations where we had planned to use AdvaGenix test kits. We are concurrently exploring other testing options in the event that we will no longer be able to use AdvaGenix as our supplier for testing.
Multiple sources agree on the following: the situation is developing, there are many more questions than answers at the moment and the issue is serious. One source said, “It’s a complete mess.” Because the state and the feds are involved, the county lacks both complete information and complete control over the matter.
All of this gives rise to many, many questions. Here are a few that need to be answered.
Is there an accuracy issue with the tests?
Specifically, have they generated false positives or false negatives, and if so, how many? Will we ever know?
Is there an impact on county health data?
County health data on cases and test positivity rates have been used to guide decisions on business reopenings. Given the issues with the tests, is this data accurate? If not, what happens then?
Are the issues with the tests correctible?
This question can’t be fully answered until the problems with the tests, and their effects, are fully understood.
How long will it take to rebuild county testing capacity?
If the issues with AdvaGenix can be fixed easily, it could happen quickly. Otherwise no one knows.
Is there a disproportionate impact on first responders and essential workers?
Back in May, when the contract with AdvaGenix was first signed, LocalDVM.com reported:
In the first phase of the contract, which is underway, the County will receive a minimum of 7,500 tests per week. Priority groups to be tested initially will be first responders; nursing home and long-term facility staff and residents; and employees of the County’s Department of Correction and Rehabilitation. The second phase of the testing plan will begin the week of May 31 and will test County employees who are essential workers, and hospital workers and health care providers. Phase three begins June 8; and at that point, the County will begin receiving 20,000 tests per week. By then, testing is scheduled to begin at sites such as grocery stores and other essential businesses for their employees; and testing will also be available for the general public.
This means a lot of county employees have been administered these tests. The county employee unions will be intensely interested in how this issue proceeds. Health and safety is a mandatory subject of bargaining and is subject to grievance procedures and arbitration. This comes in a context of strained labor relations between the unions and the executive branch.
Speaking of legal issues, there could be a whole lot of them associated with the AdvaGenix contract. How much has the county paid AdvaGenix? When did the issues with the tests begin? What recourse is available for the taxpayers? Legal issues are generally not discussed in public but they can have millions of dollars of implications.
What role will the state play?
The fact that the state issued a cease and desist order on AdvaGenix is an interesting development. Elrich and Governor Larry Hogan have a terrible relationship that was exacerbated by their dispute over closing private schools. (Predictably, the state won that battle.) Elrich’s new Chief Administrative Officer, Rich Madaleno, ran for governor in 2018 and spent much of his time on the campaign trail (and even before) blasting Hogan at every opportunity. There is no love lost on Team Hogan for either Elrich or Madaleno. If this issue turns political, then it will get truly complicated.
The full dimensions of this problem are currently unknown. It may take a while for it to be worked out and the legal questions alone will probably prevent some information from being made public, at least for now.
