Along with COVID-19, local physicians struggle with disinterest, disinformation and insults

After decades of tending to Libby’s residents, delivering their children and treating their ailments, Dr. Gregory Rice finds himself labeled a socialist, accused of pushing Marxist propaganda on local schoolchildren.

Rice, like other local health workers, has become the target of derision for petitioning elected officials to take more stringent pandemic measures and helping to create a grassroots campaign, called Team 56, aimed at encouraging residents to take basic precautions.

But he also has seen longtime patients struggle with COVID-19. Earlier this year, he described the final days of a person succumbing to the disease, telling the Lincoln County Board of Commissioners that doctors are forced to “watch the lungs dissolve.”

“It’s difficult,” Rice said last week while discussing treating patients for the coronavirus. “A lot of patients you know really well. When they get sick, you just pray they get better. You do whatever you can for them.”

From his perspective, those most outspoken about their opposition to pandemic measures — from flaunting mask mandates to dreaming up international conspiracies that involve the doctors in Libby — are a vocal minority. Most of the people he interacts with take the coronavirus, which has killed more than 220,000 Americans to date, seriously.

But he has grown frustrated with a federal response to the pandemic. Vacillation at the top has trickled down to the state government and even to local officials, Rice said.

“The [county] commissioners, the city councils to some extent, but particularly the state is hamstrung by the federal leadership, and the federal leadership has fanned the flames of political divisiveness,” he said. “The commissioners aren’t calling us socialists, but they’re also being more neutral at this point. Everybody is just kind of cowering.”

He paused for a moment.

“I’m not cowering.”

The playbook for dealing with an outbreak is straightforward and time tested. Rice said the first step is closing all truly nonessential activities for two weeks. Public health officials would mobilize a massive surveillance testing effort, with contact tracing to follow. Quarantine and self-isolation orders would follow.

“The low tech stuff works,” he said. “You can’t isolate forever. You have to be prepared to really slam it, in terms of isolating people that need to be isolated and surveillance testing, and we just have failed to do that.”

Dr. Brad Black, Lincoln County’s public health officer, agreed that concepts like quarantining sick individuals and closing gathering places have been mainstays for decades. From a public health standpoint, the steps for handling an epidemic or pandemic are noncontroversial.

“We could all continued to have a pretty good life if we all agreed on the simple things like that, but we have too many obstacles and the biggest ones are politics, which shouldn’t even be part of a public health problem like this,” he said. “It always involved surveillance testing and isolation and quarantine. It’s the key steps we’ve done forever — it’s not political thing.”

But politics took center stage months ago, the pandemic becoming a flashpoint in this year’s presidential election. On local social media pages, whether an individual or organization, public or private, supports pandemic measures has come to represent their political leanings.

In recent weeks, a group of residents has petitioned the board of commissioners, calling on them to dissolve the county health board, fire the health officer and reject Gov. Steve Bullock’s mask mandate. Their concerns vary from a loss of civil liberties to worries that a future COVID-19 vaccine will be used to alter Americans’ genetics.

Dr. Kelli Jarrett called the commissioners’ entertaining of the effort “irresponsible,” serving only to give them a public platform. Whereas Rice considers the board neutral at best and unsupportive of the health department at worst, Jarrett said members have, through their actions, undermined public health measures undertaken by the county.

“I definitely am concerned, especially at our local level, particularly with the county commissioners, [of officials] not taking this seriously,” she said.

Like Rice, Jarrett petitioned commissioners earlier in the year to adopt more robust pandemic measures. While she agrees with Rice and Black on the steps to contain an outbreak, she saw little political will for the subsequent war of words.

“Do I think it’s the right answer right now? No, it’s more nuanced than that and politically we’re not in the right environment to do it,” Jarrett said. “I’m really going to be concerned with what is going to be the outcome with any measure the board of health is going to take. People are just so angry and unable to listen to any sort of reason.”

Politics aside, the coronavirus is advancing, with Montana among the states with the highest daily reported cases per capita. In Lincoln County, active case numbers have bounced back-and-forth from the 80s to the 60s, the count fluctuating as residents recover and new patients are confirmed.

Black said the percent positive, the figure officials have used locally to measure the level of spread, is at about 10 percent. Earlier in the year, he said keeping that figure at five percent or lower was paramount.

“We’re in tough shape. I think you’re going to have to [employ] more drastic measures to go down. If you get to 10, 15, 20 percent, that gets devastating then,” he said. “The probability is high that we’re going to be just like other places where the [medical] system is overloaded.”

Jarrett said Cabinet Peaks Medical Center already has been unable to transport a COVID-19 patient. Hospital beds in the harder hit Flathead County were unavailable, she said.

Jarrett worries that if the virus continues to spread unchecked, shortages of personnel and beds will become the norm.

“When we really get our big wave and a large number of people who get sick, our hospital is going to get filled and we won’t have the resources and we will have no place to send them,” Jarrett said. “That’s where we get into the scary, unnecessary deaths.”

Some of those deaths would come from COVID-19. Others, though, might result from heart failures or trauma. Jarrett said that as the virus worsens locally, the risk of medical personnel falling ill with it increases. Libby is home to one general surgeon, she said, and if he gets sick that will put a lot of residents at risk.

“It’s a thin, frail system that could easily be broken down,” Jarrett said.

What has happened with the public schools in Libby, temporarily closed earlier this month in part because of a lack of available teachers, could occur in the community’s medical facilities, warned Rice.

“When we get to the point where we can’t take care of regular patients in the hospital — that’s bad,” he said.

And both he and Jarrett raised concerns about long-term damage caused by COVID-19.

“The people who get hospitalized, they’re wiped out for a while,” he said. “The college students who caught it in April, about 10 percent of them aren’t doing well. Their performance is down. That’s one of the reasons the professional athletes are terrified. It has a chance of ruining their career.”

All of those concerns have weighed on Black, who has simultaneously been accused of profiteering from the pandemic and trampling on the Constitution.

“We only have a limited capacity in Libby, Montana, to handle these patients and then you’re sitting there saying, ‘Sorry, don’t even bring them to the hospital,’” Black said. “The same thing that happened in New York City could happen here.”

Given the increase of coronavirus activity and the potential consequences, Black said this week that the time was coming to consider new possible restrictions. Despite the controversy surrounding the mask mandate in Lincoln County, Black said officials had refrained from penalizing people for ignoring or flouting it.

A move toward regaining control over the spread would be enforcing the directive, he said.

“It’s getting to the point where the spread of the virus is reaching levels to where we have to intervene,” Black said.

If that fails to work, Black said rules curtailing group activities, to include additional restrictions on bars and restaurants, might follow. But it could be avoided if residents return to using masks in greater numbers, he said.

“It’s hard for everybody, but we’ve got to realize that what we’re doing right now, we’re going to look back and wish we’d never done it,” Black said of those giving up on measures like face masks, social distancing and hygiene.

Black acknowledged that would take backing by the county’s elected officials as well as buy in from local law enforcement agencies, which have thus far declined to police pandemic restrictions. Like Rice, though, Black believes that the majority residents are either concerned about the pandemic or wavering out of exhaustion. Those people need to make their voices heard, he said.

“It’s hard to do as a public health entity by itself. I think the community needs to speak and I don’t think we’ve heard them speak,” Black said. “I think … we need that support. People like that don’t tend to be the ones out there screaming.”

Rice also expressed hope that local elected officials could bolster their support of the medical community. In a perfect world, the federal, state and local authorities would promote a consistent public health message, as they have in countries like Vietnam, China and Rwanda, which have done a better job of managing the pandemic, he said. In lieu of that, encouraging people to wear masks, social distance and practice basic hygiene would be helpful.

As for the opponents, those who have deemed him a socialist and accused Team 56 of pushing communism, Marxism and antifa, Rice said in his experience their bark was worse than their bite.

“That is very much a minority of people,” he said. “They could easily be drowned out. I think you’re always going to have an element of people like that, who take advantage of the situation. That’s their prerogative. It’s a free country.”