Built for a surge that never came, a massive isolation facility for COVID-19 patients in Spokane County has sat nearly empty on most days.

Now, local officials are rethinking how to provide a service that, while nearly unused thus far, will be vital to the region’s plans to reopen its economy.

In the early days of the public health emergency, local leaders hurriedly established a facility at the county Fair and Expo Center that could accommodate up to 100 people diagnosed with or suspected to have COVID-19, who need to be isolated but could not safely do so at home.

But the facility’s size and cost have far surpassed its actual use, which has never exceeded a handful of individuals at a time.

Since its opening early last month, the isolation facility has taken in26 people. Of the few who have used the Spokane fairgrounds facility, none have tested positive for COVID-19.

“Obviously transitioning from the existing site at the fairgrounds is inevitable,” Spokane County Health Officer Dr. Bob Lutz told The Spokesman-Review.

Although the virus has not been “contained,” Lutz said the focus now is on how to suppress it. And the capacity to isolate those diagnosed with COVID-19, as well as trace and quarantine their contacts, will be crucial.

In his SafeStart plan, Gov. Jay Inslee indicated the availability of isolation and quarantine beds would be a factor in assessing the readiness to relax restrictions in a region.

Moving forward, the state is considering designating Spokane as a regional hub for isolation and quarantine, given that it is already one for medical services. Local officials have identified a number of potential sites across the region that could serve as isolation facilities.

Lutz has been asked to coordinate with state officials on the effort. Rather than have isolation sites scattered throughout the state, officials see the potential of greater efficiency in having isolation and quarantine facilities centrally located.

Often used interchangeably, isolation and quarantine are actually different practices. Isolation facilities are for those with symptoms of the disease or those who have already been diagnosed with it but do not require hospitalization. Quarantine spaces are for those who may have been exposed to a person with the virus. Both are used to prevent the spread of the virus.

Lutz said isolation is the priority over providing a space for quarantine because people in isolation have been diagnosed or show symptoms of the disease.

“Functionally, we’re really looking, 98% it’s the isolation component,” Lutz said.

The state already has established a quarantine facility at the Maple Lane corrections facility in Thurston County. State officials are assessing options across the state, a Department of Health spokesman said on Thursday.

While the preference always is to have a COVID-19 patient isolate at home, that’s not always possible – for example, if that patient lives with someone who has a compromised immune system, Lutz said.

The goal moving forward is to provide “literally a menu of places where we could have individuals isolate for a period of time.”

A person who is autonomous could be housed in a college dormitory with little more than a small refrigerator and a microwave. But some might be unable to make their own meals, for example, and would require a hotel or motel with food service.

At Maple Lane, for example, the state has designated four RVs for people who may have been exposed to a person diagnosed with COVID-19 and need to quarantine. Another four RVs are set aside to isolate those showing symptoms but who do not require hospitalization and can not safely isolate at home.

Medical personnel are on site and monitor the health of people in isolation and quarantine.

Sites in Spokane County considered by a review committee at the Spokane County Emergency Operations Center include hotels, motels, vacant buildings and even dormitories. Viable options have been identified and it’s now a matter of finalizing a plan and negotiating the costs, Lutz said.

One big facility, many empty beds

The isolation facility at the fairgrounds opened as public officials around Washington and the nation were preparing for a surge of COVID-19 cases. In Seattle, an Army field hospital built at the CenturyLink Field Event Center was constructed and dismantled in a span of a few days without ever treating a patient.

And because the Spokane facility’s use has been meager, officials are looking to pare back the cost replacing it.

Spokane’s isolation center at the fairgrounds, which has thus far been funded through coronavirus aid money and not with local dollars, has never come close to reaching its 100-person capacity. But officials girded for the worst.

“We first set it up expecting a surge and not knowing what to really expect,” Lutz said.

Isolation is not just a need among the homeless population, but people living in shelters often have no feasible way to self-isolate.

Fearing an outbreak of COVID-19 in Spokane’s homeless shelters, mobile triage teams led by the Spokane Regional Health District have entered shelters every night at check-in time and screened up to 200 people for symptoms.

CHAS assigned medical personnel at the isolation center site daily and linked patients through telehealth with a primary care physician or behavioral health care provider who could provide prescriptions.

Test results for COVID-19 were turned around in a matter of hours, and patients were discharged when they came back negative, Jason Campbell, senior vice president of operations at CHAS, explained in a briefing at the county’s Emergency Operations Center last month.

CHAS was tasked with providing medical care, while the Guardians Foundation, a Post Falls-based nonprofit, was contracted to oversee security and transportation for individuals to and from the facility.

In analyzing the cost of isolation, the most burdensome expense “is truly the security side,” said Spokane County Sheriff Ozzie Knezovich.

Last month, the Guardians negotiated a contract for its isolation services at a cost of up to $348,040 per month. The organization’s response to a request for proposals issued by the city of Spokane stated it would staff the facility with 59 full-time equivalent employees, allowing for around-the-clock coverage.

The facility was funded through the $1.5 million Washington State COVID-19 Outbreak Emergency Housing Grant given to Spokane County in March, which also has been used to pay for several homeless shelter providers who have expanded to allow for social distancing of their guests.

The Guardians CEO Mike Shaw defends the cost of the contract and said the bed count at the fairgrounds already has been reduced along with staffing.

Shaw negotiated the isolation contract based on a pay rate of about $30 an hour, including payroll taxes, for his employees – a rate Shaw said reflects what he and others believed was needed to recruit workers exposed to COVID-19 patients.

On April 30 the contract with the Guardians was amended to include the nonprofit’s oversight of the temporary homeless shelter at the downtown Spokane Public Library and the Cannon Street warming center. The new contract reduces pay from $30 per hour to $16 per hour when Guardians staff are working at either of the two shelters.

“My operation is accommodating staffing and space requirements based on need,” Shaw said.

As restrictions are relaxed, Shaw said the Guardians has to be “in a nimble spot,” prepared for a potential surge in use but also trying to stretch the budget for isolation services.

“Out there it was a full-on hospital,” Shaw said. “I’m going to fight for my employees the best I can.”

The Guardians contract was approved under the auspices of the county Emergency Operations Center but signed with the city of Spokane and Mayor Nadine Woodward on April 16. The contract expires on May 15.

“The EOC authorizes ‘this is what needs to be done,’ and they hand that off to whatever agency has the ability” to make it happen, explained City Administrator Wes Crago. “They authorize the work, we make the work happen.”

Spokane City Council President Breean Beggs was not directly involved in the contract negotiations but has played a role at the EOC. Although he acknowledged having the advantage of hindsight, he said “looking backwards it doesn’t look like a very good contract.”

Ideally, it would have been a per-bed contract with a guaranteed minimum payment, Beggs said. But still, he stopped short of sharply criticizing the initial plans, which were built on dire forecasts for COVID-19’s potential impact in Spokane.

“The thing I felt like we fell short on was when it became clear we weren’t going to be in that situation, they just continued on,” Beggs said. “There was clearly no need for anywhere near the capacity that they contracted for. … The challenge is there’s not a very clear chain of authority of who does what in that process.”

But Beggs believes local leaders have learned the lesson.

“The high cost of that site has caused all of us collectively to say we need to look at doing things differently,” said Lutz, who noted that the Guardians was the only organization with “the capacity or the resources” to meet the immediate need for service last month.

Lutz also noted that as plans for the isolation center were formulated, it was unknown if rapid testing would be available. That meant potentially isolating a person for days, not just a matter of one night.