For years, when an infectious disease reared up in Spokane, there was a simple but important reaction: Call Dorothy MacEachern.

A flare-up of salmonella or E. coli? Botulism from improper home canning? Measles, mumps, whooping cough?

Call MacEachern. Until her retirement last year, she was one of this community’s most important disease detectives, and then its lone infection preventionist, during a 20-plus year career at the Spokane Regional Health District.

What neither she nor her colleagues saw during that time was something most of them had expected: a pandemic.

“We talked about a pandemic for a long time,” she said last week, “but we always thought it would be influenza.”

Turns out the pandemic, when it came, was a novel coronavirus and it was worse than expected. As state Health Department officials prepared to fight it, they did the natural thing: Called Dorothy MacEachern.

MacEachern came out of retirement in March, working for the Department of Health on the West Side and then back in Spokane to help long-term care facilities – where the risk of viral spread was high and the populations were at greatest risk – improve their prevention practices. She’s been the head of a team contacting nursing homes, adult family homes and assisted living facilities, and making sure they know what to do and what they need to do it.

It’s mostly phone work – calling and asking questions and offering advice.

“ ‘Are you screening people at the door? Have you limited or excluded visitors?’ ” she said. “We ask them all these questions.”

It’s a crucial job, but she’s not a cop or regulator. She uses experience, authority and persuasion – the tools that her colleagues say have made her such an important figure in public health here.

Jessica Baggett, a communications supervisor with the Department of Health, said MacEachern’s expertise in preventing infection comes from a growing understanding of how important disease preparation and prevention is, particularly in long-term care facilities, which account for about 60% of all COVID-19 cases and 20% of all deaths.

“We need more people like Dorothy,” Baggett wrote in an email message. “There are not enough infection prevention experts in public health and health care to provide the level of support needed. … Using Dorothy’s supportive outreach model, we now know that public health is a key partner in building infection prevention capacity” in these facilities.

Kim Papich, a former spokesman for the health district who worked with MacEachern for 10 years, said, “She’s a hero. She is. I think she has a really genuine passion and concern for what communicable disease prevention looks like in vulnerable populations.”

‘Working their tails off’

MacEachern retired in June. The first call from the state Health Department urging her to get back to work came at the end of January.

“I was really glad, honestly, because I have a skill that could benefit my community and also my colleagues, who are working their tails off,” she said.

MacEachern was on the job in Spokane starting in mid-March.

The disease has been at its deadliest, and fastest spreading, inside nursing homes and other long-term care facilities. The New York Times reported May 11 that a third of the nation’s COVID-19 deaths have been nursing home residents or workers. More than 200 long-term care facilities have reported coronavirus cases in Washington state, and many of the worst outbreaks have been in such facilities, including Spokane’s single biggest concentration of cases at the Spokane Veterans Home.

The reasons such places are at greater risk are obvious. Residents are older and may have health problems. They live in close proximity to others and require a lot of contact with caregivers. Visitors might come in from all over the community.

Helping such facilities improve their practices involves coordinating among different agencies and organizations to educate about best practices, consult with facilities to see where they might improve and give them the help they need to take those steps.

As Baggett wrote, “When the COVID-19 was first identified in a nursing home in Western Washington, we (DOH) needed help to better support nursing homes to prepare and respond to COVID-19. Her impressive infection prevention, public health, and epidemiology experience have been invaluable in this response.”

When MacEachern arrived in Spokane, one of the first hot spots she encountered was an adult family home where three of the six residents had died of the disease. Adult family homes are residential homes with six or fewer people living there, offering varying levels of care.

She knew that in the 175 similar facilities around Spokane County, there was not nearly enough personal protective equipment – which she immediately began trying to remedy.

“That really concerned me because these were not medical facilities and they didn’t have any PPE,” she said. “I begged them to get PPE to these people.”

By late April, she had helped coordinate an effort with the medical community and the National Guard to deliver masks, gloves, gowns, goggles and hand sanitizer to all adult family homes in the county.

She said that the PPE shortages have eased somewhat, and yet there still isn’t enough. People are reusing equipment that’s meant to be one-time only, and the demand for more is not going away.

“We’re going to need a lot more for a long time,” she said.

The experience she brings to the current crisis was earned during the last several years of her career. Prior to that, she had been a kind of infection investigator – an epidemiologist, who responded when a communicable disease was reported, investigated how it came about, and pursued ways to limit the spread, including communicating with the public or focused populations.

“What’s the reason they all got sick and how can we control that?” she said. “It was kind of like medical detective work.”

‘We have the tools’

Five years ago, the Centers for Disease Control and Prevention began a new effort to prevent the spread of infectious diseases in nursing homes and long-term care facilities. As a part of that, MacEachern took a new turn in her career, becoming trained as an infection preventionist – one of three in the state.

That role was part of a federal effort to limit deadly infections in nursing homes, one that established a mandate that all such facilities would have one person trained in infection control practices by November 2019.

The Trump administration has proposed undoing that mandate, as part of a deregulatory effort that has continued even as COVID-19 has wreaked havoc in nursing homes. It’s one of the many ways in which the federal response to the virus – as with widespread PPE and testing shortages – have hamstrung and endangered those on the front lines.

MacEachern’s training was perfect for this moment. What she did for the district was consult with facilities, ranging from hospitals to dental clinics to nursing homes, to work on preventing infections. It represented a shift in attack from essentially playing defense, and controlling diseases when they arose, toward playing offense.

“It used to be called infection control but now it’s called infection prevention, because we know we have the tools to prevent infection,” she said.

During her three years as the district’s preventionist, she visited more than 100 facilities, taught infection prevention procedures to nursing home staffers here and around the country, and created public-health partnerships with Oregon and Idaho, Baggett said.

Some of the tools MacEachern teaches are the well-known, if not always well-observed, ones that everyone should be using now. Hand-washing. “Respiratory etiquette” – covering your mouth when you cough. Being considerate of others when you’re sick. Part of her job was to be an ambassador for safe practices, and help people in health care facilities be prepared – and it still is.

MacEachern believes that if people will use what we know about preventing infection, we can figure out how to resume parts of our normal lives while we wait for a vaccine.

“I think our population is going to be smart,” she said. “If we just observe masking, social distancing and hand-washing, it’s going to go a long way toward limiting the spread of illness.”

Her temporary return from retirement is probably going to come to an end within a few weeks – at least for this stage of the pandemic.

“Then we’ll see what happens in the fall,” she said. “It’s going to have to be a sustained effort for a long time.”