For example, the local Public Health Department in Skagit County, which has been hardest hit by the epidemic, has half the staff it did four years ago, and most of its preventive care programs have disappeared:
The county’s top medical officer, Dr. Howard Leibrand, who is also a full-time emergency room physician, said that in the crushing triage of a combined health crisis and budget crisis, he had gone so far as to urge local physicians to stop testing patients to confirm a whooping cough diagnosis.
If the signs are there, he said — especially a persistent, deep cough and indication of contact with a confirmed victim — doctors should simply treat patients with antibiotics. The pertussis test can cost up to $400 and delay treatment by days. About 14.6 percent of Skagit County residents have no health insurance, according to a state study conducted last year, up from 11.6 percent in 2008.
“There has been half a million dollars spent on testing in this county,” Dr. Leibrand said late last week. “Do you know how much vaccination you can buy for half a million dollars?” And testing, he added, benefits only the epidemiologists, not the patients. “It’s an outrageous way to spend your health care dollar.”
State health officials suggest that there could be more pertussis cases than current estimates show. Due to incomplete testing, as few as one in five cases is being tracked because of incomplete testing. Becky Neff, a registered nurse with a school district in Skagit County, told the New York Times that she has stopped asking for confirmation of suspected Whooping cough cases because there are only two nurses processing the disease reports instead of the five nurses doing the job a few years ago.
Mary Selecky, the state’s secretary of health, said under-immunization in children could be a compounding factor in the rapid increase in pertussis cases. Until the Washington legislature changed the state law last year to make it more difficult to opt out of childhood vaccines, Washington state had the highest number of kindergartners who did not meet state or national goals for any required immunizations, according to a Centers for Disease Control and Prevention study.
And because the vaccine for pertussis fades over time, the CDC recommends that adults receive a booster shot every 10 years to increase their protection against pertussis. Officials say this is especially important for adults who are around infants too young to be vaccinated because of how easily pertussis can spread.