It’s here. It’s real. It’s not going anywhere soon.

Some 19 months in, the coronavirus pandemic continues to result in infections, hospitalizations and lives lost. At the center of the local response is the La Crosse County Health Department, and while they understand the community is tiring of masking and distancing, the have seen the devastation of COVID-19 firsthand, and they are urging residents to take the virus seriously.

Paula Silha

Paula Silha

“It’s been 18 months of crazy and ‘when is is this going to end?’,” says Paula Silha, health education manager at the La Crosse County Health Department (LCHD) and COVID response testing lead. “This is a marathon, not a sprint.”

La Crosse County Health Department Director Audra Martine


Jacquie Cutts, nurse manager for the LCHD, says, “A lot of people are just pretending it’s not a thing anymore, and that’s just not true. And we’re concerned about how that will impact people, how it has impacted people and how it will continue to impact people. And there’s a balance there to be had. We have to find ways to live our lives. But there are ways that we can do that safely, and a lot of those ways are not being leveraged right now and there are consequences to that.

“So there are people who would be alive right now and aren’t. There are people that have really astronomically high medical bills that don’t need to have those. And what we’re trying to get across to people is the message that COVID is still with us for a while longer,” Cutts continues. “We need to to bring back some of those practices to protect people and that they should have a vested interest in doing that. So you can find a safer way to see your friends and family and recreate that doesn’t necessarily put put as many people at risk.”

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Jacquie Cutts

Jacquie Cutts

In late spring, the state experienced something of a reprieve from COVID with a dip in case rates and, from mid May to early August, no coronavirus deaths, Cutts says. For a while, the CDC relayed masks were no longer essential for the vaccinated. But the delta variant proved rapidly spreading and a catalyst for breakthrough infections, and masks for all were once again strongly urged.

In August, cases started trending up again in La Crosse County, with a 60-fold increase from July to mid-August through early October. During the latter time period, the county recorded 13 deaths. Cases in general were more severe than during the initial surge in 2020. The average number of La Crosse County residents under age 50 who were hospitalized per month between January to July 2021 was 5.6. In September that number was over 20. In addition, some local fatalities have been among individuals under 60.

“I think that every death matters. I don’t think that just because somebody is older, we should value that any less. But I do think it carries a different weight for the community to understand that it’s it isn’t people who live in nursing homes that are necessarily dying now or people that are being hospitalized,” Cutts says. “It’s people who are our workers and parents and general community members.”

The people who have required hospitalizations or succumbed to the disease, Cutts says, “are like each of us, people who were exposed doing the same activities that many of us do, people that could just have easily been us or a treasured loved one. And we can see ourselves in their stories when we start to listen.”

Many of these individuals, Cutts emphasized, were infected at work, while eating out, at a sporting event or festival, attending a wedding, going to church or visiting relatives — normal activities.

“The majority of patients with severe COVID illness are admitted due to issues like severe shortness of breath, difficulty breathing or cardiovascular issues ranging from blood clots to to heart attack to stroke,” Cutts says. “When we talk with patients who are hospitalized or dying or the family of those individuals, they often recount how terrifying it feels to be unable to breathe, to be awake and cognizant, but unable to fulfill the basic functions that keep us alive. (They) wonder if they’ll ever see their kids, spouse, parents, siblings or friends again.”

No one, Cutts emphasizes, is impervious to COVID. This includes children — since April 2020, the American Academy of Pediatrics reports, some 4.8 million youth have contracted the virus, and while most cases are not severe, hospitalizations have around tripled since the start of the pandemic. Over 600 patients 18 and under have died.

Many children have also been affected by parents and guardians dying from COVID-19. From April 2020 to June 2021, over one in 500 children lost a primary caregiver with whom they lived and who provided for their needs, the CDC says. There are racial disparities, with American Indian and Alaska Native children 4.5 times more likely to lose a parent or grandparent caregiver than their white counterparts. Black and African American children were 2.4 times more likely, and Hispanic or Latino children were nearly 2 times more likely than white youth.

“There are families that have lost a parent or caregiver that live in our county, that live in our region. … They’re never going to get that person back,” Cutts emphasizes. “Those people were seemingly healthy and they they aren’t going to be here ever again. And that didn’t have to happen. There are ways that we can prevent that from happening.”

As part of her job, Cutts receives notification of every COVID hospitalization or death of a La Crosse County resident, and she looks over the records carefully and thoroughly to understand the source of their viral contraction and circumstances to hopefully help prevent others from suffering in the same manner. There is a “human side” to the numbers, she says — a face, a personality, a family.

A common misconception, or even conspiracy, among some COVID skeptics is deaths are being labeled as due to COVID even if the main cause is unrelated. However, Cutts negates this, as she reviews death records herself.

“I get the the honor of honoring somebody’s life, and part of that is understanding how they died, and I review death abstracts and electronic health records. That’s part of what we do,” Cutts says. “And I can tell you that there have been very few instances where somebody died of something else. Unless COVID is listed as a contributing factor on the death certificate, those aren’t counted as COVID deaths, and those have been, like, one or two. They are not the majority of our COVID deaths. (When the) primary cause of death was COVID, they were in acute respiratory failure, or they had an acute heart attack that was secondary to a COVID infection … they had an event directly related to COVID and they died from it.”

Cutts emphasizes, “I can vouch for that myself because I review those records, all of them. I appreciate people who have differing opinions on things like vaccines. I think that we live in a place where we can have conversations and have disagreements and still be respectful. But in terms of of COVID illness, there is no question. People die from COVID, period.”

Even cases that don’t result in death can have lasting effects, with long COVID among the potential detriments of the infection.

“I hope that none of the people who are questioning the veracity or whether or not they should get vaccinated experience what that feels like,” Cutts says. “I can tell you that when they do get COVID and they get really ill — that’s a hard thing for anybody to go through.”

Practicing prevention

Vaccinate, mask, distance.

The recommendations haven’t changed, but there remains a sizeable population that refuse to adhere, whether they feel it is an infringement on their rights, not a real danger, or are fearful or distrusting of the vaccine. And for those under 12, vaccination is not yet an option, thought approval for those 5 and up is expected soon.

Silha says there are ways to enjoy socialization and everyday activities safely: mask up, keep it to small groups, and visit outdoors if possible. Persons who travel are urged to avoid others for a few days after their return and to get tested. Silha feels, she quips, “at times like ‘La Crosse County’s nagging mother, telling people to wear seatbelts and put your kids in car seats and don’t smoke and be physically active and eat your fruits and vegetables. All those are important. So is COVID (prevention).”

Prevention tactics, Silha says, are something we can control, and she implores those who wouldn’t do it for themselves to do so for others. Family members, friends and co-workers could become seriously ill or even die from an infection you spread.

“(I hope) people start thinking about getting vaccinated to help prevent disease among others too. The world doesn’t revolve around me, the world revolves around how I can be a part of a solution to help others,” Silha says. “We live in a free country. But when you live in a free country, then there are certain things that you give up for those freedoms. You can choose to be vaccinated or not. But if being vaccinated allows you to have a little bit more normal life, and reduces that fear that you could pass that infection to other people, why (wouldn’t you)?”

The health department, Martine says, is always willing to field questions regarding vaccine safety, and no query is a bad or silly one. A great deal of misinformation is being spread on social media and unreputable websites, and the staff hopes to help dispel myths and alleviate concerns with information and facts rooted in science.

Individuals over 12 have had months — for some as many as nine — to be inoculated, and it might seem those remaining people are unable to be swayed. Cutts notes the rate has definitely slowed, but every week there continues to be an uptick in local vaccination.

“They are few and far between, and sometimes we have to work pretty hard to go out, find them and ensure that they have convenient, quick, free access to the vaccine,” Cutts says. But anyone who can be reached is a win.

COVID, Cutts says, “will always be with us, similar to influenza, E. coli and other communicable diseases that we sometimes deal with and respond to as needed. But at (some) point, it’ll be occasional, not persistent, pervasive and overwhelming. Although we do not have a crystal ball, this will likely happen when a higher proportion of our population is fully vaccinated, and that will likely happen a few months after our younger ages of kiddos are eligible to be vaccinated.”

Silha stresses no shortcuts are being taken on vaccine approval for the 5-11 demographic, just as none were taken for the initial adult use authorization.

“This vaccine has been studied more than or as much as any other vaccine that has been developed. The time period was shorter because of the pandemic and the urgent need for this strategy to help get us past it. But but the amount of research isn’t less,” Silha says.

Vaccination of K-5 students will certainly help with youth case rates, but for now schools need to continue to enforce prevention. Local schools, Martine says, have been doing well with their mitigation strategies, and an analysis of local schools directly shows those who had full precautions in place had half the cases of those without masking and other rules.

While dropping or low school rates may seem like a reason to go back to normal, Silha cautions that easing restrictions will only drive cases back up.

“It’s working — let’s stick with it because COVID is still here,” Sillha says.

Testing remains imperative, especially with cold, flu and RSV seasons already here or impending.

Event attendance remains a concern for the health department, which notes while cases were once primarily traced to small gatherings, they are now largely attributed to public and large group exposures. Testing before and few days after attendance can help control spread.

Time for a mask mandate?

Mask requirements remain a hot button issue, and at present the health department has no immediate plans to reinstate a mandate. However, it is something consistently being reviewed. A number of factors figure in, with case rates one of them. But with testing numbers down, it is unknown how many infections are going unaccounted for. The health department also looks at hospital capacity.

“We want our hospital staff to be refreshed and healthy and work reasonable hours and feel like their job is manageable because it’s consistent and predictable,” Silha says. “And when (they are) constantly focusing on COVID, their routines are not what they should be. We want them to be able to do preventative care.”

There is difficulty in enforcing a mandate, especially when people can respond belligerently or even physically when asked to mask. School board meetings have become heated, and business owners have had to face angry confrontations with customers. The safety of staff could be at jeopardy — employees at the Public Library have had experiences of asking patrons who are visibly ill — coughing and sneezing — to put on a mask, and are in turn yelled at.

“I think every county in the state is trying to figure out where that balance is and what’s the right thing to do — is it better to have people have some choice and be allowed to make their own decisions? Does it put other people at risk too much? Every day we talk about is it time to change something? Do we need to be tighter? We’re trying to predict going forward what’s going to happen,” Martine says. “And that’s a hard thing to do.”

Notes Silha, “Unfortunately, this public health issue has been politicized and people are very entrenched in their thought process. … (There) may be a point at which, based on case rates and other data, that we our hands get tied and we have to take action.”

It is in the best interest of the community at large, the health department points out, to comply when individual establishments enforce masking. Infection spread leads to staff shortages, income loss and parents needing to take off work because their children are virtually learning or ill. Some persons may not be patronizing establishments for fear of exposure. And isolation can exacerbate mental health issues or substance abuse, leading to other health crises.

The health department too is in need of the public’s cooperation, so they can turn some of their focus to other important health initiatives. Public health, they note, is their mission, and while the pandemic has been immensely stressful they are in it until the end.

“We’re in this for the greater good of the community, and I can say that about everybody that I work with in the health department team,” Silha says. “It’s not about us. It is about what we can do to keep our communities safe. And I think that’s the passion that comes through.”