Sunday, March 10, 2019

What does a medical exemption from vaccination mean in the Olympia School District?

Measles can be prevented.

Medical exemptions for vaccinations in the Olympia School District and Washington State might not be what they appear to be.

On their face, these exemptions allow children who cannot be vaccinated (because of weakened immune systems, for example) to waive vaccination requirements and attend school. But, from what I've been able to gather from a public document request from the Olympia School District, the differences between personal-belief and medical exemptions is murky.

So murky that (please read to the bottom), I wonder if doctors or any medical professionals are necessary for the medical exemption process.

Let's work backward first to see how I got here:

About a month ago, while the measles outbreak in Clark County was still new news, I updated what the vaccination rate for schools in Olympia was like. This was similar to other times I'd done this update, there are some scary high exemption rates in Olympia schools. But this time I noticed a new wrinkle: the top schools for personal-belief vaccine exemptions were also the top schools for medical exemptions.

Top Medical (bold if on both):

1. Olympia Community School (12.9 percent)
2. ORLA Montessori (8.5 percent)
3. Olympia Regional Learning Academy (6.3 percent)
4. Lincoln Elementary (4.6 percent)
5. Pioneer Elementary (2.7 percent)

Top Personal (bold if on both):

1. Lincoln Elementary (19.4 percent)
2. Avanti High School (17.6 percent)
3. Olympia Community School (16.1 percent)
4. Olympia Regional Learning Academy  (15.8 percent)
5. ORLA Montessori  (15 percent)

To me, this made little sense. If you were a parent of a child who had a medical reason to avoid immunizations, then I think you'd want to then use the herd immunity at your child's school to help prevent infections. What I could see was that there was a correlation between parents who would seek a personal exemption from vaccines, ones that would seek a medical one, and the school they chose.

That made me assume that parents who are seeking medical exemptions are also not necessarily afraid to send their children into environments where a scarily low percentage of the children are vaccinated. This got me curious about the nature of medical exemptions in the Olympia School district overall.

So, I made a public records request for all medical exemption forms that represent active students in the Olympia School District. These are the documents I received and this is the spreadsheet I put together summarizing what I found (folder with both files here). The district blacked out student names and addresses before they gave me the documents, but they didn't black out the names of doctors that signed medical exemptions.

Here is what I sussed out:

1. Naturopaths are slightly more likely to sign medical exemptions. While 25 percent of the medical exemptions I received from the school district, naturopaths only make up 20 percent of the provider types (family, pediatric and naturopath) that I assume would likely be presented with the form. Some forms were also signed by physician assistants and nurse practitioners.

2. Some doctors sign more than others. Like schools that seem to collect medical exemptions, some doctors seem to sign more than their share. This may be a consequence of who they see (people that are more willing to ask for a medical exemption), but I will probably never find that out. While a vast majority of the doctors who signed the forms only signed one, there were a few that signed several:

Jennifer Ash ND, 7
Lisa Barer MD, 6 
Amy Belko MD, 4
Bridget Sipher MD, 4
Kevy Wijaya MD, 4
Richard Faiola NP, 4

3. What does a medical exemption even mean? Over 75 percent of the forms had both the "medical" box and "personal" exemption marked on the form. This seems to undercut the meaning of the medical exemption form altogether. What may seem like an inexplicable bunching of both medical and personal belief exemptions (why would an immune deficient child attend a school full of unnecessarily unvaccinated children?) isn't. What it really could be is just a larger group of children whose parents declined vaccination for personal beliefs but got their doctor to sign a medical waiver.

Then there was this:


You might have already perused the documents the school district gave me, but if you haven't, this is (as far as I can tell) a full-on medical exemption form with no details, exempt the student's name and a parent's signature. No medical professional's name, no medical professional's signature. This isn't even a double-marked personal/medical exemption. This is a pure medical exemption that is on file at the Olympia School District, that purported to clear a student to have not been vaccinated for medical reasons, with no medical professional's name on it. 

If a parent can sign a medical exemption form and it be accepted by the school district, what is the point of even requiring them at all?

Wednesday, March 06, 2019

Where Olympia has lost population

When you think about population change in a growing region, you think of it as a constant. And, even though Olympia has been lagging behind Lacey in growth rate for the past few decades, Olympia is still on a gradual population climb.

But, that population growth has not been consistently spread across the city. In fact, there are numerous neighborhoods that have actually lost a significant amount population in recent years.

To explore this phenomenon, I built a map in a tool called Policy Map. The variable I used was the rate of change in the five years between 2013 and 2017, according to the American Community Survey. These are interesting years because it was a time when the incoming population of our area outpaced new housing. So, at least in theory, our available housing became more crowded, not less.

A small caveat about this data. It is based on survey results collected by the Census Bureau. Being survey results it is less accurate than actual decadal census data. That said, all of these neighborhoods have seen measured losses of over 13 percent, which would probably outstrip any margin of error.

The first neighborhood in Olympia that lost a significant amount of population (again, more than 13.46 percent) was this one up in far northeast Olympia.


This Lilly to Southbay Road neighborhood is the outlier in the type of neighborhood that has lost population though. The much more typical neighborhood (in dark brown below) is an older, inner residential neighborhood.


Here's the map key:

I've written about these neighborhoods before and in my mind, these are the neighborhoods that beginning in the late 1970s started seeing the impacts of growth cascading out of downtown. They experienced an influx of what we now call "missing middle" housing, multiplexes and small apartment buildings. But, instead of welcoming the growth and naturally more dense neighborhoods, these neighborhoods downzoned and pushed additional growth towards the edges of town. This new growth, in turn, paved over farms and forests.


But, why now are these neighborhoods that up until a few months ago were protected habitat for single-family homes losing population? Obviously, the neighborhoods weren't becoming denser. I'm having a hard time finding data on the change in household size in the same year, but it stands to reason that stable households would have children age out eventually. If the parents stayed put, then theoretically, the population would decline. 

Sunday, February 03, 2019

Your semi-regular update on what schools have low vaccination rates around Olympia

Usually, about when there is something in the news about an outbreak around here, I'll go to the state Department of Health and find out what the vaccination rates are at our local schools (and here). This time around, there is a measles outbreak just about an hour south of us, so I thought it would be nice to narrow in specifically on exemptions (personal, religious or health) for the measles, mumps, rubella vaccination.

According to the most recent data, there are a handful of schools in the Olympia area with fairly high exemption rates for the MMR vaccine.

SchoolPercent exempt for measles, mumps, rubellaPercent with any personal and religious exemptions (not just MMR)Percent with medical exemption (not just MMR)
OLY REGIONAL LEARNING ACADEMY16.2%22.1%6.3%
ORLA MONTESSORI15.5%23.5%8.5%
OLYMPIA COMMUNITY SCHOOL12.9%29.0%12.9%
LINCOLN ELEMENTARY12.7%24.0%4.6%
GRAVITY12.5%12.5%0.0%
AVANTI HIGH SCHOOL12.0%19.0%1.4%
Paramount Christian Academy9.1%9.1%0.0%
TUMWATER WEST9.1%9.1%0.0%
NOVA SCHOOL8.6%10.5%1.0%
PIONEER ELEMENTARY5.9%10.6%2.7%
BLACK LAKE ELEMENTARY5.7%7.7%1.7%
REEVES MIDDLE SCHOOL5.1%13.6%2.0%
MICHAEL T SIMMONS ELEMENTARY5.0%6.7%1.4%
THURGOOD MARSHALL MIDDLE SCHOO4.9%8.2%1.8%
BOSTON HARBOR ELEMENTARY4.7%8.3%2.4%
ROOSEVELT ELEMENTARY4.6%7.2%1.7%
GARFIELD ELEMENTARY4.6%9.9%2.2%
EVERGREEN CHRISTIAN SCHOOL4.4%7.8%0.0%
TUMWATER HIGH SCHOOL4.1%6.5%0.8%
NEW MARKET HIGH SCHOOL4.0%4.0%0.0%
EAST OLYMPIA ELEMENTARY3.9%5.5%0.4%
MARGARET MCKENNY ELEMENTARY3.9%4.2%0.0%
OLYMPIA HIGH SCHOOL3.9%9.6%0.3%
JEFFERSON MIDDLE SCHOOL3.9%6.6%0.9%
CENTENNIAL ELEMENTARY3.7%5.4%1.1%
BLACK HILLS HIGH SCHOOL3.7%6.4%1.5%
CAPITAL HIGH SCHOOL3.7%7.0%0.6%
PETER G SCHMIDT ELEM3.7%4.5%1.0%
GEORGE WASHINGTON BUSH MS3.5%6.7%0.6%
LITTLEROCK ELEMENTARY3.1%4.5%1.4%
SOUTH BAY ELEMENTARY3.1%4.1%1.0%
TUMWATER MIDDLE SCHOOL3.1%5.0%1.0%
TUMWATER HILL ELEMENTARY3.1%4.2%0.5%
WASHINGTON MIDDLE SCHOOL2.8%6.3%1.0%
LACEY ELEMENTARY2.8%3.6%0.8%
OLYMPIA CHRISTIAN SCHOOL2.6%10.5%0.0%
LYDIA HAWK ELEMENTARY2.5%3.1%0.2%
MEADOWS ELEMENTARY2.4%2.8%1.0%
SOUTH SOUND HIGH SCHOOL2.4%3.0%0.0%
SECONDARY OPTIONS2.4%3.9%0.8%
OLYMPIC VIEW ELEMENTARY2.3%2.5%0.9%
NORTH THURSTON HS2.3%5.8%1.4%
NORTHWEST CHRISTIAN HIGH SCHOOL2.3%2.3%0.8%
CORNERSTONE CHRISTIAN SCHOOL2.2%2.2%0.0%
JULIA BUTLER HANSEN ELEMENTARY2.2%2.2%1.1%
MADISON ELEMENTARY2.1%5.4%0.0%
GOSPEL OUTREACH2.0%2.0%0.0%
HORIZONS ELEMENTARY SCHOOL1.9%2.6%0.9%
L P BROWN ELEMENTARY1.8%2.4%0.3%
COMMUNITY CHRISTIAN ACADEMY1.8%3.0%0.0%
ST. MICHAEL SCHOOL1.7%3.5%0.9%
KOMACHIN MIDDLE SCHOOL1.7%3.5%0.9%
TIMBERLINE HIGH SCHOOL1.7%3.4%0.4%
CHAMBERS PRAIRIE ELEMENTARY1.7%3.3%0.7%
NISQUALLY MIDDLE SCHOOL1.5%2.7%0.7%
WOODLAND ELEMENTARY1.4%2.2%0.3%
RIVER RIDGE HIGH SCHOOL1.4%3.2%0.5%
SALISH MIDDLE SCHOOL1.3%2.3%0.7%
ASPIRE MIDDLE SCHOOL1.2%4.9%0.0%
EVERGREEN FOREST ELEMENTARY1.2%2.8%1.2%
HOLY FAMILY SCHOOL1.2%1.2%1.2%
POPE JOHN PAUL II HIGH SCHOOL1.1%1.1%0.0%
MCLANE ELEMENTARY1.0%2.3%1.3%
CHINOOK MIDDLE SCHOOL0.9%4.0%0.9%
MOUNTAIN VIEW ELEMENTARY0.8%2.0%0.5%
PLEASANT GLADE ELEMENTARY0.7%1.7%0.7%
SEVEN OAKS ELEMENTARY0.7%2.0%0.2%
NEW MARKET SKILLS CENTER0.3%0.3%0.0%
TOUCHSTONE SCHOOL0.0%0.0%0.0%
CAPITAL MONTESSORI SCHOOL0.0%0.0%0.0%


Here is the most recent data from the state and the spreadsheet I used.

What leaves me scratching my head about this data is that when you parse out the medical and personal exemptions, they seem to follow the same general pattern. Schools with high personal/religious exemptions also have high medical exemption rates. 

When I first started looking at this stuff, I assumed medical exemptions would be evenly dispersed across the area. It follows that since all of the schools that have high exemption rates are schools you either generally lottery into or opt into, that the personal/religious exemptions would gather there.  In the same way that opting into certain schools is an expression of a family's choice, so is opting out of vaccination. But the medical reasons for not being vaccinated, I don't think, would be more general and would not necessarily be tied to a family's school choices.

If you're new to this issue or just need some background, here is some information you might find useful:

Here is an explanation on how those exemptions work.

You've heard about herd immunity, or how the vaccination rate in a group of people that protects people who can't receive a vaccine. This is why a 16 percent exemption rate at ORLA or a 12 percent exemption rate at Lincoln are sort of scary.

According to the CDC, an immunization rate of 94 percent is necessary to prevent pertussis from persisting in a community. That is above the 88 percent that the exemption rate at Lincoln would indicate is that school's immunization rate.

 

Monday, December 10, 2018

The Timberland Library Capital Facility Proposal was a reflection of our current reality

Timberland counties have changed a lot since the 1960s. Thurston County used to be about the same size as the other four counties. Now, all four combined are smaller than Thurston County.
So far, the dominant narrative about the now shelved Timberland Library capital facility proposal has been about the possible closures and consolidations of rural libraries. Hardly anywhere in the coverage is a good understanding of the balance of where Timberland's revenues come from and how that money is spent. It has been just calmly accepted that closing any rural library is a sin, notwithstanding gaps in service in other parts of the five county district.

Here's a link to the draft proposal. It generally calls for consolidation of rural libraries buildings and the roll out of different types of library models (like Open+) that could have expanded hours.

During my tenure (between 2010 and 2016) on the Timberland board, we had to twice explain to east Lewis County communities that despite them voting to annex into the district that we would not automatically open libraries in their cities. Toledo and Morton both annexed, and because of the nature of the district (TRL doesn't build libraries inside cities) and the budget (pretty thin), there was no way we'd vote to open new buildings.

The capital facilities proposal would have helped the board take a look at the hard issues of where to spend money, but unfortunately, the board of trustees put it back on the shelf in favor of what will probably be across he board budget cuts.

The capital facilities plan itself wasn't a step back from serving rural communities, but a recognition of how the demographics of the district have changed and how library services have changed. It was also an acknowledgment that for decades the district has served some rural areas at the detriment of others.

I saw this process fold out slow motion when we were discussing the future of library services in Amanda Park. We had the option to close or drastically scale back services there because of some facilities issues with the library building. Stepping back from Amanda Park would have allowed the district to provide some service to the North Coast (Taholah down to outside Ocean Shores), which has always been part of Timberland but has never been directly served. But at almost the last minute, Grays Harbor County came through with funding to save the Amanda Park library and services there, and dooming any expansion into the North Coast.

So, there's that, the choosing of one rural community over the other. Additionally, there is also the seemingly forced ignorance of leaders and activists in rural communities of how the library is even funded.

Take this passage from Brian Mittge in the Centralia Chronicle:
Timberland’s professional library administrators in their Tumwater headquarters should spend a lot more time out in their rural communities. They had planned an elaborate set of listening sessions. Maybe instead of that, they should also spend some time in the Randle mill a half mile from their library. Or go in the woods with some of those namesake loggers whose revenue still pays for a big chunk of Timberland’s operations.
Timber funds pay for less than 10 percent of Timberland's budget and have been a shrinking part of the revenue stream for years. They are also extremely volatile, meaning the library cannot count on them from year to year. Property taxes, on the other hand, are stable and are making up a larger and larger portion of the district budget.

I want to pause and make sure this point is heard, because this has been missing from the coverage of the library facility debate so far: Thurston County, where more than half of the people in the district live and who pay for more than half of the budget, only receives 41 percent of the expenditures from the district. 

In fact, next year, Thurston County residents will spend $1.4 million outside of their own county on library services in Pacific, Grays Harbor and Lewis County.

From the Capital Facilities Proposal:


And, this isn't just because Thurston County has the largest population, the most stable economy and valuable property. It also gets to the nature of the communities in Thurston County. It is simply just cheaper to provide library services in urban areas.

This is an interesting set of stats from the proposal:

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Daily Cost per borrowerCost per circ
Grays Harbor $38.97$9.72
Lewis $31.72$8.11
Mason $35.10$9.47
Pacific $35.50$9.08
Thurston $22.89$5.92

It costs almost half per borrower and per circulated item to provide library services in Thurston County than it does in Grays Harbor County. And it cost significantly less than in any other county. This is because on average the libraries are larger and more popular, meaning economies of scale can be created making it less expensive per head to deliver services. People also live closer together, meaning no matter where you live in Olympia, Tumwater and most of Lacey, the trip to the library isn't too far.

I understand we're part of big library district. I understand that services in rural areas are harder and more expensive to deliver. But, I also want folks advocating for their branches in incorporated areas of rural counties to recognize that if my county were not part of an inter-county rural library district, we would have $1.4 million more to spend on library services. Pointing out to us that the library district was founded to provide services in the rural areas does not change the fact that if we left, we could maintain more than four Hoquiam-sized libraries in Thurston County.

Timberland Regional Library has a hard choice to make in the next year if we wan to stay afloat. We can cut services across all libraries and make them less valuable across the board. We can close and consolidate library services. We can also raise taxes.

But before we make those decisions, everyone needs to take a clear look at how this whole thing is put together.