Measured by the ultimate marker of pandemic success — the death rate — San Juan County, population 17,850, ranks as the second-best county on the West Coast, and among the top dozen in the nation.
The San Juans also had the lowest hospitalization rate in the state, by far, even though it’s one of the older counties demographically (35% of its people are 65 or older).
“For the first two years, we had the lowest case rate in the United States,” says San Juan’s health director, Dr. Frank James. “You’re the first person in the media who has called to ask us how we did it.”
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So how’d the San Juans do it? For starters, they are islands, which James says gave them a built-in virus management advantage. It’s also a relatively homogeneous population.
But the story of what happened there isn’t just geographic luck. The county with the highest death rate in Washington state, Ferry County, has less than half the people of the San Juans, and is more remote. The reality is the novel virus eventually infiltrated every corner of every state. (Example: the North Slope Borough, up on the Arctic Ocean in Alaska, reports a COVID death rate more than 10 times higher than the San Juans).
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Long story shortened: The San Juans imposed the first mask mandate in the state, and possibly the first one in the nation. When the sheriff told James he couldn’t enforce it due to lack of manpower, James turned to the businesses to impose it instead.
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Ironically the San Juans are one of the least vaccinated places for childhood diseases. Against COVID it became the most vaccinated county in Washington, at 83%, and more than 95% for its seniors.
Bottom line: By the time of the San Juans’ first death, in January 2022, the state had already suffered 11,000 deaths, the nation more than 875,000.
The virus crashed through eventually. Suddenly this spring towns that had mostly evaded it were reporting the highest case rates in the state. By then most everyone had been vaccinated and boosted, “so it didn’t end up causing the severe disease that was experienced by almost every other community in the U.S.,” James says.
The islands’ grand total of two deaths, one in January and one in March of this year, were among unvaccinated residents, the health department says.
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The counties with the highest death rates bring up the rear in getting vaccinated. Ferry County is still only 43% vaccinated. Its neighbor Stevens County remains the least vaxxed place in the state, at 36%, despite 158 deaths and a rate nearly 30 times that of the San Juans.
The tragedy is that most of the deaths in these counties happened after vaccination became widely available.

Anecdotal. But worth looking into.
Something not mentioned is the COVID variants hitting in the later stages of the pandemic were probably less deadly. If they were able to nearly eliminate entry of the first, and perhaps most deadly, variant(s) to the island then that may have contributed to lower death rates.
Also not mentioned and necessary for a full analysis is the vaccine injury/death rates.