Commissioner Jayapal's Newsletter: May 12, 2020

May 12, 2020
Latest News And Resources On COVID-19

Dear friends and neighbors,

Last week I saw the Governor’s announcements of the next stages of planning and action on re-opening. There has been lots of media coverage, and you may be saturated and have all the information you need on this; but the emails I’m receiving indicate continued confusion and concern, so I’ll do my best to summarize my understanding of those announcements.  I’ll also touch on Multnomah County’s planning for reopening, CARES act funding for public health work, and some data recently released by the Oregon Health Authority (OHA).

Statewide Reopenings and Changes in Guidance

On May 7, Governor Brown announced Reopening Oregon, her plan for restarting public life and business.  This included the statewide lifting of certain restrictions, some new statewide guidances, and a phased process for county-by-county reopening of other businesses and facilities. Taken together, here’s how I understand all of this:

  • As of May 1, medical and dental clinics were permitted to offer non-emergency procedures, at 50% of their capacity, and subject to having sufficient PPE on hand.

  • As of May 5, outdoor recreation areas where physical distancing could be maintained were allowed to open. Individual jurisdictions and parks departments are making their own decisions regarding whether and when they will reopen. Some state parks have opened, but the Columbia Gorge and coastal areas remain closed at this time.

  • Statewide restrictions on stand-alone furniture stores, art galleries, jewelry shops and boutiques will be lifted on May 15. These stores will need to meet OSHA guidelines related to COVID health and safety, found here

  • Statewide restrictions on childcare facilities, summer school, camps and youth programs will be lifted on May 15. Reopening is contingent on meeting guidelines and restrictions that are being developed.

  • New statewide requirement that employees in businesses where physical distancing cannot be maintained must wear a face-covering. These include grocery stores, pharmacies, public transit, salons/personal services, and ridesharing services. In addition, it’s strongly recommended that these businesses establish a mandatory face-covering policy for customers.

  • Strong recommendation that face-coverings be worn in any indoor public space, especially where six feet of distance cannot be maintained. 

The plan continues guidance to limit visits to nursing homes and hospitals; stay home if you’re sick; limit nonessential travel; keep up hygiene and sanitation; and telework if possible. And it also states that “vulnerable populations must still stay at home”. 

County Reopenings

The next phase (referred to as Phase 1 in the Governor’s framework) of reopening will happen on a county-by-county basis. I believe this makes sense: a small, isolated rural county with few cases is in a very different situation than, say, Multnomah County. 

Phase 1 will reopen restaurants and bars; personal care services (salons, barber shops, massage, etc); gyms and fitness facilities; and, tentatively, local gatherings of up to 25 people.

Counties must apply to reopen by showing certain prerequisites have been met. Counties are grouped into health regions; some of the prerequisites must be met region-wide, and others county-wide. The prerequisites are:

  • Declining COVID-19 prevalence (county)

  • Adequate contact tracing system (county)

  • Sufficient isolation facilities for people who test positive and cannot quarantine at home (county)

  • Minimum testing capacity (region)

  • Adequate healthcare capacity (ie beds) (region)

  • Adequate PPE supply (region)

Counties were permitted to submit applications beginning May 8, and 28 counties currently have applications under review. If approved, these counties could move into Phase 1 on May 15. If you’d like to see what the applications consist of, they are all available here. Multnomah County is part of Region 1, which also includes Washington, Clackamas, Clatsop, Tillamook, and Columbia counties. (Note that all counties in a region do not need to move in lockstep; but the three metro area counties have agreed that it would be ideal to move together, since people work and live fluidly across our county lines.)

Multnomah County Reopening Plans

In addition to being the most populated and densest county in the state, Multnomah County has the highest prevalence of positive COVID cases, with 27% of the statewide total (compared to just under 19% of the state’s population). We have not submitted an application to reopen, and I don’t have a timeline for when we will.

Multnomah County’s reopening decision will be guided not only by the prerequisites laid out in the Governor’s framework, but also by our own values and goals. These values include balancing the desire to allow people to return to work so they can support themselves and their families with the need to minimize the risk to frontline workers and to protect those at highest risk of severe illness, especially communities of color.

In the past week, I have received dozens of emails and phone calls from dental hygienists, salon workers, and others whose work does not allow physical distancing, expressing their alarm about having to go back to work. Refusing to return would mean forfeiting their unemployment insurance or other benefits. These are the rock and the hard place between which many of our lowest paid workers will be wedged. And many of these workers are also those who are most vulnerable to complications from the disease -- people over 65, those with underlying health conditions, and those whose household members are particularly vulnerable.

In addition to the prerequisites set forth in the Governor’s plan, we need to ensure that our most at-risk communities have true access to information, to testing, and to the economic and policy supports that allow them to prioritize their health (and thereby safeguard the community’s health). (Note that access to testing is distinct from testing capacity: we could have sufficient capacity, and still not be testing those most at risk of complications.)

Our Public Health Department is developing a dashboard to track and show how we are progressing toward the Governor’s criteria and our own. As an example, here is Governor Inslee’s dashboard for Washington’s progress toward its criteria. We expect the dashboard to be made public within the next week or so.

CARES Act Funding For County Public Health Work

A word (or more) about the costs of our COVID-related public health work. As you may know, the CARES Act provided funding to states and localities for COVID-related work. This funding was allocated in two ways: cities and counties with more than 500,000 in population received direct allocations from the federal government; and states received additional monies to allocate statewide. In all, Oregon received a total of $1.6 billion.

Multnomah County, the City of Portland, and Washington County are the three Oregon jurisdictions with populations over 500,000. Based on their populations, Washington County received $105 million in direct funding, and the City of Portland received $114 million. But because Portland is within Multnomah County, Multnomah County received only $28 million, theoretically to use for the part of the County outside Portland. And because Multnomah County received a direct allocation, the state has indicated that it does not plan to provide us any additional funding.

Multnomah County’s Public Health Department, however, remains responsible for all public health work for the entire County, including Portland. With very preliminary estimates of the costs for this work as between $60 and $80 million, this puts us in a very difficult position. (And this is without even discussing the revenue hole created by COVID -- the CARES act does not reimburse for lost revenue.)

This outcome is inconsistent with reality of the public health role played by Multnomah County -- a public health role that’s critical to a successful reopening. 

OHA Zip Code Data

The Oregon Health Authority recently released data that shows the number of positive cases by zip code. While I appreciate all efforts to continue to build our understanding of the pandemic through data collection, this particular data should have been presented with more narrative and analysis. 

In particular, it should be made clear that this is not useful for individual decision-making about where to walk, shop, eat, etc. A home address does not tell us where someone got infected. Nor does it indicate that being in that zip code increases risk of infection to others. 

This data may provide useful information about patterns of disease prevalence that allow us to shape our public health interventions. For example, it may confirm that neighborhoods with greater concentrations of people of color also have higher concentrations of people testing positive. Health and economic disparities rooted in racism mean that, among other things, they are more likely to be in public-facing jobs that expose them to risk, and are more likely to have underlying health conditions that lead to more severe symptoms. Knowing this allows us to focus resources and policy on reducing those risks. 

Without the appropriate context, however, data like this can be more harmful than helpful, reinforcing stereotypes and creating fear without improving outcomes.

Budget: Week 1

With last week’s release of Chair Kafoury’s Executive Budget, we have begun our budget deliberation process. I’ll provide an overview in my next newsletter. For now, you can review the proposed budget and upcoming worksessions here, and FY 2021 Departmental Countywide Budget Presentations will be posted here.

Other highlights

And finally -- primary election day is next week! This Thursday, May 14 is the last day for you to mail in your ballot, and May 19 is the deadline for submitting your ballot. Here are Multnomah County ballot drop off sites.  Please vote! Our health depends upon it.

 

And as always, stay safe.

With gratitude,

Susheela

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