Oregon has identified more than 1600 COVID-19 cases among individuals tested; as of this writing there have been 58 deaths; full results are on the Oregon Health Authority (OHA) Coronavirus website. Data specific to Clackamas, Multnomah, Washington and Yamhill counties are available here.
The regional case number is approaching 1000, with about a quarter of confirmed cases requiring hospitalization. The number of mildly symptomatic and asymptomatic cases remains unknown as testing capacity has precluded systematic sampling of this population. The vast majority of lab-confirmed cases have cough, fatigue, and fever. Other symptoms found in Multnomah County cases are on the data dashboard.
Overall, case numbers continue to increase, but the most recent modeling suggests that hospital capacity will meet regional needs in the coming weeks if everyone continues to adhere to physical distancing recommendations.
The Oregon Department of Human Services (DHS) is maintaining a list of COVID-19 affected Long Term Care Facilities and Adult Foster Care Facilities as their residents are disproportionately affected.
Personal protective equipment (PPE)
Supply chains continue to be unreliable; most if not all health systems are using conservation strategies. County and State Emergency Operations Centers are tracking supplies closely. Oregon Health Authority has posted updated guidance on conservation and reuse strategies
OHA has posted updated infection control guidance that answers several questions about PPE use, criteria for stopping patient isolation precautions and return to work criteria for exposed health care workers.
OHA has COVID-19 Daily Updates including hospital bed and PPE status here.
See also CDC for the most current healthcare guidance.
Testing
Several commercial labs and most hospital systems are testing for SARS-CoV-2, with variable turnaround times. Testing at the Oregon State Public Health Lab (OSPHL) remains limited to priority individuals and situations. Updated guidance for submission of specimens to OSPHL was posted 4/4/20 on the OHA website.
As testing capacity increases and no longer needs to be restricted to hospitalized patients, please consider this prioritization scheme:
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Symptomatic individuals who live or work in high risk settings such as health care, skilled nursing facilities, assisted-living facilities, or correctional settings. Positive tests in these groups are high priority for public health follow up.
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Symptomatic individuals who are continuing to work as essential employees including but not limited to: utilities, food supply, transit, and deliveries. Positive tests in these groups can inform contact follow up to limit spread in these settings.
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Symptomatic individuals who identify as African-American, Black, Latinx, or Native American; early data shows these communities are at particularly high risk of infection and severe complications of COVID-19. Lab confirmed cases in this group should be candidates for close follow up and additional education about avoiding spread in their households.
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Public Health does not recommend testing asymptomatic individuals at this time in the setting of routine clinical care.
Indeterminate tests: There are a small but significant number of tests that result as indeterminate. These results should be treated as positives. Providers may retest at their discretion.
Types of tests
PCR: Increasingly available with a number of different platforms. Refer to guidance from your labs about types of samples accepted and sample collection and handling requirements.
POC testing: Abbott is producing rapid PCR SARS-CoV-2 testing, which is starting to become available.
Serology: Serologic tests to detect IgM, IgG, and both are becoming available for SARS-CoV-2 but at this time should be used cautiously and in-context. As of today, only one test has received a FDA Emergency Use Authorization. At the same time however, FDA has temporarily allowed many other manufacturers to market their serologic tests without FDA review. In most of Oregon, COVID 19 has been relatively uncommon making the ‘pretest probability’ low, leading to a high rate of false positive results. Such results may lead to a false sense of reassurance among recipients. In addition, it is not clear whether the presence of IgG indicates long term protection AND whether there is some cross reactivity with other coronaviruses.
There are several scams about home testing and other rapid testing; vet vendors carefully.
Isolation
For those who have positive PCR test results or for individuals who have symptoms that are awaiting tests or remaining home without a test:
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Advise to stay home until fever-free for at least 72 hours without the use of antipyretics, other symptoms have resolved, AND at least 7 days have passed since symptoms first appeared
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Even after symptoms have improved individuals must continue to follow Oregon’s Stay Home executive order which includes only going out for essential needs such as groceries and medical care, and returning to work as determined by your employer.
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Household members and other close contacts should also remain home as much as possible--while there are not separate quarantine requirements at this time beyond community wide physical distancing recommendations, these individuals are clearly at a higher risk of contracting the disease and should be strict about following guidance to stay home as much as feasible.
Public health reporting, follow up
Automatic reporting of lab results to local public health is inconsistent. Until there is a system solution, providers please batch report positive test results to the local health department during daytime hours. Highest priority are reports of positives among individuals who live or work in any high risk congregate settings. This can expedite a public health investigation and interventions.
Other resources
Weekly COVID-19 Informational Sessions for Oregon Health Care Providers (Tuesday info sessions for all health care providers, noon to 1 p.m. )
Project ECHO learning sessions for Oregon clinicians, noon to 1:15 p.m. Thursdays
Missed OHA webinar on Telehealth?
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For slides: http://bit.ly/telemedslides.
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For a video recording: https://youtu.be/h3A7IeTidso.
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For other documents and updates: http://bit.ly:/hsdcovid19
