July 2, 2020

Six months into the global COVID-19 pandemic, 10 million people have tested positive and more than 500,000 have died. Oregon’s numbers remain relatively small, but the pace of disease spread is quickening, with moderate estimates projecting the state could log as many as 900 cases a day by the end of July. 

And in Multnomah County, cases are also rising, and hospitalizations are also trending up.

Health Officer Dr. Jennifer Vines recommends demonstrators take precautions.

“This is a reminder that COVID-19 can work like compound interest if we are not careful,” Health Officer Dr. Jennifer Vines told the Board of Commissions on Thursday during a briefing on the disease response. “We are in this position where, once we see bad things are happening, it could be too late to put in preventative measures.”

Whereas once most people who had close contacts with a sick individual were primarily those living with that person, case investigators are increasingly tracking contacts who were exposed at social events and workplaces.

As residents look ahead to a warm and dry July 4 holiday, Vines worried that a weekend full of social events could cause those rising numbers to spike.

She said it’s best to remain close to home and avoid expanding your social network. But if people do choose to mingle, she said, “keep things local, outside, and stick to your household and closest social contacts.” 

Vines said people should wear face coverings whenever they’re near others or whenever they’re in public indoor spaces. Some studies have found as much as an 85 percent reduction in virus transmission in areas where people uniformly wear face coverings and maintain physical distance.

Gov. Kate Brown this week expanded her regional face covering mandate so it applies statewide and warned businesses that Oregon Occupational Safety and Health and other state agencies would enforce the requirement.

As public health agencies track the rise in cases along with continued constraints on testing supplies, health officials also warn there’s little chance of Multnomah County applying to enter the next phase of reopening any time soon. Instead, a surge could lead governments across Oregon to reintroduce restrictions on business and social life. 

“In the absence of any coordination at the federal level, at the state, and locally, we have risen to respond to the complexity of this pandemic. Nothing here has been linear,” Vines said. “I want to temper expectations that we are on a forward march.”

Immigrant and refugee partnerships

The rise in cases and hospitalizations has hit Black, Indigenous and People of Color communities hardest, with significant clusters in particular refugee groups.

During a briefing with media earlier in the week, Communicable Disease Director Toevs provided more detail on higher rates of COVID-19 among communities of color. In addition to disparities in Latinx communities, a disproportionate number of residents who immigrated from Africa, South Asia and the Pacific Islands are contracting the virus.

The County has worked through a network of community liaisons, leaders and advisory boards to craft its emergency response centering the needs of people of color.

Manu Malo Ala’ilima sits on the Multnomah County Health Department’s Pacific Islander Coalition advisory board. The group worked with the County to hold two testing drives through community nonprofits last month. The first, on June 20, tested 217 people. The second, held June 27, tested 284.

It’s been hard to look at the Oregon Health Authority’s weekly case summary and see the astronomical rates of infection in their communities, Ala’ilima told reporters Tuesday.

It’s taken intense effort to reach out to people, make sure they know how to get tested and then have the services necessary to isolate people when requested. Multnomah County is now funding two community health workers, through a number of nonprofit organizations including Utopia PDX, to help with that culturally specific support.

“We have such a drive within our community to do these things, to the point that we’re helping people in other counties,” Ala’ilima said. “It’s great to partner with Multnomah County.... There are moments where there are certain gaps, and Multnomah County was able to help us through some of the unfamiliar territory to provide the services we want within our community.”

Djimet Dogo, associate director of Immigrant and Refugee Community Organization and director of IRCO’s Africa House, is helping coordinate outreach and testing for refugee families, many of whom have been in the United States only for a few years. They’re focusing on residents from Africa and Southeast Asia, refugee communities where COVID-19 has spread most widely.

Refugee communities can face particularly acute challenges during COVID-19: Many aren’t able to read educational material provided in English or even in their native languages. Families double up in households, leaving little space to keep distance if someone falls ill. People also arrive in the country with underlying health conditions that make COVID-19 more dangerous.

“It adds more pressure on community-based organizations like ours that are trying to figure out how to help,” Dogo said Tuesday.

IRCO is recording public health messages as audio files and sharing those with refugee families through the phone application Whatsapp. They’re magnifying health messages through refugee-owned businesses and faith groups. They deliver supplies of protective gear to families. And they’re coordinating with Multnomah County on testing events for residents in hard-hit communities and apartment complexes. 

“In doing this outreach, partnering with Multnomah County will help a lot by providing adequate testing,” Dogo said. “I want to thank Multnomah County for coming to our help.”

Testing capacity remains strained

Multnomah County’s primary care clinics, like other primary care providers and health systems, continue to provide COVID-19 tests to symptomatic patients. Some testing sites also serve asymptomatic residents who have been in contact with a sick person.

But Public Health Director Rachael Banks warned that continued limits on testing capacity, in the face of rising demand for testing, is slowing case investigations. Those constraints continue to force agencies to make choices about when and how to test asymptomatic residents. 

Labs across the United States are struggling to stock enough supplies to meet demand. In Multnomah County, Quest Diagnostics asked the Public Health Division to help identify high-priority cases that need a rapid turnaround for results, while sending lower-priority specimens to a backup lab outside Oregon and delaying the response time on those tests for days.

For now, little evidence suggests testing asymptomatic people in the general public yields even modest positive rates. Rather, the studies that have shown high positive rates among asymptomatic people were all conducted among close contacts of known cases within an outbreak. That circumstance significantly increases the likelihood of a positive test.

For example, among clients of color who were symptomatic when they were tested at a County clinic, about a quarter were found to be positive. But after three testing events that Multnomah County stood up for culturally specific community groups — testing all comers, whether they had symptoms or not — less than 1 percent tested positive.

Banks said the County’s “highest yield” of positive results has come when testing is “focused, and we’re testing symptomatic people and contacts.”

Multnomah County continues to offer low-barrier drive-through testing at Multnomah County East’s County Health Center. Those tests are available for immigrant and refugee residents, people of color, and others who are symptomatic or have been exposed to a known case, and who don’t have a health provider or insurance. For a limited time, the site is also seeing people who recently attended a demonstration and who don't otherwise have access to healthcare. Testing is free.

Commissioners Sharon Meieran and Susheela Jayapal said they wanted testing available for any person of color, regardless of whether they show symptoms or have been in contact with an ill person.

“In an ideal world, there would be lots of testing, if we weren’t concerned about supply shortages,” Banks said. “But throughout this pandemic, it's become, ‘How do you prioritize, given the limitations?’”

Cover up and keep it local

If you gather with people outside your household this holiday weekend, stay outdoors, wear a face covering and keep your distance
Thursday, as the holiday weekend approached, Public Health Officer Dr. Vines urged people to recommit to the core guidelines that kept COVID-19 from taking off in Oregon in the first place: Don’t introduce new people into your circle, wear face coverings when you’re near people outside your closest circle, and wash your hands well.

Any travel, and social mixing, will increase the risk of spreading COVID-19. Staying home is still the safest option to limit exposure. 

For those who do choose to gather with people outside your household, follow these tips for a safer gathering:

  • Keep it small — the fewer people the better

  • Keep it the same — hang out with the same people

  • Keep it outdoors — this is a safer option than being inside

  • Maintain a distance of at least 6 feet from others

  • Wear face coverings

  • Wash your hands or use hand sanitizer frequently

“This is not the future. We can change this,” Vines said of rising cases in Oregon and Multnomah County. But, she said, “the only tools we have are face coverings, hand washing and physical distancing. Those are the tools we have to get through the next few months.”