Multnomah County began working with an additional lab this week in hopes of speeding up turnaround times for COVID-19 test results. The shift comes as both total cases and testing turnaround times have increased, health officials told the Board of Commissioners during a briefing Thursday on disease trends and the County’s public health response.
Thursday’s briefing touched on testing capacity and supplies, rates of disease transmission and hospitalizations, and Public Health’s efforts to prepare local schools for the possibility the state will allow in-person classes this fall.
Global demand for testing chemicals, reagents, components and devices has restricted widespread access to tests and stretched turnaround times so long that results are useless to slow the spread of the virus, Communicable Disease Director Kim Toevs said.
“Right now, for our own clinical services, we have had a really long lag time where it's taking 11 to 14 days for test results,” Toevs said. “At that point we can’t take action on that information. Basically they are out of their quarantine and probably have already transmitted it to other people, if they were going to, by the time we get those test results.”
A two-week lag hobbles a contact tracer’s ability to identify an infected person’s close contacts and stop the spread. That’s why the County sought out a second company, Molecular Testing Labs in Vancouver, Wash., to process their tests. As of Thursday, July 23, Toevs estimated, turnaround times for tests at Public Health’s low-barrier drive-through site in east County will drop to about 24 hours.
Commissioner Susheela Jayapal balked at the seeming lack of a unified national plan for widespread testing.
“Is it likely to be this hopscotch that we have to do in order to get testing quickly?” she asked. “That it just depends on who we contract with? And if they aren’t able to deliver, we have to look around? There must be a better way to even out resources. Some way to make this more organized and more systemic.”
“I guess what you’re asking for is a national policy that’s cohesive around promoting industry and hospital systems and health departments to support testing, in a way that hasn’t happened at any time during the whole duration of the pandemic, to speak frankly,” Toevs responded.
The federal government at one point did invest in local and state testing programs. But it closed those down after states — who’d watched as federal cuts whittled down their health departments over the years — struggled to immediately staff them.
“A lot of the reasons the states and the local health departments didn’t have capacity to stand up their own testing is that honestly, public health funding at the federal and state level has been gutted over the years,” she said. “So the public health system was not the most robust when we started this pandemic.”
But that’s not all, Toevs went on, calling out the fractured system of private care in the United States — in contrast with government-centered systems in other countries where COVID-19 rates have sharply declined.
“Here it’s very piecemeal, so there is less the government can do to support that,” Toevs said. “But we also have federal leadership that is not promoting a cohesive, aggressive approach to testing.”
“Absolutely,” Jayapal said. “Sorry to make you describe what’s become obvious.”
As the County seeks to shore up access to timelier testing, Public Health officials continue to track key metrics on disease spread.
That’s based on an equation known as a disease’s reproductive or “R” number — for every one person infected, how many people does the person spread it to?
If one person passes COVID-19, on average, to one other person or more, then naturally the disease will increase, Toev explained. If that average number drops below one, then the disease will decrease. If people develop immunity to the virus, that reproductive number will drop. But the number will also drop if people take precautions such as wearing face coverings, and regularly washing their hands and using hand sanitizer.
But the reproductive number isn’t dropping, she said.
“What we have seen with the R number for our actual spread of disease, since mid-May, is for every one person infected, they infect 1.5,” she said. “Some extrapolations suggest, right now, that disease in our population, the part of the iceberg underwater, is probably the highest it's ever been.”
After weeks of increasing hospitalizations, last week's number dipped slightly. That came despite a sharp increase in cases — 33 percent last week over the prior week — and a doubling of total weekly case counts in just the past three weeks.
Latinx and Pacific Islander residents continue to be disproportionately impacted, and numbers are rising among children and young adults. Meanwhile small outbreaks in worksites, congregate care settings and, now, childcare centers have increased.
There are seven day care centers with reported COVID-19 outbreaks — with an outbreak as two or more cases. Toevs cautioned commissioners to keep that number in perspective in a County with hundreds of childcare centers. There have still been no reported outbreaks at homeless shelters or among inmates at county jails.
Public Health and in-class education
As health officials work to control the spread of COVID-19, parents, schools and officials are planning for what the fall might bring, including how and whether to safely return kids to their classrooms.
Oregon has required each school to develop an “Operational Blueprint for Reentry,” in partnership with their district and with review by their local public health authority, as part of the state’s Ready Schools, Safe Learners plan.
The Multnomah Education Service District led the work, with support from Multnomah County, to develop a communicable disease response plan that will serve as a template for schools.
Multnomah County’s Public Health Division, which acts at the county’s Local Public Health Authority, has so far received a trickle of plans ahead of an Aug. 15 deadline, said Jessica Guernsey, the division’s deputy director. That’s when each of the County’s 245 schools, both public and private, will need to submit their proposals for a review of communicable disease and outbreak protocols.
Per the state’s direction, the County must review components such as physical distancing plans, protocols for personal protective equipment, cleaning and cohorting, and movement and attendance logs in case of an outbreak. Schools also must detail plans for providing services such as meals.
Guernsey said these questions must be resolved at some point, whether school buildings welcome back students this fall or later in the school year.
“These are central to schools’ reopening plans, regardless of when it happens,” Guernsey said. “I want to emphasize that.”
Public Health, with support from the county’s Emergency Operations Center, established a review panel that includes youths alongside staff from school-based health centers, SUN schools, adolescent health teams, the Environmental Health Division.
The formal review is following months of frequent but informal communications with schools and school districts.
“We are constantly providing support to districts and some private schools, and we get technical questions all the time,” she said. “There are a lot of unanswered questions from the state.”
Commissioner Sharon Meieran said she opposes reopening schools in the fall and said she anticipates Gov. Kate Brown will come to the same conclusion. She said the state should have directed schools and counties to spend time planning for distance learning, rather than a return to class.
“We are in no position to open our schools for in-person learning in the fall,” she said. “And to be spending time trying to sort through that and operationalize a complex, difficult, challenging system, when the reality is we shouldn’t be doing it.”
No matter what education looks like come fall, it’s going to be a school year unlike any other, said Kim Melton, Chair Deborah Kafoury’s chief of staff. She said families, regardless of the format, will need more and different support services come September.
Melton detailed some ways the County — through SUN schools, school-based health centers, and its Behavioral Health and Public Health divisions — are working with social services providers, schools and families to ensure access to food services and rent assistance, health services and education. That includes crafting new supports meant to fit the times and bringing in the voices of youths, who can advocate directly for what they need and want.
Commissioner Jessica Vega Pederson agreed with Meieran that it’s frustrating to be a parent in limbo.
“It is really hard when I think, as a parent with two school-age children, that there are so many unknowns,” she said.
The data suggest teens and children are contracting the virus more quickly than other age groups, even if they are less likely to become seriously ill. And the overall increase in cases doesn’t suggest things will improve by fall.
“Even if we try to open schools, we’ll end up online only,” she said. “I’m just afraid mid-August is going to be too late.”
Chair Kafoury assured commissioners that elected officials, Public Health officials and school districts from across the area are pushing the state to issue prompt guidance.
“We’re working very closely to influence the state. Our team, at many, many levels, is working closely to try and get clear direction, and I’m actually anticipating that next week the state is going to release some further guidance and criteria,” she said. “I don’t think anybody would say ‘this is the way it should be’ or ‘the best way to get things done.’ But it is what it is.
“One thing is certain, is that everything will change. By next week we'll be having a different conversation.”