March 18, 2021

Cases of COVID-19 bumped up slightly last week after a long and steady decline in Multnomah County, Public Health Director Jessica Guernsey told Commissioners during a routine briefing on the pandemic and county response. 

The percent of tests that returned a positive result also increased slightly, from 1.5 to 2 percent, but other key metrics—the number of hospitalizations and outbreaks—continue to drop. 

COVID-19 disease curve, through March 7, 2021

“We have been happy to see a steady decline in our numbers. This week it appears we have a bit of a plateau in our downward trend,” Guernsey said. “We need to see where this goes.”

The shift comes after the state downgraded Multnomah County’s risk level, which dropped from “Extreme” to “High” on Feb. 12 and from “High” to “Moderate” a month later, on March 12. 

Public Health experts are watching those disease trends closely, Guernsey said, even as they scale up vaccination efforts and support school districts that are preparing to return kids to class.

Planning for school reopening

On March 12, Oregon Governor Kate Brown ordered schools to reopen to in-person learning by the end of the month. The timeline prompted some school districts to quicken the pace of planning, training and union negotiations. But most school districts already had one thing in place: a relationship with public health.

Multnomah County’s Public Health Division has met regularly with districts, schools and the Multnomah Education Service District since the pandemic began, Deputy Health Officer Dr. Ann Loeffler told the Board Thursday. 

“We have met every Monday with health systems from school districts over the course of the pandemic. Shared data, acted as a resource, reviewed blueprint plans,” she said. “Now we’re making more granular plans about how schools will react when the inevitable cases occur in schools.”

Communicable Disease Services has long-standing partnerships with the Multnomah Education Service District, school districts, and staff. They work together on vaccination education and events, and anytime there are cases of communicable diseases, such as measles, in a school. Under the governor’s Ready Schools, Safe Learning guidance, each school submits an operational blueprint to Communicable Disease Services for review and feedback. 

But Public health experts don’t expect cases in schools to contribute to community spread, Loeffler said Thursday. That’s because transmission between children in schools has been low—lowest among younger kids and increasing by middle and high school. And the risk in class is lower than the risk during extracurricular and social activities.

But risk is directly correlated to how closely a school adheres to public health recommendations on campus and how well families adhere to public health recommendations at home. It’s many of the same recommendations:

  • Mask up around others

  • Wash hands regularly and well

  • Keep at least six feet of distance from others

  • Limit social gatherings, especially indoors

  • Don’t expand your social circle too quickly to widely

“Risk of in-classroom exposure is very low when mitigation measures are in place. But play dates, carpooling, other events, that’s where there will be transmission and we will bring it into schools,” Loeffler said Thursday. “We anticipate there will be cases. We anticipate bumps in the road. We have a small and mighty dedicated team to help them, and a much broader communicable disease team to help as cases are identified, people need to be interviewed and accommodations made.”

When a case is identified in a school, that school and the County’s Communicable Disease Services team work together to identify people who might have been exposed and mitigate the risk of spread. For now, Multnomah County Public Health is recommending a “cohort” model for classes, transportation and extracurricular activities and sports. A cohort is a distinct group that stays together to reduce interaction between groups.

If a case is identified, the entire cohort is considered exposed and asked to quarantine for at least 10 days. That quarantine could be longer if the exposure was in a setting with more risk because of close interactions or fewer masks. That protocol will be reevaluated in the fall of 2021.

Health experts say COVID-19 will pose some risk during any in-person interaction for a long time, and the region may see cases go back up as variant strains spread and public health guidance relaxes. But because evidence nationally and internationally suggests community spread is not driven by spread in schools, Public Health would evaluate data to determine whether schools were contributing to that trend before recommending schools revert to remote learning.

Vaccination planning

By mid-March, about 100,000 County residents had been fully vaccinated and another 70,000 had received one dose. An analysis of vaccination data shows nearly half of all older adults in the County are already protected.

“We have a ways to go, but we’re starting to see some good numbers in coverage,” Public Health Director Guernsey told the Board Thursday.

The state has provided about 50,000 doses of the vaccine to Multnomah County. Most of that has gone to support clinics and programs that can administer the vaccine to vulnerable residents. Public Health has directly administered about 11,000 doses, primarily to County employees, incarcerated people, home-bound adults, communities of color, and immigrant and refugee communities.

Oregon Health Authority data shows nearly half of older adults in Multnomah County have received a COVID-19 vaccine.

The pace of vaccine allocation is soon to speed up if federal officials deliver on a promise to provide enough vaccine to states to make all adults eligible by May 1. Guernsey said she received confirmation from the State on Wednesday that it would also shift eligibility to match the federal government’s May 1 timeline.

“We are still learning the details about what that means for rollout and we continue to plan our efforts around racial and ethic disparities in terms of disease and access issues,” she said. “Regardless of what happens by May 1, we are planning for how to reach people in low-income housing, in agricultural industries and food prep, working actively to roll out vaccination for the unhoused.”

Local health agencies will not stand up mass vaccination clinics for the general public; that role will remain the same: to fill gaps in access and focus on residents at highest risk of contracting the virus and of dying from it. 

The County has focused on reaching adult care homes left out of the federal pharmacy program, eligible seniors experiencing homelessness, and eligible people from communities of color experiencing the highest rates of disease, serious illness and death.

But mobile and pop-up events are challenging to organize, coordinate and promote. They will continue to be necessary in some cases, but Public Health is preparing to transition the bulk of its vaccination efforts to four permanent and predictable sites in Northeast Portland, Mid-County, the Rockwood neighborhood and East Multnomah County. 

“We are hoping to see a significant increase in supply and allocation by the end of the month. Anything can change, but we are told we’ll see an increase in supply,” Guernsey said. “We have been engaged in multi-system surge planning with our regional county health department partners and hospitals and healthcare systems, looking out 30, 60, 90 days out.”