Together we are the local public health leadership that represents the Portland-Vancouver metro area and just under half of the population of Oregon. We all share the goal of slowing the spread of COVID-19 to lessen the impact on our communities and in particular our health care systems. We also acknowledge that these are uncertain times that feel scary. Actions that seemed unthinkable just a few weeks ago - like extended school closures - are now viewed as essential to our shared efforts to address this new virus.
We weighed in recently on the question of whether our elected officials should consider a “shelter-in-place” order similar to that in the San Francisco Bay Area. To be clear, we fully support the spirit of such an order and strongly encourage everyone to avoid all types of gatherings of more than 20 people, and smaller is better. We support physical distancing and policies that support limiting interactions in workplaces and businesses. That said, we are obligated to carefully consider the effect of such a policy on our population including the downsides. There are unintended consequences to a local or statewide shelter in place order that can disproportionately affect marginalized populations in rural and urban parts of our state
The definition and enforcement of “essential” outings is difficult at best, and risks squandering precious time and energy that is better spent supporting the efforts to prepare our health systems and provide essential needs to the individuals and families that are already grappling with the sweeping measures to limit gatherings and close schools and businesses. The lives of those who are facing immediate loss of income related to these measures matter too, and the negative impacts to them could be long-lasting.
We must also acknowledge the behavioral health effects of such an order, given the reality that we will likely be in the throes of this pandemic for the next several weeks if not months.
Furthermore, the idea of insisting people remain indoors as the weather improves goes against what we know about the physical and behavioral health benefits of being outside, especially in times of stress; the risk of transmission outdoors is likely minimal if people follow the 3 foot rule. In regular times, we know that social isolation in the home is a particular concern for rural communities, immigrants, refugees, and communities of color. We do not want to risk people feeling trapped indoors or afraid to fill their essential needs.
As offers of help roll in for a range of needs including boosting the supplies of protective equipment, to child care for essential workers, we believe for now that we are better off as a community if we tap into this generosity and creativity rather than risk spiraling into suspicion, isolation and enforcement. Our role as government is to help organize and support collective solutions during this difficult time.
The spread of this virus has, in just a few weeks, shined a spotlight on social realities that have developed over years, including income inequality, food insecurity, racial health injustices, disparities in education, patchy access to healthcare and homelessness. Despite ongoing efforts among our leadership and communities, there are no quick fixes to these issues.
We may continue to promote physical distancing through policies that further discourage or limit close physical interactions. We are mobilizing campaigns that encourage physical distancing, hygiene measures and steps to limit spread of infection in households.
As the situation changes along with our collective response to it, here are things everyone can do to stay safe and well:
Get outside for walks or bike rides in small groups. Limit the number of individuals you and your children routinely interact with. Everyone should be well and be able to wash or sanitize their hands regularly.
Reach out to elderly or vulnerable neighbors by phone or with a note. Let them know they are not alone. Offer to drop off food or pick up their prescriptions.
Use video technology to stay in touch with loved ones and come together in groups.
For directions on how to volunteer or donate, visit Multnomah County Novel Coronavirus COVID-19 site: https://multco.us/novel-coronavirus-covid-19
Christina I. Baumann, MD, MPH
Health Officer, Washington County
Tricia Mortell, RD, MPH
Public Health Division Manager, Washington County
Alan Melnick, MD, MPH, CPH
Director/Health Officer, Clark County (WA)
Sarah D. Present MD, MPH
Health Officer, Clackamas County
Health Housing and Human Services Director, Clackamas County
Joe Skariah, DO, MPH
Health Officer, Columbia County
Jennifer Vines, MD, MPH
Health Officer, Multnomah County
Rachael Banks, MPA
Public Health Director, Multnomah County