March 31, 2020

Multnomah County’s Board of Commissioners on Tuesday, March 31, held its first virtual public meeting since the state ordered everyone to take drastic measures to physically distance themselves from others to slow the spread of COVID-19.

Mary Li, who normally leas efforts at the Multnomah Idea Lab, takes a leading role at the emergency operation center

Commissioners heard from department leaders about rapidly shifting services for seniors and people experiencing homelessness, how disease investigations are ramping up, how public health is stepping up with community guidance, and about the sweeping coordination harnessing much of that work within the County’s emergency operations center.

“In just a few weeks these leaders have helped stand up a response unlike anything that we’ve seen in our lifetime,” Chair Deborah Kafoury said from her temporary office in the Health Department, two floors below the emergency operations center. “Today we’re going to get a window into part of that work.”

Tuesday’s presenters included Director of Emergency Management Chris Voss, Public Health Director Rachael Banks, Joint Office of Homeless Services Director Marc Jolin, Aging, Disability & Veterans’ Services Director Lee Girard and Department of County Management interim director Travis Graves. 

Public Health 

As of March 29 a team of seven nurses and epidemiologists at Multnomah County Communicable Disease Services had responded to 661 phone calls about COVID-19 from residents, employers and doctors.

By that time 3,204 County residents had been tested for COVID-19, and the County team had followed up with the 97 residents who tested positive. They are also reaching out to 241 people who had close contact with those 97 people. 

a team of seven nurses and epidemiologists at Multnomah County Communicable Disease Services follow up with every person diagnosed with COVID-19

And this week Communicable Disease Services launched an interactive dashboard of COVID-19 cases across four counties, detailing everything from common symptoms to hospitalizations 

“This is what a modernized public health system does: disease tracking and preparing for epidemics,” said Public Health Director Rachael Banks. “That’s the work we do, the bread-and-butter work.”

The team has now added three staff from within the Health Department and is hiring more than a dozen on-call nurses and public health graduate students so they can continue disease tracking if cases surge.

The Public Health Division has crafted dozens of sets of guidance for slowing the spread of COVID-19, including guidance for long-term care facilities, schools, first responders, healthcare providers, shelters, people camping without shelter and the general public. Public Health  has called on its Public Health Advisory Board to help shape its most sensitive recommendations. 

“Our advisory board used the equity and empowerment lens to grapple with some really hard issues that are part of this pandemic: physical distancing and the role cohesion plays in our community,” Banks said. “Most recently they grappled with the application of scarce medical resources should we face a shortage, and how those decisions need to get made.”

Homeless Services

Throughout the pandemic, Chair Kafoury has made limiting COVID’s spread her top priority.

And her office — directing both the Joint Office of Homeless Services and the County’s emergency operations team — has demonstrated that commitment with a particular focus on the thousands of vulnerable neighbors experiencing homelessness in Multnomah County.

Some of that work involves basic education and outreach. 

Twice a week, the Joint Office hosts calls where advocates and service providers, whether funded by the Joint Office or not, can share updates and connect directly with experts in Public Health and other departments for guidance and news. The office is also curating a list of programming changes and other information for providers across the community at ahomeforeveryone.net.

And the Joint Office, working with more than a dozen community providers, spent a week bringing safety and survival supplies — along with a laminated information card about COVID, including when to seek medical care — to people camping all across the County. Those teams engaged with more than 2,500 people.

“Our outreach providers are still out there,” said Jolin, the Joint Office’s director, “and we continue to invest in supplies for outreach workers who are out and trying to care for folks.” 

But providing safer shelter environments, with enough space to limit the spread of COVID, has made up most of the County’s homelessness response to date.

Chair Deborah Kafoury temporarily moved her office into the Health Department Headquarters to respond to COVID-19.

Starting March 20, the Joint Office has worked with other local governments and nonprofits to open three shelter sites in unused public buildings. 

The Oregon Convention Center, owned by Metro, has 120 beds. And two community centers owned by the City of Portland, Charles Jordan and East Portland, have 120 and 75 beds, respectively. Those sites don’t provide new shelter capacity; instead, they give shelter operators across the system room to comply with physical-distancing guidance meant to limit the spread of COVID.

Also in that span, the County on March 26 announced an agreement for the use of all 81 rooms at the Jupiter Hotel, offering a place for isolation and care for people in shelter who develop respiratory symptoms.

Before that, the Joint Office kept its winter shelter beds open instead of closing them in the spring. And the office, working with Public Health and the County’s emergency team, is still working to add additional spaces as needed. One of those upcoming sites will offer recuperative care for people experiencing homelessness who test positive for COVID-19 but do not require hospitalization.

All of that work is urgent, because without space for physical distancing, shelter providers have had to limit or even pause intakes. As intakes resume, beds will still be accessed through  reservations only, just like before. Walk-ins or drop-offs can’t be accommodated.

“Once we’ve achieved physical distancing, we will open the system again to folks who are able to be in a congregate setting,” Jolin said. “We expect to see new people coming in, whether referred from the hospital or the streets, in a way we’ve not seen over the past couple of weeks as we’ve taken on this effort.”

Travis Graves, interim director at the Department of County Management, told the Board that some 240 County employees have stepped up to help staff those shelters, ensuring they can run 24 hours a day and provide services that include meals, laundry and behavioral health care.

Each shelter needs 25 to 50 employees, Graves said, with a special emergency human resources team working to fill those spots.

Employees have come from all across the County, Graves said, with a significant share from the Multnomah County Library. Graves said the County is also working with temp agencies and directly hiring temporary employees through a major recruiting push (see multco.us/shelterjobs to learn more). So far, 55 temporary employees are on board.

“The hope is to get to stable staffing, so that however long this lasts, we can keep those shelters going 24/7,” Graves said. “Every day, we’re learning how to do this better. Every day, we’re creating better connections. This isn't’ something we’ve done before.”

Commissioners asked how much the combined outreach and shelter work was expected to cost. Jolin said the total was roughly $3.5 million a month.

Normally, the Joint Office would contract with shelter operators, who rely on fundraising, donations and volunteers to help defray the cost of needed services like food and laundry. During a pandemic, when donations are down and volunteers aren’t able to come to shelter, that’s not possible.

“This is definitely a lift for us financially,” Jolin said. 

And, he added, nonprofits around the community are also struggling. The Joint Office is working to help them, too, with contract support and other assistance.

“To all of the nonprofit partners who have continued to show up and serve,” Jolin said, “I cannot thank you enough.”

Staff, donations and protective gear

The county’s Emergency Operations Center went online in February to coordinate the public health and emergency management response to COVID-19. Today it operates out of the eighth floor of the Health Department Headquarters.

“This is not something we see every day,” Voss, director of Multnomah County Emergency Management, said of the COVID-19 emergency. “Sixty-two days ago I got a call from the state about repatriating people from China. At that time, we increased our activation level, and two people were working on that. Yesterday I looked at the organizational chart, and there were 128 boxes, some with multiple people.”

State employees deliver personal protective equipment for distribution to regional hospitals.

One of those boxes represents a team of 35 liaisons who act as a bridge to community  stakeholders such as schools, childcare, faith settings, aging residents, healthcare providers, and people living with HIV. Liaisons host conference calls and webinar sessions attended by as many as  200 people. 

By late March the emergency operations call center had fielded 1,300 calls. 

To reach residents who speak a language other than English, the emergency operations center  has had materials translated into 24 languages and worked with the City of Portland to create audio files with guidance in 20 languages. And the emergency center maintains a database and listserv with representatives from more than 80 culturally specific organizations.

The emergency center is also working to coordinate reserves of personal protective equipment to distribute to regional hospitals, long-term care facilities and social service providers as it prepares for a potential surge in sick residents who need hospital care that could begin as early as next week.

Multnomah County last week received more than 250,000 gloves, nearly 100,000 N95 respirator masks, 5,000 procedural masks, and nearly 1,000 gowns from the state of Oregon’s emergency stockpile. 

The materials were delivered March 26 and March 27, and all but a fraction are being distributed to hospitals across Clackamas, Clatsop, Columbia, Multnomah, Tillamook and Washington counties.

The delivery exhausts the state’s reserve of personal protective equipment, which included 465,940 N95 masks, 53,850 surgical masks, 11,928 face shields, 55,899 surgical gowns and 695,000 gloves.

The lack of personal protective equipment has driven concern nationwide and from Oregon’s congressional delegation. On March 12, U.S. Sens. Ron Wyden and Jeff Merkley joined with U.S. Reps. Earl Blumenauer, Peter DeFazio and Suzanne Bonamici in a letter to Vice President Mike Pence asking the administration to fulfill a demand by Gov. Kate Brown for COVID-19 aid, including surgical masks, respirators, ventilators and more.

This week the state is anticipating its first shipments from the federal stockpile, including 134,159 N95 masks, 319,100 surgical masks, 64,642 face shields, 52,949 surgical gowns, 1,904 coveralls, 281,324 gloves, and 140 ventilators.

The supplies are separate from thousands of donated materials that have come in through Multnomah County and City of Portland’s Joint Volunteer Information Center.

As of March 31, residents and businesses had donated nearly 355,000 gloves, 29,000 respirator masks, and hundreds of thousands of other first aid and cleaning supplies, which the joint center is rapidly distributing to healthcare and social service providers across the County.

Among the guidance to residents, public health asked families to avoid playgrounds with high-touch surfaces.

Even those donations won’t be enough to protect healthcare workers if a surge of cases hits the region, health experts say. 

“Supply of protective equipment is a top priority,” said Dr. Jennifer Vines, “we are tracking the state’s efforts to assure we have what we need in the coming weeks.”

Social services

The Department of County Human Services has shifted the way it delivers service to seniors, people with disabilities and others, Aging, Disability & Veterans’ Services Director Girard said during Tuesday’s briefing.

Teleworking has allowed the department’s essential employees — everyone from domestic violence advocates to case managers for individuals with developmental disabilities — to continue delivering vital services.

“We're really focusing on making sure that people have access to their public benefits such as SNAP and Medicaid healthcare benefits,” Girard said. “We're also focused on making sure that older adults, people with disabilities, and folks with intellectual and developmental disabilities receive the long-term services and supports they need.”

While the majority of the department’s work is being done remotely, Girard said, some services are still offered in person. Two of the five Aging, Disability & Veterans’ Services offices remain open during normal business hours, with physical distancing guidelines strictly enforced to protect staff and the public.

During the outbreak, Girard said, demand for services has gone up. All of the County’s congregate meal providers have either moved to home-delivered or to-go meal services. A surge in demand resulted in 10,000 home-delivery meals the first week of March, and 15,000 are expected this week — that’s more meals that the program delivers in an average month.

Programs are now discussing how to supplement shortages of personal protective equipment for long-term care workers, maintaining capacity at facilities with confirmed COVID-19 cases, and ensuring vulnerable residents get timely delivery of meals and medications.

“We're very fortunate because there have been a number of important regulatory changes that have happened at both the state and the federal level,” Girard said. “We're focusing on people who are vulnerable, culturally specific communities, and people who are newly isolated.”

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