April 8, 2020

Multnomah County’s Board of Commissioners Tuesday continued their practice of holding meetings virtually to comply with Gov. Kate Brown’s orders to stay at home to the maximum extent possible in order to slow the spread of COVID-19. Members of the public are able to join the board briefing as observers online or by calling in.

Kim Toevs, director of Communicable Disease and Sexually Transmitted Disease Programs, is joined by Public Health Director Rachael Banks, Lead Health Officer Dr. Jennifer Vines updates during a January 2020 board meeting.
Tuesday’s briefing marked the start of Public Health Week, focusing on the Health Department’s ongoing response to the COVID-19 outbreak as a way to highlight public health’s role in community health and safety.

“How we move into a modernized public health system is so crucial,” Chair Deborah Kafoury said. “I appreciate the work [Public Health is] doing, the work you continue to do and the work we will do together.”

The commissioners heard from Public Health Division leaders, including Division Director Rachael Banks, Community Partnerships & Capacity Building Manager Pei-ru Wang, Ph.D., and Communicable Disease Services Director Kim Toevs and Health Officer Dr. Jennifer Vines.

Public Health before, during and after COVID-19

Multnomah County Public Health Director Rachael Banks set the tone for the briefing by describing the disease tracking work that Public Health does every day. In general, the role of Public Health is to create healthier conditions for a community’s residents by decreasing people’s vulnerability to disease and death. 

The work centers around core competencies: communications; epidemiology; equity; policy, systems, environmental conditions; and stakeholders. These are the tools Public Health uses to create healthy and resilient communities, Banks said.

The community’s health becomes particularly important during a public health emergency like COVID-19.

“We know existing conditions can exacerbate COVID-19. And we can see the healthier the community is, the better chance we have of fighting a novel virus like COVID-19,” Banks said.

During a crisis like COVID-19, Public Health leans on those skills to limit the spread and mitigate harm of the disease and the cure. Banks provided examples of how these tools have been deployed in Public Health’s COVID-19 response:

  • Communication: Regular and timely press conferences, press releases and comprehensive guidance gives the community access to the most specific information they need to stay safe and healthy.

  • Epidemiology: Public Health workers track the disease to understand how it affects the community. They use data to strategically intervene and protect as many community members as possible. 

  • Health equity: Public Health is intentional about identifying areas of bias in the broader healthcare system’s response, understanding that the stressful conditions of a pandemic can cause systems to revert back to utilizing biases in decision making.

  • Policy, systems and environmental change: Public Health helps people modify behaviors to stay as safe as possible through the use of policies, procedures and changes to physical environments.

Public Health also continues to support the community’s safety and well-being in other ways. 

Thousands of food establishments in Multnomah County have looked to the Environmental Health department for help transitioning to a takeout-only model. Public Health also has partnered with the Department of County Human Services and the Department of Community Justice to reduce the risk of domestic violence during a time of increased stress and home isolation.

A group picture of the Multnomah County Public Health Advisory Board and staff, taken July 2019.
And Multnomah County’s Public Health Advisory Board — which also serves as Public Health’s ethics committee — has engaged in difficult conversations about crisis care amidst limited resources, making sure to conduct that discussion through the lens of racial equity.

The COVID-19 crisis will pass, and when it does Public Health will continue its work to mitigating leading causes of death and address social determinants of health.

“We know where we live in a general sense impacts our life expectancy by as much as 15 years, that our income impacts as much as 10 years and education plus-or-minus nine years,” Banks said. “This pandemic has magnified the way these things come together.”

And so Public Health will return to that mission: becoming a modernized public health system that protects against communicable disease, lifts up chronic disease prevention, promotes environmental health and ensures equitable access to health services.

“There’s a renewed interest in public health and the public health system, as people can see a really concrete example through this pandemic,” Banks said. “We know we have a part to play in helping to rebuild society.”

Updates on COVID-19 cases and medical responses

Lead Regional Health Officer Dr. Jennifer Vines and Joint Incident Commander Kim Toevs provided the Board of Commissioners Tuesday with an update on COVID-19 cases in the region and the health system’s response. While Oregon has certainly struggled with its outbreak, “we are one order of magnitude behind the State of Washington,” said Dr. Vines.

Currently, according to Dr. Vines, one out of every four positive cases of COVID-19 are hospitalized. What’s telling about that data, she said, is that though the healthcare system is appropriately focused on older adults who are at higher risk, the state is seeing hospitalizations of younger people, too. She pointed the commissioners to the hospitalization data found on the County’s new COVID-19 dashboard, developed and maintained by the county’s Communicable Disease Services team.

Public Health is encouraging and prioritizing testing of hospitalized patients because that “gives some of the most specific information on who has the virus, how severe it is, how to plan around hospital capacity and needs,” Vines said. As the bottleneck of COVID-19 testing starts to loosen — the metro area currently has the capacity for approximately 1,000 tests a day, split among the County, the State, and individual health systems — Public Health is in conversation with healthcare systems about how to use test results strategically to anticipate the next phase of the pandemic through more accurate disease spread modeling, and to contain the spread through more robust case identification and contact tracing.

Based on the modeling data Public Health has now, officials believe the region’s cases will peak in late April or early May.

“There’s plenty of information out there that suggests that we have successfully slowed the transmission of this virus and that hospital capacity will match the need,” Dr. Vines said. But models can be wrong, she said. So the healthcare system must continue to prepare to receive a surge in hospitalizations.

For that reason, Dr. Vines talks daily with chief medical officers of the region’s major healthcare systems to ensure hospitals are ready to respond. Together, the County and the healthcare systems have developed a coordinated response. This includes determining how many patients each facility can take and identifying triggers that would necessitate further coordination. Each hospital, Vines said, has done contingency and surge planning for their emergency, inpatient and intensive levels of care.

“These systems, who are competitors on a given day, are very much collaborators in this time of community need,” Vines said. “Our health systems are coming together to the extent they can within their regional or national frameworks to work together. I feel really good about that.”

As health officials continue to learn more about the virus and media tout potential developments around treatments, Dr. Vines says that Public Health’s guidance remains the same: stay at home except for essential needs.

Forging community partnerships

Dr. Pei-ru Wang, the manager of the Public Health division’s Partnerships and Capacity Unit, informed the Board of Commissioners about the broad work her team has been doing with community organizations, particularly those serving communities of color, in response to COVID-19. 

“Community partnerships is one of the key public health foundational capabilities,” Dr. Wang said.

Their work began in January, before Multnomah County had its first COVID-19 case. The Partnerships and Capacity team called numerous community leaders to open up conversations about the virus and its anticipated impacts. In turn, the leaders spoke about their communities’ concerns and fears, and even shared early instances of COVID-19 discrimination. The early dialogue also led to discussions about strategies that the County and its partners could use to tackle these anticipated challenges.

In early February, the Community Partnerships unit, working in tandem with colleagues from the City of Portland, started planning COVID-19 trainings for community health workers, who are often on the front lines of educating community members about health issues. A total of 118 participants attended the trainings, 75 percent of whom were from communities of color.

Dr. Wang shared that the success of their work with engaging and supporting community organizations is built on years of building trust with communities of color, which have historically distrusted the government due to the collective traumas of racism and discrimination. Her team’s approach, she said, is grounded in not just pushing out information, but rather demonstrating partnership by listening to and walking alongside communities of color. 

A community resource guide created in partnership with the Future Generations Collaborative — a group of Native indigenous peoples, community organizations, educational institutions and government agencies — serves as a prime example of partnership in the midst of the pandemic. The guide was created in response to the Native community’s request for accessible and culturally relevant information about COVID-19. Contributions from members of the collaborative have grown it into a comprehensive guide that includes resources about substance use disorder recovery and harm reduction support, instructions for enrolling in food assistance, connections to healthcare and behavioral health, technology inclusion, Native Power Hour and much more. 

The breadth of resources also served as a template for Multnomah County’s own community resource page on its COVID-19 website.