November 20, 2020

Case investigators in Multnomah County have until recently conducted detailed interviews with every person diagnosed with COVID-19 they could reach. They also attempted to reach every close contact. But a precipitous surge in cases has forced Multnomah County Public Health to change its strategy over the coming weeks.

As cases of COVID-19 surge, public health struggles to reach everyone who tests positive. Nov. 19, 2020

“We did expect we would see growth in the fall. And here it is,” Communicable Disease Director Kim Toevs told the Board of Commissioners on Thursday in a regular briefing on Public Health’s response to the pandemic. “But the rapidity at which it has started to change is alarming.”

Last week in Multnomah County, case counts increased for the sixth consecutive week, while hospitalizations and the overall positivity rate increased to the second highest point since the beginning of the pandemic. That means, in the past week, case investigators received an average of 223 new cases per day.

On some days the Public Health Division was so overwhelmed with incoming lab results it wasn’t able to keep up with entering new case records, the records used by the Oregon Health Authority to publicly report daily case numbers. 

That means that some days the County’s case counts have been artificially low. Health officials have re-assigned some contact tracers to help move through the backlog, which will cause case numbers to appear artificially high on other days.

“We had been keeping up, but in the last two weeks we maxed out,” Toevs told the Board. “Cases increased very drastically, and we had to pivot really fast. I’m pretty proud of how fast the team was able to make some clear-headed decisions.”

That pivot was made easier because of Communicable Disease Services Manager Lisa Ferguson, who in February, well before the county saw its first case, began asking the team to anticipate a time when Public Health wouldn’t have capacity to do intense investigation and contact tracing for every single case.

Cases in Multnomah County increased for six consecutive weeks as state enters "Freeze."
In recent weeks the Public Health Division has diverted senior epidemiologists from individual case investigations to conduct more of the higher-level, data-driven analysis that’s needed to inform policy, so the government can better answer questions such as, “How do you know closing restaurants and bars is the right thing to do?” and “Where are the areas of greatest risk?”

Case investigators have begun prioritizing outbreaks, specifically in high-risk settings such as long-term care facilities and other congregate spaces. Investigations are no longer able to reach every person who tests positive for COVID-19 across the community, and contact tracers are no longer able to attempt to reach all close contacts. 

Case investigators developed a COVID-19 outbreak guide to offer employers at businesses with multiple cases, so they know what information to gather and send to Public Health. The toolkit includes employee sick leave information, protocols on employee testing, and details about when an employee can return to work.

And Public Health is asking the public, if you find out you have COVID-19, don’t wait to hear from a case investigator. Let your close contacts know, so they can quarantine, watch for symptoms and seek testing as needed. 

The County has produced an ”after testing” guide that spells out the steps to take after a test, while waiting for results, and then if you test positive. It includes information on isolation and quarantine, and when and how to tell close contacts and employers.

“We have hit our limit,” Toevs said. “Now we’re asking everyone to be a partner in the work with us.”