May 22, 2020

Multnomah County continues to make progress toward meeting the State of Oregon’s prerequisites, as well as the County’s own additional thresholds, that must be met before easing restrictions put in place to slow the spread of COVID-19, Public Health leaders informed Portland City Council in a special briefing on Thursday, May 21.

County Public Health Director Rachael Banks kicked off the presentation with an overview of the role the County's Public Health division plays as the local public health authority. In general, the role of Public Health is to create healthier conditions for the community — including environmental, economic and social contexts — by decreasing people’s vulnerability to death. 

Focusing largely on the top causes of death, Banks said, gives Public Health the best chance to intervene and save the most years and quality of life. Communities with existing health disparities are at more risk for serious illness and death from COVID-19.

Before a select group of sectors in Multnomah County, including restaurants and bars, gyms and personal services, can reopen under Phase One, Multnomah County must submit an application that demonstrates that it has met a set of statewide metrics, as well as unique requirements specific to a “health region” that also includes Clackamas, Washington, Clatsop, Tillamook and Columbia counties. 

Screen shot of PPE requests by type of organization
A slide from the presentation showing a breakdown of personal protective equipment requests from the County by type of organization.
Multnomah County Emergency Manager Chris Voss informed the city commissioners that the County has already met the state’s regional requirements for personal protective equipment, as well as its threshold for the County to have enough PPE for first responders. However, Multnomah County has yet to have a sufficient amount of PPE to distribute to key community constituents like community-based health and social service agencies. If these organizations are unable to secure enough PPE for their operations through the regular supply chain and have less than a week’s worth of supply, the County should be able to fill the gap, Voss said. The County is working toward meeting this threshold.

Banks picked up the presentation, sharing that the County has met the majority of the other prerequisites, including:

  • a percentage of emergency room visits for COVID-19-like illnesses that are lower than the average seasonal rate for flu visits

  • a decline in COVID-19 hospital admissions

  • sufficient isolation facilities, and

  • enough capacity for the regional healthcare system to accommodate a 20 percent increase in hospitalizations. 

Multnomah County has also met its self-set requirement for a demonstrated reduction in impact of the virus’s spread in communities of color.

“It would have been possible with [Multnomah County’s] demographics to have a 14-day decline in hospital admissions overall, but see an increase for Black, Indigenous and other people of color,” Banks said. “We reported yesterday that we met that threshold.”

The County has met one of the two testing capacity metrics. While the region is able to administer testing at a rate of 30 per 10,000 per week, work remains to ensure sufficient testing sites accessible to underserved communities. Safety net and community health clinics have run into shortages of PPE and testing supplies, while some labs were lacking the chemicals needed to run the tests.

Over the last three weeks, safety net and community health clinics have coordinated with hospitals to increase the equity of testing access, said Communicable Disease Services Director Kim Toevs. However, Public Health continues to work with healthcare partners across the region to offer better access to people who don’t have a regular healthcare home, don’t have health coverage, or are wary of the mainstream healthcare system.

A slide from the presentation showing of the three components of Multnomah County's contact tracing system.
Public Health is working on meeting the three prerequisites around contact tracing: being prepared to trace 95 percent of all cases within 24 hours, expanding the disease detection team, and hiring and building a contact tracing team that’s reflective of the county and ready to work in appropriate languages.

According to Banks, the County is currently prepared to trace approximately 80 percent of all cases within 24 hours.

Based on the ratio of contact tracers to residents set by the state, Multnomah County needs to hire approximately 120 contact tracers; there are 45 currently on staff and more are being hired. The County’s contract tracing system actually entails various roles, including community-based health workers (people who work as health navigators, family advocates or case managers), case investigators and epidemiologists, Toevs said. But building a team that is prepared to meet the needs of Multnomah County’s diverse population by finding the right combination of knowledge, skills, language abilities and cultural competence requires methodical and strategic hiring.

“We don’t need to get to that full-staffed steady state in order to check the box. I think where we’re at is we’re getting there with the numbers and we’ve got strong technical skills. We’re working fast right now to develop enough of the language capacity and the culturally specific folks that we need to feel like we’ve got that right mix of all of those skills,” said Toevs. “We just don’t want to be heavy in one skill set and not enough of the other right now. We’re getting close but were not quite there yet.”

Public Health’s work around contact tracing goes beyond filling the required number of positions, Banks said. Working with community-based organizations to ensure robust wraparound services that can support individuals, families and households who are exposed to the virus or become sick and must be quarantined for 14 days is a key part of case investigation.

Expanding the contact tracing system to meet both the state’s requirements and the scope of work Public Health anticipates for the next year is projected to cost $25 million to $35 million, Banks informed the council. The total includes personnel, wraparound isolation support, contracting with community-based organizations, testing, services and supplies.

A weekly report of Multnomah County’s progress toward meeting Phase One prerequisites is available here.