March 17, 2020

The top regional health officer for the Portland metro counties Dr. Jennifer Vines on Monday night issued updated guidance to clinicians in the region, warning of an imminent shortage of protective gear and asking clinics and hospitals to prepare for a potential surge at area hospitals.

Regional lead health officer Dr. Jennifer Vines asked clinicians to prepare for the worst of COVID-19

The guidance comes after researchers issued forecasts of how bad the outbreak could get without serious and swift intervention, and as state officials work to secure a federal resupply of protective equipment including masks, gloves and gowns.

State and local officials have issued increasingly strict guidance to minimize crowds, including limiting the size of gatherings to no more than 25, closing schools, sending home nonessential government employees and closing public buildings. 

Vines, meanwhile, is supporting preparation of the health systems for the surge in demand that has overwhelmed other states and countries..

In Monday night’s guidance, Vines asked providers to: 

  • Increase telephone and virtual health visits for all patients who don't need an in-person, hands-on visit. 

  • Cancel nonessential medical or dental programs that require any personal protective equipment (PPE) such as gloves, masks and gowns.

Dedicated people

During a Tuesday March 17 morning press conference, Vines outlined her frustrations at limited testing capacity, her fear of dwindling supplies of masks, gloves, goggles and gowns, and the risk of a surge at hospitals that often operate at near capacity.

“You see me, but I represent hundreds of dedicated people working on this response every day,” she said. “We’re focusing on today’s work, and doing our best to anticipate what’s coming in the next days and weeks.”

Vines has anchored a long standing coordination of the Portland metro health system. The network pivoted their focus from influenza to COVID-19 as soon as the first cases were reported in the United States. They have aligned testing priorities, infection control guidance, and visitor policies. 

During a press event on Monday, Gov. Kate Brown announced the formation of a statewide healthcare task force to expand on the coordination of the Portland Metro network.

Supplies

The Metro region network has tracked reserves of personal protective equipment and sought new supplies, informing the state’s request to the federal government for additional masks, for instance.

Gov. Kate Brown this week said the federal government has delivered a fraction of the state’s request, and they expect more to come. 

“We are continuing to coordinate with the federal government,” she said. “I’m told supplies are forthcoming.”

Pat Allen, director of the Oregon Health Authority, said if there’s not a significant increase in supply, “We will run out of PPE,” he said. “And that’s not just Oregon. That’s nationwide.”

Beds

Oregon hospitals together have an estimated 6,000 hospital beds — a number that fluctuates based on staffing levels and patient needs. But that figure won’t be nearly enough to treat the additional patients who fall seriously ill with COVID-19, researchers determined last week in a forecast of virus transmission and hospitalization rate through April 11.

In a worst case scenario, 75,000 people in Oregon could get ill.

“That data is dependent on what we do now,” Dr. Renee Edwards, chief medical officer at Oregon Health & Science University said at a Monday press event at the Portland State Office Building. “We have an obligation to work together to prepare for the worst case scenario.”

Dr. Renee Edwards, chief medical officer at Oregon Health & Science University, at a March 16 press event on COVID-19

The forecast assumes case counts will double every 6.2 days, and 20 percent of those who test positive will need hospitalization. At that rate, the state would need 1,000 hospital beds and another 400 intensive care unit beds just for COVID-19 patients. But hospitals already operate at near capacity.

OHSU alone would need 80 beds to meet that need, double its current capacity, Edwards said.

“This modeling does tell us that without significant slowing, Oregon will not be able to serve the needs of Oregonians without more hospital beds,” she said.

Last week the OHSU scientist shared Portland metro’s forecast with local elected leaders. The region would require more than 800 hospital beds and another 150 critical care beds for its COVID-19 patients.

“We know the hospitalizations will actually start before the surge,” he wrote to area leaders. “This also assumes we are able to turn the tide like South Korea did with actions we are taking right now.”

Tests

Vines laid out to clinicians this week a tiered priority for testing patients with symptoms of COVID-19: 

  • Testing at the Oregon State Public Health Lab remains limited to about 80 people per day, and is reserved  for public health investigations and patients hospitalized with viral pneumonia who test negative for the flu.

  • Commercial lab testing is now available at LabCorp, Quest Diagnostics and the University of Washington, but capacity is still building.

“The testing situation is a frustration for all of us,” Vines said Tuesday. “That is our tool for understanding disease location and transmission. I just want to be clear that there is no withholding of supplies or testing capability. We are doing the best we can.”

Dr. Edwards at OHSU, speaking at a press event Monday, shared Vines’ frustration. 

“We don't know who is carrying the virus and who is not. Particularly among Oregonians who don’t get very sick,” she said. “For the people who are less symptomatic, you don’t know who to isolate and who not to isolate. Testing really helps us determine that.”

Individuals 

Even as Vines coordinates a regional public health response to COVID-19 and offers guidance to clinicians, she reserves her personal plea to individuals who each have the power to slow or spread the virus.

People who are mildly ill should stay home, especially anyone who has a cough illness. 

“If you wouldn't otherwise get medical care, now is not the time to seek it,” she said. 

All available healthcare resources must be reserved for testing of symptomatic people at high risk for illness or who live in places that are at high risk of spreading the virus. That includes long-term care facilities and shelters or a corrections setting.

Most people who get the virus won’t become seriously ill, but they can unknowingly spread the virus to people who will need treatment. And that risks displacing others who also need care.

“You may not be worried about yourself and others, but as the COVID-19 surge comes, people still need to deliver babies safely, people will still have heart attacks and strokes,” Vines said. “We need that care to be available to those who need it without putting them at risk for acquiring COVID-19 in our healthcare system.”