June 18, 2020

Where they once sought to stop the spread of COVID-19, health officials are now making clear — on the eve of Multnomah County easing restrictions on social life and businesses — that their original hope is long gone.

As Multnomah County becomes the last to enter Phase 1 reopening, allowing seated service in restaurants and bars, personal services by appointment, the use of gyms and fitness centers, and gatherings up to 25 people, health officials are asking Commissioners and residents to reset their expectations: There is no vaccine. This virus will spread. Case counts will go up.

During a warm May afternoon in 2020, Portlanders flocked to the water even as the state ordered people stay home.

But how many people get sick, they say, will depend not only on contact tracers and access to testing. Those numbers will also depend on the rest of us.

“The more people you are with, and the longer you are with them, the more likely you are to catch the virus,” Health Officer Dr. Jennifer Vines said Thursday during a briefing for the Board of Commissions. “Reopening without a vaccine does not mean people can go about their lives in some normal way. Reopening as we come to understand is a sense of tradeoffs.”

The State notified Multnomah County on Wednesday, June 17, that it was approved to enter Phase 1 on Friday, June 19.

The approval is tied to a three-week state-mandated pause on further reopening of neighboring Washington and Clackamas counties, which are already both in Phase 1. Going forward, the three counties will be treated as a single region for reopening. The state’s announcement also came with another mandate: Beginning June 24, community members in the Tri-County region, and also Marion, Polk, Lincoln and Hood River counties, must use a face covering whenever they are indoors in spaces shared by people outside their households.

Vines was joined Thursday by Communicable Disease Manager Lisa Ferguson and Public Health Director Rachael Banks to brief commissioners on the status of COVID-19’s spread now, how they anticipate that will change, and key metrics to track its spread going forward. 

“We want folks to understand this is a mitigation approach, not suppression,” Banks said. “We need to set realistic expectations. Ultimately the spread of COVID-19 depends on how we as a community interact. How we are with loved ones. How businesses protect employees. All of us have a role to play.”

The metrics the state tracks  to determine if and when counties can lift restrictions include hospitalizations, testing capacity and contact-tracing capacity. But Banks questioned whether those are the metrics that local Public Health should use to determine the risk of a surge.

Even as case counts rose across Multnomah County and the state, hospitalizations remained relatively flat last week at 14 (a number corrected from the initial nine hospitalizations reported June 17, due to an Oregon Health Authority data error). 

Those cases include not only people admitted to the hospital solely because of COVID-19, but also anyone who arrived at the hospital for a different reason, like preparing for an elective procedure, and was tested as part of hospital protocol.

“So not everyone needs hospital treatment,” Banks explained.

Commissioner Susheela Jayapal asked why the County’s metric would include those cases, if the intent is gauging hospital demand due to COVID-19.

That’s a state definition, Banks explained. “We are looking locally at COVID-like symptoms and are more laser-focused on ICU beds and ventilator needs.”

Multnomah County is feeling more confident in its ability to provide low-barrier testing to communities of color, close contacts of known cases, individuals who attend protests and develop symptoms, and other members of the public who do not otherwise have a provider or insurance. 

Testing capacity continues to improve across the region, and Multnomah County’s East County Clinic is serving about 30 people a day at its drive-through clinic, with capacity to test as many as 80 people a day. A mid-County site is expected to open in July.

Meanwhile Communicable Disease Services’ team of contact tracers continues to grow. They are now reaching out to more than 95 percent of new cases within the first 24 hours — a key metric the state required for entering Phase 1.

Ferguson and her team of epidemiologists are expanding on the state’s metrics moving forward. 

With hospitalizations, her team wants to focus on trends in hospital capacity, rather than simply admissions week-by-week. A large outbreak at a long-term care facility might skew the numbers, both when older adults are admitted and when many, all in a short time, are discharged.

With contact tracing, her team also wants to look at how many people they actually connect with, not just how long it takes to reach out for that connection.

“We look at how many people we try to reach in the first 24 hours. It tells us how quickly we are doing our work. It doesn’t tell us how well we’re doing our work,” she said. “We want to look at more than just how quickly we are making that first call to reach people.”

They hope to track the percentage of positive cases they successfully reach (it’s more than 80 percent right now), the duration of those interviews, and the number of close contacts they are able to identify, and whether those contacts are household or community contacts.  

“That can tell us a lot about our spread,” she said. “As we see people move around, our outside contacts have gone up. That can be a good indicator for us. These are things we want to start reviewing more robustly.”