November 4, 2020

Multnomah County, mirroring state and national trends, has reported its highest case counts of the pandemic in recent days. Case counts locally increased last week for the fourth consecutive week, with public health investigators in Multnomah County now responding to nearly 100 new cases every day. 

As the region entered its ninth month of the pandemic, health officials say they expect that trend to continue. Case investigators are still able to interview more than 75 percent of new cases within three days, but Public Health officials warn they may not be able to manage that pace for much longer.

The County is also preparing for a time when case numbers are so high that investigators may not be able to reach out to every person who tests positive for COVID-19. To help people who might not get a call, or who might get a call a few days late, officials have published a booklet for people who test positive to guide them on who would be considered a close contact and how to let them know. 

Chair Deborah Kafoury and local Public Health leaders have asked the state to consider new strategies to control the spread of COVID-19.

At the same time, student volunteers working with Multnomah County’s Emergency Operations Center told the Board they’ve been working on a plan of their own. Cleveland High School students Tuesday presented Commissioners with a new guide meant for teens and their families. 

Taking Care of Ourselves and Others: A COVID-19 Guide for Youth and Families” is a toolkit that empowers youth and families to cope with the COVID-19 pandemic. Created by students, parents and guardians in partnership with Multnomah County, the toolkit covers:

  • COVID-19 basics

  • Testing and quarantine supports

  • Safer socializing and dealing with peer pressure

  • Coping with loss and grief

  • How to stay informed, access care and get involved

Teen volunteers Emma Kogut and Klara Kjome Fischer have served as youth liaisons with the county’s Emergency Operations Center since April. They met weekly with Public Health officials to provide a youth perspective on proposals and plans to control the virus. The teens also helped organize two forums to hear from fellow youth, for thoughts and feedback that informed the final toolkit published this week. 

Volunteer Sasha Burchuk coordinated the youth involvement.

“We heard through the forums that youth didn’t feel heard or know where to find information, just as COVID was increasing among young people,” Burchuk told the Board. “We were approaching the start of the school year. We were able to create a resource they had specifically asked for and then create it together.”

Among the basics, the guide simplifies public health recommendations to the “Three W’s”: “Wear a Mask,” “Wash Your Hands” and “Watch Your Distance.” 

“During this pandemic, I have heard from some youth that their family isn't following the ‘Three W’s,’ and they felt unsafe,” student Emma Kogut told the Board.

Other young people reported pressure from friends to gather without masks or without physical distancing, and they didn’t know how to respond.

“If it is happening to one person I know, it’s happening to others,” she said, “which prompted us to include conversation starters.”

The guide offers recommendations on how to talk about safety and raise concerns without putting friends and family on the defensive. 

Commissioner Jessica Vega Pederson called the guide impressive, and critical to the moment.

“This is a good example of a partnership that creates meaningful things for the audience it's intended for,” she said. “Making sure we’re engaging the people most impacted by the policies we create. Especially because of the impact on kids, the way it's changed our lives.”

A new approach

Youth involvement is one way Multnomah County hopes to shape messages that resonate at a time when residents are worn down by isolation, stress and uncertainty. 

“Pandemic fatigue is real; I don't want to minimize that. And we’re pivoting our messaging to acknowledge that fatigue,” Public Health Director Jessica Guernsey told the Board.

The hardline message of physical isolation is wearing down, too, she said. People have an innate need to connect and gather, increasingly, with friends and family. Because risk is ultimately an individual assessment, Public Health needs to offer options to mitigate risk and suggest ways to discuss those choices with friends and family.

“There is a complex dance of policies and approaches,” Guernsey said. That balance of strategies includes supporting people to make informed choices and working with the state to develop new policies.

“The trends are not good, and dramatically not good,” Commissioner Susheela Jayapal said. “The fact that the trends are going up population-wide, is there more to be done? What is the state thinking about in terms of controlling the spread.”

Guernsey said Multnomah County Public Health has scheduled a meeting with the state to discuss new proposals, specifically focusing on the needs of the populous and diverse metro region.

Commissioner Sharon Meieran said she was particularly concerned that the state doesn’t appear to be considering new strategies even as disease rates rise and we head into colder months.

“I’m troubled by the state’s response,” Meieran said. “I haven’t seen anything proactive. What are we doing about it? And that actually does scare me.”

She asked whether Public Health would recommend scaling back from Phase One of reopening, and close businesses and limit service at restaurants and bars.

Guernsey said it’s too soon to propose a rollback. 

“We’re talking about those measures we have used previously, and using data to make sure there’s a return on investment,” she said. “We want to make sure there’s a correlation between a policy action and a reduction of cases.”

That need for a deeper analysis is one thing the County plans on discussing with the state. Multnomah County  already plans to pull senior epidemiologists away from individual case investigations so they can focus on  high-level analysis to identify behaviors and trends that could inform those policy decisions.

Chair Kafoury, who joined the briefing late after meeting with Gov. Kate Brown and the Chair’s two counterparts in Washington and Clackamas counties, said Multnomah County has asked for a closer relationship with state officials and the Oregon Health Authority in shaping policies.

“The Tri-County, having the largest population, it's crucial we have a strong connection to OHA, to the governor’s office,” she said. “Having a stronger voice when we’re working with the governor’s office and OHA has been important, and it's going to be even more important as we head into the winter months and focus on trying to get our schools open for our kids.”