Numi Lee Griffith and Alexis Dinno
Griffith is health care advocate for the Oregon State Public Interest Research Group. She lives in Milwaukie. Dinno, is a Portland State University professor of community health and a social epidemiologist. She directs the community health Ph.D. program at the OHSU-PSU School of Public Health and lives in Portland.
So far, Oregon has avoided the worst impacts of the coronavirus pandemic. However, that’s largely because of our state’s rapid response to the threat: Oregon Gov. Kate Brown’s “Stay Home, Save Lives” order prevented exponential growth of COVID-19 infections in Oregon communities, preserving hospital resources and giving us time to prepare for the long process of recovery.
Even so, the virus has still had a substantial impact on the lives of Oregonians. More than 7,800 Oregonians have had confirmed COVID-19 infections, and more than 200 have died. While closing businesses probably saved lives, it also inflicted real economic hardship. So, when Gov. Brown announced her “Building a Safe and Strong Oregon” plan to reopen the economy, OSPIRG spoke out in support of it. The plan was a science-based strategy to move towards some semblance of normal life while avoiding a resurgence of COVID-19. Counties could only reopen if they demonstrated falling hospitalization numbers and sufficient public health staffing to perform contact tracing - the process of contacting newly identified COVID-19 cases, and identifying further potential infections by tracking recent contacts.
However, the success of that plan depends on its consistent application. That’s why it was a surprise when Gov. Brown announced that Multnomah County, Oregon’s most populous, would be allowed to move into Phase 1 reopening despite a clear upward trend of COVID-19 infections. In doing so, the governor relied on a report from the Oregon Health Authority stating that COVID-19 hospitalizations in Multnomah County had fallen over the last week. Unfortunately, those numbers were wrong. One day later, health authority officials admitted that they had undercounted hospitalizations in Multnomah County. The uptick should have made the county ineligible to proceed to Phase 1.
Despite this error, the state still allowed the county to move forward, and businesses began to reopen on June 19. Making matters worse, this was not the only shortcoming in Multnomah County: the county is still failing to meet the state’s goal for contact tracing.
Back in May, Oregon counties were told they would each need to have the equivalent of 15 full-time contact tracers on staff per 100,000 population. This is around half of the staffing level that the National Association of City and County Health Officials recommends for a pandemic scenario. However, Multnomah County has not even met Oregon’s less ambitious goal. According to data released by the health authority, Multnomah County only has 34 full-time staff, 19 part-time staff, and 10 other “available” staff to perform contact tracing. Given Multnomah County’s population of 812,855, it should have 122 full-time people doing that work.
It has become increasingly clear that even counties that have met the state goal do not have sufficient contact tracing capacity to meet the circumstances. In Lincoln County, which has a population of 47,881, 14 staff were available for contact tracing -- double the seven required by the state. However, a single workplace outbreak in Newport completely swamped the county’s public health team, according to state metrics. In the first week after the outbreak, Lincoln County only made timely contact with 70% of newly-diagnosed COVID-19 patients. The second week, that number fell to 39%. The response in both weeks fell far short of the state goal of reaching out to 95% of patients within 24 hours.
However, a far more important metric is the percentage of cases that can be traced back to a known source of infection. The state has set a goal for counties to trace 70% of cases back to a known source. In Multnomah County, contact tracers could not pinpoint a known source for 49% of the cases. This suggests a high level of “community spread,” and indicates that testing and tracing alone are insufficient to keep COVID-19 contained in the Portland metro area.
Furthermore, the most recently released data shows that the situation is getting worse around Portland. Weekly hospital admissions for COVID-19 rose from seven at the end of May to 20 for the week ending June 20. The number of cases has continued to rise, with two daily records set over the first weekend of Phase 1. Furthermore, the burden of this disease has overwhelmingly fallen on minority communities: Of the 313 cases reported over the last week in Multnomah County, at least 216 (69%) were reported among Black, Indigenous, or people of color.
We’re not calling on the governor to change her plan to reopen Oregon. We’re asking her to stick to the original plan. Multnomah County did not qualify to reopen on June 19 under the state’s own metrics, and all indications are it would not have qualified to reopen last week either. We’ve seen what happens when states don’t stick with the advice of public health experts. Check out the surging case numbers in Texas, Arizona, and Florida. If we want Oregon to reopen safely, we need to get back on track. If the situation in Multnomah County continues to escalate, new public safety restrictions -- potentially including another lockdown -- need to be strongly considered.
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