Summary
Make vaccines and boosters easily available to your patients and their families, especially those over age 50 and with underlying conditions; know about shortened isolation and quarantine guidance and make sure your COVID-19 positive patients know what to do and how to talk to their close contacts; plan for disruptions to your services due to staff illness.
Background
COVID-19 cases and hospitalizations are expected to continue to accelerate in the next 4 weeks because of the highly contagious omicron variant. Emergency Departments, inpatient services and intensive care units in the region are already at or near capacity. Vaccine remains an important health intervention despite clear evidence of breakthrough infections. Fully vaccinated and boosted individuals have a lower risk of infection and remain less likely to have severe disease or require hospitalization compared to unvaccinated. Local public health is unable to notify individuals or their contacts, so health education and notification from health care providers will be important.
We recognize that all providers will be affected by the surge and have limited capacity. However, in order to preserve some critical services, we are asking Multnomah, Clackamas, and Washington County health care providers for help.
Take pressure off Emergency Departments
- Consider extending clinic hours or creating more same-day appointments to ease pressure on urgent cares and ED’s for the next 4 weeks.
Actively support ongoing vaccination efforts
- Make sure you and your clinic staff are fully vaccinated and boosted.
- Use every opportunity to vaccinate. Have your staff check Oregon’s “ALERT” immunization information system for each patient you see, regardless of the reason for the visit. Strongly recommend vaccination including for those with prior infection. Continue to focus efforts on groups with low vaccine uptake like Latinx and Black/African American/African Immigrant & Refugee.
- Make sure patients know about how and where to access vaccines in Clackamas, Multnomah and Washington Counties.
- Promote community vaccine events your patients may want to attend.
Make testing easily available to patients
- Continue to offer and encourage SARS-CoV-2 testing to patients who report exposure and/or symptoms during routine visits, scheduling calls and/or during any other points of contact.
- Patients with a positive home test are considered infected. They should not have any type of repeat test. Patients and providers do not need to report any home test results to local public health.
- If testing is not available symptomatic patients should be presumed to have COVID in the absence of an alternative diagnosis.
Provide education and direction to patients who are positive or exposed
- Per CDC, isolation for COVID positive patients who are asymptomatic or mildly ill has been shortened to 5 days as long as they are improving and diligently wearing a mask for the last 5 days of the infectious period when around other people.
- Patients with a known exposure should wear a mask around others for 10 days. Some are recommended to stay home for the first 5 days: individuals who are unvaccinated and anyone over age 16 who is overdue for a booster dose. Test at day 5 if possible.
- Local public health is unable to reach every case or contact. Make sure patients who need access to food, rent and utility support during isolation/quarantine know about the links below.
- Stay aware of prescribing information for monoclonal antibody and antiviral oral treatments.
- Currently available antiviral treatments have limited efficacy against the Omicron variant. Sotrovimab has the best efficacy among the monoclonal antibodies against Omicron. However it is not yet approved for outpatient, subcutaneous treatment, and the supply is quite limited. Antiviral oral treatments are on the horizon but we do not currently have information about availability. Prevention through vaccination is the best way to avoid severe disease and hospitalizations.
Model good infection control precautions
- Stay home and seek testing, even if you are only mildly ill and even if you are vaccinated/boosted.
- Review revised CDC guidance for health care worker isolation and quarantine, including in the setting of severe staffing shortages (crisis).
- Masks are still required indoors statewide. Model appropriate mask use in your professional and social settings.
- Maintain adequate supplies of PPE and use appropriately for all patient care.
Resources
Each of the three metro counties have resources on their web-sites including community specific vaccine events, testing resources and community based organization contact information:
- /novel-coronavirus-covid-19
- https://www.clackamas.us/coronavirus
- https://www.co.washington.or.us/covid-19
Patients, families and clinicians can also call “211” for regional resources specific to their community
Thank you for your partnership,
Jennifer Vines, MD, MPH, Health Officer, Multnomah County
Christina Baumann, MD, MPH, Health Officer, Washington County
Ann M Loeffler, MD, Deputy Health Officer, Multnomah County
Sarah Present, MD, MPH, Health Officer, Clackamas County
