Clinician Alert: What to know and do about the Delta-fueled surge

August 23, 2021

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Use motivational interviewing to recommend COVID-19 vaccine; urge those already vaccinated to talk to friends and family members about the vaccine; restore or increase COVID testing capacity; know what to tell COVID positive patients to do for isolation and quarantine of their close contacts. 

Background:

COVID-19 cases and hospitalizations are at their highest ever because of the more contagious delta variant, now dominant across the state. Emergency Departments, inpatient services and intensive care units in the region are at or beyond capacity. Vaccine remains an important health intervention despite clear evidence of breakthrough infections. Fully vaccinated individuals still have a lower risk of infection and remain far less likely to have severe disease or require hospitalization compared to unvaccinated. The rapid increase in cases has outstripped local public health’s ability to notify all individuals who are positive and perform contact tracing. 

We recognize that all providers are being 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 to:

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 6 weeks.

Actively support ongoing vaccination efforts:

  • Make sure you and your clinic staff are fully vaccinated.

  • 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. Use motivational interviewing techniques with patients who may be hesitant. 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 and vaccine incentives (up to $150) in Clackamas, Multnomah and Washington Counties.

  • Ask patients who are already vaccinated to commit to approaching specific friends and family members about getting vaccinated

  • Offer a third dose of mRNA vaccine to patients meeting criteria for immunocompromised.

  • Be on the lookout for more information about booster doses for all coming soon.

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. 

  • Abbott BinaxNOW rapid point-of-care tests are available to any primary, urgent or emergency care provider in Oregon for free for testing of symptomatic patients or those with recent known exposure to COVID-19. Testing must occur under a CLIA certificate and providers must accept Medicare and Medicaid patients. Contact ORESF8.AOCTestingBranch@dhsoha.state.or.us

Provide education and direction to patients who are positive or exposed:

  • Local public health will not be able to reach every case or contact. Nevertheless encourage patients to speak with local public health to ensure access to food, rent and utility support for isolation and quarantine. See links below.

  • Offer “after-testing” guidance (note updated quarantine guidance insert) and educate patients about isolation, quarantine, and limiting transmission to close contacts.

  • Consider offering subQ monoclonal Ab treatment as part of your practice as it has been shown to reduce the likelihood of hospitalization of high-risk patients with COVID-19 by 70%.

Model good infection control precautions

  • Stay home and seek testing, even if you are only mildly ill and even if you are vaccinated.

  • Masks are now 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 (CBO) contact information:

https://www.multco.us/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