August 11, 2021

Multnomah County commissioners Tuesday expressed support for a countywide mandate that requires all people 5 and older to mask up in indoor public spaces beginning Friday, Aug. 13.

The County is in the midst of a fifth wave of disease in a pandemic that has lasted 18 months, Health Officer Dr. Jennifer Vines told commissioners during a briefing on COVID-19. And this wave is among the most challenging yet. 

Nearly 70 percent of County residents have received at least one dose of one of three highly-effective vaccines, and yet more people than ever in Oregon — almost all of them unvaccinated — are hospitalized with the virus, thanks to a variant strain that spreads more easily, including among vaccinated people. Meanwhile hospitals are struggling to retain weary staff as more and more people come in seeking care.

And demand for testing has ebbed, even as the percentage of people who test positive is climbing, leaving public health experts less certain about how quickly the virus is spreading. 

“We are lucky to have three vaccines that are excellent at preventing severe illness and death,” Vines explained. 

But unvaccinated people are more at risk than ever from the virus’ Delta variant, a strain that may cause more severe illness and spreads more easily than prior forms of the virus. And disparities in vaccination rates have led to disparities in hospitalizations in some communities of color, particular in Black and African American communities. 

“These are almost all preventable hospitalizations,” Vines said. “But as long as we see high percent positivity and low vaccine uptakes, we’ll see excessive hospitalizations. Top of mind, lots of work going into prevention here.” 

As cases soared and hospital beds filled, and as Public Health learned more about the Delta variant’s power to seed “breakthrough” cases in some vaccinated, Multnomah County on Monday announced a universal masking requirement for all public indoor spaces. Universal masking can allow businesses to remain open and other activities to continue, while still limiting COVID-19’s ability to spread and giving people more time to get vaccinated.

It is the first County in Oregon to issue such an order.

Any complaint will prompt the County to reach out to an individual or business and provide materials on masking along with signage for businesses to post. The County can escalate enforcement from there, with fines of up to $1,000.

“We’re taking this important step now to protect the community because we know masks work and we need more time to vaccinate our community members,” Chair Deborah Kafoury told Commissioners, who all said they supported the mandate. “Masks remain one of the best strategies to keep each other as safe as possible.”

Commissioner Susheela Jayapal asked whether Public Health could project what other measures might be needed to limit the spread of the virus. Dr. Vines said Public Health is working this week to determine which of circumstances would prompt further interventions.

Just six weeks ago, Gov. Kate Brown lifted all COVID-19 restrictions and declared the state “reopened.” The week after the Governor’s announcement, Multnomah County logged its fewest number of cases in more than a year, just 136. But now, five weeks later, without restrictions and with the far more contagious Delta variant driving up new infections, the weekly total topped 700 cases.

Dr. Vines said the ultimate goal is for a very high percentage of the population to build immunity to the virus.

“We want it to happen by vaccine, but it can also happen by infection,” Dr. Vines said. “The mask mandate slows spread and gives people time to get vaccinated. And if we find ourselves in the fall, well into the flu season and with kids back in class and cases still taper off, she said, we might lift those restrictions sooner.”

Commissioner Jessica Vega Pederson asked how enforcement would work. 

Chair Kafoury said the mask mandate’s framework is meant to set a communitywide expectation, similar to how Public Health encourages businesses to uphold laws banning smoking indoors. The County will send businesses educational materials and posters, while focusing more severe enforcement measures like fines on anyone who acts in bad faith.

“Our goal is not to fine people,” Chair Kafoury said, but rather to prompt communitywide behavior change. She noted that the voluntary masking recommendation Public Health issued last month did little to achieve that goal.

Commissioner Lori Stegmann wondered whether the mandate should even include crowded outdoor events such as concerts. 

Dr. Vines said people still generally have a much lower risk of spreading the virus outside, with winds, sunlight and room to spread out. “But you raise an important point,” she said. “In crowded outdoor settings, with people yelling, talking, drinking, laughing, shouting, we can’t quantify the  risk.” 

For simplicity’s sake the County focused the mandate on indoor settings, she said, but Public Health strongly recommends masking outdoors in crowded spaces, regardless of vaccine status.

Commissioner Stegmann  asked Chair Kafoury, hours before Gov. Brown eventually signaled she would announce statewide masking requirements, what it would take for the State to step in with a broader mandate. Chair Kafoury said Tuesday that she had spoken with the Governor, who made it clear, before adjusting course this week, that any prevention measures would be left to local governments.

“I’m so proud of the work Multnomah does. We lead and others follow,” Commissioner Stegmann  told Chair Kafoury. “I’m so appreciative of you for making this executive order and leading.”

Vaccine delivery

Also Tuesday, Communicable Disease Director Kim Toevs provided an overview of local efforts to track the  disease and an update on changes to vaccine delivery.

Multnomah County Public Health, like most jurisdictions across the nation, saw a sharp drop in the late spring in the number of people seeking a vaccine. It wasn’t a surprise, Toevs told Commissioners. People who were motivated to get the vaccine found a way to get it as soon as they could. And the healthcare system made it easy, through pharmacies, primary care providers, outdoor clinics, drive-through clinics, culturally specific clinics, workplace clinics and faith-based clinics.  

Toevs said among those who remain unvaccinated, aside from people under 12 who aren’t eligible yet, are those emphatically against the vaccine and those who would choose to be vaccinated if it weren't for competing life priorities. 

“We’re trying to make this as convenient as possible,” she said. “We have, overall, since January done, all of us, an incredible amount of work to stand up the vaccination clinics.” 

Public Health has delivered vaccines to more than 20,000 people, she said. The County’s Community Health Center program — Oregon’s largest federally qualified health center — has provided vaccines to more than 10,000 people. Partners at the City of Portland have reached an additional 7,000 people.

Toevs said these efforts all focused on serving people who had barriers to accessing vaccines at larger, standing vaccine sites. 

As interest waned, the County in July launched an incentive program, offering gift cards to offset financial barriers such as having to find or pay for childcare, having to find or pay for transportation to a clinic, and losing income from taking time off work to get the vaccine, recover from side effects, or both.

And now, as other health systems and primary care providers are increasingly able to offer vaccines, Public Health is preparing to shift its strategy again. Instead of hosting standing clinics at Mt. Hood Community College and Portland Community College, it will focus on culturally specific and hyperlocal mobile clinics in partnership with the Oregon Health Authority.