May 19, 2020

Multnomah County is moving closer to meeting key metrics required by Oregon for lifting restrictions on dine-in restaurants, salons and fitness centers, Public Health leaders told the Board of Commissioners in a briefing Tuesday, May 19, on COVID-19 and the County’s reopening plan.

To be considered for “Phase I” under the state’s three-phase “Reopening Oregon” plan, Multnomah County must submit a proposal that shows it meets several statewide prerequisites along with some requirements as part of a health region that includes Clackamas, Washington, Clatsop, Tillamook and Columbia Counties.

The County has met several key criteria overall  — including a drop in hospital admissions for COVID-19, emergency room visits for COVID-19 that remain lower than seasonal average visits for the flu, available locations for people who cannot self-isolate if required. And, as of Tuesday, all first responder agencies in the County attested to having an adequate supply of personal protective equipment.

Multnomah County wants to ensure social and health service agencies have enough protective gear to reopen safely.

One additional criteria, a detailed response plan for three outbreak scenarios, was set to be completed Tuesday, Communicable Disease Services Director Kim Toevs told the Board.

Only one regional benchmark — sufficient testing capacity for underserved communities — has yet to be met. Communicable Disease Services is also working to meet three outstanding statewide requirements specific to contact tracing: hiring culturally competent contact tracers, expanding its disease detection team, and the ability to reach out to all new positive cases within 24 hours.

An analysis using data from the Oregon Health Authority suggests County staff reach out within a day about 60 percent of the time. But there are quality control concerns with data and the county’s figures are likely higher, Toevs told the Board. “I don’t think that’s accurate,” she said.

Hiring requirements are also a moving target, said Public Health Director Rachael Banks.

State criteria require counties to eventually have 15 contact tracers per 100,000 people. In Multnomah County that would be about 120 staff. With 45 full and part-time employees on the payroll now, the County would need to hire about 75 new employees. 

But there’s some flexibility from the state around building the capacity to that goal, Banks clarified for the Board on Tuesday. “We need to be able to ramp up,” she said, “and know we have the right breakdown of skills.”

Public Health leaders began working with communities of color last month to build health equity strategies into the County’s COVID-19 response; those strategies are reflected in the contact tracing hiring plan. The County analyzed case demographic data, data on the burden of chronic disease, and Census data to determine required language skills and cultural competencies for new employees. 

“We need to have a workforce that is prepared for what we know in terms of underlying conditions and who is impacted,” Banks said.

In addition to criteria laid out by the state, Multnomah County established two additional County-specific criteria to meet health equity standards: ensuring health and social service agencies have adequate supplies of protective gear, and showing a reduction in disease among communities of color.

Hospitalization rates for residents of color are a key metric to reopening Multnomah County

“I really applaud these metrics so that as we recover we’re taking into consideration all of our communities,” ]Commissioner Jessica Vega Pederson said. “How are we using data in terms of decisions to reopen? This reduced impact isn’t a specific metric. How do you measure that?”

Banks laid out one metric that suggests the County is on track to meet that goal: Hospital admissions among people from communities of color are declining overall, although the number of Latinx residents specifically has remained relatively constant.

Public Health has built culturally-responsive strategies into its plans for testing and contact tracing, as well. 

New data suggests people of color are less likely than white residents to have access to timely testing. That’s why Public Health  is working with its primary care centers and other community clinics to expand low-barrier testing sites and hours, especially in east Multnomah County. It’s also working with culturally specific groups to develop other community testing models.

To reach and support individuals identified through case investigations of COVID-19, Communicable Disease Services is crafting teams of nurses and epidemiologists with linguistic and cultural skills, and teaming up with community-based organizations to provide wraparound services for those who become sick or have been exposed to the virus and must stay home for 14 days.

The reopening proposal is projected to cost $25 million to $35 million, Banks told the Board. That accounts for additional staff, wraparound isolation support, contracts with community groups, and some field testing.

“I want to say how appreciative I am that we’ve added to the state criteria, and let’s be as detailed as we can,” said Commissioner Susheela Jayapal. “The model I appreciate is the work that has been done around what else people need to stay home.”