August 19, 2020

Multnomah County may be on the verge of a plateau in the COVID-19 pandemic, health officials told the Board of Commissioners on Tuesday, as new infections and hospitalization rates stabilize, and requests for protective equipment drop 

Cases began increasing in June and peaked by mid-July, Health Officer Dr. Jennifer Vines explained, using a graph of weekly case counts that began in March.

“You can see an increase and hint of a plateau for the month of July and early August,” Vines said during the Board’s latest regular briefing on the County’s response to the virus.. “So we may be leveling off.”

But it’s too soon to trust the trend and way too soon, even if the trend bears out, to ease off precautions such as masks and physical distancing.

new cases of COVID-19 have stabilized in recent weeks, hinting at a plateau

Last week the state released a study that showed 1 percent of Oregonians who had not been diagnosed with COVID-19 had evidence of past infection in their blood. The findings support what Public Health has long suspected, Vines said. “The number of actual undiagnosed, unreported infections is about 10 times what we are finding with our testing.” 

Herd immunity — the point at which enough people have antibodies that protect against infection and thereby protect the broader community from spread — occur once a majority of residents, often 60 to 70 percent, develop antibodies, she explained. 

Oregon is nowhere close.

“Clearly with only 1 percent showing” evidence of past infections, she said, “we are a long way off.”

Vines said she has been asked why Public Health doesn’t simply relax restrictions and allow the virus to spread, so we can reach that herd immunity more quickly. Those asking the question, she says, highlight the small percent of people who get really sick from COVID-19, and the even smaller share who die. 

Of the 23,676 people who have tested positive for the virus in Oregon, 397 have died as of Tuesday, Aug. 18.

“But a small percent of a lot of people is still a lot of people,” Vines told commissioners. And COVID-19 doesn’t strike equitably across the state or the County, she said, pointing to sustained disparities in rates of disease between white residents and residents who identify as Black, Indigenous and People of Color.

Those disparities emerged early, and the gap hasn’t closed. 

Latinx residents continue to experience extremely high rates of infection compared to their representation in the population, Communicable Disease Director Kim Toevs explained. And access to testing for those residents continues to lag. 

That gap in testing remains even as local and regional demand for testing has surged. And the chemicals needed to perform lab tests are still too often in short supply.

“We have been stumbling along for months lacking, locally and nationally, one or another piece of the puzzle that we need to provide high-volume testing,” Toevs said. “Some health systems have needed to reduce testing to process high-priority specimens. Criteria has shifted. That is stabilizing, but we do not expect a huge increase in capacity in the near future.”

Commissioner Lori Stegmann asked whether testing shortages are also occurring at the County’s low-barrier drive-through test site at East County Health Center.

“We still have some capacity for testing in East County, for people who have symptoms and for contacts referred to the test site as part of case investigations. We are not fully using all capacity,” Toevs said. “Our goal and primary focus is to test people of color, those who don’t have insurance or people who don’t have a medical home.” 

Toevs said Public Health continues to work with community partners to stand up a second drive-through test site in Mid-County, likely in the Rockwood area. 

Commissioner Jessica Vega Pederson asked whether Public Health is seeing improvements with cooperation as they work increasingly through culturally specific partners and employ contact tracers and case investigators who could work with residents directly in their preferred language.

In general, investigations go better when County staff share the same cultural background and language as the person they’re working with, Toevs said. Working with an interpreter can cause delays in communicating, missed nuance and interrupted rapport. People may also feel more comfortable sharing details about where they have visited and who they have been with when talking with someone who shares their language or culture.

“Sometimes people are involved in group settings that they may be hesitant to share or describe, or they feel like someone from the dominant white culture might not understand why it is so significant,“ Toevs said. “People think about being judged. And this is true for anyone.”

Communicable Disease Services has hired most of the case investigations, epidemiologists and contact tracers needed to support the COVID-19 response. The County continues to seek applicants with certain language skills — specifically Spanish, Russian and Chuukese — but expects to have a full team in place by fall, Toevs said. 

In another sign that the region is adjusting to COVID-19, requests for supplies from the County’s stock of personal protective equipment — or PPE — have steadily declined, allowing the County to focus on supporting communities most at risk. 

“One thing we’re seeing, the N95 masks, which are really only used for medical procedures and times when people are aspiring, those numbers are going down. The PPE supply chain is improving,” said Chris Voss, director of the Office of Emergency Management.

Voss said requests from healthcare organizations and other sectors “continue to diminish as those agencies get more and more supplies from the open market and rely on us far less.”

Multnomah County continues to focus its support for protective supplies on organizations that support Black, Indigenous and People of Color communities, people over age 65, people with underlying health conditions, and congregate care settings, including shelters and homeless outreach teams.