Multnomah County dropped from “Extreme Risk” to “High Risk” in the state’s reopening framework on Friday, May 7, but health officials warn the real risk of the region’s spring surge hasn’t waned, with case counts still high and more contagious variants of COVID-19 dominating the spread.
The county, like the nation and world, is locked in a race between vaccine and variant.
“The big picture is this inescapable metaphor between vaccines and variants,” Multnomah County Health Officer Dr. Jennifer Vines told commissioners Thursday at a briefing on the COVID-19 pandemic. “We are on a steady march of vaccination. The U.K. variant has crowded out our original virus, and that explains the more recent rapid spread.”
Case counts appear to be leveling off after weeks on the rise, but case investigators continue to field more than 100 new cases a day. The rate of positive cases has also steadied, but remains above 5 percent.
And hospitals in Multnomah County are still too busy. Vines said she hopes that will ease if case counts drop back to the levels of February and March.
“Now that many people at highest risk have been vaccinated, we hope to see hospitalizations blunted. But they aren’t zero,” she said. “And there is a pattern trending younger.”
More contagious variants may be partially to blame. The so-called California variants continue to be the most commonly detected so far. Those are about 20 percent more contagious than the original strain. The detection of B117, also known as the U.K. variant, has also increased. That strain is about 50 percent more contagious, and possibly leads to more severe illness.
Outbreaks dropped off considerably in long term care facilities, as residents there were prioritized early for vaccination. And schools have largely succeeded in preventing outbreaks since returning kids to in-person learning, Vines said.
Of 42 official school “outbreaks” reported in Multnomah County, almost all are single cases; most of those are related to activities outside of class. That has led local Public Health to reiterate strong recommendations for prevention during sports and extracurricular activities. She said public health is hopeful that soon children and young teens will be able to get their vaccine.
“In this reality of finite resources for prevention, vaccines are a public health win,” Vines said, acknowledging that families will need good and clear information about what it means to give a child vaccine approved under emergency authorization use.
“The bottom line is the most important thing people can do is get a vaccine,” she said. “The second-most important thing is to wear a mask indoors and anytime you can’t keep your distance outdoors.”
Vaccine: a first-line defense
About 60 percent of people 16 and older in Multnomah County have received at least one dose of the COVID-19 vaccine, Public Health Director Jessica Guernsey told the Board. And nearly 40 percent are fully vaccinated.
Public Health has played a role in reaching about 19,000 people, 80 percent of whom identify as Black, Indigenous or other people of color.
Of 97 clinics stood up by local Public Health, about half focused specifically on meeting the needs of specific cultural and racial communities. That helped reach those people at greatest risk for infection and who face disproportionate barriers to vaccine access. Other vaccine clinics have focused on people with intellectual and developmental disabilities, homebound adults, adult foster care homes, community health workers and doulas, people in custody, and others in the first priority wave of vaccination.
Commissioner Lori Stegmann said she had been reading so much about herd immunity, the concept that the whole community is protected once a certain percent of the population is vaccinated.
“What Is the magic number?” she asked. “Is there one?”
Guernsey explained that number varies depending on the disease, often ranging from 50 to 90 percent; 70 percent is a common number tossed out in the conversation of COVID-19. But Guernsey said with so many unknowns, she wouldn’t focus on that as an end goal.
Vines said public health experts are discussing this intensely.
“It takes a long time to get the herd protected. And within that time we have seen variants emerge,” she said. “Models right now are predicting a summer of fairly low transmission… But beyond that, In the long term it’s fuzzy. We have to let science do its thing while we continue to focus on getting people vaccinated.”
Public Health, like many vaccine providers across the nation, are beginning to find demand decreasing. There are more ways people can get their COVID-19 vaccine, with increasing supply through pharmacies and health centers.
“We have [already] seen those early adopters, people who wanted it as fast as possible. Now we’re moving on to folks who are thinking harder about it,” Guernsey said. “This is the natural course of decision making. You have folks ready for action and then you back into people in contemplation and pre-contemplation.”
People increasingly say they want to talk with their primary care provider about the vaccine. And soon, vaccines may be approved for use in children. Guernsey said the work right now is to focus on getting people good information so they can make that choice.
In other vaccine news, Pfizer has applied for authorization to the U.S. Food and Drug Administration so its two-dose vaccine may be used for children ages 12 and older, Guernsey said.
“As the mother of a 13 year old, I am very excited for the age to be decreased,” said Commissioner Jessica Vega Pederson. “I can’t wait for it to be released.”
Also underway, the County is reviewing how it plans for available stock of the one-dose Johnson & Johnson vaccine, after federal and state authorities in April lifted a pause on its use following several cases of a rare blood clot associated with the vaccine.
Vaccine providers in Oregon may now use the Johnson & Johnson COVID-19 vaccine so long as they ensure people get new warning information regarding the risk of clots.
“We do have the vaccine. We are working on ensuring our educational materials are ready to meet the standards of the FDA and CDC so people can make an informed decision,” Guernsey said, “Having a one-shot vaccine is helpful for communities who are difficult to reach, but we want to make sure we can offer them information to make that decision for themselves.”
There is a particular risk to women, added Vines. The best candidates for the one-dose vaccine are men and older adults.
“Younger women can get the vaccine, but we need to make sure they understand the risk,” she said. “The risk of getting COVID-19 is, on the whole, higher. That said these events can be catastrophic.
“I also don’t want to undersell Johnson & Johnson. It’s a single dose and has fewer immediate side effects. It does offer really good protection. So we’re working to convey all of that to people who will need to make that decision.”